Inmate’s Lack of Follow-Up Care Prompts a Reprimand : Medicine: Officials say Anaheim hospital provided no continuity of treatment. The patient says he was improperly discharged before heart surgery.

A local hospital with a contract to provide care for Orange County jail inmates has been cited by state health officials for improperly discharging a prisoner who was undergoing treatment for a serious heart ailment.

Investigators for the licensing division of the state Department of Health Services found that Western Medical Center-Anaheim officials violated state regulations by not making arrangements for Jesus Perez Espinosa of Orange to go to a specific doctor or clinic when they released him on Sept. 5.

Regulators said that Western Medical’s staff only advised Espinosa to go to the emergency room at UC Irvine Medical Center in Orange if he felt chest pains or had difficulty breathing.

“This was not reasonable continuity of care, considering the status of his cardiac problem and advice that he needed (heart) valve surgery soon,” state officials concluded in a seven-page report about the incident.

Espinosa was arrested in July on suspicion of several drug-related misdemeanors and held in lieu of bail before becoming sick and being transferred to the hospital’s jail ward for treatment. He was so ill that he could not make his scheduled court appearances, so he remained in custody until a judge said on Sept. 5 that Espinosa could be released without posting bail. Espinosa said the hospital released him on the eve of his scheduled heart surgery.

In the hospital’s favor, investigators said they found no evidence to support Espinosa’s claim that he was discharged on Sept. 5 to avoid the expense of the heart operation.

Although Espinosa was being considered for heart-valve replacement, state officials said, the surgery had not been scheduled at the time of his discharge. Valve replacement surgery can cost as much as $25,000, and Espinosa did not have health insurance.

The licensing division, a watchdog agency responsible for inspecting and giving credentials to hospitals across the state, concluded its investigation last Thursday. The unit found five violations of the state health code related to Espinosa’s release and incomplete medical records.

“Any time we cite a hospital for deficiencies, we consider that serious,” said Jaqueline Lincer, a district administrator for the licensing division office in Santa Ana. The licensing division requires cited hospitals to immediately correct the problems or face stiffer civil penalties, which may ultimately lead to revocation of the hospital’s license.

On Monday, Western Medical Center submitted to the agency a required list of corrective actions that it plans to take to prevent similar problems in the future. Hospital officials could not be reached for comment Tuesday, but Administrator Tim Carda has maintained that Western Medical treated Espinosa properly and did not release him for financial reasons.

The investigation, which began in October, was prompted by a Times article about Espinosa’s discharge from Western Medical’s jail ward, where he was undergoing treatment for a host of health problems.

The 48-year-old laborer was arrested in July on charges of being under the influence of drugs and possessing $15 worth of cocaine and black 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 Center. He remained there until Sept. 5, when Orange County Municipal Court Judge Gregory Lewis lifted his bail and ordered him released from custody. The charges against him are still pending.

Espinosa claimed that in the afternoon he was forced out of Western Medical Center, he was presented a waiver stating that he was leaving the hospital against medical advice. He said he refused to sign it.

His discharge triggered a frantic effort by his family to obtain care for him until Western Medical finally agreed to readmit him and operate on Sept. 11. Espinosa still maintains that his heart surgery was scheduled for Sept. 6, the day after he was discharged from the hospital.

“They are making me out to be a liar, and I’m not. I was being prepped for surgery. They had shaved my chest. I had been evaluated,” he said Tuesday. “When I was released, that canceled everything.”

The licensing division concluded that hospital staff must ensure adequate care through appropriate discharge planning and clear instructions to patients.

“In this case,” investigators said in their report, “no arrangements had been made to refer the patient to a specific physician or clinic at the other medical center except to report to the emergency room for chest pain or difficulty in breathing.”