Inaction Delays Payment of Malpractice Settlement

It’s been three years since Charles Hamilton died at the county’s Martin Luther King Jr./Drew Medical Center after an unsupervised first-year surgical intern stuck a catheter into a vein in his chest and his heart went haywire.

As the Los Angeles County lawyers representing the hospital later would conclude, it was a high-risk medical procedure that Hamilton did not need. The 56-year-old Lucky Foods truck driver, who had undergone surgery after an automobile accident, was in good condition, the attorneys found, and had no need of the intravenous heart monitor the catheter was supposed to provide.

But intern Massoud Amini inserted the catheter anyway June 14, 1995, into a vein just under Hamilton’s collarbone.

Immediately, the man’s heartbeat became wildly erratic. A nurse sounded a “code blue” emergency. But for more than half an hour, as Hamilton’s heart rate slowed to a stop, no staff doctors came to help the inexperienced Amini. Even the anesthesiologist, who was in charge of the post-anesthesia recovery room, failed to respond, according to hospital records obtained by The Times.

Hamilton’s family sued, alleging that as a physician in training at the teaching hospital and trauma center, Amini was essentially practicing his surgical technique when he inserted the catheter. The suit alleged that Hamilton’s death was caused not only by the intern’s clear medical negligence, inadequate training and lax supervision, but also by the failure of properly trained doctors to respond to the crisis.

Ultimately, Hamilton’s family agreed to settle their $1.1-million wrongful death lawsuit for $625,000. County lawyers recommended the settlement to avert a trial, conceding in a memo to the county Claims Board that “the immediate cause of [Hamilton’s] death was attributed to an abnormal heart rate caused by the [catheter] procedure,” which “was an unnecessary procedure.”

That was in November.

Almost eight months later, Hamilton’s survivors haven’t seen a penny.

The reason: County regulations require that medical malpractice settlements involving doctors on the public payroll can’t be approved by the Board of Supervisors until the hospital conducts a thorough review of the case. In this instance, the review was supposed to determine whether King/Drew needed to correct any problems that contributed to Hamilton’s death. That formal study and the hospital’s plan to correct any problems that are uncovered must be reviewed and approved by the Health Services Department, which oversees the county’s six public hospitals.

Remedial Plan Delayed

But, according to the health department’s chief medical trouble-shooter, King/Drew’s plan to correct the problems that led to Hamilton’s death--including lax oversight of surgical interns--wasn’t completed until last month, nearly three years after the incident occurred. Dr. Donald C. Thomas III, associate health services director, said the hospital properly examined the case only after being ordered to do so by department officials, who were angry that they couldn’t settle the case until a review was completed.

For Hamilton’s family, however, justice delayed has been more than a bureaucratic inconvenience.

“I’m about to lose my home if I don’t get that money,” said his widow, Beverly, who can’t make the payments on their Windsor Hills house without his $6,000-a-month income. “We were planning our retirements together, so we could travel around the country and visit our grandchildren.”

“Now,” she said, “I’m looking at what in the world I am going to do. My whole life, my whole future, has been crushed.”

Last week, a judge told Hamilton’s lawyers that he was so tired of the county’s delays that he would take the unusual step of setting an Aug. 18 trial date in a matter that has long been settled.

“It is frustrating and I have often thought about throwing the court’s power into the foray,” Superior Court Judge Michael Rutberg said after criticizing the county for delays in the Hamilton case and others like it. “If you don’t get your money [soon], you will get your trial in August. That’s the best I can do.”

On the very next day, the county Claims Board recommended approval of the settlement--even though its legal papers in the case didn’t include the required corrective action plan. The Board of Supervisors is set to take up the matter July 7, which means that the Hamilton family could soon put the matter behind them.

“We’re not an ambulance-chasing family,” Beverly Hamilton said. “But it was an injustice, and we want to see some resolution so we can move past this. . . . I believe that [Amini] was practicing on my husband.”

Hospital officials deny that assertion in legal motions, and the settlement of the lawsuit is drafted in such a way that the hospital is not blamed for Hamilton’s death. King/Drew’s administrator, Randall Foster, and other hospital officials did not return repeated calls seeking comment on the case or on the delays in formulating a remedial plan.

Amini is now working as a surgical assistant, aiding in operations on patients at private hospitals in the Long Beach area. He said he did nothing wrong and that he was just one doctor among many working on Hamilton that day.

“I cannot explain the case,” the Iranian-born Amini said in halting English. “The lawyers say not to talk.”

But the county’s own lawyers concluded that the hospital failed to provide “the appropriate standard of care.”

What’s more, medical and legal records show that although the hospital has recently moved to tighten supervision of interns and residents, they also show that King/Drew essentially closed its books on Hamilton’s case even before his body was sent to the morgue.

Serious Problems Overlooked

In a sworn deposition, King/Drew chief of surgery Dr. Arthur W. Fleming testified that the incident was of “no concern to me,” because he believed that Hamilton died of injuries suffered in the car crash, including chest bruises and a ruptured spleen.

Fleming avoided questions as to whether he had read the autopsy report on Hamilton, which concluded that the truck driver did not die of the injuries

suffered in the accident. “I mean from the day that I talked to the family . . . I had considered this a nonissue case,” Fleming testified. “So, no, nothing we have done in the last year and a half relates to this case directly.”

Thomas, the associate health services director, said in an interview that he finally was forced to order Fleming’s hospital to go back and review the case “in the last few months.”

“The only thing I can say is a mea culpa,” said Thomas, who joined the department last year.

“You have to investigate these things” when they happen instead of three years later, he said, “and we are in the process of fixing that right now.”

Thomas said the health department also wants to ensure that all six of its hospitals aggressively

investigate all unexpected patient deaths and injuries, and that problems identified at one hospital are fixed at the others as well.

In the past, he said, that didn’t happen: “It was a bunch of little duchies. Doctors try to avoid the process as much as possible. It is a challenge, especially in a system as big as ours.”

Indeed, the Hamilton case shows that, for three years, the hospital overlooked serious problems that could jeopardize patients taken to the busy South Los Angeles trauma center after being shot, stabbed or injured in car wrecks.

Among those problems:

* The hospital did not have clear-cut guidelines regarding what kinds of medical procedures interns like Amini could perform, and whether staff doctors needed to oversee them. Fleming said in his deposition that insertion of the so-called Swan-Ganzs catheter “would normally have been done in [the surgical intensive care unit], period, under direct supervision.” But when asked by Hamilton family lawyer Colleen Newkirk in October if such guidelines were adopted after Hamilton’s death, Fleming refused to answer. In “1995, there was not” such guidelines, Fleming responded. “So that’s all I have to say.”

* Although Amini contends that a staff surgeon told him to insert the catheter, there were no written physician orders in Hamilton’s medical records indicating that. Those records, in fact, show that Hamilton was stable and in good condition. County lawyers who investigated the case later agreed. “Experts will be critical of the decision to subject Charles Hamilton to [the] high-risk procedure,” lawyers Mark Weinstein and Gary Miller conclude in one legal memo. “Experts will be further critical of medical personnel in their performance in placing the catheter.”

* Medical and court records, including Fleming’s deposition, show that no staff doctor was there to oversee Amini’s work or to respond to the code blue--not even Dr. Peter Meade, the director of the surgical intensive care unit, who Amini says told him to insert the catheter, or the recovery room anesthesiologist, Dr. Anjan Ghosh. “This was a life-threatening emergency in the surgical recovery room in the middle of the day on a Wednesday afternoon,” the Hamilton attorney, Newkirk, said in one legal brief. “Where were the experienced physicians?” When she moved to depose Meade, Ghosh and others on duty that day, the county quickly settled the case--on the condition that the doctors not be questioned under oath.

Beverly Hamilton also has testified that hospital officials told her no autopsy was needed to determine the cause of her husband’s death, even though he was in top physical condition and one doctor had said he had come through surgery so well that he would “walk out of the hospital” in a matter of days. Amini left blank one required form that was supposed to be sent to the coroner regarding cause of death, and another form that he did fill out never mentioned inserting the catheter.

As a result, the county coroner’s office never performed an autopsy, as it is required to do in every unexpected death in a public hospital.

Had it not been for one King/Drew doctor who Beverly Hamilton says privately told her to obtain an independent autopsy, the widow and her daughter say they might have believed hospital officials who said Charles Hamilton died of his injuries.

In their sworn testimony, Beverly Hamilton and her daughter, Toni, recall that surgery chief Fleming insisted that Charles’ cardiac arrest was caused by the injuries he suffered in the crash.

“He probably assumed his comments were sufficient to satisfy us . . . and that we would walk away,” Beverly Hamilton said. “But we knew he was trying to pull the wool over our eyes.”

The Hamiltons paid for their own autopsy, which showed that Hamilton did not die of his injuries. They learned that Amini had received his medical training in Iran almost a decade earlier and had not “touched a patient” in the interval between leaving his native land and his admission to a one-year internship program at King/Drew.

In fact, Amini testified that he had spent the past six years trying to get accepted as a surgical resident at teaching hospitals throughout the United States and Canada, without success. A few weeks after Hamilton’s death, King/Drew said it too would not accept Amini in its own full five-year residency program, and dozens of other hospitals have since rejected him as well, Amini testified.

Seeking Changes for Everyone

By October, the Hamiltons’ lawyers had amassed so much evidence that the county’s lawyers recommended the out-of-court settlement, saying that the family could conceivably get much more from a jury that would probably be sympathetic to their case.

But the Hamiltons demanded more than just money.

They also insisted upon “evidence of positive change” at the hospital to make sure untrained or unsupervised medical interns would not perform potentially life-threatening medical procedures on other patients.

“The Hamilton family has emphasized to us that they wish to see some good come from this tragic and preventable death,” their lawyers wrote in a legal memo to the county a year ago. “The family seeks to ensure that facilities serving the indigent--as well as middle-class citizens, such as Mr. Hamilton--are in compliance with the same standards that apply in private care.”

Beverly Hamilton says she has never received a letter, phone call or document of any kind to inform her that such corrective actions were taken. And although she welcomes final settlement of the case, she says she was troubled to learn from a reporter that the hospital only drafted a plan of corrective action after top county health officials ordered it to do so.

“When you don’t believe anything is wrong, you convince yourself that nothing needs fixing,” she said. “And that’s the problem. That is what is so totally unacceptable.”