The Contested Cases: Medical Experts Fault King’s Doctors

As part of a months-long review of Martin Luther King Jr./Drew Medical Center, The Times studied dozens of cases treated at the hospital during a recent 2 1/2-year period. Four distinguished physicians outside Los Angeles County reviewed 12 cases for The Times at no charge. What follows are brief descriptions and a discussion of several of the c a ses they reviewed.

At 2:13 a.m. on Sept. 17, 1987, a 30-year-old woman arrived by ambulance at King’s trauma center with a bullet lodged in her brain.

The patient was a secretary employed by a Westside computer company who had been abducted at gunpoint from Los Angeles International Airport. She was gang-raped and terrorized for 12 hours before being shot in the head and dumped in the parking lot of a mini-market at 99th and South Figueroa streets in South-Central Los Angeles.

Miraculously, she was conscious when she arrived at King.

But during her stay there, the hospital failed to provide her with the prompt neurosurgical attention that trauma centers are required to give, according to the medical experts who reviewed her case.

Through the night, the patient lingered without examination by a qualified attending neurosurgeon, according to her medical records and interviews with four King physicians familiar with her case.

As dawn came, Dr. Harvie Dale Harrier, an attending surgeon, arrived at King to make his usual morning rounds. Upon discovering that the patient had not yet been seen by a neurosurgeon, he said he launched an effort to transfer her by helicopter to UCLA Medical Center for care.

“In this specific case,” Harrier recalled, “I came in and, to me, she needed care that I was not sure we could deliver at King.”

It was not an unusual situation, he said.

Asked why the trauma center lacked the neurosurgical capability to care for the patient, he said, “No comment.”

Dr. Richard H. Cales, chief of emergency medicine at San Francisco General Hospital, said after reviewing the case:

“The issue here is that the expertise of the attending (neurosurgeons) is simply not available. The system allowed a patient to be taken to a hospital that did not provide the service that she required and then could not transfer her in a timely manner. That is . . . scandalous.”

Dr. George Locke, chairman of neurosurgery at King, said he does not recall which neurosurgeon was on duty the night the patient arrived. But he said that he personally examined her in the morning. He said she did not need to be examined before then because she was conscious and in stable condition.

“I thought the patient got good care and was appropriately treated,” he said.

About 10 hours after she was delivered to King by ambulance, the patient was transfered by helicopter to UCLA Medical Center, “due to a lack of surgical intensive care beds at MLK-Drew Medical Center at this time,” according to her medical records. At UCLA, she successfully underwent five hours of brain surgery and is now almost fully recovered. She requested that her name be withheld.

Pete Flores, a 28-year-old nurseryman, underwent routine surgery as an outpatient at King on April 21, 1987, to repair a hernia.

Five days later, he was dead, leaving behind his wife and two young children, who have since filed a medical malpractice claim against the hospital.

Flores died from post-surgical infection of his wound that was not promptly diagnosed or treated by King physicians, despite his repeated complaints of pain and telltale symptoms of infection, according to the doctors who reviewed his medical records for The Times.

After surgery to repair his hernia, Flores was sent home with instructions to report any discomfort, fever or pain. Twice, he came back to King’s emergency room seeking care.

During the first visit four days after the operation, records show, he had a fever, intestinal bleeding and a swollen groin. But a surgeon was not called to evaluate his condition. Instead, he was sent home.

Less than 24 hours later, he returned to the emergency room. It was about 4 a.m. on April 26, according to his medical records. This time, he was critically ill with a dangerously low blood pressure.

He lingered about 10 hours before he was finally seen by a surgeon, who concluded that Flores was suffering from a life-threatening infection requiring immediate surgery.

But instead of being rushed to the operating room, Flores had to wait another six hours, finally dying on the operating table.

The failure to recognize the patient’s symptoms of infection, compounded by an inability to move swiftly once the problem was diagnosed, constitutes “flagrant malpractice,” said Dr. Michael L. Callaham, chief of emergency medicine at the University of California’s Moffitt-Long Hospital in San Francisco.

During a deposition, the surgeon who repaired Flores’ hernia, Dr. Kenneth Sim, acknowledged that Flores should have been admitted to the hospital for treatment the first time he reported to the emergency room.

Dr. Arthur Fleming, King’s chief of trauma and surgery, who did not personally treat Flores, also acknowledged that Flores waited “a long time” for care. He said the delay was “not acceptable” given the emergency nature of his condition.

Martha Castellanos, 31, and eight months pregnant, was rushed to King’s trauma center the afternoon of March 10, 1987, after she was injured in an automobile accident.

Doctors in the emergency room quickly assessed the woman’s condition--and also detected the baby’s heartbeat. Records show that they ordered the woman admitted to an obstetrical ward and placed on a fetal monitor to safeguard the baby.

But 12 hours later, the woman was still languishing, unmonitored, in the emergency room. The baby’s heartbeat could no longer be detected, and the infant was born dead.

Cales said, “Nobody ever took the case in hand . . . and did what had to be done.”

He said the patient apparently “got lost in the ER (emergency room).”

Callaham agreed that the patient encountered an “inordinate delay. . . .”

“She got lost in limbo,” he said.

Dr. Ezra Davidson, chairman of King’s department of obstetrics, declined comment on the case.

Mary Hodge, 74, was injured in a traffic accident the morning of Nov. 20, 1987. She was promptly rushed by ambulance to King’s trauma center, where she was held for several hours, examined and released with instructions to take some aspirin.

At home, about nine hours later, she lost control of her bowels, became unconscious and was rushed back to King, where she died almost immediately from massive internal injuries and bleeding that had gone untreated during her initial emergency room visit. She suffered from third and fifth rib fractures, multiple bruises, a lacerated liver and internal bleeding, according to an autopsy report.

Cales, at San Francisco General Hospital, faulted King’s physicians for failing during their initial examination of the patient to frequently monitor her vital signs or to order tests that might well have detected her injuries.

The failure to diagnose her problem, he added, is “clearly unacceptable in a trauma center.”

Fleming, King’s trauma chief, commented after reviewing Hodge’s medical records that if the patient had gone to a hospital with more resources and fewer patients, she “would have gone into a critical-care room” instead of being discharged to her home. He called her death an “unfortunate loss” and said she appears to have “slipped through the cracks” because emergency room physicians released her without first calling trauma surgeons to evaluate her condition.

“For good trauma management,” he acknowledged, surgeons should be called to examine all traffic accident victims.