State Probe Criticizes Doctor After Toddler's DeathNov 30, 2003 | SAN JOSE MERCURY NEWS Even though an emergency room doctor knew 2-year-old Beatriz Garcia was bleeding internally and gasping for breath after an accident, he failed to take several potentially life-saving measures such as calling in a pediatric surgeon or giving her a blood transfusion, according to state health investigators.
A 10-page report from the state Department of Health Services released last week criticizes the doctor, Dr. John Longwell Jr., president of the Santa Clara County Medical Association, and Regional Medical Center for failing to use all the hospital's resources to save Beatriz, who died later in the evening of Oct. 17 after being transferred to a trauma center.
The state department will ask the California Medical Board for a separate review of Longwell's handling of the case. It cited Regional for two violations of California's Health and Safety code and recommended the federal government investigate whether the East San Jose hospital should lose its Medicaid funding. In addition, the hospital must develop a plan to correct the deficiencies highlighted in the report.
Longwell said the report contained "inaccuracies" and noted that his conduct had been reviewed by peers at the hospital and that no action was taken against him. Debbie Mark, a spokeswoman for Regional, said the hospital was "working with the state" and takes "all deaths seriously to see if there is anything we can learn from them."
The state inquiry was prompted by San Jose Mercury News articles in which Beatriz's father complained Regional didn't do all it could to save his daughter's life after she was accidentally run over by a neighbor's car.
The state investigators found:
A pediatrician and pediatric surgeon were on call at Regional the day Jeronimo Garcia carried his daughter into the hospital, but were never summoned.
The surgery department was not placed on standby.
An anesthesiologist and surgical nurses were on site but weren't called.
Blood units were available but weren't used.
Two operating rooms were available but weren't used.
After more than two hours, Beatriz was eventually transferred to a trauma center, San Jose Medical, where she died that night.
State investigator Glenn Koike told a reporter that Regional had ample resources to operate on Beatriz. He said she was in no condition to be transferred, based on her "abnormal vital signs" and deep, pained gasping breaths.
"Why didn't they treat her there? That's a real good question," Koike said. "That's the question the Department of Health Services would like to know."
"We are very, very concerned about the findings," said Norma Arceo, spokeswoman for the state health department. "We are requesting an immediate correction of action."
No one knows for certain if different treatment would have saved Beatriz, but it's well known in the medical world that patients' chances of survival increase dramatically when they are treated within 60 minutes, or the "golden hour."
The physician is not named in the report, but Dr. John Longwell Jr. confirmed that he was the doctor who evaluated Beatriz at Regional that night.
The critical point, the report states, was at 4:40 p.m., 55 minutes after she arrived at Regional, when a radiologist called Longwell and told him the girl was bleeding from a spleen injury and had "major blood loss," and "severe anemia and low platelet count."
A pediatric surgeon could have arrived at Regional within 30 minutes, the state report says. However, she was transferred to San Jose Medical, where she arrived at 6:10 p.m. and died there at 7:09 p.m.
As she was being moved by ambulance, Regional staff did not give Beatriz any medication or extra blood, even though they knew she was bleeding internally, the report found.
When contacted last week, Longwell said he was stunned by the "inaccuracies" in the state report, and said they were too numerous for him to detail.
He said it was not clear from her symptoms that Beatriz had been run over by a car, or just hit by one. Federal law mandates that doctors thoroughly check out patients before transferring them to other centers.
When a CT-scan came back showing internal bleeding about 4:30 p.m., Longwell said he was faced with a decision of calling Regional's pediatric surgeon to come in, or transfer Beatriz 2.5 miles away to San Jose Medical.
He said he thought both options would take the same amount of time. He chose to transfer Beatriz to San Jose Medical, which is equipped to handle traumatic injuries. Longwell said he had been in constant contact with San Jose Medical surgeons within minutes after Beatriz arrived.
"We tried to get her to a trauma center as soon as possible, but that as soon as possible wasn't soon enough," Longwell said. "This is going to be bad for me however this turns out."
Longwell said he volunteered to take himself off Regional's schedule until an internal investigation by an outside expert is completed. He continues to have a private practice in Saratoga.
He had not seen a copy of the state report until it was provided to him by the Mercury News. Longwell said he was shocked at the state's findings because a peer review conducted at Regional a few days after Beatriz's death did not result in any action against him.
Longwell, who has been in practice since 1971, is president of the Santa Clara County Medical Association and used to head the former Alexian Brothers Hospital ethics committee. According to the California Medical Board, he has never been cited for any malpractice. He unsuccessfully ran for the 13th State Senate District seat in 2000.
Regional's associate administrator Debbie Mark said Longwell has been a "respected member of the medical community for almost three decades."
She would not discuss the state's findings in detail.
Regional has 15 days to write a "plan of correction."
In addition, Regional has been cited by the state for a June 27 death. An EKG strip showed a patient's heart rate dropping to alarming levels. A bell at the nurses' desk was activated, but no one responded for 35 minutes, the report shows. Regional's "plan of correction" was to force the nurse to resign, re-educate the staff and implement an "action plan" to prevent patients being ignored for that long again.
The deaths involve different doctors and different hospital units.
However, Koike said that two deaths as the result of questionable care in five months is "out of the ordinary."
Of the hundreds of investigations Koike performs annually, he only recommends a maximum of "two or three" federal "validation surveys" each year, which involve the possible loss of federal Medicare funding. Hospitals cannot survive financially without this money.
Steven Chickering, spokesman for Centers for Medicare and Medicaid Services in San Francisco, said his agency authorized Koike's request. Of about 450 hospitals in four states, about 30 to 40 of these surveys are conducted a year, he said. No hospital has ever lost its Medicare funding in the last few years, he said, because staff have always been able to correct the problems.