Six staff members at Martin Luther King Jr.-Harbor Hospital -- including a nurse and two nursing assistants -- saw or walked past a dying woman writhing on the floor of the emergency room lobby last month but did not help her, according to a report made public Friday.
Their discipline: a letter outlining how they should behave in the future.
The six are in addition to two others whose roles have already been made public by The Times: a contract janitor who cleaned the floor around the woman as she vomited blood and a triage nurse who oversaw the whole episode and pointedly refused requests to intervene.
The janitor was counseled verbally; the triage nurse was placed on leave and later resigned, the report said.
The report released Friday was written by the U.S. Centers for Medicare and Medicaid Services and included the public hospital’s responses. It provides the greatest detail to date on the death of Edith Isabel Rodriguez, 43, in the early hours of May 9, which was captured on a security videotape.
Besides the nursing staffers and the janitor, three of the employee witnesses were financial services workers.
According to the report, the videotape shows that for about 30 minutes, “staff members walked past the patient or worked to clean the floor next to her without interacting with her. One staff person was observed sitting behind the financial/registration window and had a view of the patient in the lobby.”
The tape, now in the hands of the Los Angeles County Sheriff’s Department, has not been publicly released because the incident remains under investigation. But it was reviewed by the inspectors for the federal report.
At 1:30 a.m., when Rodriguez was “kicking with her feet” on the floor, “two staff members looked at the patient and then walked back through the door to an area within the ER,” the report said without specifying who the workers were.
Rodriguez died a short time later of a perforated bowel that probably occurred in her last 24 hours of life, the county coroner ruled. Experts have said her death might have been prevented had she received treatment sooner.
The incident was the latest in a series of patient care lapses at King-Harbor, formerly known as King/Drew, which serves a poor and minority community in the South Los Angeles area. But this episode has drawn national attention, largely because of the videotape and the public release this week of recordings of two 911 calls in which Rodriguez’s boyfriend and another onlooker unsuccessfully begged sheriff’s dispatchers to send help.
In an interview Friday, county health services director Dr. Bruce Chernof said the “letters of expectation” given to the six staff members -- which carried no other penalty -- were appropriate forms of discipline given their previous performance history and their role in the event. The county owns the hospital.
Chernof put most of the blame on the nightshift triage nurse, Linda Ruttlen. She turned away requests for help from police officers who had brought Rodriguez in from benches in front of the hospital, where she was crying for help. Ruttlen has been referred to the state nursing board for investigation. “The majority of the staff raised their concerns to the triage nurse,” Chernof said. “My expectation is that if they didn’t get the response that they wanted that they would have gone beyond that.”
Ruttlen has not returned telephone calls seeking comment. A man answering the telephone at her residence would not take a message Friday.
The federal government cited King-Harbor for violating the Emergency Medical Treatment and Active Labor Act, which requires hospitals to screen and stabilize all patients seeking emergency care.
In a written response, hospital officials said they had made changes, such as adding training for emergency room staff, improving methods for logging patients seeking treatment and posting additional signs advising patients of their right to a medical exam.
Rodriguez was being taken into police custody when she became unresponsive and died. In responding to a complaint from Ruttlen that she was causing a disturbance, officers ran a computer search on Rodriguez and found that she had a parole violation for possession of a controlled substance.
In its response to the report, the hospital said that in the future, officers must get a medical clearance before taking patients into custody.
“It’s really hard to explain how something this bad could happen,” John R. Cochran, the health department’s chief deputy director, told deputies to the Board of Supervisors at a briefing Friday afternoon. “Nobody faulted the policies in place. Nobody faulted the procedures in place. What they faulted was the person [who] failed to do the work,” he said, referring to Ruttlen.
From now on, county health officials said, a supervising nurse will check the emergency room waiting area at least once every eight-hour shift to ensure that no patient is left unattended.
“No one did regular sweeps?” asked Martha Jimenez, senior health deputy for Supervisor Gloria Molina
Not in the waiting room, Cochran replied.
King-Harbor must still respond to a separate federal report, not yet released, that found emergency room patients in immediate jeopardy of harm or death.
That report was based in part on the experience earlier this year of a brain tumor patient who waited fruitlessly in an emergency room bed for four days before giving up and seeking emergency surgery at another hospital.
Responding to the uproar caused by Rodriguez’s death, the chairman of the U.S. Senate Finance Committee on Friday asked federal regulators to explain how they plan to protect patients at King-Harbor in light of “horrific” and “appalling” lapses in patient care.
In a letter to the Medicare agency, Sen. Max Baucus (D-Mont.) said he was concerned about the quality of care being delivered at the hospital.
“There have been many prior deaths and long-standing problems,” Baucus wrote of King-Harbor, “and local and state attempts to improve the hospital have failed.”
He said the Medicare agency had “taken significant measures and allocated federal resources to help correct the standard of care at King-Harbor to no avail.”
Officials at the Medicare agency did not comment Friday afternoon.
In the last 3 1/2 years, King-Harbor has made significant changes, including closing its once-busy trauma center, disciplining hundreds of workers, slashing services and reducing the number of inpatient beds from more than 200 to 48.
The issue now is whether these changes are enough to satisfy federal inspectors, who could arrive as early as next month for a final review to determine whether the hospital should lose critical funding.
State officials, who license King-Harbor, have some decisions to make as well.
S. Kimberly Belshe, the state’s health and human services secretary, said she had thought the hospital was making a lot of progress toward correcting its problems -- at least until now.
“We are all so taken aback by the recent incidents at MLK-Harbor,” Belshe said. “It does call into question the extent to which meaningful progress has in fact been made.”
She said officials are trying to figure out whether more harm would be caused by closing the hospital or keeping it open.
“When do the dangers associated with keeping the hospital open outweigh the dangers of this hospital closing?” she asked. “That’s a very important balancing act.”