Ruling Limits Damages in Girl’s Death at Hospital

Hospitals that refuse to treat medically unstable patients are protected by a state cap on jury awards even when they violate a federal law against patient dumping, the California Supreme Court decided Thursday.

The court made the ruling in the case of Mychelle Williams of Watts, who was 18 months old when she died in 1993 of a treatable infection that a simple blood test would have detected.

Her health maintenance organization refused to authorize the blood test at another hospital, where she had been brought by ambulance. She was transferred to her HMO--four hours after her arrival at the first hospital--and died shortly thereafter.

A Compton jury determined that Williams died of medical malpractice and patient dumping, and awarded her mother $1.35 million for pain and suffering and $3,000 in economic compensation to cover funeral expenses.

But the state Supreme Court, upholding lower court judges, said the patient dumping violation involved professional negligence, and triggered a state law that limits damages for pain and suffering to $250,000.

The $1.35-million jury award will be cut to $250,000 under the decision. After costs and attorney fees are deducted, Williams’ family will probably receive less than $150,000.

Kenneth Sigelman, the lawyer for Mychelle’s mother, complained that the ruling makes the 1986 anti-dumping law moot in California.

“Mychelle Williams died not because a doctor didn’t know what to do, but because of her health insurance status,” he said.

Sharon J. Arkin, a lawyer for the hospital, noting that “a lot of people go to emergency rooms for care,” praised the decision for upholding state legislators’ efforts to curb health costs.

The decision is important because it comes at a time when patient advocates say that transfers of unstable patients have been growing dramatically with managed care.

Particularly affected are the families of children who die in patient dumping situations. Awards in such cases are relatively small because economic damages, which are unlimited, primarily are based on past earnings or future medical care.

In the case before the court, Dawnelle Keys, 37, a trained paramedic, summoned an ambulance when her daughter began having trouble breathing. Mychelle had been vomiting and had diarrhea.

The ambulance took Keys and Mychelle to the nearest hospital, Los Angeles County’s Martin Luther King Jr. / Drew Medical Center. Mychelle had a fever of 106.6 degrees and an abnormally high pulse and respiratory rate.

Dr. Trach Phoung Dang examined Mychelle at King. He later said he knew she might be suffering from a massive bacterial infection that could be treated with antibiotics. But a blood culture was needed before antibiotics could be administered.

Mychelle was with Kaiser Foundation Health Plan, and Dang called Kaiser for permission to do the blood culture. Dr. Brian Thompson, a Kaiser physician, said the blood work should be done at Kaiser after the girl was transferred.

Dang telephoned Thompson again and repeatedly suggested doing the blood test at King. Their telephone conversations were tape-recorded by Kaiser. Thompson told Dang not to do the tests. In the medical chart, Dang wrote: “Dr. Thompson at Kaiser did not want me to do any blood test.”

Two and a half hours after her arrival at King, Mychelle had a seizure. Dang treated her for dehydration, breathing difficulties and the seizure, but did not administer antibiotics. When her mother began to panic and demand better care, hospital security was called to escort her out of the building.

By the time Mychelle reached Kaiser--four hours after entering King--she was near death. Her heart stopped 20 minutes after arriving at Kaiser.

The federal anti-dumping law prohibits hospitals from transferring or discharging patients known to have emergency conditions, regardless of insurance carrier or ability to pay. Complaints can be filed with a federal agency and fines assessed. The law also allows victims to sue and recover whatever amounts are permitted under state law.

The California Supreme Court said Thursday in its ruling that the state medical malpractice cap applies in California, because failing to stabilize a patient constitutes “professional negligence.”

A patient dumping claim “based on failure to provide medically reasonable treatment to stabilize a patient, would, if brought under state law, constitute a claim of professional negligence,” Justice Stanley Mosk wrote for the court.

Los Angeles County had asked the court for a broader ruling that would cover all patient dumping cases, including claims involving a hospital’s failure to even screen a patient. The court declined to decide that issue.

Justices Marvin R. Baxter and Ming W. Chin, in a separate opinion, said they believed the malpractice cap should be applied to all patient dumping cases.

Jamie Court, director of Santa Monica-based Consumers for Quality Care, called the ruling a “very dangerous precedent for patients in this state who deserve the right to be treated when it is not safe to transport them.”

“It’s terribly disappointing that the Supreme Court could not recognize a distinction between an administrative decision made for business and financial reasons and an instance of medical negligence made because of incompetence,” the consumer activist said. “The ruling tells hospitals and HMO doctors that they have another shield of immunity.”

Court said consumers’ groups will lobby the state Legislature to change the law to ensure that patient dumping is treated separately from medical negligence.

Keys said she was very surprised by the decision. “I am hurt, very hurt,” she said. “I would just hate for anybody to walk in the same footsteps I walked in.”