Vindication Came Hard for Doctor in Deputy’s Death

She was on her way up, the first black woman in the country certified as a thoracic surgeon, hellbent on becoming a chief of surgery, then, someday, a medical school dean.

Dr. Rosalyn Sterling Scott was no stranger to high-profile cases: She’d operated on a senator who’d been shot, a SWAT team member who’d accidentally shot himself, a little girl gunned down in a schoolyard.

But the case of Sheriff’s Deputy Nelson Yamamoto nearly decimated her dreams.

Months after the deputy died at county-run Martin Luther King Jr./Drew Medical Center in 1992, she and other doctors found themselves under investigation for criminal negligence.

Though they were never charged, the Los Angeles County district attorney’s office produced a report in 1995 that blamed Scott and another surgeon for mistakes that killed Yamamoto. The Medical Board of California sought to yank her license, and the county abruptly pulled her from clinical practice.

With or without the formal charge, she felt branded as “a murderer.” “I decided,” she said, “not to go quietly.”

So she fought back--hard. This year, with the support of several medical societies and leaders in the surgical field, she won. In a terse, one-sentence notice filed in July, the medical board dropped the accusations against her.

But that, to the 47-year-old Scott and her advocates in the medical community, does not put the matter to rest. To them, the case has come to symbolize the dangers of blending criminal prosecution and medical review. And it has come to signify the perils of practicing medicine in a political minefield.

These critics say the explanation for the unusual investigation lies in the tenor of the time, when the King/Drew hospital was shellshocked by negative publicity, the county was under pressure to respond, and the state medical board was under fire for failing to protect the public.

Even without all that, authorities were pushing for answers in the case of a wounded rookie deputy who went into the hospital still able to talk but whose heart stopped two days later.

“I think all of those factors contributed to a search for a scapegoat and that turned out to be Dr. Scott,” said Dr. Brian Johnston, former president of the Los Angeles County Medical Assn.

Nonsense, says prosecutor Brian Kelberg. “We had a credible basis of information to suggest that a fuller investigation was necessary to see if the care was criminally substandard. . . . We stand by the report that we issued based on the evidence we had.”

The outcry from highly placed physicians across the country has been sharp, sometimes shrill. Criminal prosecution of doctors for alleged medical mistakes is rare--especially when an earnest effort is made to save a life. Normally, hospital peer committees and the medical board investigate possible medical errors, referring cases to prosecutors only when doctors are reckless, or have criminal intent.

“I about blew a gasket!” said Dr. Robert Replogle, former president of the Society of Thoracic Surgeons. “I just about fainted. I said, ‘If this happens, when patients come in filled full of bullets, doctors are going to lock the doors.’ . . . This one had to be stopped.”

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Nelson Yamamoto, 26, had been on patrol only two months in March 1992 when he and other officers were summoned to a converted garage in Walnut Park where gunmen were holed up. When the deputies ordered the men outside, they opened fire. The rookie slumped to the ground, struck in the stomach, shoulder, thigh and foot.

That night, as he was rolled into King/Drew, Yamamoto was conscious but losing blood and in need of emergency surgery. During two operations over nine hours, doctors rushed to repair his numerous wounds.

Scott, the hospital’s vice chairwoman of surgery, became involved the next day, when she was asked by her boss to keep administrators informed and ensure that the care went smoothly.

This is where accounts of the case diverge. According to Scott, she offered to “cover” for a surgical resident who had been up all night so he could get a few hours of sleep. Scott says she never intended to take over the case. “I was being nice,” she said.

According to the 1995 district attorney’s report, Scott effectively assumed the role of supervising physician, removing other doctors from the case.

Unfortunately, Yamamoto did not fare well. While Scott was filling in, his blood pressure plunged. She stabilized him on epinephrine, a drug that boosts pressure, and also gave him albumin, a fluid replacement.

The following day, when Scott was not there, Dr. Jonathan Heard attempted to stabilize Yamamoto’s racing heartbeat using two different drugs within 45 minutes of one another. His efforts failed, and Yamamoto died that afternoon, two days after he had been admitted.

Months later, Scott and other doctors were summoned to a local medical board office to discuss the case. They were surprised, she said, that a criminal prosecutor, Kelberg, was asking most of the questions.

“Kelberg was insulting to Dr. Scott. He was putting words in her mouth, so I stopped [her interview],” said William Moore, an attorney for the doctors. Ultimately, Scott and others were questioned before a grand jury. She invoked her 5th Amendment rights, on the advice of her attorney.

Kelberg makes no apologies, saying he was doing his job, following up on tips by one or more knowledgeable informants that the deputy’s care had been substandard, perhaps criminally negligent. The probe, he said, was jointly handled by his office, the medical board and the Sheriff’s Department.

But a medical board attorney not involved in the early stages of the case said, “It was more the D.A.’s game. They were taking the lead.”

Although prosecutors ultimately raised questions about the deputy’s surgical care, focusing on actions of two anesthesiologists, it was Scott and Heard who bore the brunt of blame for the deputy’s death, according to the prosecutors’ 1995 report.

One of the report’s three medical experts criticized Scott for her use of albumin and epinephrine in combination with the later cardiac drugs given by Heard. The report also said Heard ought not to have given the heart drugs in close combination because of the danger of cardiac arrest.

“The evidence . . . clearly establishes that an immediate case of Deputy Yamamoto’s death was the inappropriate administration of two heart drugs, Verapamil and Labetalol, by Dr. Jonathan Heard, compounded by the overall mismanagement of Deputy Yamamoto’s postoperative condition” by Scott and Heard, said the report, which received wide media coverage.

Forwarded to county officials, the report contended that evidence was “sufficient” to prove Heard was guilty of involuntary manslaughter but was “less clear” about Scott. In any case, the report said, charges would not be filed against either doctor because juries were unlikely to convict them.

The medical board went forward with administrative charges of gross negligence against Scott, Heard and two anesthesiologists. (All accusations against the doctors have since been dropped, with the exception of those against one anesthesiologist, whose case is still pending.)

The next day, “I was front page news,” Scott said dryly. The county informed her that she was being reassigned, with full pay, to administrative duties, and she hasn’t operated since.

The case, by any measure, was complex, involving numerous players and split-second decisions. Confusing matters further was the mysterious disappearance of X-rays and explanatory “progress notes” made by Scott and others.

What was left in the record has been read multiple ways. The district attorney’s report, bolstered by three medical experts, blamed Scott and Heard. But Scott maintains--with considerable support, gathered recently from other experts--that Yamamoto died as a result of his injuries and respiratory complications.

Kelberg did not have access to opinions from experts that Scott and her supporters rounded up later. But an April 1992 autopsy report stated that Yamamoto died from his gunshot wounds, the type that can cause death “even with excellent medical and surgical attention.” Other early reviews by local physicians--both inside and outside King/Drew--also found the care met medical standards.

Why, Scott’s supporters ask, weren’t the district attorney, the medical board and the Sheriff’s Department satisfied?

They say her case came at a perilous time politically. King-Drew had recently been hit with a barrage of stories in The Times detailing cases of poor treatment and preventable deaths. In fact, the district attorney’s report included copious details from news articles about other cases at the hospital.

Then, at the beginning of 1993, the medical board got bombarded by bad press. An investigative report concluded that the board had disposed of hundreds of complaints against doctors in 1990 to clear a growing backlog--including complaints that medical personnel at King/Drew Medical Center clinics “were culpable in the death of five patients.” Consumer advocates charged that the board had failed in its mission to protect patients.

The investigation into Yamamoto’s death was proceeding about the same time. “From my perspective and reading the newspapers, it was clearly motivated to a certain extent by politics,” said Alan Heilpern, president of the Los Angeles County Medical Assn. “People [were] clamoring to know, why is this guy dead?”

Kelberg bristled at the suggestion. “The one thing I will not tolerate is any outside influence,” he said. “All I care about is the facts.”

Kelberg, a bright and aggressive attorney, likes to point out that his unit was the first in the country to convict a doctor of murder due to poor care. Dr. Milos Klvana was convicted in 1989 of nine counts of first-degree murder involving eight infants and a fetus.

Prosecutors charged that he was incompetent and ill-equipped to handle high-risk deliveries.

“If you look at Klvana, you understand why there is a criminal sanction available,” Kelberg said.

Maybe so, say physicians who defend Scott, but they say her case was in no way similar to Klvana’s. There is room for disagreement over what she and her colleagues did, they say, but that is so in every complex medical case.

It is vital to distinguish, they say, between normal medical disagreements, the sort of gross negligence probed by the medical board and criminal negligence of the sort handled by prosecutors.

Throughout most of the investigation, Scott kept a low profile, and county and university administrators, to her dismay, remained mostly silent. But last year, when she decided to seek support from the wider medical community, it came fast and furious.

“I think when a surgeon who is well-trained and well-motivated gets into this kind of scrape . . . we rise up in defense,” said Dr. Arthur E. Baue, former chairman of surgery at Yale University, who called the allegations “preposterous” and the probe “a witch hunt.”

Committees of both the Society of Thoracic Surgeons and the Los Angeles County Medical Assn. independently reviewed medical records in the case and concluded the care met medical muster.

“The thing I’m concerned about is, if you have to guarantee success, then I can understand why surgeons would not want to be involved with the trauma patient” at all, said Claude H. Organ Jr., a professor of surgery at UC Davis and former chairman of the American Board of Surgery.

It was the medical board that came in for the most stinging criticism from Scott’s advocates. It is the board’s job to investigate medical quality issues, but it bowed to the district attorney, they said.

“The lack of courage of the medical board is amazing,” Replogle said. “Somebody should have stepped in here and said, ‘Wait a damn minute.’ ”

Medical Board Executive Director Ron Joseph, not the board’s chief when the case first arose, declined to comment.

This year, after the board consulted with a wider array of experts and had a physician interview Scott, it dropped the accusations against Scott and Heard.

Still, the case did not die. The board tried to force the two doctors to take competency examinations. Both refused. Heard ultimately took the exam and passed. In August, the board notified Scott that she would not be required to take the test after all.

Scott has yet to be restored to her clinical duties and still is waiting to hear whether the county will pay to help her freshen up her surgical skills. But she hopes the worst is over.

“Most doctors when they get into a situation like this, they try to settle, they want it to go away. . . . I was not going to allow the D.A. and the medical board to push me into taking any position that would represent anything short of complete vindication.”