Gross Negligence in Case at King Hospital Alleged : Probe: Emergency care doctors face loss of licenses in death of wounded deputy. Lawyer disputes the accusations.

In an unprecedented condemnation of medical care at Martin Luther King Jr./Drew Medical Center, a government investigation has concluded that the death of a police officer who was shot in the line of duty three years ago resulted from “gross negligence” in his postoperative care at the county-run hospital.

Deputy Nelson Yamamoto had a better than even chance of surviving his wounds after nearly eight hours of surgery at King in March, 1992, the probe found, but he died after a physician gave him a lethal combination of heart drugs.

Based on those findings, the state’s medical board late Wednesday filed administrative charges to strip the licenses from four doctors who treated Yamamoto. Among those accused of gross negligence and incompetence is King’s vice chairwoman of surgery, Dr. Rosalyn Sterling-Scott.

Meanwhile, the Los Angeles district attorney’s office--which considered charging the doctors with involuntary manslaughter but decided not to--has forwarded its report on this case and six other “preventable deaths” to top county officials as a warning that “the level of care at this hospital will lead to further unnecessary patient deaths.”

“I hope this [report] actually saves some lives in the future,” Dist. Atty. Gil Garcetti said Thursday in an interview.

“This is not the definitive study

on the quality of health care that MLK provides,” Garcetti added. “We are simply saying that there are [a] sufficient number of instances that raise grave concerns concerning that level of health care, and that we needed to bring this to the attention of . . . the Board of Supervisors.”

An attorney for three of the doctors said late Thursday that he had not seen the administrative complaint or Garcetti’s report. But he disputed the accusations.

“The doctors I defended during the investigation were outstanding doctors,” said William G. Moore. “Mr. Yamamoto came in; he was mortally wounded. They attempted to save his life.”

Neither Sterling-Scott nor her attorney in the county counsel’s office could be reached for comment Thursday.

Supervisor Yvonne Brathwaite Burke, whose district includes the hospital, called the report “terribly indicting. . . . It’s a horrible situation.” But she cautioned against condemning the entire hospital, which largely serves the poor in South-Central Los Angeles.

County spokeswoman Sharon Wanglin said health officials have referred the matter to the county health department’s inspection and audit division.

A History of Preventable Deaths

The report, a copy of which was obtained by The Times, is a severe blow to the financially troubled 334-bed county teaching hospital near Watts that has long been dogged by accusations of substandard patient care. Several years ago, state and federal health authorities threatened to shut down the hospital by withholding Medicare and Medi-Cal reimbursement money after a series of articles in The Times disclosed numerous preventable patient deaths, medical mismanagement and inadequate supervision by attending physicians.

The report took note of these disclosures and pointed out that preventable deaths at King have continued despite assurances from the hospital that all problems have been corrected.

King administrators have blamed questionable deaths on overworked doctors, outdated equipment and inadequate public funding.

But Deputy Dist. Atty. Brian Kelberg, whose unit led the investigation of Yamamoto’s death, said problems uncovered by the probe are “not a question of economics. It is competency of care.”

The hospital’s chairman of surgery, Dr. Arthur Fleming, has defended the hospital’s care of Yamamoto and accused the district attorney of being on a “witch hunt.”

The district attorney’s 160-page report summarizes a 2 1/2-year joint investigation with the California Medical Board.

The result is a brutally candid analysis that alleges physician incompetence and cover-ups. It says one doctor may have falsified records, some were guilty of lax supervision, and others who reviewed the case after Yamamoto’s death either ignored or downplayed obvious signs of botched medical care.

The report criticizes the doctors at King for pumping so much blood into Yamamoto during surgery that some had to be drained afterward, but reserved its harshest language for what one of the medical experts said was the “ridiculous” mistake of mixing the heart drugs--a deadly error that could have been avoided by reading the standard physician’s reference manual.

The doctors “were clueless,” Dr. Ronald H. Wender, chairman of the department of anesthesiology at Cedars-Sinai Medical Center, said in the report. “I would say that a six-month intern could have handled it better than this.”

The doctors defended their decision to administer the heart drugs in a memorandum that cited a study involving pigs. Wender said their argument was “absurd.”

“If I were a plaintiff malpractice attorney,” Wender said in the report, “I think I would open an office across the street from Martin Luther King Hospital, because there is a lot of bad practice there. . . . This is crazy.”

Yamamoto was a healthy, 26-year-old, 205-pound sheriff’s deputy who had been on patrol less than 20 days when he was wounded in a Walnut Park shootout March 29, 1992.

Shot in the abdomen, thigh, shoulder and toe, Yamamoto was conscious and alert when he arrived at King. Surgeons worked nearly eight hours in two consecutive operations to repair his colon and intestine, and to tie off blood vessels in his pelvic area and thigh.

He died about 32 hours after surgery and was accorded a hero’s funeral. The coroner later ruled that Yamamoto had died from massive bleeding, shock and lung damage caused by his wounds.

The district attorney’s office and California Medical Board began an investigation in May, 1992, after informants alleged that other factors led to Yamamoto’s death. His family has filed a medical malpractice lawsuit against the hospital.

The report says that after surgery, Yamamoto had a 60% chance of surviving.

Investigators found that anesthesiologist Anthony Calloway, a third-year resident at King with the “hands-on” responsibility for Yamamoto, over-transfused the deputy with blood during surgery. Calloway’s notes showed he made the decision about how many units of red blood cells to order based on the results of a “spun hematocrit test,” a procedure that uses a centrifuge to determine the patient’s ratio of red blood cells.

But the report said that centrifuges at King had been removed and the hospital lab didn’t perform such tests. Medical experts told investigators it appeared that Calloway, who no longer practices at King, made up the test results to justify his actions.

Calloway’s attorney declined to comment on the report’s specific allegations.

Dr. Jake Davis, the supervising anesthesiologist at the time, realized that Calloway’s records were inaccurate but took no steps to supplement or correct them, the report said.

Administration of Heart Drugs

But the major damage occurred after surgery when Sterling-Scott took charge--but failed to write out a treatment plan or enter any progress notes, the report said.

“This patient did not have a captain of the ship,” Wender concluded. “His care was being directed by a dysfunctional committee.”

Sterling-Scott and Dr. Jonathan S. Heard worried about the patient’s accelerated heartbeat, but overlooked two obvious reasons for it, experts said. Yamamoto was not only in pain but was being administered Epinephrine, a drug that increases the heart rate and blood pressure.

“To me, it is absolutely incredible that these people are focusing on [the heartbeat] when they have two explanations right in front of them for why it’s being caused,” said Donald Trunkey, a trauma surgery expert from the Oregon Health Sciences University in Portland.

Without consulting a cardiologist or taking an electrocardiogram, Heard gave Yamamoto a second heart drug, Verapamil, designed to decrease certain kinds of accelerated heart rates.

When that drug failed to work, the report said that Heard gave Yamamoto the heart drug Labetalol about 45 minutes later. The medical experts told investigators that the two drugs don’t mix--a fact noted in the 1992 Physicians’ Desk Reference.

Seven minutes later, the deputy was in full cardiac arrest.

Prosecutor Weighed Criminal Charges

“The evidence . . . clearly established that an immediate cause of Deputy Yamamoto’s death was the inappropriate administration of two cardiac drugs, Verapamil and Labetalol, by Dr. Jonathan Heard, compounded by the overall mismanagement of Deputy Yamamoto’s postoperative condition . . . by Dr. Sterling-Scott and Dr. Heard,” the report says.

Garcetti determined there was enough evidence to charge Heard with involuntary manslaughter but he stated he decided not to file a case, primarily because juries are reluctant to send doctors to jail for mistakes made in good faith, no matter how grievous.

The medical board filed administrative charges seeking the licenses of Heard, Sterling-Scott, Calloway and Davis. Dixon Arnett, the agency’s executive director, said the investigation showed “clear and convincing evidence” of negligence and incompetence.

The agency has also been investigating half a dozen other cases of alleged physician negligence at King, but Arnett said investigators have been stymied by the hospital’s poor record-keeping, including important “missing” documents that would pinpoint responsibility.

The report by the district attorney’s office detailed six cases “of preventable patient deaths due to physician mismanagement” at King. They include:

* A 37-year-old woman who underwent routine surgery for an ovarian cyst and died after a series of surgical mistakes summed up by the county coroner as a “therapeutic misadventure.”

* An 18-year-old victim of a drive-by shooting who was taken to King’s emergency room, where inexperienced physicians slashed both jugular veins in her throat while trying to open a small airway.

* A 56-year-old heart patient with a surgical wound infection who died after he was treated in King’s emergency room by a dentist-in-training instead of a senior physician. He was sent home when he should have been admitted to the hospital for treatment of his bleeding infection.

* A 32-year-old victim of a drive-by shooting who died after surgery last year when he was sent to the wrong ward and was left unattended for about 10 hours. When the patient became dehydrated, doctors overdosed him by prescribing the wrong drugs without seeing him, according to attorney Joseph Cane who represents the family of the deceased, Edward Wilson. Cane said his medical experts have concluded that “Wilson had a much better chance of surviving if, after he was shot, he just went home and lay on the couch than what he went through at Martin Luther King Hospital.”