January 4, 1999
Honorable Board of Supervisors
383 Kenneth Hahn Hall of Administration
500 West Temple Street
Los Angeles, California 900l2
Re: Maricella Palacios v. County of Los Angeles
Los Angeles Superior Court Case No. TC 165 227
Dear Supervisors:
The Claims Board recommends that:
1. The Board authorize settlement of the above-entitled action in the amount of $210,000.00, plus assumption of the Medi-Cal Lien not to exceed $49,864.11, and Lifetime Acute Medical Care.
2. The Auditor-Controller be directed to draw warrants to implement this settlement from the Department of Health Services.
Attached is the settlement request and a summary of the facts of the cases.
The Litigation Report, including corrective action, is being transmitted to you under separate cover by the Department of Health Services.
Return the executed, adopted copy to Frances Lunetta, Room 651 Kenneth Hahn Hall of Administration, Extension 4-1754.
Very truly yours,
Barbara N. Uyeda, Chairperson
Los Angeles County Claims Board
BNU/fsl
Attachment
M E M O R A N D U M
December 21, 1998
TO: THE LOS ANGELES COUNTY CLAIMS BOARD
FROM: Schuler and Kessel
By: Jack M. Schuler, Esq.
GARY N. MILLER, Esq.
Principal Deputy County Counsel
RE: Maricella Palacios v. COUNTY OF LOS ANGELES
Los Angeles Superior Court Case No. BC165227
DATE OF
INCIDENT: July 2, 1996
AUTHORITY
REQUESTED: $210,000, Plus Assumption of the Medi-Cal Lien Not To Exceed $49,864.11, And Lifetime Acute Medical Care.
COUNTY
DEPARTMENT: DEPARTMENT OF HEALTH SERVICES
_______________________________________________________________
CLAIMS BOARD ACTION:
Approve Disapprove Recommend to Board
of Supervisors for
Approval
, Chief Administrative Office
BARBARA N. UYEDA
, County Counsel
LLOYD W. PELLMAN
_____________________________, Auditor-Controller
MICHAEL L. GALINDO
on , 1999
SUMMARY
This is a recommendation to settle for $210,000 the medical negligence lawsuit brought by Maricella Palacios for the injuries she sustained while being treated at Harbor/UCLA Medical Center on July 2, 1996. The State, having paid $49,864.11 for the provision of Medi-Cal care, has a claim for reimbursement, which will be settled by the County. In addition, the settlement also provides for lifetime acute medical care related to the injuries Maricella Palacios suffered as a result of this incident.
LEGAL PRINCIPLE
The County is liable for failure of its hospital and medical staff to provide services consistent with the appropriate standard of care for the circumstances encountered.
SUMMARY OF FACTS
Maricella Palacios, a 33 year-old-woman, was treated for a number of years at Harbor/UCLA Medical Center for an inflammatory connective tissue disease with variable features (systemic lupus erythematosus [SLE]). This disease can cause persistent liver function test abnormalities.
Over the years, she had multiple abnormal liver function test results which led to the decision, on June 3, 1996, that it would be necessary to remove a small piece of tissue from her liver for microscopic examination (biopsy) to establish a definitive diagnosis regarding her liver.
On July 2, 1996, she was admitted to Harbor/UCLA Medical Center for the liver biopsy. Medical personnel determined the boundaries of the liver without the assistance of ultrasound guidance, utilizing instead a technique of tapping on the abdomen and listening with the aid of a stethoscope. A biopsy needle was then inserted between the ribs, through the diaphragm, and presumably into the liver. It was necessary to insert the biopsy needle four times in an attempt to obtain liver tissue, and the obtained specimen was sent for analysis. Maricella Palacios remained under observation for seven hours, and was discharged the same day.
On July 5, 1996, it was determined that the biopsy specimen consisted of bowel tissue and fecal material, not liver tissue. On that same day, medical personnel called Maricella Palacios, and even though they were informed that she was experiencing abdominal pain and cramping, they advised her to return to Harbor/UCLA Medical Center on July 7, 1996, instead of requesting that she return immediately.
On July 7, 1996, she was admitted to Harbor/UCLA Medical Center complaining of severe abdominal pain, and immediately underwent surgery which determined that the biopsy needle had perforated a portion of the large bowel, creating a localized collection of pus (abscess). The abscess was drained, the perforated portion of the bowel removed, and an opening was made to the surface of the abdomen for diversion of the fecal stream during thehealing process (ileostomy). Additionally, a liver biopsy was attempted by trying to get a shallow slice of liver tissue during the surgery. However, no liver tissue was obtained. She was discharged on July 27, 1996.
On August 26, 1996, Maricella Palacios was admitted to Harbor/UCLA Medical Center for management of an abnormal passage from a normal cavity to a free surface or another cavity (fistula) that developed in the third portion of the small intestine (ileum). The fistula was thought to be caused by the tightening of sutures placed during the July 7, 1996, surgery or the weakening of the intestinal wall when the binding together of two surfaces (adhesions) were pulled loose. The ileostomy was enlarged to enable the ileostomy and fistula to drain into the same bag. She was discharged on September 1, 1996. However, she later experienced abdominal pain, and was readmitted on September 26, 1996. She was discharged on September 29, 1996.
In November, 1997, she had the ileostomy removed, and appears to have recovered from the bowel perforation. She may need future medical care to treat subsequent problems with her liver and intestine.
DAMAGES
If this matter proceeds to trial, the claimant will likely seek the following:
Maricella Palacios, Future Medical Expenses $ 100,000
Pain and Suffering (MICRA Limit) $ 250,000
TOTAL $ 350,000
The proposed settlement includes:
Maricella Palacios, Cash Settlement $ 140,850
Attorneys Fees (MICRA Estimate) $ 64,150
Cost of Litigation $ 5,000
TOTAL $ 210,000
STATUS OF THE CASE
The current trial date has been vacated pending approval of the settlement.
Expenses incurred by the County of Los Angeles in the defense of this case, through December 14, 1998, are attorneys' fees of $27,066.50 and $16,722.63 in costs.
The total cost to the County of Los Angeles, as a result of this settlement, exclusive of lifetime acute medical care, is as follows:
Indemnity (Settlement Amount) $ 210,000.00
County Attorneys' Fees and Costs $ 43,789.13
Medi-Cal Lien $ 49,864.11
TOTAL $ 303,653.24
EVALUATION
Medical experts will be critical that medical personnel perforated Maricella Palacios' bowel during a liver biopsy, and, despite four attempts with the biopsy needle, failed to obtain a liver tissue specimen.
Additionally, medical experts will be critical that the results from the analysis of the biopsy specimen taken on July 2, 1996, were delayed for two days. Medical experts will also be critical that medical personnel, with knowledge that the biopsy specimen was bowel tissue and fecal material, did not inform Maricella Palacios of the urgent need for medical attention when informed that she was experiencing abdominal pain and cramping.
Medical experts will be critical of the failure of medical personnel to obtain a liver tissue specimen after having determined a liver biopsy was necessary. The liver biopsies attempted on July 2, 1996, and on July 7, 1996, failed to obtain a liver tissue specimen, and Maricella Palacios is still in need of a liver biopsy.
We join with our private counsel, Schuler and Kessel, and our claims administrator, Professional Risk Management, in recommending settlement in the amount of $210,000, payment of the Medi-Cal lien up to $49,864.11, and lifetime acute medical care for the injuries Maricella Palacios suffered as a result of this incident.
The Department of Health Services concurs in this settlement.