On March 18, 2016, plaintiff Gevorg Haroutunyan, 81, a retiree, was placed on BiPAP therapy at Hollywood Presbyterian Medical Center, in Los Angeles, after there was no response to progressive respiratory therapy and oxygenation methods were unsuccessful.
Haroutunyan was previously admitted to the emergency department at Hollywood Presbyterian Medical Center for a humeral fracture to the right arm on March 15, 2016, which was one day before his 81st birthday. The fracture occurred at home, where Haroutunyan lived with his daughter and son-in-law. Upon his admission to the hospital, he was noted to be dehydrated and have acute renal failure and respiratory distress. He was also noted to have a long history of multiple medical conditions, including end-stage chronic obstructive pulmonary disease, Parkinson's disease, diabetes mellitus type 2, benign prostatic benign hypertrophy, obesity, moderate Alzheimer's dementia, coronary artery disease, and a pacemaker.
Two days after his admission, a closed reduction was performed, but Haroutunyan's respiratory condition and renal function continued to worsen. He was subsequently placed on BiPAP therapy on March 18, 2016, after there was no response to progressive respiratory therapy and oxygenation methods were unsuccessful, but his perfusion was poor, so intubation was recommend. However, the family refused. The next day, it was noted that Haroutunyan had some areas of deep tissue injury, and excoriation on his lower back and sacral area. The family eventually agreed to have Haroutunyan intubated in the late afternoon of March 22, 2016. However, when Haroutunyan was intubated and the BiPAP mask was removed, it was noted that Haroutunyan had developed a deep tissue injury on his nose.
Haroutunyan, through his guardian ad litem, Ruzanna Khachatryan, sued the operator of Hollywood Presbyterian Medical Center, CHA Hollywood Medical Center L.P., and a subcontractor that provided respiratory therapists for the hospital, Gem Medical Management LLC.
Gem Medical Management ultimately settled out of the case on the second day of trial.
Plaintiff's counsel argued that the deep tissue injury that developed on Haroutunyan's nose was the result of respiratory therapists from GEM Medical Management not properly monitoring the BiPAP mask and that the respiratory therapists and GEM Medical Management were acting as agents of the hospital. Counsel contended that a protective barrier should have been used when the mask was initially placed, but that it was not. Further, plaintiff's counsel argued that the mask was not properly removed for "rest" periods and that records that reflected mask changes were fraudulent or erroneous.
As to the sacral/back wounds, plaintiff's counsel argued that the hospital's nursing staff failed to properly assess (pursuant to the Braden Score), Haroutunyan's potential for development of skin breakdown and, therefore, failed to institute appropriate preventative measures. Specifically, counsel contended that the nursing staff failed to keep Haroutunyan clean and failed to timely reposition Haroutunyan every two hours.
Thus, plaintiff's counsel argued that all of the failures in care were not only negligent, but constituted elder abuse and/or neglect.
Defense counsel for CHA Hollywood Medical Center contended that both the device-related pressure injury and pressure sores to Haroutunyan's nose and sacrum/back were the result of unavoidable medical conditions that pre-existed Haroutunyan's hospitalization, including his end-stage COPD, which ultimately required a tracheostomy and ventilator dependency to survive. Thus, counsel argued that all appropriate measures were taken by both the respiratory care staff and nursing staff to prevent skin breakdown, but that in order to save Haroutunyan's life, the patient had to be placed in a position in bed (bed raised -- known as semi-fowlers), which caused additional pressure to Haroutunyan's lower back and sacrum in order to prevent him from decompensating. Defense counsel also contended that offloading was done to alleviate pressure, mask changes were performed, and routine skin checks were done on the nose in relation to the BiPAP mask. In addition, counsel contended that a protective barrier was placed on Haroutunyan the day after the mask was placed to prevent skin breakdown, but that, ultimately, the wounds developed despite the best of care.
On Dec. 30, 2013, plaintiff's decedent Dona Higgins, 73, was admitted to the Acute Rehabilitation Unit at Providence Little Company of Mary Medical Center San Pedro, a hospital in San Pedro, for acute rehabilitative care following neck surgery. Upon admission, she was to be at risk for aspiration, and required maximum assistance with feeding. The physician's orders subsequently required the nursing staff to supervise Higgins during all meals, and to hold oral feeding if she were coughing or lethargic.
On Jan. 3, 2014, a peripherally inserted central catheter line was re-inserted. However, the next day, Higgins started developing swallowing problems, and was noted as having crackling sounds in her lungs and having thick brown, yellow secretions. As a result, she required suctioning. Higgins was then seen by a speech therapist, who recommended that Higgins' diet be downgraded from regular to finely-chopped due to her dysphagia (difficulty swallowing). In addition, the speech therapist recommended that a videoesophagram be performed. Higgins' physician followed the recommendation, and ordered the diet be changed to finely-chopped and ordered a videoesophagram be performed on Monday, Jan. 6, 2014, because a videoesophagram was not available over the weekend.
On Sunday, Jan. 5, 2014, Higgins' labs returned and showed a white blood count of 34.4, which is critically high. Her physician subsequently noted the lab results, but did not make any orders for treatment of the elevated white blood count. However, since Higgins continued to have swallowing problems, had lost her voice, and suspected to have possible vocal cord paralysis, her physician downgraded her diet from finely-chopped to pureed, and ordered the staff to watch Higgins frequently with feeding.
On the morning of Jan. 6, 2014, the hospital's speech therapist did a bedside swallow evaluation, testing Higgins with a regular diet of scrambled eggs and oatmeal from her breakfast tray, which should have been pureed. Within an hour, Higgins was found in respiratory failure and pulmonary arrest. During intubation, the pulmonologist noted that copious amount of secretions, which looked like tube feeding, were suctioned from her trachea. As a result, it was determined that Higgins had aspirated her breakfast. She then remained ventilator dependent until her death on April 4, 2014.
The decedent's husband, Gary Higgins, sued the operator of Providence Little Company of Mary Medical Center San Pedro, Providence Health System-Southern California. He alleged that the hospital's staff negligently treated his wife and that this negligence constituted medical malpractice, resulting in his wife's wrongful death.
Plaintiff's counsel contended that the staff of Little Company of Mary Medical Center failed to take all aspiration precautions with the decedent during her admission, knowing that she was at high risk for aspiration. Counsel asserted that throughout the decedent's admission until Jan. 6, 2014, the hospital's nursing staff failed to supervise or assist the decedent with meals. Counsel also asserted that the hospital's nursing staff failed to notify the decedent's physician of the critical white blood count and that the high white blood count should have been monitored by either hospital physicians or nursing staff, but it was not. In addition, the decedent's family testified that although the decedent's physician ordered to have the decedent's food pureed, the decedent always received a regular diet, up until her aspiration event on Jan. 6, 2014. Plaintiff's counsel further asserted that that there was no documented evidence showing that the decedent received the correct diet(s) after the physician changed it.
The plaintiffs' experts testified that the staff of Little Company of Mary Medical Center breached the standard of care in failing to assist and supervise the decedent with all meals. The experts also testified that the hospital's staff breached the standard of care by failing to make the decedent "NPO" (nothing by mouth), starting Jan. 4, 2014 until the videoesophagram was performed on Jan. 6, 2014, to protect her airway while she was waiting for the test. The plaintiffs' medical experts further testified that the decedent had a pulmonary arrest due to her aspiration on breakfast that morning.
Defense contended that the orders for change in diet were signed off by the hospital's nursing staff, but because the tray tickets are only maintained for 60 days, there was no documented evidence showing that the decedent received the correct diet(s) after the physician changed it. However, defense counsel asserted that the consistency of the eggs and oatmeal on the decedent's breakfast tray was what both the plaintiff's and defense experts testified to as being the appropriate consistencies of food that speech therapy should use for testing swallowing ability.
Defense counsel asserted that there was never any signs or symptoms of aspiration, as noted by the speech therapist after testing. Thus, counsel argued that the decedent aspirated during the Code Blue as a result of the performed chest compressions, a common occurrence of which is regurgitation, and that the decedent's aspiration was not a result of swallowing food particles. Defense counsel also contended that it was noted by subsequent treating physicians that what was found in the trachea were "gastric contents" and/or "tube feeding," despite the fact that the decedent was not on tube feeding, and that no solid food material was found.
In addition, defense counsel argued that the decedent's arrest on Jan. 6, 2014 was due to septic shock from the infection she developed from the PICC line and that it was not the result of aspiration. Counsel contended that although the decedent's treating physician noted the lab results on Jan. 5, 2014, the physician failed to make any orders for treatment of the elevated white blood count. Counsel argued that as a result, Higgins was not given an antibiotic for the critical white blood count, and it was the defense's expert's opinion that had the decedent received IV antibiotics starting on Jan. 5, 2014, more likely than not, the decedent would not have gone into arrest on Jan. 6, 2014.
In response, plaintiff's counsel contended that the decedent was not on a gastric tube, and the plaintiff's experts opined that more likely than not the alleged "tube feeding" content was the oatmeal, since it was the same color.
As a result of the aspiration event on Jan. 6, 2014, Dona Higgins went into pulmonary arrest, requiring intubation. She then developed aspiration pneumonia and was on a ventilator for the remainder of her life. To treat the aspiration pneumonia and recurring pneumonia, it was undisputed that Ms. Higgins required to be on prolonged antibiotics, which caused her to develop clostridium difficile (C.Diff), a potentially life-threatening bacteria, and sepsis. She ultimately died on April 4, 2014 from sepsis secondary to C.Diff.
The decedent's husband, Mr. Higgins, sought recovery of wrongful death damages for the loss of his wife. He also sought recovery of $239,005.63 in past medical costs, based on the Medicare lien.
The decedent's daughters, Shawna Higgins and Shelle Higgins, were named as nominal defendants in the case. They claimed that they were very involved in their mother's care, and they were present throughout the entire trial.
The jury found that Providence Little Company of Mary Medical Center San Pedro was negligent in the care and treatment of the decedent, and that it committed elder abuse neglect. It also found that the decedent's death was caused by the hospital's negligence and reckless neglect. However, it did not find ratification under elder abuse neglect. As a result, the jury apportioned 70 percent liability against the hospital and 30 percent comparative fault against "other." ("Other" was not specified.)
The jury determined the estate's damages totaled $1,743,894.65, including $239,005.63 in past medical costs, $1.5 million in non-economic damages and $4,889.02 in economic damages.
Plaintiff’s mother was admitted to defendant hospital with pneumonia. Plaintiff, the estranged daughter of decedent, originally brought a claim for Elder Abuse, and Intentional Infliction of Emotional Distress against defendant hospital. Because decedent’s other daughter was the trustee of the living trust of decedent, upon Demurrer, it was held that plaintiff had no legal standing to bring any claim on her mother’s behalf, and the Demurrer to that cause of action (Elder Abuse) was sustained, without leave to amend. The case ultimately went to trial only upon the claim for Intentional Infliction of Emotional Distress against defendant hospital and plaintiff’s two sisters (who were also defendants on that claim), and a claim for Wrongful Death against co-defendant physician.
Plaintiff claimed that she had been denied access to her mother to visit her as a patient at the hospital, and that the risk manager had threatened her with arrest if she set foot on the premises; and that these "threats" were not precipitated by any bad conduct on her part. The decedent had an Advance Healthcare Directive which gave specific instructions regarding her end of life care. Plaintiff was not the surrogate decision maker and did not agree with her mother’s end of life healthcare decisions. She came to the hospital on three occasions and was allowed to visit her mother but became verbally abusive to staff, and had to be escorted by security out of the hospital the last evening visit. Plaintiff would not speak with her sister, who was the surrogate decision maker who had been appointed by decedent pursuant to the Advanced Healthcare Directive.
Plaintiff was claiming years of emotional distress by her sisters, which was exacerbated by conduct of staff at defendant hospital. She also contended that co-defendant doctor was negligent in the care and treatment of her mother causing her death.
Claimed sexual assault of plaintiffs’ mother on 9/12/08. Also, claimed neglect while plaintiffs’ mother was a patient in the subacute unit of Defendant’s hospital from July 2008 to her death in June 2010.
Plaintiffs’ decedent, Marta Pineda, was initially seen in defendant’s acute unit. After a few days, she was transferred to the subacute unit. Ms. Pineda was semi-comatose, on a ventilator and a G-tube. She developed decubitus (pressure) ulcers while she was a patient. On September 12, 2008, a bruised and swollen labia were observed by family members. They called the police, claiming their mother had been raped.
Plaintiffs contended that the defendant’s employees failed to turn and reposition Marta Pineda every two hours, and left her lying in feces. The 9/12/08 "rape" was not properly investigated and reported. There was a "cover up" by management.
Defendant contended that Mrs. Pineda was appropriately turned and repositioned. There was insufficient evidence of an assault. The incident was reported by defendant hospital to the Department of Health Services as required. The family did not move her from defendant’s facility after the incident, where she remained for another 1-1/2 years until her death, so they must have been satisfied that the bruising was inadvertent.
Lilly Lipton was admitted to defendant hospital on May 20, 2003 with low blood pressure, atrial fibrillation and a UTI. She developed a large decubitus ulcer on her buttocks that because visible 4-1/2 days after admission. The ulcer became very large and extended to the bone. She died of sepsis on November 29, 2003 after an extended hospitalization.
Plaintiffs, the husband and daughters (daughters dismissed before trial) contended that Mrs. Lipton was not turned and repositioned every two hours as required by hospital protocol. The experts claimed that "since it was not charted, it was not done." This alleged failure to turn and reposition caused the decubitus ulcer in the first place and then made it worse. The ulcer was a substantial factor in causing the death of Mrs. Lipton. The persistent failure to turn and reposition Mrs. Lipton over a six month timeframe was "reckless." The hospital administration ratified the reckless misconduct by doing nothing about it after Mrs. Lipton’s family members complained to upper management. The hospital allegedly violated a number of regulations governing extended stay facilities.
Defendant contended that the "ulcer" was actually a "deep tissue" injury that resulted from Mrs. Lipton passing out on the toilet at home before coming to the hospital. Although turning and repositioning was frequently not charted, that did not mean it was not done. Although the ulcer did get worse, it was, by the time of her death, beginning to heal. The cause of the sepsis which lead to Mrs. Lipton’s demise was not the wound.
75 year-old plaintiff was a patient in the Torrance Memorial Medical Center Transitional Care Unit ("TCU") which is a separately licensed as a skilled nursing facility (although located on the premises of Torrance Memorial Medical Center). Prior to her admission to the TCU, she had undergone a total right knee replacement at the acute care hospital. She was in the TCU for rehabilitation and training in activities of daily living before going home with her daughter. On June 4, 2004 at 3:15 a.m., the plaintiff was out of bed on her own trying to reach the bathroom. She claims she pushed the call light and no one came to her assistance (and that this was a pattern and practice during her entire admission to the TCU where she had been for several days prior to the fall). She fell and suffered a compression fracture of her L1 vertebrae and a large scalp laceration.
(Note that this verdict was appealed by plaintiff on grounds of abuse of discretion by court in refusing to allow evidence of (1) prior Statements of Deficiency and Plans of Correction issued by the Department of Health Services upon annual inspections and complaint visits to the facility (violation of health care regulation), not involving plaintiff; and (2) policies and procedures to establish standard of care (motions in limine by defendant were granted on these issues), as well as other minor evidentiary exclusions. The Appellate Court found no error, and affirmed the verdict.)
On July 5, 2000 plaintiff DeRoy Green, a 38 year-old singer/dancer was a patron a Club Ripples, a nightclub in Long Beach, California, that was owned by Ocean Granada, Inc. Green claimed that while he was on the dance floor, he slipped and fell on a liquid substance and injured his leg, causing substantial injuries to his leg. Green contended that the liquid on the dance floor constituted a dangerous condition and that Ocean Granada’s inspection procedures were not adequate.
Ocean Granada contended that there was no substance on the floor and that reasonable inspection procedures existed.
Green sustained a comminuted displaced fracture of the distal fibula. He claimed $30,000 in past medical expense, $10,000 in future medical expense, and over $1 million in past and future loss of earnings.
Plaintiff suffered ankle injuries, right knee contusion and lower leg abrasion, claiming permanent injury to his ankle when he slipped and fell on a railroad tie ramp at the defendant golf course. The plaintiff contended that the defendant failed to maintain the premises in a safe condition, failed to remove the railroad tie ramp and replace the area of sod, and failed to warn of the known dangerous condition.
Defendant denied liability and contended that the plaintiff failed to use due care for his own safety and failed to park his golf cart in the appropriate designated area.
Plaintiff was in her front yard gardening when defendant, George Ravelling (coach at the time of USC Basketball team), was involved in an automobile accident and crashed through her fence and into her yard, hitting a large tree very close to where she was. She contended that as a result of the loud noise of the crash she hard a "boom" in her head and thereafter had constant ringing in her ears. Dr. John House, of the House Ear Clinic, testified that plaintiff’s current condition was due to the incident, aka trauma-induced tinnitus.