A 7-year-old girl will receive $950,000 from Los Angeles County to compensate her for intestinal damage that left her unable to eat regular food after an anesthesiologist at Olive View/UCLA Medical Center failed to respond for emergency surgery, according to county attorneys.
Jessica Perez, who has Down's syndrome, had to have three-fourths of her small bowel removed, leaving her dependent on intravenous feeding for the rest of her life, following delays in surgery at Olive View in 1991.
County supervisors last week approved the settlement with her family after attorneys indicated the county could lose up to $11 million if the case went before a jury.
Jessica's attorney, Phil Michels, said she was experiencing stomach problems on April 12, 1991, when her parents took her to a doctor in San Bernardino County who gave her some medication. But the girl's condition deteriorated that evening, and her parents took her to the emergency room of Victor Valley Community Hospital, a small nonprofit facility in Victorville.
She was treated, and then her parents, who are unemployed, were told to drive her to Olive View in Sylmar, the attorney said. The emergency room doctor has since agreed to pay Jessica $850,000 in an out-of-court settlement, according to a summary of the case by Los Angeles County attorneys. The hospital's lawyer declined comment.
By the time the girl reached Olive View at almost 8 a.m. the next day, she was complaining of severe stomach pain, according to the county summary. An emergency-room physician determined that she was suffering from an obstruction of the small bowel, a critical problem.
Physicians planned to give her antibiotics and fluids intravenously, then perform surgery to clear the blockage, according to the county summary. But since her health continued to fail, they decided it would be better to stabilize her before surgery.
At 3 p.m., the girl was transferred to the pediatric intensive care unit, according to the county summary. At 4:30 p.m., with her condition still deteriorating, it was decided that surgery needed to be done soon.
Surgeons contacted an anesthesiologist who was on call at home, but the anesthesiologist "failed to respond for surgery," according to the summary. Michels and an Olive View official identified the anesthesiologist as Dr. Immini Abraham.
Dr. Irwin Ziment, Olive View's medical director, said Abraham did not refuse to appear, but told the surgeons she had no expertise in pediatric surgery. She said she was reluctant to assist but would do so "if she had to," said Ziment.
Abraham also wanted to get more details of prior surgeries on Jessica's throat that might affect how the girl reacted to anesthesia, Ziment said.
Ziment said surgeons made a "big effort" to find another anesthesiologist but were unable to do so. One of the surgeons, angry and frustrated, then wrote in Jessica's chart that Abraham had not responded, Ziment said.
By 5:30, it was clear that Olive View could not provide the surgery that Jessica needed, and the decision was made to transfer her by helicopter to UCLA Medical Center. However, she did not arrive at UCLA until 7:56 p.m.--12 hours after she arrived at Olive View.
"This 12-hour period was the most critical period, during which her surgery should have been conducted," county lawyers noted in the case summary. Ziment said there were more delays at UCLA.
The following day, Jessica underwent surgery at UCLA to remove 80% of her small bowel because the tissues had died. As a result, she "cannot eat regular food and must remain on intravenous nutritional supplements for the remainder of her life," the summary said.
Carolyn Rhee, chief operating officer at Olive View, said Abraham has been "counseled" but not otherwise disciplined and remains on the hospital staff.
"We don't think that only one person was responsible," said Rhee. "A whole bunch of different factors were involved."
Ziment said Olive View was ill-prepared to care for such a sick child on a weekend and should never have accepted the transfer from Victor Valley hospital. Jessica, he said, should have been sent directly to UCLA.
Since the incident, which Ziment described as a "system failure," Olive View keeps two anesthesiologists on call, including one with with pediatrics training. He added that most anesthesiologists hired since 1991 have been required to have some pediatrics background.
"We think we've corrected the system problem," he said. "We've worked really hard to prevent a disaster like this from happening again."