December 21, 1999
Honorable Board of Supervisors
383 Kenneth Hahn Hall of Administration
500 West Temple Street
Los Angeles, California 900l2
Re: Malik Ramseur, a , minor, by and through his Guardian ad Litem, Nudasha Tanco, Nudasha Tanco and Jachon Ramseur v. County of Los Angeles
Los Angeles Superior Court Case No. TC 010 617
Dear Supervisors:
The Claims Board recommends that:
The Board authorize settlement of the above-entitled action in the amount of $950,000.00, plus assumption of the Medi-Cal Lien not to exceed $68,366.00 and Lifetime Acute Medical Care.
The Auditor-Controller be directed to draw warrants to implement this settlement from the Health Department.
Enclosed is the settlement request and a summary of the facts of the case.
The Litigation Report, including the Corrective Action Report, is being transmitted to you under separate cover by the Health Department.
Return the executed, adopted copy to Frances Lunetta, Suite 648 Kenneth Hahn Hall of Administration, Extension 4-1754.
Very truly yours,
Barbara N. Uyeda, Chairperson
BNU/fsl Los Angeles County Claims Board
Enclosure
December 13, 1999
TO: LOS ANGELES COUNTY CLAIMS BOARD
FROM: GEORGE E. PETERSON, Esq.
Bonne, Bridges, Mueller, O’Keefe and Nichols
GARY N. MILLER
Principal Deputy County Counsel
RE: Malik Ramseur, a minor by and through his Guardian Ad Litem, Nudasha Tanco, Nudasha Tanco and Jachon Ramseur v. County of Los Angeles
DATE OF
INCIDENT: January 5, 1997
AUTHORITY $950,000, Plus Assumption of the Medi-Cal Lien Not to Exceed
REQUESTED: $68,366.00, 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 $950,000 the medical negligence lawsuit brought by Malik Ramseur, a minor, for the injuries he sustained as the result of treatment he received at King/Drew Medical Center on January 5, 1997. The State, having paid $68,366.00 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 Malik Ramseur suffered as a result of this incident. The parents, Nudasha Tanco and Jachon Ramseur, have separate causes of action for emotional distress, which are also being resolved by this settlement.
LEGAL PRINCIPLES
The County is liable for the 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 January 4, 1997, at 9:15 p.m., Malik Ramseur, a 23-month-old boy, was seen in the Emergency Room of King/Drew Medical Center with complaints of seizures and a cough over the preceding 24 hours. He was noted to have a fever of 104.7 degrees, and was diagnosed with an inflammation of the middle ear (otitis media) on the right side and an inflammation of the lungs caused by infection (pneumonia).
On January 5, 1997, at 3:30 a.m., Malik Ramseur was transferred to the Pediatric Outpatient Clinic for the purpose of determining whether or not he had an inflammation of the membranes of the brain or spinal cord (meningitis) by inserting a long needle into the spinal canal, at the level of the lumbar spine to extract a sample of spinal fluid (lumbar puncture). This procedure began at 5:00 a.m. In order to perform the lumbar puncture, it was necessary for Malik Ramseur to be held by his arms and legs against the chest of one of the medical personnel assisting with the lumbar puncture, to prevent Malik Ramseur from struggling. The first three attempts to obtain spinal fluid were unsuccessful. During the third attempt, while the needle was being inserted, Malik Ramseur stopped fighting and crying, went limp, and defecated. Notwithstanding that these are all signs that he may have stopped breathing, medical personnel believed that he had fallen asleep. A fourth attempt was then made to extract a sample of spinal fluid, which was successful. Results of tests performed on the spinal fluid indicated that Malik Ramseur did not have any evidence of meningitis.
Malik Ramseur was placed on his back, and he was cleaned at the conclusion of the lumbar puncture. Medical personnel then left the room, and while they were out of the room, Nudasha Tanco, Malik Ramseur’s mother, who was present during the procedure, began screaming that her child had stopped breathing. Medical personnel returned, and noted that Malik Ramseur was turning blue, indicating a lack of oxygen. Restoration of heart and lung function using artificial respiration and manual closed chest compression (cardiopulmonary resuscitation [CPR]) was immediately initiated, but medical personnel, who were without the proper size face mask for a pediatric patient, and without a scope used to establish an airway (laryngoscope), were unable to resuscitate Malik Ramseur.
At 5:25 a.m., a distress call requiring immediate resuscitative efforts (code blue) was made. In response to the code blue, arriving medical personnel, who had a larygnoscope and a breathing tube, initiated CPR, and Malik Ramseur was resuscitated. Medical personnel believe that at least ten minutes elapsed between the time Malik Ramseur’s mother noted that he had stopped breathing and the time he was resuscitated.
On January 5, 1997, at 6:50 a.m., Malik Ramseur was admitted to the Pediatric Intensive Care Unit. An analysis of his blood drawn at 7:28 a.m., indicated a high level of acid in the blood (metabolic acidosis), which is evidence that he was exposed to low levels of oxygen (hypoxia).
On January 6, 1997, Malik Ramseur was diagnosed with possible brain injury (hypoxic encephalopathy) resulting from of a lack of oxygen (cyanosis) occurring during the lumbar puncture performed on January 5, 1997, and was transferred to Harbor/UCLA Medical Center for further management. On January 10, 1997, he was transferred to Kaiser Hospital (private facility).
On February 5, 1997, he was transferred to a private long-term care facility. He currently has a defect of motor power and coordination related to damage of the brain (cerebral palsy), profound mental retardation, behavioral blindness, and is severely handicapped.
DAMAGES
If this matter proceeds to trial, the claimant will likely seek the following:
Malik Ramseur,
Future Medical Care $3,000,000
Loss of Future Earnings $ 500,000
Pain and Suffering (MICRA limit) $ 250,000
Nudasha Tanco,
Pain and Suffering (MICRA limit) $ 250,000
Jachon Ramseur,
Pain and Suffering (MICRA limit) $ 250,000
TOTAL $4,250,000
The proposed settlement includes:
Malik Ramseur,
Cash Settlement $670,833
Nudasha Tanco,
Pain and Suffering and
Future Wrongful Death $ 25,000
Jachon Ramseur,
Pain and Suffering and
Future Wrongful Death $ 25,000
Attorneys Fees (MICRA Estimate) $214,167
Costs of Litigation $ 15,000
TOTAL $950,000
A portion of the recommended settlement may be directed by claimants to be used to purchase an annuity. The amount and structure of the annuity has not been selected at this time.
STATUS OF CASE
The current trial date has been vacated pending approval of this settlement.
Expenses incurred by the County of Los Angeles in the defense of this case through December 13, 1999, are attorneys fees of $30,638.50 and $17,711.62 in costs.
The total cost to the County of Los Angeles as a result of this settlement is as follows:
Indemnity (Settlement Amount) $ 950,000.00
County Attorneys Fees and Costs $ 48,350.12
Medi-Cal Lien $ 68,366.00
TOTAL $1,066,716.12
EVALUATION
Medical experts will be critical of the failure of medical personnel on January 5, 1997, at about 5:00 a.m., to appreciate at the point when he stopped fighting and crying, went limp, and defecated during the lumbar puncture that Malik Ramseur may have stopped breathing. This failure resulted in an unknown period of time elapsing during which Malik Ramseur was without oxygen.
Medical experts will also be critical of the failure of medical personnel to ensure that necessary resuscitative equipment was available on January 5, 1997, during the lumbar puncture procedure performed on Malik Ramseur. The failure to have an appropriate size oxygen mask available for a pediatric patient, and the failure to have a laryngoscope available to establish an airway, resulted in the failure to immediately resuscitate Malik Ramseur, and delayed the time of his resuscitation.
Medical experts will be critical of the failure of medical personnel on January 5, 1997, to immediately make a distress call requiring immediate resuscitative efforts (code blue) when it was noted that Malik Ramseur was turning blue and not breathing. This failure resulted in a ten minute delay before additional medical personnel were able to initiate CPR and resuscitate Malik Ramseur, and is directly responsible for the injuries observed here.
We join with our private counsel, Bonne, Bridges, Mueller, O’Keefe and Nichols, and our claims administrator, Professional Risk Management, in recommending settlement in the amount of $950,000, and payment of the Medi-Cal lien in the amount of $68,366.00, and lifetime acute medical care for the injury Malik Ramseur suffered as a result of this incident.
The Department of Health Services concurs in this settlement.