Inmate’s Ouster Before Surgery Spurs Inquiry

A local hospital with a contract to provide care for Orange County Jail inmates discharged a seriously ill prisoner on the eve of open-heart surgery last month, leading to charges that the facility tried to avoid the costs of providing the operation.

Jesus Perez Espinosa, 48, of Orange says he was abruptly forced out of Western Medical Center-Anaheim on Sept. 5, the day before he was scheduled to have a diseased heart valve replaced.

The unexpected discharge, according to his family, triggered a frantic effort to obtain care for him until Western Medical finally agreed to readmit him and perform the operation. At the time, the unemployed laborer, who has no health insurance, had been in the jail hospital 1 1/2 months with a host of major health problems after his arrest on drug charges.

“I think they just wanted to get me out of the hospital to avoid the costs,” Espinosa said. “My life was at stake here, and I was very sick. How would you like to be sent home the day before your operation?”

Espinosa’s release has prompted a Municipal Court judge and a supervising attorney in the Orange County public defender’s office to look into the discharge, which, they said, could have been the result of a simple misunderstanding or--at worst--a callous attempt by the hospital to save money. They said they would try to prevent a similar situation from occurring in the future.

“I don’t want an inmate released because of a medical problem if he is entitled to care under the county guidelines,” said Orange County Central Municipal Judge Gregory Lewis, who has presided over a felony drug case involving Espinosa.

In addition, state health officials, after learning about the matter from a Times reporter, have begun an investigation to determine whether Western Medical violated state and federal laws designed to prevent the improper transfer of critically ill patients to other hospitals.

Although prohibited from discussing specifics of Espinosa’s care without his permission, Tim Carda, Western Medical’s top administrator, said he was baffled by the assertion that Espinosa was deliberately ejected from the hospital.

“This is not true. There has never been a time when a patient has been forced to leave for financial reasons,” Carda said. “Many patients released from custody continue to receive treatment here, and we provide hundreds of thousands of dollars in care that the hospital is never compensated for. . . . Why would someone make a statement like that?”

Espinosa was first admitted to Western Medical in late July after his arrest on charges of being under the influence of drugs and possessing $15 worth of cocaine and tar heroin. Unable to post $5,000 bond, he was booked into Orange County Jail.

Shortly thereafter, Espinosa fell ill and was transferred to the jail ward at Western Medical, which provides about 40 prisoners with medical care that typically includes six or seven major surgeries every week.

Dr. Clyde Dos Santos, an internist who initially treated Espinosa, said other physicians eventually determined that Espinosa needed to have a heart valve replaced. The cost of such an operation with hospitalization can run about $25,000.

Espinosa says his surgery was scheduled for Sept. 6. However, on Sept. 5, the day before his operation, Judge Lewis removed Espinosa’s bail and ordered him released on his own recognizance.

Deputy Dist. Atty. G. Stewart Hicks, the prosecutor, said he discussed a release with Deputy Public Defender Jon Alexander before asking Lewis to reduce bail. He said he believed that Espinosa had served enough time in jail--roughly two months--for a relatively minor offense.

“Our intent was to make things easier on him. We had no idea it would turn out this way,” Hicks said. “We thought he would have gotten the surgery anyway, gone home, and then come back to court to resolve the case. It was never anyone’s intent to deprive him of the operation.”

But on the afternoon of Sept. 5, Espinosa says, he was discharged from Western Medical Center by staff members who told him to go on his own to UCI Medical Center in Orange. He asserts that he protested when Western Medical wanted him to sign a release form that stated he was voluntarily leaving the hospital against medical advice.

“I told them I am not signing anything that releases you from your obligation,” Espinosa recalled. “I might have my problems, but I am no fool. I am not that dumb.”

His sister, Gloria Arroyo, said she picked him up at the hospital and was stunned to learn that he was being told to leave, given his condition. She recalled that at her home that evening, her brother was pale, coughing and constantly out of breath.

“Our family was upset and all in tears. How could they do this? He looked like he was ready to keel over, and they told him you can go home now. How can that be?” Arroyo said. “They had us going back and forth like yo-yos.”

The next morning, the family took him to the emergency room at UCI Medical Center. Elaine Beno, a UCI spokesperson, said a doctor attended to Espinosa but would not admit him because he was the responsibility of Western Medical Center.

Espinosa and his sister then went back on their own to Western Medical Center’s emergency room, where, they say, he was refused admittance until they threatened to sue the hospital. Espinosa eventually received his heart surgery and was allowed to go home on Oct. 11.

“From what our client has told us, it appears that he was forced out,” Deputy Public Defender Jeff Lund said. “This man goes through preparation for surgery and then he is released from the hospital. It looks like (the hospital was) trying to avoid the surgery.”

Lewis said that he reduced Espinosa’s bail without knowing how ill he was but that the bail reduction did not mean Espinosa should have been discharged from the hospital. The judge said he will discuss the situation at the next meeting of the Municipal Court bench to make sure that requests for bail reductions are scrutinized more thoroughly for prisoners with serious medical problems.

Nancy Rimsha, a staff attorney for the Legal Aid Society of Orange County, said Espinosa might have been qualified for MediCal or Indigent Medical Services, a government-funded program to help the poor pay for care.

But, she said, there are no guarantees that someone will qualify for such benefits and the application process can take up to a year in the case of MediCal. Hospitals also are “not crazy” about the Indigent Medical Services program, Rimsha said, because the reimbursement rate is so low.

Jaqueline Lincer, a district administrator for the state Department of Health Services licensing division in Santa Ana, said her agency will begin seeking medical records and interviewing those involved to see what happened.

As long as Espinosa was a county prisoner, Lincer said, “they have an obligation” to care for him, but once he was released from custody, “if it’s not an emergency, it might be nobody’s responsibility” to care for him.

Times staff writer Lanie Jones contributed to this report.