How a hospital death became a cause celebre

It might have gone down as the death of a “quasi-transient” woman with a history of abusing drugs. That’s how the May 9 death of Edith Isabel Rodriguez was initially reported to the Los Angeles County coroner’s office.

But five weeks later, her demise has become a cause celebre, a symbol of bureaucratic indifference. It is fraught with significance not just for one struggling inner-city hospital but for political and health leaders in the Los Angeles area and perhaps beyond. The county Sheriff’s Department, health officials and the Board of Supervisors all are feverishly trying to determine who was to blame and how to prevent a recurrence.

Despite a long history of problems at Martin Luther King Jr.-Harbor Hospital, two things set the Rodriguez case apart: the existence of a security videotape showing the woman writhing for 45 minutes on the floor of the emergency room lobby and the public release this week of two 911 calls in which witnesses unsuccessfully pleaded with sheriff’s dispatchers for help.

The case — first reported by The Times — has crystallized people’s fears that even in their most desperate moments, the emergency system won’t take them seriously. The videotape itself has not even been made public; mere descriptions of its content by those who have seen it have evoked outrage.

“Here’s a person crying for help. Will no one help?” said Arthur Caplan, a bioethicist at the University of Pennsylvania who discussed the case on CNN this week. “What kind of a society are we when we can’t even render aid to someone who’s in their own blood and vomit on the floor and you’re mopping around them? It’s a kind of morality tale of a society gone cold.”

Said Marcela Sanchez, Rodriguez’s sister: “It could be you. It could be your mom, your baby, your sister…. Unfortunately, it was my sister.”

Nearly every major broadcast network has devoted segments to what happened to the 43-year-old woman. The death has even become fodder in the emerging debate over the U.S. healthcare system: Filmmaker Michael Moore, whose new documentary, “SiCKO,” chronicles the system’s problems, has added a photo of Rodriguez to his website with the phrase “Died trying.”

As new details have emerged, public officials have hastened to show their concern. The Sheriff’s Department said Thursday that it will review for a second time the way dispatchers handled the 911 calls from Rodriguez’s boyfriend and a female bystander. One dispatcher curtly told the bystander that the situation was not an emergency; the other said there was nothing she could do because Rodriguez was already in a hospital. Previously, the department had provided written “counseling” to the dispatcher who was curt.

The department is also examining how it handles 911 calls from hospitals, said Capt. Steven M. Roller of the sheriff’s Century Station. There is no current policy, but Roller said paramedics would only take patients to the nearest hospital, which would be the one where they were.

Meanwhile, county health officials are finalizing their response, due today, to a federal report citing serious deficiencies in the way Rodriguez was treated. And they are reviewing the conduct of all emergency room workers, including contract physicians, who evaluated Rodriguez over the three days before she died but each time found nothing seriously wrong.

She died of a perforated bowel, which probably developed in the last 24 hours of her life, according to a coroner’s report.

Hers was one in a series of cases allegedly mishandled by King-Harbor, formerly known as King/Drew. In 1994, a woman was infected with HIV after the hospital mistakenly gave her a transfusion with blood that had tested positive for the virus. Years later, a woman died after drinking a glass of tissue preservative left by her bedside. In 2000, a 9-year-old died from a cascade of errors stemming from treatment of two broken teeth.

More recently, nurses have been faulted for turning down the alarms on cardiac monitors and not noticing when patients went into distress and died.

But the Rodriguez case has garnered more attention than any of the others, in part because of the video showing her extended time on the floor and a janitor cleaning around her. It is not the usual “he said, she said” account. The county has repeatedly refused to release the tape, however, citing the ongoing sheriff’s investigation.

“If there wasn’t a videotape, we wouldn’t be discussing it. Period. The end,” said Miguel Santana, chief of staff to Supervisor Gloria Molina.

Supervisor Yvonne B. Burke, whose district includes the hospital, said the emotional 911 calls made the difference. “Everyone I run into feels it was so callous the way this woman was treated,” she said. “Plus it’s been replayed over and over and over again.”

Rodriguez, a California native, was poor and uninsured. She reportedly had a history of narcotics use and lived with various relatives.

Many people like her die, their cases forgotten by everyone but friends and family.

“They don’t die on camera,” said Dr. Felix Nuñez, medical director of the South Central Family Health Center in Los Angeles. “It’s usually poor people dying on skid row, and they’re just carted away. We don’t hear and see anything about them.”

Perhaps the case also struck a chord because everybody, rich and poor, relies on emergency rooms, although King-Harbor serves a largely poor and minority population. When patients show up, they often discover they must wait hours to be seen.

“The incident embodies the frustration that Americans feel with the waits at hospitals, with the negligence at hospitals,” said Jamie Court, president of the Foundation for Taxpayer and Consumer Rights. “Everybody one day visits the emergency room.”

Some local officials understood the potential significance of Rodriguez’s case almost immediately.

Days after her death, coroner’s records obtained by The Times show, county officials and politicians weighed in with questions and suggestions about the investigation.

Dr. Robert Splawn, senior medical director of the county Department of Health Services, called the coroner’s office several times.

During a May 12 call, he voiced his “great concerns over this case” and suggested that Rodriguez was high on cocaine or methamphetamine at the time of her death, according to the documents.

Results of toxicology testing by the coroner showed that Rodriguez did not have cocaine in her system. She tested positive for methamphetamine, but the level was not “life-threatening.”

At another point, on May 18, Splawn called, “wondering why nobody called him,” and Deputy Medical Examiner Louis Pena declined to take his call, the documents say.

Earlier this week, Splawn was named interim medical director of King-Harbor.

Others who talked to the coroner’s office included county lawyers, health department director Dr. Bruce Chernof, and Molina and members of her staff.

Sharon Harper, the No. 2 county administrator, said she does not believe that anyone, including Splawn, acted inappropriately in investigating the matter; they were simply inquiring about a major case.

“I don’t think that the health department is trying to skew any results,” she said. “This was serious to them.”

For previous articles on King-Harbor, audio recordings of the 911 calls and Rodriguez’s autopsy report, go to http://161.35.110.226/kingharbor .