Buenos Aires,September 17,2009
REF.11-2003-144255
11-2003-144256
11-2005-166043
PHYSICIANS. GERONIMO RODRIGUEZ,JOSEPH Y LI AND MICHAEL GUREVITCH
FACILITY:HUNTINGTON MEMORIAL HOSPITAL,PASADENA COMPLAINT CA 00034156 COUNTY OF LOS ANGELES DEPT OF HEALTH SERVICES,HEALTH FACILITIES DIVISION.
Buenos Aires,September 17,2009
To :
The Medical Board of California
Mrs Barbara Jaroslavsky
Barb Johnston
Renee Threadhill
Att: Mrs Susan Cady
cc. Gov.Arnold Schwartzenegger´s office
cc. Charles Ornstein Pro Publica org.
cc. David Gumpert
“ You can have good health insurance,live in a community with state of the arts facilities and yet none of that matters if you can´t find a doctor,or the doctor treating you is incompetent,negligent or dishonest. That´s why medical boards matter”…Barb Johnston,may 7,2009“The most crucial step toward healing is having the right diagnosis. If the disease is precisely identified, a good resolution is far more likely. Conversely a bad diagnosis or the absence of diagnosis generally jeans a bad outcome , no matter how skilled the physician is. Healing begins with the correct diagnosis”..
THE KILLING OF VERONICA, is a clear case of wrong diagnosis (lack of it ) originated in a mix of incompetence and negligence of doctors and nurses worsened by the hospital´s further complicity to veil the true facts.Moreover,after realizing the mess,the involved physicians concealed the evidence of their failures.The prenatal records and all the symptoms were blatantly clear to any skilled professional. Not in this case.
This letter is to reply your attached letter dated July 15,2009 and at the same time to insist once more with my request of a complete and fairer revision over Case 11-2003-144255 and Case 11-2003-144256.Geronimo Rodríguez MD and Joseph Li MD, both OBGYN who I blame as main responsibles of the death of my 28 years old daughter Veronica Solange Glaubach at the Huntington Memorial Hospital,Pasadera,on June 30th 2002,at the age of 28 .
I will expose and point out in a clear cut the reasons which will sustain and explain my insistence in pursue a disciplinarian action to be taken against those irresponsible and unskilled physicians .
Mrs Cady: as you explain in your letter,the Board must be able to obtain the whole necessary information …etc…etc ..within seven years of the date of the incident,according BPCODE Section 2230.5, it´s true,but,it doesn´t fit to this case. Why ? , because in my complaint,timely submitted, I am reporting not only a medical malpractice case, because at the same time I´m accusing Rodríguez and Li for unfair procedures as a furtherance of their failures.
That´s mean: unprofessional conduct based on incompetente,gross negligence and worse of all willful and intentional actions in order to conceal from discovery his failures as even the most distracted analyst can easily realize just taking a simple but thorough look over his hypocritical ,coward and prevaricant discharge summary, our experts discovered indeed.
Just contrasting said “discharge summary” with the death certificate,signed by Rodríguez,and with the contradictoty and misleading hospital´s attestation report,even the most dull witted analyst will clairly see the flagrant existent contradictions which I have to attribute to the urgency with which they runnned (hospital authorities+nurses+doctors) to conceal, to mislead and to hide the true events after the death of Veronica.
I was pressing requesting in a firmly manner at the medical records office to full copy of medical records,which they gave to me,at last,but in the most incredible disorder which leaded me to go inside the office and to work there for at least six hours to organize those papers ant to assemble big flowsheets. Late,very late,those “papers” whose the hospital is “custodian” were been already “touched” Well Mrs Cady,it seems that they committed errors again.That simple indeed
The Board spent almost three years (just a little delay ¿??) to investigate (or whatever) this clear case of medical malpractice. Just to compare: The Public Health Service spent no more than six months to conduct a thorough depth investigation and to submit it conclusions. The same documentation and witness reports has been given to the PHS and to the MBC.
Mr Alan Irish can state how many times I´d been going to Diamond Bar to provide elements germane to this case.Same as Dave Thornton and former President Ron Wender, and DAG Robert Mc Kim Bell ,so I am absolutely “on time” having into account the unacceptable delay of the Board to insist in my request of true and decency and disciplinarian actions against the aforementioned wrongdoers.
The California Department of Health Services,declares in a ten pages summary signed by Marlene Taylor Chief of HFD and Eric Stone,Supervisor AAU:…” A review of the closed medical record revealed that the diagnosis of hipertensión in pregnancy,preeclampsia/eclampsia and HELLP síndrome were absent from MD 1´s discharge summary despite documentation of these syndromes by MD 1 in the medical record and that they were the critical events and conditions that led to the patient´s death”.
MD1 is ,of course, Mr Gerónimo Rodríguez, Why ?..because he signed the aforesaid discharge summary.
Which has been the diagnosis signed by Rodríguez ?
“Disease due to failure to cardiorespiratory system due to brain hemorrhage”
So it seems that my poor daughter died due to a brain hemorraghe ,yes,it´s true,if you want,..,but that was the last outcome of the store: an inexistent diagnosis and as a logical consequence of said inexistent diagnosis, the absence of any timely accurate treatment to manage the sickness. That´s why my daughter went to the sky.
About the “failure of cardiorespiratory system”… it doesn´t deserves any further comment.Everybody knows that people dies due to the aforesaid failure.A real stupidity.
Why did Rodríguez remain silent and avoided to state and sign the correct diagnosis of preclampsia/eclampsia/Hellp ? It´s quite simple. Because by signing the aforesaid diagnosis (lately realized by Gurevitch not for him) he was admitting his wide incompetence and gross negligence since he never ordered any accurated treatment to manage preeclampsia,eclampsia or Hellp indeed..
So Rodríguez (maybe in combination with Li and some authorities of the Huntington ¿?) decided to mislead and conceal his lack of ability ,to mislead further investigations,shading the true facts, in short :he lied. What for ¿ To avoid disciplinarian consequences.
That´s why this case is not subject to the limitation provided for by subdivision a) pursuant to Section 11503 of the Government Code as it apppears on paragraph (c) on BPCode Section 2230.5
It´s quite clear that the Medical Board didn´t take into account the dishonest action performed by Rodríguez on his signed prevaricant summary and related documents, which in my humble opinión means that this case is uncomplete whatsoever .
The Medical Board of California is owing us explanations about this incongruent and false discharge summary,and about the other existing incongruences and contradictions emerging from the documentation.
But,we still have many other details concerning this complaint:
Let´s see:
Rodríguez signed his false discharge summary on July 2nd,2002 on which he mentioned “cord entangle” without giving relevance to said situation ,he stated: “..cord around the neck was seen..” Its clear that “cord around the neck is germane to the baby situation. Nothing to do with my daughter´s preeclampsia in progress , eclampsia or further HELLP and death as well.
On July 7th,2002, Rodríguez signed a death certificate stating as immediate causes of death:
1.- Cardiorrespiratory Arrest
2.- Intracerebrum Hemorrhage
3.- Hellp
The Hospital´s final diagnosis written in the “attestation report” of July 8,2002 has been the following:
Principle Diagnosis: Cord entangle neck (¿?)
If cord entangle neck (a stupidity) was the principle diagnosis recognized by the Hospital authorities as main circumstance which developed to Hellp,you need no further analysis to conclude that nor Rodríguez nor Li,neither nurses or whoever,did any accurate diagnosis. We face contradictions and incongruences one after another.Pure Lies.
Secondary Diagnosis:Cerebrovasculart disease (consequence of HELLP))
Coagulation deficiency (consequence of HELLP)
Severe preeclampsia .
Allow me to ask: Severe preeclampsia stated by the hospital,?? But where is the Hellp stated by Rodríguez on his summary ¿? And why he signed hellp on the death certificate ¿? Who told rodríguez that it was a Hellp ¿?
Why the hospital statement postulates a “ severe preeclampsia “as secondary diagnosis ? ..,because only Gurevitch started a slight procedure to try to stop the outcoming drama when my poor daughter,medically abandonned ,was irremediably out of any hope. Previously to that point, for instance Li was prescripting a liquid diet . Do you need more proofs ¿???
It is more than clear the existing incongruences between Rodríguez discharge summary,the death certificate signed by him and the hospital´s attestation report .Same pattern of default of honesty and decency to avoid responsibilities.
It seems that Rodríguez discovered the real diagnosis five days after the death of my daughter, It seems… or …are we facing another incongruent lie (having into account what he signed on the aforesaid summary ¿?One lie after another lie.
Let´s analyze the rest of the aforesaid “untruthful “discharge summary:
Rodríguez stated that at the time of admisión (01.20 am) blood pressure was: 133/86 (which is high) and… nothing else was remarkable. Did Rodríguez take even a quick look over the prenatal records ¿? The prenatal records are full of clear warnings and concerns about preclampsia,preterm labor, IUGR, proteinuria+2 and HBP all symptoms of a mild preclampsia ,a big signal notifying to everybody that Veronica was a “high risk patient” indeed.
Moreover ,when admitted Veronica mentioned to have seen spots the previous day. What else ¿?
Blood pressure at 03.00 am 142/91
Blood pressure at 03.32 am 151/91
Moreover: at 04.10 am it´s written: she had alive reflexes,which are clear symptoms of neurological disturbance
At 06.48 Veronica gave birth to my granddaughter who weighted 2029 grams,thats a clear sign of IUGR and even all the aforesaid symptoms Rodríguez did not considered the possibility of preclampsia.
At 6.50 she vomited 100cm3 of clear liquid.
Where are the instructions given by Rodríguez to make specific and more rigorous chekups on my daughter ¿? They do not exist.
Blood pressure at 07.00 am 148/92
Blood pressure at 07.15 am 148/97
Blood pressure at 07.45 am 138/75
Blood pressure at 08.00 am 153/83
All the blood pressure levels were abnormals,all the time:
Notwithstanding the aforementioned high blood pressure levels we can read
The entry signed by Rodríguez on the Hospital Course: Laboratory initially was done,as I mentioned,because the blood pressure was “ somewhat elevated,although the patient was completely asymptomatic and denied any headache,blurry vision or epigastric pain”….
What means “somewhat elevated”? A little elevated,less elevated ¿??
High blood pressure is anything else than that: high blood pressure. Our experts felt astonished reading that outrageous explanation indeed. All the blood pressure levels has been abnormals,all the time.-
What is the worse:….the patient was completely asymptomatic and denied any headache,blurry vision or epigastric pain”….this assertion is another big lie,but at the same time it unveils a real true.Let´s see:
Rodríguez assertion that Veronica was asymptomatic is anything else than a complete recognition of his wide ignorance about symptoms germane to the existing eclampsia in progress to hellp since he was watching -but not recognizing- clear symptoms saiod pathology.
At the same time he is lying since Veronica mentioned having seen spot lights and complained about headaches,terrible unbearable upper abdominal pain,suffered nausea,vomits and her hands and legs showed edema.
The California Dep..of Health Services statement indicates:…”A review of the closed medical record revealed an incomplete and unsigned physician´s Progress Note on June 30th,2002 at 6.03 am “….Further review of the closed medical record revealed that the physician´s Progress Note on June 30,2002,entered after the Progress note of 7PM couyld not be read and the signatura cannot be identified. The same handwriting was found in a Progress Note on July 1,2002 for which no time of entry was documented”…
…” a review of the closed medical record revealed that MD 2 (Li) did not indicate the time of his note on June 30,2002”
…” a review of the closed medical record revealed that a Physician´s order on July 1,2002 at 06.16 am was not signed”…
…” Although an autopsy was not performed,( it´s been declined by an e-mail signed by Dr Lois Pena who never saw the body ) the record review revealed that the patient was hypertensive throughout her hospital course untill hours before her death.The clinical diagnosis were Eclampsia and Hellp Syndrome”…(diagnosis ignored by Rodríguez on his discharge summary)
Rodríguez states on the summary:…”Then the patient went to the floor.In that area at approximately 12 in the afternoon the nurse called saying the patient was having vomiting.She vomited the Tylenol #3 and seemed like she had some gastritis and that time Mylanta was ordered (by whom ¿?)and DC´d Tylenol and give her vicodin and they believed (who believed ¿? Nurses ¿?)) that perhaps the codeine produced her gastritis”…
This statement is an absolute lie. One of the nurses suspected that the symptoms were germane to preclampsia and she did informed Rodríguez about said concerns.
Veronica was accompanied by her mother and her boyfriend.They witnessed everything.Nurses also. At 12.15 am Veronica had a growing and unbeareable epigastric pain.,nausea,saw spot lights,showed edematic hands and legs,She was given Tylenol which she vomited right away.It seems that Rodríguez ordered Tylenol and Mylanta telling the nurses (by telephone because he was absent) that it was a post partum pain (what is expected in puerperium is perineal pain not epigastric pain).
Rodriguez ordered additionnaly Vicodin which she vomited as well.Vicodin is a narcotic analgesic (hydroxycodone). Medically,narcotics analgesics are not indicated for a patient suffering from usual labor pain but for a thorougly different symptoms,unrelated to organs envolved in labor process.
Another proof of medical ignorance ant the total disorientation of Rodríguez.He was attacking the pain not the causes. Why ¿? Because he never identified the sickness which was producing said symptoms indeed.
On the contrary,what world have been advisable was to be on guard considering that those symptoms were the most frequent of HELLP syndrome (65% of cases).In addition: in the Clinical resume there is no record of investigations carried out due to epigastric pains.
Thereafter,Rodríguez abandoned the patient for a long long while almost three “golden” hours.Several attempts to contact Rodríguez were absolutelly unsuccesful.In spite of having being paged once and again Rodríguez has been all the time unavailable and out of reach or else he has been always late.
Not only has he always been late or absent but also he has not even dared to enter any entry in the medical records and clearly enough he had left the case in the hands of the registered nurses without even giving a diagnosis .
After 14.30 pm till 18.00 pm there is a total absence of entries in the medical history.
As Rodríguez was out of reach,Li had to be called in emergency (he atended Veronica during pregnancy so he must know her prenatal records indeed).He ordered some lab tests and a stupidity: a liquid diet(¿? What for) and a vial of Demerol to calm pain.He never inquirid or investigated the real cause of that upperabdominal pain,whose cause remained without any explanation.
There you have another demonstration of medical incompetence
Rodríguez and Li knew the results of blood tests ordered at 16.05.Platelets showed a dangerous low lever of 119.000 mm3. All studies are coincidental :platelets below 150.000 mm3 shall cause great concern about Hellp.They saw that result but haven´t done any accurate managment :v.g .a platelets transfusión for example.
So: of what single departures are you talking about ¿?
The Board´s final conclusión about Rodríguez and Li is outreageously and daringly unacceptable and it offends and underestimates the inteligence of any skilled and trained doctor or/and any forensic witness expert.
It is by far clear that Rodríguez failed by far in much more than to order a simple urine protein determination.,as the board´s states.He failed to diagnose,(he didn´t diagnose),thereafter he failed to recognize any single symptom of the progressing eclampsia,he abandoned the patient,he lied and falsified his report to conceal his own ignorance from discovery and experts are strongly concerned about the missing sheets of the medical records and many obvious incongruences on statements and entries.
About the other wrongdoer Li,the board´s final report:…” …he failed to properly evaluate Veronica´s complaint by reviewing the medical records.The persistent complaint of epigastric pain (without an alternative diagnosis..??)should have prompted therapy with magnesium sulfate..” shows the same pattern of irresponsible indulgence and a wide distortion of the true .
The real true is that nor Rodríguez neither Li took a minnimum single look over the records (pre natal and hospital recordsas well) and both of them ignored the upper abdominal unbearable pain germane to eclampsia,so they never started any therapy with Mg sulfate.Mg sulfate has been administered just when it was very late.
As(renowned) forensic expert Dr Ricardo Bocacci reported, (I attach with this letter the full report) Dr Gurevich was the first one to wonder about the possibility of preeclampsia during pregnancy but it was very late (19.00 pm) but Veronica was already out of any hope.Late very late.
The Board´s conclusion seems to be aimed to protect those two dangerous negligent and incompetent wrongdoers.Experts are absolutely coincidental about the lack of ability and their further intentional misleading and concealing behaviour.
The Board spent almost three years to investigate this clear case of medical malpractice. The Public Health Service spent no more than six months to conduct a thorough depth investigation and to submit it conclusions.Same documentation and witness reports has been given to the PHS and to the MBC,moreover,Mr Alan Irish knows how many times I´d been going to Diamond Bar to provide elements germane to this case.Saqme as Dave Thornton and former President Ron Wender,so I am absolutely “on time” to insist in my request of true and decency and disciplinarian actions against the aforementioned wrongdoers.
By the way: Your qualification of “single departure from standards” is unsustainable from every point of serious view.,no matter what kind of interpretation you give to that “bargain clause” a big “black hole” of the
MPAct of BPCode. Anything ,I repeat anything can be framed with the aforesaid definition.Not in this case.
When I say “bargain” I know (as you know) of what I´m talking about. Said definition (bargain) was given to me at the office of former Senator Sheila Kuhel
I mean:she knows of what is talking about.
A copy of this letter will be sent to Governor Arnold Schwartzenegger´s office and to LATimes investigative reporter Charles Ornstein autor of “When caregivers harm” …Veronica Glaubach Joy of birth,then drama ,and to David Gumpert,maybe the next investigative report should be:”When Medical Board harm ¿?”
I demand true and justice. Just human rights Nothing else.
Roberto A Glaubach,
The father of Veronica
Architect
The following report ,which is by far very clarifying, is the transcription of the original signed by Ricardo Boccacci,MD,forensic,expert before The Supreme Court of Justice,a wellknown pathologist, and clinical expert with almost 40 years of expertise and international experience.
A) BACKGROUND: PREECLAMPSY
The patient Veronica Solange Glaubach was having a high-risk pregnancy due to several indicators of preeclampsy, namely:
1. She had positive albuminuria type 1 on June 8th and 25th and type 2 on June 11th. In general, proteinuria is the last sign to appear in preeclampsy and therefore, such sign is of highly clinical importance.(pages 1-2)
2. According to checkups made on her during pregnancy, levels of blood pressure were of 90/60 and 100/70 as from January 9th till May 1st and 112/70, 112/68, 110/70, 100/60, 116/70 as from March 21st till June 25th what clearly shows that the patient had a caracteristical basal hypotension . When she went into the Hospital, the levels of blood pressure increased significantly : on June 30th . 01.20 blood pressure was of 133/86; 04.10 am : 140-150/80- 90 mm Hg. Although there exist several definitions of preeclampsy, many describe it as clinical symptoms with tensional levels above 140/90 mm Hg , an increase of systolic blood pressure of 30 mm Hg or an increase of the diastolic blood pressure by 15 mm Hg after week 20 together with proteinurea in excess of 300 mg during the 24 hours. It is obvious that Verónica had all to fit that diagnostics.(page 3)
3. Moreover, it is important to point out that in the pre-natal control flow sheets you can read several times that precautions must be taken. Shall I ask you why?(pages 1-2-3)
4. When she got into the Hospital, it has been written in the Maternal Clinical Resume that the reports of pre-natal controls had been noticed. In such reports you can read in several places the existence of proteinurea and the need of taking precautions . Notwithstanding, in the Clinical Resume there is no reference that such warnings had been communicated to the doctors in charge. (page 4)
5. From the moment Verónica got into the hospital , she had shown high tensional values and mentioned to have seen spots on the previous day. Moreover, at 04.10 it`s written,she had alive reflexes.,symptoms of neurological disturbance. At 06.50 she vomited 100 cm3 of clear liquid . However, these symptoms didn’t arise any concern to the medical staff in charge so that nobody gave instructions to make specific or more rigorous checkups on the patient, being no record that this abnormal symptoms have been informed to any of the doctors in charge. (page 5)
6. At 6.,48 Verónica gave birth to her daughter who weighted 2029 grams . There exist several definitions for I.U.G.R. (retarded intrauterine growth ). However, most of the doctors agree to define I.U.G.R. as less than 10 percent of predicted fetal weight for gestational age. In general , any birth in term with the newborn weighting less than 2.500 grams implies an I.U.G.R. Now my question is, considering the weight of the newborn baby , nobody of the medical staff considered the possibility of preeclampsy? (page 6)
B) LACK OF ADEQUATE POSTPARTUM CONTROL–ONSET OF
ECLAMPSY – H.E.L.L.P. SYNDROME:
1. The labor which in the medical staff view required precautions, took place on June 30th. at 06.48 . However, the next record was only made at 09.00 indicating breastfeeding without any mention of the health of the parturient.(page 7)
2. In all Obstetrics services, it is wide known that immediate puerperium must be strictly surveyed, mostly during the first two hours , putting emphasis on heavy bleeding, frequency of the pulse, blood pressure, and uterine involution. Such controls must be made each 15 minutes. Pursuant the post anesthesia recovery data sheet , blood pressure has been controlled each 15 minutes and levels were all abnormal , worrying and unrelated to the levels the patient had shown during pregnancy and that were registered in prenatal control data sheets: at 7.00 blood pressure of 148/92; 7.15 – 148/97; 7.30 – 138/5 ; 7.45 – 148/76 and at 8.00 –153/83. Notwithstanding this abnormal tensional increase, there is no mention of it in the Patient Progress Record so as there is any mention of actions taken by doctors or registered nurses to clarify this anomaly. In fact, the Patient Progress Record goes from the record taken at 6.31 when Dr. Rodriguez arrived to the corresponding verification of birth taken at 6.48 , and from there to the record of no breastfeeding taken at 9.00 and to “growing epigastric pain” at 12.15. In short , for more than six hours , there have been no statements regarding the medical condition of the patient, her blood pressure, diuresis, uterus involution, etc.
In the Progress Record the situation is worse though, there is no record till the intervention of an obstetrician in emergency[2].. This means that from the medical staff point of view the patient almost did not exist : she was a problem ascribed to the registered nurses.
However, it is clear enough that five from eight records of systolic blood pressure taken between 7.00 and 8.00 were within hypertensive range, same as two of those of diastolic blood pressure. (page 7-8-9)
3. The lack of controls and negligence are obvious also in the Maternal Flow Sheets because there are sporadic records of the levels of blood pressure taken at 03.00, 04.00, 05.00 and 06.00 being all of them abnormals 142/91, 139/50, etc. However, next register is only at 09:00 – 140/56 and the next one at 12:00 – 170/55 , that is to say three hours later. Pain level is also therein registered but only at 11:00, 12:00 and 14.:00. At 12:00 she was administered Vicodin and at 14:00, Demerol.
4. At 12:15 Veronica had a growing epigastric pain . She was given Paracetamol, an unespecified anesthetic (Tylenol) which the pacient vomited right away. What is expected in puerperium is perineal not epigastric pain. Nobody cared for this symptom which is in fact one of the first symptoms to appear when HELLP onsets. (page 7)
5. Faced with a growing epigastric pain and vomits , Dr. Rodriguez administered Mylanta (antiacid) and narcotic analgesics (hydroxycodone) whose commercial name is Vicodin , what she immediately vomited as well. Medically, narcotic analgesics are not indicated for a patient suffering from usual labor pain but for a thoroughly different symptoms, unrelated to organs or structures involved in labor process. On the contrary, what would have been advisable was to be on guard considering that those symptoms were, as aforementioned , the most frequent of HELLP syndrome(present in 65% of the cases). In the Clinical Resume there is no record of investigations carried out due to epigastric pains.
6. With growing pain, sickness and vomits , it has been attempted to contact Dr. Rodriguez , unsuccessfully though. In spite of having being paged once and again, as from Veronica’s admission to the Hospital till her demise, Dr.Rodriguez has been all the time unavailable and out of reach or else he has always been late. Not only has he always been late or absent but also he has not even dared to enter any entry in the medical records and clearly enough , he had left the case in the hands of the registered nurses without even giving a diagnosis .
7. As Dr. Rodriguez was out of reach, an obstetrician Dr.Li had to be called in emergency and ordered to have medical tests done , a liquid diet (???) and a vial of Demerol (derived from morphine) which was absolutely useless for this is used to calm but not to find out the real cause of such pain. It is important to point out , that the idea was not to calm genital pains caused by labor but the epigastrics, whose cause remained without any explanation. (page 9)
8. Also, in the medical record you can read an entry saying “Respiratory stand by’s intro ven x 45’ ” which is very confusing . There is no reference made to the real status of the patient , her medical condition or time of the entry. Worse though is that there is an electrocardiogram covering the page hindering whatever important or not had been written below.(page 10)
9. The only real fact is that controls had been few and isolated and in spite of the alarming signals, the medical staff remained unconcerned. Besides, after 14:30 till 18:00 there is a total absence of entries in the medical history. Although is truth that in the separate pages you can find entries of the Code Blue but there is no chronological sequence in it. So, in a page you find entries about what happened at 18:00 and in the next page, strangely enough, you find entries with the diagnosis and treatment given at 17.45: Eclampsy. Haematuria. Hyperreflexia. Maintain magnesium sulfate. Sodium bicarbonate . (page 11)
10. Patient Progress Records states at 18:00 - Admitted into maternity , accompanied by the doctor. +RN – slight hypertension - lungs condition was stable - Respiratory Assistance (RA) – Haematuria . (page 10)
11. When was Respiratory Assistance administered? In the succinct CODE BLUE pages the equipment was required at 16:30 and it came at 16:33. It is also stated that the patient went into convulsions and was completely unconscious. Various tensional levels are registered (the first being particularly abnormal: 146/ 99,22 mm Hg) Determination of arterial blood gas is requested by the doctors .The report says AERIAL TRACT IS ORAL…. What does this phrase mean? Aerial tract is always oral and incidentally nasal or by tracheotomy. Why then it has not been acknowledged that beyond doubts she needed to be intubated or managed with an ambu, to get RA? (page 12-13)
12. What for and where was she administered local anesthesia? (Dermoplast-Benzocaine)The patient didn’t have pelvic pain and even if this had been the case , local anesthesia would have not eased the pain. Usually, these type of anesthetics are used to anesthetize the oral part of pharynx so as to insert a nasogastric tube or a tube for endotracheal intubation . So why she was administered local anesthesia on June 30th. at 11:40 hs?(page 14)
13. Regarding respiration, in the CODE BLUE sheet , as aforementioned, the only reference made is that the aerial tract WAS ORAL. In addition you can read that the oxygen saturation ,when the team arrived ,was of 92% and that there was a wheezing in the superior aerial tract. Under the item intubation, you have no entries. However, the pressure of arterial blood gas was of 150 mm Hg at 16:49. How did she reach that value when arterial blood gas on room air is 100 mm Hg? How is it that she has to go intubated to IUC when in the CODE BLUE sheets there is no reference to such a situation? The only description therein made was AERIAL TRACT IS ORAL…(page 12)
14. Poor and almost sporadic information is shown in the prenatal flow sheets on June 30th. Before labor blood pressure entries are at 03:00; 04:00 , 05:00 and 06:00. The values shown there were all abnormal and even quite unbelievable, eg. Value change from 151/91 mmHg goes to 142/55 without any medical intake in the middle. Also, after labor checkups were made during 2 hours each 15 minutes, but as above mentioned after 08:00 the next entry was only made at 09:00 with a value of 140/56 and the next one at 12:00 yielding an alarming value ( 170/55 mm Hg) that should have caused alarm and consequently, the immediate staff intervention.
15. Unfortunately , if we consider the Progress Record , such medical staff didn’t exist since there is no record on the medical history till the doctor for emergencies , Dr. Lee , intervened and without registering the timetable of his intervention , he prescribed analysis and anodyne measures , such as a liquid diet.!
16. Apparently the registered nurses are the ones to be blamed for they were not conscious of their role which was, supposedly, to replace the doctors and therefore the checkups had been scarce and they failed to give the symptoms the importance they have . On June 30th. at 11:00, 12:00 and 14:00 they registered in the maternal flow sheets ABDOMINAL PAIN - ACHING GRADES 6, 5 and 8. No reference has been made that this symptom had been informed to the doctors in charge, which as aforementioned , has nothing to do with the normal consequences of labor. On the contrary , this symptom is a clear alert of eclampsy and most of all of H.E.L.L.P.syndrome.
17. Moreover, in the same maternal flow sheets , same time as before mentioned you can read “Behavior : Agitated” . Once again the nurses were not alarmed by this. Six hours have passed by after labor , the parturient was still being agitated but there was nothing to be worried about.
18. Poor information, lack of clarity in the registers most of them illegible which is a serious fault since if a doctor was called in emergency , how could he get an idea of what the patient previous medical scenario was?; All these have been a constant in the medical history. In fact, the medical history is full of abbreviations or acronyms almost unknown for the common of the doctors. To picture this, in the progress record on June 30th. at 17:15 you can barely read : “Code Blue Note: Code Blue Note called 2º to pt. Because unresponsive eyes rolli … foamy secretions … “ (the rest of it is illegible)(page 15)
19. The issue of the platelets remains particularly unclear to any fairly educated doctor . We all know that the normal number of this cells in peripheral blood is of 150.000 to 400.000 mm3 . In Veronica’s case, the register at 04:35 showed 222.000mm3 and strangely , another blood test was ordered at 16:05, showing 119.000mm3 . This last test should have raised alarm since in all studies, treatises or papers made on the subject, it is very clear that platelets below 150.000 m3 shall cause great concern . Why? Because proteinuria and the increase of the levels of uric acid are useful to diagnose preeclampsy but not to detect H.E.L.L.P. syndrome. The best indicator to detect H.E.L.L.P. syndrome is the number of platelets. Doctors and nurses of Huntington Memorial Hospital had seen that result but haven’t done anything . It was exactly at that moment that H.E.L.L.P. syndrome should have been diagnosed. Accordingly a vigorous line of action should have been carried out so as to control blood pressure and to substitute by means of blood transfusions the platelets that were in decrease. It is obvious that an early diagnosis was critical for effective treatment of such syndrome.(page 16)
20. However, long before there had been a tests whose abnormal results should have been reason enough to be taken as a warning. At 04:35 fibrin degradation products (pdf) which should be lower than 5, showed a level higher than five but lower than twenty. This result that forced to discard the onset of a consumption coagulopathy has not been object of concern to the health professionals involved. In fact, they should have ordered a D-Dimer test, which is a sensitive indicator of a sub-clinical coagulopathy and it can be positive before that coagulation tests show abnormalities. However, this hasn’t been done. The subsequent progress of the patient reports coagulopathy : at 18:15 pdf was higher than twenty , fibrin diminished to 113 mg % ( reference level: 200 to 400); as for the platelets they diminished much more. (page 17)
C) FINAL DIAGNOSIS :
1. None of the involved obstetricians , Dr. Lee or Dr. Rodriguez, have registered a specific diagnosis in the clinical history till it was too late. Moreover, their almost inexistent and poor remarks are superficial and incidental. They’ve not made any reference to hypertension, proteinurea, thrombocytopenia, etc. They treated abdominal pain as a regular puerperal pain by administering Vicodin and Demerol or as it would have been a gastritis they administered Mylanta. They have never been conscious of the existence of a preeclampsy , eclampsy or H.E.L.L.P. syndrome. Only at 17:15 (page 15)they wrote :” Pt is in eclampsia (pt has elevated BP during peripartum period” . Then , at 05,15 on July 1st. when the patient did not respond to verbal orders or pain stimulus, that is to say , when she was beyond hope , gone for ever, Rodriguez wrote: “ Lab: as noted: Hellp syndrome”.
2. Dr. Gurevich (page 18)has been the first one to wonder about the possibility of “preeclamsy during pregnancy “, at 19:00 , once the symptoms were completely displayed and as an unidentified subject established that Veronica was already in an eclampsic condition (page 11).However, although he had suspected a preeclampsy and he was witnessing the first eclampsy consequences such as convultions, even though the patient had upper abdominal pain, and in spite of her having a low quantity of platelets , he has not concluded a H.E.L.L.P. syndrome diagnosis , neither did he indicated platelets transfusions to the patient nor any other effective action in order to stop the coagulopathy.
3. The Hospital ‘s final diagnosis written in the Attestation Report has been the followingpage 19)
Principle Diagnosis: Cord entangle neck
Secondary diagnosis :
674.02 – Cerebrovascular disease
666.32 – Coagulation deficiency
642.52 – Severe preeclampsia
The above categorization of the diagnosis is incoherent : If Cord entangle neck is considered as the principle diagnosis just because it has been the first one , that could work but if we consider this as the main diagnosis it is absurd.
The cordon around the neck might harm the newborn baby but not the mother.
She died because she suffered bassicaly a preclampsia undetected by RN and doctors of Huntington Memorial.Hospital.With any kind of managing or accurate treatement,preeclampsia progressed to severe eclampsia which developed in a HELLP syndrome with a drastic drop of platelets and intravascular consumption of fibrinogen which led to an intracerebral hemorrhage ,killing Veronica.
4. In the Discharge Summary ,(page 20) Dr. Rodriguez describes the evolution of the medical symptoms of the patient without mentioning eclampsy diagnosis or H.E.L.L.P. syndrome in it. As discharge diagnosis he establishes the following: “Disease due to cardiorrespiratory failure due to brain hemorrhage. However, cardiorrespiratory failure is the final form of death of all individuals and brain hemorrhage might respond to many causes: brain injury, artery aneurysm rupture, arteriovenous malformation, hypertensive crise, encephalic tumor, coagulopathies, etc. In short, the Discharge Summary failed to provide a specific diagnosis ( It`s obvious that Rodriguez made a false statement to hide the true fact of his enormous lack of knowledge and gross negligence)
5. Finally, there is another surprisingly fact. No one from Los Angeles County Department of Coroner has reviewed the medical history. However, in the entry To Report a Death you can read that this death was not a coroner case per LA Coroner Office. Apparently , the communication was made through Internet because at the superior angle of the page you can read : “ Dr. Lois Pena @ L.A. coroner Office declines as coroner case”.(page 21)
CONCLUSIONS:
1. Veronica was a healthy young woman
2. She was intelligent and blessed with great artistic sensibility
3. However, she -as any other human being- could have passed away for many reasons: a road accident, an infection or as a result of unpredictable complications during pregnancy such as an hemorrhage due to placenta previa , an endovascular coagulopathy due a detached placenta, etc.
4. But, she was treated by doctors and registered nurses whose gross negligence and clear lack of skill led my daughter to her death:
a. They didn’t notice that the patient was having clear signs of preeclampsy during the pregnancy
b. The abnormally high tensional registers taken from the very beginning when she had been admitted into hospital have not caused any concern to the doctors neither have they given rise to communications of any kind among them.
c. After labor the levels of blood pressure during the first two hours have been abnormal. However, there is no proof that this situation has been informed to the doctors and therefore, controls more often . After the first two hours controls and entries are scarce and more isolated.
d. Epigastric pain, nausea and vomits are symptoms that should have given raise to great concern. Mostly since the frequency of such symptoms are clear indicators of H.E.L.L.P. syndrome . However, they have been minimized, attributed to gastritis and ridiculously treated with a diet, Mylanta, etc.
e. The indication to administer Vicodin or Demerol (narcotics agents) to trat an epigastric pain is also an obvious and blatant example of the lack of medical skill.
f. The fact that the medical staff has not taken immediate action when an sudden drop of platelets has taken place, which in fact could not have been attributed to nothing but intravascular coagulation which is the most important sign of H.E.L.L.P. syndrome , is another proof of their lack of skill.
