Facts

This wrongful death/civil rights action involved the highly publicized death of Edith Rodriguez in the waiting room of the Emergency Department at King/Drew Medical Center on May 9, 2007. Portions of the hospital's videotape of the waiting room, which were prominently displayed and publicized on television and in the news shortly after her death, showed Ms. Rodriguez laying on the waiting room floor in apparent agony, for approximately 45 minutes, with hospital personnel essentially ignoring her pleas for assistance. She died approximately one hour after entering the waiting room.
Ms. Rodriguez was 43 years old at the time of her death. She was not married. She was survived by three adult children, who reside in the Central California area. Ms. Rodriguez was unemployed, and homeless in the South Central area of Los Angeles for a significant period of time prior to this event.

In the three weeks prior to May 9, 2007, Ms. Rodriguez had been seen in the ER at King/Drew on at least six occasions. She was last seen on May 8, 2007, at approximately 6:15 p.m. She had been experiencing abdominal pain, had previously been diagnosed with gallstones and recommendations were made that she follow-up with a surgical consult. Between 6:15 p.m. on May 8 and 1:00 a.m. on May 9, she did not leave the hospital grounds. Shortly before 1:00 a.m., she was observed laying on a bench in front of the hospital in apparent distress. Two County police officers stationed at the hospital and a hospital attended obtained a wheelchair and wheeled her into the ER.

According to plaintiff's counsel, when Ms. Rodriguez was brought into the ER, the triage nurse, Linda Ruttlen, was heard by at least one person to say, "She's not coming in, she was already discharged." Nurse Ruttlen denied making such a statement and according to defense counsel, Nurse Ruttlen attempted to locate a place for Ms. Rodriguez in the ER, but there was no place for her. Ms. Rodriguez was not taken to the triage area for assessment. She was left in the ER waiting room in the wheelchair. Soon after that, she slid out of the wheelchair and for much of the next 30 minutes was laying on the floor, crying out in pain and saying something "burst" inside of her. At least one patient in the waiting room called 911 asking for someone to be sent to help Ms. Rodriguez. Emergency personnel did not respond, as Mr. Rodriguez was already in a hospital. That same patient also tried to obtain assistance from medical personnel in the ER, to no avail.

During the approximate one hour while she was in the ER, Ms. Rodriguez did not receive any medical treatment from any hospital personnel. There was no medical documentation establishing that her condition was ever assessed by any medical personnel.

While she was in the waiting room, because of the disturbance that was being created, county police at the hospital ran a warrants search on her, and learned there was an outstanding no-bail parolee-at-large warrant. One of the officers, Sgt. Perez, confirmed the validity of the warrant by calling the Department of Corrections and receiving instructions to detain Ms. Rodriguez. The officer also contacted the Century Regional Detention Facility and confirmed that if Ms. Rodriguez was transported there, she would receive medical treatment.

It was around that time when Ms. Rodriguez' boyfriend entered the ER. He implored medical personnel to assist, and also called 911. At approximately 1:51 a.m., officers informed Ms. Rodriguez and her boyfriend that they were placing her under arrest and would transport her to Century where she would obtain treatment. They wheeled Ms. Rodriguez out to a waiting patrol car. Ms. Rodriguez did not respond to requests to enter the vehicle, at which time officers noticed that she was not responsive, and they checked for a pulse but did not find one. She was wheeled back into the ER, where efforts to resuscitate her were not successful.

The cause of death, per autopsy, was cardiac arrest related to perforated focal colonic diverticulitis with free stool in abdominal cavity.

PLAINTIFF'S CONTENTIONS:
MICRA had no application, as Ms. Rodriguez was never assessed nor provided any medical treatment on May 9. Defendant County violated EMTALA (42 USC 1395dd) because medical staff refused to assess Ms. Rodriguez' condition as required by EMTALA. MICRA's cap on general damages does not apply to a violation of EMTALA for failure to assess a patient's condition.

On May 9, two triage nurses were supposed to be assigned to the ER, but only one was assigned. There was also a shortage of other nursing personnel at the time. There was no medical documentation of Ms. Rodriguez' entry into the ER at approximately 1:00 a.m.

Defendant County violated 42 USC 1983, specifically a Monell violation for engaging in a custom and policy of providing substandard care to patients at King/Drew. For several years prior to the incident, the county knowingly and with a deliberate indifference to providing adequate or reasonable care to patients, underfunded, understaffed, and failed to correct known deficiencies at King/Drew, including in the ER. Commencing in 2004, Medicare/Medicaid, and the California Department of Public Health, performed multiple surveys of the care provided at King/Drew and repeatedly found events that severely compromised patient health and safety. In 2006, King/Drew was found to not meet Medicare's Conditions of Participation required for Medicare/Medicaid participation/funding. Among other things: the hospital was routinely understaffed with respect to nursing personnel; the ER routinely failed to assess and treat patients in a timely manner; the ER routinely failed to ensure the immediate availability of services and qualified personnel in the ER.

The Board of Supervisors was very familiar with, and condoned, the pattern of substandard care at King/Drew. The Board, as the governing body of King/Drew, failed to develop, implement and maintain ongoing procedures for the assessment of care at the hospital, and to correct known deficiencies and minimize medical errors in the provision of patient care.

The triage nurse in the ER on May 9 had not recently been assessed for competence as required by policy, and 16 months before this incident had been warned for her failure to follow hospital protocols for patient care, but there was no plan in place for monitoring her future conduct.

DEFENDANTS' CONTENTIONS:
The ER was extraordinarily busy, at a crisis-like level, at the time Ms. Rodriguez entered the ER on May 9. At that time, the hospital was on "diversion status": all ER resources were fully committed and not available for any incoming patients transported by paramedic or other emergency transport units (they would be diverted to the next closest ER). The ER was officially closed to trauma patients and on diversion status from 12:59 am to 1:58 am, the time when Ms. Rodriguez was in the waiting room. Ms. Rodriguez therefore could not be evaluated or treated immediately on entering the ER on May 9, because of the overwhelming number of active emergency patients in the ER at that time. In addition, there was a nurse staffing shortage that night. The triage nurse was treating other acute patients in the triage area.

Because the triage nurse was familiar with Ms. Rodriguez' condition from the prior afternoon and evening, she was under the reasonable impression that there was no acute worsening of Ms. Rodriguez' condition compared to the previous occasions when she presented the same complaints.

Ms. Rodriguez was properly treated on her prior visits to the ER. On several occasions prior to May 9, she had not followed medical advice, by not following up with the surgery clinic for further treatment.

Ms. Rodriguez was lawfully arrested because of the outstanding warrant. No act or omission of any of the defendants caused Ms. Rodriguez' death. No medical treatment could have been administered in less than 1 hour on the morning of May 9 that could have saved her life.

There was no EMTALA violation, as Ms. Rodriguez was visually assessed and was never refused treatment. There was no 42 USC 1983 violation, as the county never engaged in any policy or custom encouraging deliberate indifference to medical needs of patients.
Plaintiffs' damages were limited by MICRA to $250,000 (there was no evidence of any economic loss/special damages).

Ms. Rodriguez did not have a close relationship with her adult children, and saw them very rarely. Ms. Rodriguez had a prior criminal history and a significant history of drug abuse.

Settlement Discussions

Two mediations before Jay Horton, Esq.

Damages

Plaintiffs sought general damages for wrongful death; there were no special or economic damages. In pre-litigation plaintiffs demanded $45 million, and the county of Los Angeles offered $250,000.

Result

The plaintiff accepted a settlement in the amount of $3 million from the county of Los Angeles defendants. The case against Securitas and the security guards was dismissed.

Other Information

FILING DATE: June 26, 2007.