By Hillel Aron
By Joseph Tsidulko
By Patrick Range McDonald
By David Futch
By Hillel Aron
By Dennis Romero
By Jill Stewart
By Dennis Romero
Last week, news brokethat on May 8, a 43-year-old woman was left writhing in pain on the emergency-room lobby floor of Martin Luther King Jr.–Harbor hospital and, despite pleas by her boyfriend, did not get treatment. The woman died, but MLK-Harbor officials insist the incident was an isolated mistake.
Juan Ponce’s story suggests otherwise.
Ponce is a man who tries not to be bothered by the small things. As a truck driver for Lemad Freight, a company that moves asphalt for city road work, he works long hours but likes his job. It has paid the bills for his family of six, which includes his wife, Sostenes, and four kids, ranging from Yesenia, a ninth-grader, to a baby who still clings marsupial-like to Sostenes.
Almost a statistic: Juan Ponce with mother-in-law Claudia Guzman, wife Sostenes,daughter Giselle and baby Alexander. Not pictured: Yesenia, the teen who acted to save her dad’s life. (Photo by Gregory Bojorquez)Occasionally, work is sparse. But last year he’d saved enough to buy his own truck. Overall, life was good, says Ponce. So in December, when he began getting intermittent headaches, he ignored them. The headaches ramped up in January, after the company had a seasonal slowdown, but he dismissed the pain as a byproduct of the fiscal stress he felt when not working.
“I mostly just took Tylenol” he says. “And I thought it would get better.”
When the pain got worse, Ponce’s doctor blamed high cholesterol. “He told me I needed to eat a little different.” He followed the doctor’s instructions, but by mid-February the pain was so bad he was afraid to drive and took a week off work. Then, reluctantly, a second week.
Finally, in late February, Ponce understood he was in trouble. Barely able to walk, he asked his brother to drive him to the nearest emergency room — Martin Luther King Jr.–Harbor Hospital, a sprawling facility on South Wilmington Boulevard south of the 105 freeway.
As most Los Angeles residents know, the hospital formerly known as King/Drew Medical Center — recently renamed Martin Luther King Jr.–Harbor — has what might be charitably called a troubled history.
Opened in 1972 after the Watts riots, King-Drew was intended as a beacon of competence and modernity. Instead, long before the Los Angeles Times published its devastating 2004 investigative series on the place, King-Drew was known as “Killer King,” one of the worst hospitals in America.
But, for all its scandals, it remained crucial to the county health care system — and especially to South Los Angeles. For the past several years, the five-member, elected Los Angeles County Board of Supervisors has been downscaling the facility in an effort to keep it functioning.
Yet the troubles have continued. Last September, “MLK” failed a federal inspection that nearly cost it $200 million in federal funding and its accreditation. County health chief Dr. Bruce Chernof managed to strike an emergency deal with the feds, promising to slash 300 beds to 48, and to place MLK under control of the more successful county hospital, Harbor-UCLA Medical Center, near Torrance.
Now the pressure is on to further retool MLK in order to pass a last-chance inspection in July.
Against that backdrop, Ponce and his brother arrived at MLK’s emergency room sometime after 10 a.m. on Wednesday, February 28. After explaining Ponce’s symptoms to a triage nurse, the men waited about three hours before he was ushered into an examining room where, after a quick assessment, a doctor ordered an MRI and a CT scan to find out what was going on in Ponce’s head.
When the tests came back, two physicians met with Ponce and told him he needed surgery — but that the drastically staff-reduced MLK no longer performed the procedure, so he would be transferred as soon as possible. Whether it was because of the language barrier (Ponce is Spanish-speaking) or his woozy condition, Ponce at first didn’t realize how bad the news was — that he had a brain tumor. Nor did he understand that while the tumor was serious, it was actually the least of his immediate problems.
The imaging showed Ponce was suffering from obstructive hydrocephalus — caused by the tumor blocking the circulation of cerebral-spinal fluid through his brain, like a landslide blocking a river. The blockage produced a buildup of fluid in his cranial cavity — a situation that can damage enough brain cells to cause irreversible blindness, loss of cognitive functioning, even death.
If caught early, obstructive hydrocephalus is treatable. But, with pressure on the brain, timing is everything. “The problem with the brain is that it’s resting in an enclosed space,” says Dr. Brian Johnston, the emergency department medical director for White Memorial Hospital in Boyle Heights, a 30-year ER veteran. “The liquid has nowhere to go. So the pressure continues to build unless it’s relieved. Can it be fatal? Yes, of course it can be fatal.”
Ponce’s form of hydrocephalus is usually treated by drilling holes in the skull and inserting a ventricular catheter — basically a shunt and a tube (think siphoning gas out of a tank) to drain and reroute the fluid.
Since MLK no longer had the personnel necessary, the plan was to transfer Ponce to a better-equipped hospital as soon as possible.
But it never happened.
Initially, the doctor prescribed morphine for the pain, and instructed Ponce to not eat or drink anything — since surgery elsewhere was all but imminent. Yet the day stretched into night, and he was still waiting when an MLK nurse finally called Sostenes at home to tell her to retrieve her husband’s things because he would be transferred for surgery “soon.”
The nurse also explained about the brain tumor and, for the first time, Ponce’s family understood that his life might be in danger.
A shy woman who speaks little English, Sostenes tried to get information from nurses. “They just told me they’d do the operation just as soon as there was room at another hospital,” she says. “They were the professionals, so I thought they must know what they were doing.”
But, as the hours wore on, her husband’s symptoms worsened — her fears along with them. By Thursday afternoon, Ponce was too ill to walk on his own to the bathroom, and began vomiting intermittently — although without food and little water, it was mostly dry heaves. Now truly frantic, Ponce and his wife pleaded with the nurses for news of the promised transfer and surgery.
“We kept asking and asking,” he says. “But they just told us we had to wait.”
By day three, Friday, Ponce’s symptoms had escalated — yet still no transfer was in sight. In a panic, Ponce told his wife that one side of his face was going numb and he was seeing an alarming array of lights and “feathers” in his visual field.
According to experts, with obstructive hydrocephalus, the optic nerve is the first thing often at risk of permanent damage. So, the new disturbances in Ponce’s vision should have been a huge red flag for MLK’s medical staff.
Both husband and wife say they informed hospital personnel of the escalating symptoms, but that the staff failed to act. Ponce was still being given morphine for his extreme pain, and during a lucid moment when the pain temporarily lessened, Ponce recognized one of his doctors in the hall — and pleaded with him to check on his case.
“He said he’d find out,” says Ponce. “But he never came back.”
They were reluctant to push too hard, says Sostenes, “because we didn’t want to make the hospital people mad. But we were getting really scared.” “‘Be patient,’” she says they were told. “‘You’ll just have to wait. This is the process.’”
In the end, it was Yesenia, Ponce’s smart, outgoing ninth-grade daughter, who probably saved her father.
She’d been taking care of the younger kids while her mom was at the hospital, “so I didn’t see him until Thursday night,” Yesenia says. She was startled by her dad’s deterioration. “He was pale and, like — yellow. And he wasn’t like his normal self. You could tell it was bad.”
On Friday morning, the girl confided her fears to her homeroom teacher at Animo Ralph Bunche Charter High School, who suggested that the girl talk to Abby Soto, the school’s community outreach coordinator. Upon hearing the story, Soto called Sostenes late that night, and agreed to go with her to the hospital.
Soto is a community organizer, and a not-inconsiderable force. On Saturday morning, she drove Sostenes to MLK, determined to get Ponce help. But, working her way up the line to a hospital supervisor, she had no better luck than Sostenes.
Finally, Soto asked a male nurse to check the computer to make sure Ponce, now in his fourth day, was still in the system. Ponce was. “The nurse told us, ‘All you can do is wait,’ but you could see he wasn’t happy about it,” Soto says. “Finally he said, ‘Look, if it was my family member, I’d get him out of here and take him where they can treat him.’”
Soto says the nurse suggested MLK’s sister hospital, Harbor-UCLA.
Soto, Sostenes and Ponce’s brother loaded him into his brother’s car. Before leaving, Abby tried to pry loose Ponce’s MRI and CT scans from hospital officials — who had not okayed Ponce’s departure. “But they wouldn’t give them to us,” says Soto, “because they said, ‘Then Harbor will think we sent him.’”
Ponce scribbled his name on a form indicating he was leaving the hospital against medical advice. On the boilerplate document (provided to the Weekly), in the space designated for “remarks,” someone had printed: “With the diagnosis of unstable obstructive hydrocephalus, serious adverse events could occur, including death.” The document was signed: “Dr. Maywether” at 11:45 a.m. on March 3.
When the family arrived around 20 minutes later at Harbor-UCLA, the triage nurse at first didn’t want to accept him, says Yesenia, “because he’d refused treatment at Martin Luther King.” But Soto mentioned terms like “life threatening,” “responsibility” and “lawsuit,” and the nurse relented.
After that, things moved quickly. The triage nurse slapped a bright, red/orange “RUSH” sticker on Ponce’s shirt. More imaging tests were ordered. When a neurosurgeon read the tests, and then examined Ponce, what he saw distressed him, Soto says.
“When he examined Juan’s eyes, that’s when he seemed the most alarmed,” she says. “He told us Juan’s vision was affected.” The doctor warned — according to Sostenes and Soto — that the damage might not be reversible.
They would operate immediately, the doctor told the family. The surgery was performed right in the ER. Soto describes how the Harbor docs drilled two holes into the right side of Ponce’s skull and inserted the siphon, then the ventricular catheter.
Within 20 minutes his pain had lessened, and in two hours it was gone altogether.
What did not come backwas Ponce’s vision, and his doctor again told him the damage might be permanent — a disaster for a truck driver.
The doctor’s — and the family’s — fears did not come to pass. Within a week, Ponce’s vision was nearly normal. His tumor was determined to be non-malignant.
Now, he hopes to be back at work by the end of May.
The Weekly made repeated calls to MLK and the Los Angeles County Department of Health Services, and talked to several officials who were permitted only to release this statement: “The hospital and the department have fully reviewed the clinical facts of the case and determined that the care provided at MLK-Harbor Hospital was appropriate and consistent with a non emergency.”
In other words, MLK’s treatment of Ponce was just fine because he was never in danger.
Given the scenario described by the family and Soto and indicated from the hospital’s own paperwork, serious questions remain about the behavior of the MLK staff. Moreover, the Weekly has learned, an eerily similar case occurred in the fall of 2004.
A 19-year-old girl, Nicole Davis, complained of severe headaches and disruption to her vision, and King/Drew hospital staff diagnosed her case as a non-emergency. She grew worse, and eventually an ophthalmologist diagnosed a brain tumor that was creating a buildup of pressure.
But where Juan Ponce was lucky, Nicole Davis was not. By the time she got surgery, Davis was irreversibly blind in both eyes.
Los Angeles County Department of Health Services officials admitted to fault — at least with their checkbook: On January 16, 2007, the Los Angeles County Board of Supervisors agreed to settle Davis’ lawsuit for $1.8 million.