January 4, 1999
Honorable Board of Supervisors
383 Kenneth Hahn Hall of Administration
500 West Temple Street
Los Angeles, California 900l2
Re: Pedro Luis Panuco Olguin, Jr. and Jeanett Panuco, minors, by and through their Guardian ad Litem, Pedro Panuco, Sr.; and Pedro Panuco, Sr., individually
v. County of Los Angeles
Los Angeles Superior Court Case No. TC 009 420
Dear Supervisors:
The Claims Board recommends that:
1. The Board authorize settlement of the above-entitled action in the amount of $250,000.00, plus assumption of a Medi-Cal Lien in the amount of $49,263.00.
2. The Auditor-Controller 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 23, 1998
TO: THE LOS ANGELES COUNTY CLAIMS BOARD
FROM: TORRES AND BRENNER
By: Leonard E. Torres, Esq.
GARY N. MILLER, Esq.
Principal Deputy County Counsel
RE: Pedro Luis Panuco Olguin, Jr. and Jeanett Panuco, Minors, by and through their Guardian ad Litem, Pedro Panuco, Sr.; and Pedro Panuco, Sr., individually v. COUNTY OF LOS ANGELES
Los Angeles Superior Court Case No. TC 009420
DATE OF
INCIDENT: November 5, 1995
AUTHORITY
REQUESTED: $250,000, Plus Assumption of a Medi-Cal Lien in the Amount of $49,263.
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 $250,000 the wrongful death lawsuit brought by Pedro Luis Panuco Olguin, Jr.(son), Jeanett Panuco (daughter), and Pedro Panuco, Sr. (husband) for the death of Maricela Panuco while hospitalized at King/Drew Medical Center on November 12, 1995. The State, having paid $49,263 for the provision of Medi-Cal care, has a claim for reimbursement, which will be settled by the County.
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
On September 7, 1995, Maricela Panuco, a 28-year-old woman, was admitted to King/Drew Medical Center for seizures and an abnormal network of arteries and veins within the brain (cerebral arteriovenous malformation [AVM]). She was scheduled for surgery to remove the AVM (extirpation).
On September 8, 1995, at 6:00 a.m., Maricela Panuco was transferred to the University of California at Los Angeles Medical Center (Co-Defendant) for the purpose of undergoing a preparatory procedure in which various substances are introduced into the circulation to close or bring together vessels near the site of the AVM (embolization) to prevent excessive bleeding during the extirpation scheduled at King/Drew Medical Center. The embolization was performed at the University of Los Angeles Medical Center that same day, and she was transferred back to King/Drew Medical Center on September 8, 1995, at 2:30 p.m.
On September 9, 1995, at 6:30 a.m., Maricela Panuco was found in a state of profound unconsciousness from which she could not be aroused (coma). An imaging study generated by computer synthesis of x-ray data (CT scan) taken of the brain indicated that the embolization procedure had created a localized area of dead tissue (infarction) produced by blockage (occlusion) of a vein, resulting in brain tissue being forced from one compartment of the skull into another compartment of the skull (brain herniation), and causing an increase in pressure within the cranial cavity (intracranial pressure).
On September 19, 1995, an opening was made through Maricela Panuco's neck into the trachea through which a breathing tube was inserted (tracheostomy), and an opening was made through the abdominal wall into the small intestine (jejunostomy), through which a small feeding tube was inserted into the small intestine. Medical personnel gave orders to restrain Maricela Panuco after the surgery to prevent her from inadvertently dislodging the jejunal feeding tube. However, medical records do not indicate that she was restrained after the surgery.
On November 4, 1995, at 12:30 p.m., medical personnel noted that Maricela Panuco had inadvertently dislodged the jejunal feeding tube, and at 9:30 p.m., it was reinserted. Although the placement of a jejunal feeding tube presents a risk of an inflammation caused by bacteria or irritating substances being introduced into the abdominal cavity (peritonitis), an x-ray was not taken to determine that the jejunal feeding tube was placed in the small intestine.
On November 5, 1995, at 6:00 a.m., it was noted that the site of the jejunal feeding tube was leaking. At 10:00 a.m., Maricela Panuco was showing signs of infection (sepsis). On November 6, 1995, at 9:00 p.m., thirty-five hours after showing signs of sepsis, she began receiving antibiotics for the infection.
On November 7, 1995, at 1:44 a.m., a CT scan of Maricela Panuco's abdomen indicated that the tip of the jejunal feeding tube was not positioned inside the small intestine and was discharging liquefied nourishment into the abdominal cavity. At 9:20 a.m., she underwent exploratory abdominal surgery (laparotomy), and a small portion of the bowel was removed (resection). A pathology report analyzing tissue from the removed bowel section indicated Maricela Panuco had acute peritonitis.
On November 8, 1995, at 9:15 a.m., Maricela Panuco underwent a second laparotomy for irrigation and drainage of the abdominal cavity, which concluded at 9:55 p.m. From November 9, 1995, through November 11, 1995, her condition continued to deteriorate, and she failed to respond to efforts to reverse the decline. She died on November 12, 1995, at 9:11 a.m., as a direct result of peritonitis and irreversible organ failure.
DAMAGES
If this matter proceeds to trial, the claimants will likely seek the following:
Pedro Luis Panuco Olguin, Jr.,
Loss of Future Maternal Services $ 112,200
Loss of Care, Comfort
and Companionship (MICRA limit) $ 83,333
Jeanett Panuco,
Loss of Future Maternal Services $ 89,760
Loss of Care, Comfort
and Companionship (MICRA limit) $ 83,333
Pedro Panuco, Sr.,
Loss of Future Spousal Services $253,000
Loss of Care, Comfort
and Companionship (MICRA limit) $ 83,334
Funeral Expenses $ 7,200
TOTAL $712,160
The proposed settlement includes:
Pedro Luis Panuco Olguin, Jr.,
Annuity $ 38,000
Jeanett Panuco,
Annuity $ 38,000
Pedro Panuco, Sr.,
Loss of Care, Comfort
and Companionship $ 98,650
Attorneys' Fees (MICRA Estimate) $ 74,150
Cost of Litigation $ 1,200
TOTAL $250,000
A portion of the recommended settlement includes a fixed amount of $76,000 for the minor children which claimants may direct to be used to purchase annuities.
The annuity for Jeanett Panuco, as currently structured, will generate approximately $75,000 paid out in two lump sum payments at 21 and 25 years of age.
The annuity for Pedro Luis Panuco, Jr., as currently structured, will generate approximately $84,000 paid out in two lump sum payments at 21 and 25 years of age.
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 $20,585.17 and $9,191.84 in costs.
The total cost to the County of Los Angeles, as a result of this settlement is as follows:
Indemnity (Settlement Amount) $250,000.00
County Attorneys' Fees and Costs $ 29,777.01
Medi-Cal Lien $ 49,263.00
TOTAL $329,040.01
The total settlement in this matter is $350,000, of which $100,000 is to be paid by the University of California at Los Angeles Medical Center and $250,000 is anticipated to be paid by the County of Los Angeles.
EVALUATION
Medical experts will be critical that medical personnel failed to properly restrain Maricela Panuco, as ordered, after the placement of jejunal feeding tube.
Additionally, medical experts will be critical that medical personnel, after the jejunal feeding tube had been dislodged and reinserted, failed to perform an x-ray to confirm that the jejunal feeding tube had been placed in the small intestine. The failure to properly place the jejunal feeding tube in the small intestine allowed liquefied nourishment to discharge into the abdominal cavity, resulting in the peritonitis and irreversible decline seen here.
Medical experts will also be critical of the failure of medical personnel to administer antibiotics to Maricela Panuco on November 5, 1995, at 10:00 a.m., when it was first noted that she had signs of infection. Further, medical experts will be critical of the delay in performing the first laparotomy until November 7, 1995. The thirty-five hour delay in administering antibiotics, and the forty-eight hour delay in performing the first laparotomy at 9:20 a.m., on November 7, 1995, fell below the standard of care.
We join with our private counsel, Torres and Brenner, and our claims administrator, Professional Risk Management, in recommending settlement in the amount of $250,000 and payment of the Medi-Cal Lien in the amount of $49,263.
The Department of Health Services concurs in this settlement.