Facts

On Saturday, May 11, 2013, at 1:45 p.m., Raul Lopez, 47, was admitted to San Gabriel Valley Medical Center via ambulance. He had fallen in the street near his home. An emergency room physician evaluated Lopez at 2 p.m. and he noted an examination positive for nausea and vomiting with an altered loss of consciousness. He was diagnosed later that night with traumatic head injuries and he expired around 3 a.m. the next morning.

The decedent stated that he drank six beers after an argument with his son. He denied any pain at the time of admission. His vital signs were stable and his oxygen saturations were 97 percent on room air. His respiration was noted to be even and unlabored and skin warm to touch. His abdomen was soft and non-distended and BS was present in all four quads. There was no acute distress noted and he was placed on cardiac monitor.

Fred Levin, M.D., was the emergency room physician on duty until 7 p.m. that evening. Defendant Jeffrey Wade, M.D. was the emergency room physician that worked the 7 p.m. to 7 a.m. shift that night. The initial emergency room record shows that the patient, while positive for nausea and vomiting, denied any pain.

At 2:45 p.m., the patient attempted to walk out of the emergency room and physician assistant, Raymund Gantioque, and another male brought the patient back to the emergency room. The patient cooperated with his care. However, the patient was noted to be confused and upon moving from side to side in the gurney, he removed the IV hep lock. Gantioque was made aware and obtained orders to give him Ativan I mg IVP.

At 8 p.m., the patient was unresponsive to painful stimuli. Gantioque was notified. The patient was reassessed and both pupils are dilated. New orders were written, and after conferring with Gantioque, Dr. Wade ordered STAT imaging studies. The patient's wrist restraints were removed and he was taken for a CT scan of the brain and x-ray of the cervical spine. The report was reported to emergency room physician, Jeffrey Wade, M.D. at 11:18 p.m. Dr. Wade noted that he performed a physical evaluation of the patient at this time. Dr. Wade noted that the patient's breathing was spontaneous, he had stable vital signs, and was not obtunded. Dr. Wade wrote admitting orders, neurosurgery consult and orders for transfer to another facility.

At 11:30 p.m., admitting orders received from Dr. Aaron Jeng and a call was placed to Dr. San Agustin for neurosurgeon referral but was not available. At 12:45 a.m., a call was placed to L.A. County Harbor UCLA where the patient was accepted for transfer. At 1:45 a.m., the patient remains unresponsive. His skin was flushed hot to the touch, and his temperature read at 103.1. Dr. Wade was notified, and Tylenol was given to the patient.

At 2 a.m., the patient was breathing heavy and gargling. He was suctioned orally and called to bedside. An oxygen mask was applied and oxygen was at 88-89 percent. He was intubated at 2:10 a.m. At 3:18 a.m., a Code Blue was initiated and he was pronounced dead by Dr. Wade.

Plaintiffs are decedent's wife, two adult sons and one minor daughter.

PLAINTIFFS' CONTENTIONS:
Plaintiffs contended that the decedent fell in the street with sufficient force to cause a skull fracture. He was deemed just a drunk, sedated, and ignored while in the emergency room. He later suffered another fall while in the emergency room. He was again sedated and ignored. He was later found non-responsive and died from a subdural hematoma. Plaintiffs claimed negligence from PA Gantioque who was managing the decedent's care.

DEFENDANTS' CONTENTIONS:
Defendant contended the first fall didn't cause the skull fracture and the treatment of the inebriated patient was appropriate. The nurse practitioner was not informed that the patient struck his head during the second fall at the emergency room. Defendant contended that security was at the patient's bedside at all times.

A blood alcohol screen was ordered by the previous emergency room attending, Dr. Fred Levin, at 2:30 p.m., and showed a blood alcohol of 362.0 HC mg/dl (.362). At 4:30 p.m., the security was at bedside and assisted with urinal when the patient slipped and fell to the floor from his own urine. The patient was awake and responsive. There were no noticeable injuries noted at that time. Gantioque ordered Benadryl 50 mg IVP and IV. The patient was placed on 2-point soft wrist restraints, and being monitored on the cardiac monitor. The chart noted that at 7 pm., the patient was resting quietly in his bed. Vital signs are noted to be stable. No acute distress was noted at this time, and he continued on cardiac monitor.

Settlement Discussions

Plaintiffs served CCP 998 demands totaling $267,000. Defendant served CCP 998 offers for waivers in October 2014, renewed in August 2015, and again after Gantioque testified in trial.

Injuries

The CT showed a straightening of the cervical lordosis with poor visualization of the C7 vertebral body. Additional swimmers projection was recommended, and there was no definite fracture seen. The CT of the head was reported at 11:16 p.m. and noted indication of altered mental status. It also showed a right posterior parietal subcutaneous soft tissue swelling with an associated fracture of the left parietal calvarium extending inferiorly to the skull base at the left occipital calvarium. It also showed a left frontal parietal-temporal hyperdense/acute probably subdural hematoma up to 1.6 cm thickness at the left of the left Sylvian fissure. Convex appearance likely due to large size although could not exclude epidural blood, and a close follow up was recommended. There was no immediately overlying fracture. Diffuse mass effect on the cerebral hemispheres with 1.7 cm left to right subfalcine shift, and small basilar cisterns. Small right frontal subdural hematoma up to 3.6 mm, diffuse subarachnoid hemorrhage, greatest in the frontal lobes, and small amount of subdural blood along the falx between the frontal and parietal lobes. Small amount of intraventricular hemorrhage. Slightly dilated temporal horn of the right lateral ventricle, and anterior inferior right frontal small hemorrhagic contusions. Probable very small inferior left frontal contusions, and possible small anterior left temporal lobe contusions.

Result

Defense verdict for Raymund Gantioque. Dr. Wade, Dr. Levin, and Emergency Medical Management Associates, were dismissed for waiver.

Other Information

Plaintiffs settled with defendant San Gabriel Valley Medical Center for $150,000 at mediation. An application for determination of good faith settlement was granted on Dec. 10, 2014. Motion to Tax Costs of $74,000 is pending. MEDIATOR: Jay Horton. FILING DATE: Nov. 25, 2013.

Deliberation

2.5 hours

Poll

11-1 (negligence)

Length

six days