Administrator Rebukes County Hospitals

Los Angeles County’s new chief of medical services has issued a blistering rebuke to the public hospital system he oversees, charging that some doctors and administrators not only failed to report or investigate cases in which patients have died or been seriously injured by substandard care, but also that they have tried to impede other probes.

In the confidential memo, obtained by The Times on Thursday, Associate Director of Health Services Donald C. Thomas III said he is greatly troubled by some of the medical cases presented to him since he assumed command of the public hospital system this month.

“There is no apparent urgency to report any incident until the issue is forced by publicity or tort,” Thomas wrote. “In many cases, there has been no concerted effort to cooperate with fact-finding, except with great resistance and obfuscation.”

As associate director for clinical and medical affairs, Thomas is the county’s top-ranking doctor because health Director Mark Finucane is an administrator without medical training. Thomas has served as a chief of trauma at several hospitals and, more recently, as a medical director at the Arthur Andersen consulting firm.

In an interview Thursday, Thomas confirmed that his May 22 memo was based on a review of many pending and recently settled cases of alleged malpractice, and on his meetings with county supervisors and their health deputies regarding their perceptions of the health department.

Thomas declined to comment on many of the specifics that prompted him to issue the memo, but health department sources confirmed that one of those cases was that of Torin Comeaux.

Comeaux, 31, died last month after spending more than six hours in the emergency room of the Martin Luther King Jr./Drew Medical Center while staffers searched without success for a vascular surgeon to operate on him. He was then transferred to the County-USC Medical Center, where he died after seven hours of surgery. His case is being investigated by a variety of county agencies.

Thomas could not comment on the Comeaux case, he said, because he is leading a special investigation into it that was ordered after details of delays by King/Drew officials were reported in The Times this month.

Several other cases recently settled by the county for a total of more than $2 million also caught Thomas’ attention, sources said.

Thomas confirmed that one case involved Julio Hernandez Jr., a boy who was left severely brain damaged, mentally retarded, partially paralyzed and epileptic after King/Drew doctors misread his X-rays and did not notice that he was suffocating because a kidney bean he had swallowed was obstructing his breathing. Another, Thomas said in an interview, concerned Horace Massie, a Vietnam veteran who was rendered a near-quadraplegic because of a botched operation at County-USC Medical Center.

On Tuesday, the Board of Supervisors will consider approving an $847,000 settlement in the Hernandez case, which occurred in January 1996 because an emergency room physician misread his chest X-ray as indicating “no foreign body present.” Although another doctor quickly saw the blockage in the X-ray, delays led to an acute shortage of oxygen to Hernandez’s brain, according to county legal documents.

On May 20, the Board of Supervisors agreed to pay almost $1.2 million to Massie, who was transferred to County-USC in 1994 for a sudden onset of paralysis in his lower left leg, county documents show. Doctors there misread an MRI film and performed the wrong kind of surgical procedure on his spine, did it incorrectly and failed to obtain his consent for any of it, the documents show. Massie now suffers from paralysis of both legs and his right arm, has “minimal functioning” of his left arm, and requires 24-hour care.

Despite the obvious mistakes, “it does not appear that there was anything like what you or I would call discipline done” in either case, based on his review of available documents, Thomas said.

Corrective action plans, which the Board of Supervisors maintains should be a prerequisite to any out-of-court settlement in such cases, appeared to be “re-educational” at best, Thomas said.

Overall, he added, “there seems to be a philosophy of minimal chastisement” in such cases.

Finucane said the memo was exactly what he expected of his top associate--a tough approach to substantive problems that have gone uncorrected for years.

“I’ve made it clear I needed someone to provide a sense of standardization and leadership in quality of care issues,” said Finucane, who was hired more than a year ago to turn around the troubled department. “We’ve really never had--at least in many, many years--someone downtown to make quality of care and standardization issues on a countywide level.”

In his memo, Thomas avoided specifically criticizing any one hospital or doctor. But he suggested that the entire way the county handles medical malpractice issues is ineffective, and that such shortcomings have lead to continuing problems with medical care.

And, in what knowledgeable county officials said was a reference to the Comeaux case, he said: “Internecine activities, especially in cross facility incidents, far outweigh the apparent search for verity.”

Thomas also sharply criticized health officials for more general lapses.

“It does not appear, in many cases, that corrective action was taken in a timely manner. In some instances, there has been a disregard for the responsibility to managers,” he wrote. “In other instances, it is clear that there is an apparent disbelief in the reviewer’s authority.”

Thomas warned all health officials that reports of problem cases must be timely, complete with specific details of “contributory factors,” and that substantive corrective action plans must be implemented immediately.

“It will not be sufficient,” he wrote, “to recommend nebulous, elementary and essentially empty solutions.”

In the interview--his first since joining the county--Thomas said he “wanted to set a line in the sand so that everyone knows what the expectations will be from now on.”

In the past, Thomas said, many doctors and medical staff have escaped disciplinary action because what they did wrong--including leaving patients unattended, misdiagnosing them and failing to get their consent for certain procedures--was not prohibited by a specific county rule.

“This is a Civil Service system. You have to state your expectations before you can say that people aren’t meeting them,” Thomas said.

Thomas said he will be changing the health department’s Quality Assurance Manual so that it lays out “baseline levels of reporting and procedures . . . the specifics of what kind of incidents need to be reported, what kind of information needs to be analyzed and collected.”

Now, he said, “they [are mostly] left up to interpretation.”

Supervisor Yvonne Brathwaite Burke said she had not seen the memo, which was circulated among top health officials only. But she said she supported Thomas’ calls for change.

“I am strongly behind what he is doing,” Burke said. “If he is looking at the lines of authority and who should have responsibility and accountability, that absolutely has to happen.”