Questions Raised on County Response to Suit Over Death of Infant : Hospital: The only defense offered by officials so far is that babies were switched. But little research was done before the claim was made.

A 17-year-old’s claim that negligence at the county’s Olive View Medical Center in Sylmar cost the life of her baby led not to a swift investigation of the claim but to a hard-nosed legal defense.

The Pasadena law firm hired by Los Angeles County has sought to raise doubts about whether the baby who died Feb. 5, 1990, was really the one born in the hospital five days earlier. It has also fought demands by the girl’s lawyer to produce evidence backing up that contention.

But a review of the lawsuit filed in Los Angeles County Superior Court shows that the county has offered no explanation of what happened, other than the possibility that the mother, who was 15 when the baby was born, took home her healthy baby and several days later brought another, already gravely ill, to Northridge Hospital Medical Center.

The infant died several hours after emergency surgery to repair tears in his bowel tract brought about by an undiagnosed birth defect.

The county has not exhumed the body to perform a DNA test that experts say would show conclusively whether Patricia Chavez of Northridge was the mother. It also has not interviewed the family or friends of Chavez, or her boyfriend, Reynaldo Ruiz, 21, for any evidence that the couple’s child is still alive.

After published reports about the lawsuit this week, county supervisors Mike Antonovich and Gloria Molina asked administrators to review the handling of the case by Olive View and the county’s law firm.

In response, county Chief Administrative Officer Richard B. Dixon this week ordered an investigation into Olive View’s procedures for handling newborns.

“We want to ascertain if there are weaknesses in our system, and if there are, to put in place measures that would correct them,” Dixon said.

The county’s handling of the case so far has raised questions.

Robert C. Gates, the county’s top health official, issued a memo saying that the “attorney representing the county is still fact-finding and has not yet concluded his investigation” and has “not taken a position” on the identity of the dead child.

But in legal documents, the county’s attorneys state: “To the best of defendant’s knowledge baby boy Chavez . . . born to Patricia Chavez . . . was not” the child who died.

Questioned about the apparent differences in the county’s position, the Los Angeles county counsel’s office acknowledged this week that the switched-baby defense has not been thoroughly investigated. But county officials refused to discuss the case in detail because it is the subject of litigation.

Unlike the city of Los Angeles and many other public agencies, the county does not always investigate claims internally before turning them over to outside consultants and law firms.

Attorney Leonard E. Torres, of Torres & Brenner, is handling the case and has declined to comment on the lawsuit.

The dead infant, Steven Antonio Ruiz, died when his heart stopped at Northridge Hospital Medical Center during emergency surgery. Doctors there and later at the Los Angeles County coroner’s office reported that the cause of death was an undiagnosed congenital defect known as VATER syndrome.

The condition affects one in every 8,000 babies. Symptoms include defects of the kidneys, vertebrae and anus, all of which the infant had, according to a coroner’s autopsy.

Chavez and her attorney contend that doctors and nurses at Olive View failed to notice the condition and that the child died as a result. Medical experts said the condition, if properly diagnosed, could easily have been corrected.

Aileen Norvell Goldstein, a Burbank attorney representing Chavez, said the county’s failure to investigate its claims of a baby switch have placed the unfair burden on her client to prove that the baby she and her family scraped together $838 to bury was the one pictured in happy photographs taken at Olive View.

She is suing the county for $250,000 plus punitive damages and damages caused by what she says is the county’s malicious defense involving the switched-baby theory.

Born with a head of thick black hair, the child known on Olive View medical records as baby boy Chavez appeared normal.

Over the next three days Chavez would show off her chubby son to relatives and friends in between changing wet diapers and trying to get the baby to breast-feed, according to her deposition. Diane Whittaker, a nurse who spent several hours in the room in the course of a shift, would later describe the atmosphere in the child’s room as “very happy, joyous” with the many relatives around offering support.

Once home, however, the child cried almost constantly and began vomiting a greenish fluid, according to the deposition. Chavez took her baby back two days later to Olive View, where blood was drawn before they returned home. The next day, Chavez rushed the child, his heart no longer beating, to Northridge Hospital. The child was revived; emergency surgery to repair internal damage was attempted but was unsuccessful.

Because it was obvious that the baby’s condition had gone undiagnosed, hospital personnel at Northridge advised Chavez to consult an attorney about filing a lawsuit, Goldstein said.

Dr. Arnold Platzker, head of the neonatology division at Childrens Hospital Los Angeles and an expert in VATER syndrome, said the most obvious sign of the disorder is an absence of bowel movements. He said it is not always possible to detect an imperforated anus on visual inspection alone.

The notations on the baby’s medical chart at Olive View show that at least one nurse and one doctor had seen a normal anus and that at least two nurses reported that bowel movements had occurred. After the death, those records led to questions about the identity of the baby, according to a county source familiar with the case.

But one of those two nurses said in a deposition, taken as part of the lawsuit, that her note referring to a bowel movement may have been based on secondhand information, either from the mother or from other notations on the chart. The other nurse has not yet answered questions in the case because her identity has not been determined.

When asked in legal papers to prove their claims of a baby switch, the county’s attorneys repeatedly refer to apparent discrepancies between the autopsy report and Olive View records on the newborn.

The autopsy report on the dead child established the baby’s weight as about three ounces heavier than when it left the hospital and its length as the same. Another notation in the autopsy report put the length at 1 1/2 inches longer--although the deputy coroner who reported that figure said her technique often results in longer measurements.

The county’s attorneys have also sought to raise doubts by noting that the baby’s name varies on several documents--Steven Antonio Ruiz on one and Esteban Antonio Ruiz on another. Esteban is Spanish for Steven.

The county also notes that Chavez used two different addresses--her parents’ and the nearby apartment where she lives with Ruiz.