Fatal Neglect by King/Drew Nurse Alleged

A 47-year-old woman died at Martin Luther King Jr./Drew Medical Center after an intensive care nurse ignored her deteriorating condition over the course of a day, neglecting to alert doctors until the patient was in cardiac arrest, Los Angeles County health officials said Friday.

The incident occurred Nov. 18, when the audio alarms on the woman’s vital-signs monitor -- which would have alerted others to her worsening state -- had either been turned off or adjusted so they wouldn’t sound, officials said.

The nurse, Ruth Bell, also failed for nine hours to request blood for a doctor-ordered transfusion, finally administering it just minutes before she called a “code blue” on the patient, said county health department spokesman John Wallace, confirming information obtained by The Times.

In addition, Bell allegedly falsified records to indicate she had checked the woman’s vital signs when she hadn’t, he said. The nurse, an 18-year veteran, is also accused of getting the patient’s file after her death and adding notes about the woman’s final hour, then lying about doing so, said Dr. Thomas Garthwaite, director of the county Department of Health Services.

Bell has been suspended pending discharge, officials said. She could not be reached for comment. Officials would not identify the patient, who had been suffering from pneumonia and sepsis.

“This is painful,” Garthwaite said. “This is a profession about healing ... about doing everything in your power to make someone well.”

The death has striking similarities to a widely publicized case at King/Drew in October.

In that instance, a different intensive care nurse turned down the audio alarm on a 28-year-old man’s monitor, then failed to notice that the man’s heart was barely beating, officials said. That nurse, too, allegedly falsified the patient’s medical records, indicating that he was stable more than an hour after he died.

County officials said the two deaths illustrated how hard it would be to fix the nursing problems at the county-owned facility in Willowbrook, south of Watts.

In November, nearly three weeks before the latest death, a turnaround firm took charge of daily operations at the hospital. Navigant Consulting is being paid $13.2 million over the next year to reform the troubled medical center.

Navigant Director Kae Robertson called the deaths “examples of how deeply seated” the problems are and how great “the culture changes are going to need to be.... Everything you think would be the normal way to fix a problem is not going to be the way to fix MLK.”

After the death in October, Garthwaite said, officials looked multiple times for instances of nurses recording information on charts as if they had checked on patients when they hadn’t. He said he could not explain why a nurse would fail another patient after such scrutiny and reemphasis of procedures. “It’s reflective of the challenges of trying to assess someone’s ethics and honesty,” he said.

Garthwaite and Robertson said, however, that there were some signs of progress. Unlike in previous cases, suspicions about Bell’s behavior triggered an immediate investigation.

Government health inspectors had previously determined that three King/Drew patients, all hooked to monitors, died in 2003 after nurses failed to notice their declining vital signs.

After the third patient died, the county hired an outside turnaround firm, Camden Group, to revamp King/Drew’s operations and ensure that nurses were competent. The firm was paid nearly $1 million before it handed the project off to Navigant in November, Wallace said.

In a lengthy report issued earlier this week, Navigant devoted 60 pages to the hospital’s nursing problems.

King/Drew is already fighting for its survival. It could soon lose $200 million in federal Medicare and Medicaid reimbursements. Federal officials have threatened to cut off the funds because the hospital failed to curb the use of stun guns on aggressive psychiatric patients. A decision is expected within weeks.

A national hospital accrediting group has already recommended pulling its seal of approval, which could lead to closure of doctor-training programs and the loss of nearly $15 million in private insurance reimbursements.