By Christine De La Cruz Friday, January 17th, 2014

In a case headed to trial later this month in San Luis Obispo, a jury will decide whether Sierra Vista Regional Medical Center and an affiliated surgeon conspired to conceal the true cause of a patient’s death.

The civil trial, in which Sierra Vista and Dr. Donald Ramberg face allegations of medical malpractice, fraud and conspiracy, is scheduled to begin on Jan. 29 in San Luis Obispo Superior Court.

In a statement to the Business Times, Sierra Vista said it plans to defend itself against the allegations.

A ruling by Judge Charles Crandall in 2012 allows the plaintiff to seek punitive damages, a rare decision in California malpractice cases, according to attorneys who spoke with the Business Times.

“The fact that this judge blessed the punitive damages in the case certainly signals to me some fact that the judge sees as particularly egregious,” said Erik Feingold, a partner at law firm Myers, Widders, Gibson, Jones & Feingold in Ventura who has secured multimillion-dollar verdicts in personal injury cases. Feingold is not connected to the Sierra Vista case.

The allegations

On Jan. 27, 2010, Tyrone Taylor was admitted to Sierra Vista for a cervical discectomy, an operation to remove a herniated disc in his neck. The 42-year-old Arroyo Grande man died in the early morning hours of the following day after experiencing complications.

“The evidence shows that plaintiff’s husband died approximately 12 hours after surgery, that he suffered acute airway obstruction culminating in respiratory failure and cardiac arrest, and that he died when hospital personnel were unable to resuscitate him,” according to the May 21, 2012, court ruling that has allowed Taylor’s wife, Sara, to seek punitive damages.

Sara Taylor has accused Sierra Vista of purposely obtaining a bogus autopsy report from a controversial pathologist and conspiring with Ramberg, the surgeon who performed the operation, to conceal the circumstances surrounding her husband’s death.

“We take seriously our responsibility to deliver quality, safe, health care services to our community and are fully committed to doing so,” Sierra Vista said in a statement. “We plan to vigorously defend against the allegations.”

Initially, Tenet Healthcare Corp., the Dallas-based parent company of Sierra Vista, and another doctor also were named as defendants in the case. But Taylor’s attorneys later dropped the claims against them.

Taylor is being represented by attorneys Tyrone Maho of Santa Barbara and Steven Vartazarian of Sherman Oaks. Jay Hieatt of Hall, Hieatt & Connely, which has offices in San Luis Obispo and Santa Barbara, is the legal counsel for Sierra Vista.

Fatal complications

According to the 2012 court decision, Dr. Rushdi Cader, who is no longer a defendant in the case, attended to Tyrone Taylor after the patient began experiencing complications.

The ruling says Cader documented in the patient’s medical record that the death was caused by an expanding post-operative hematoma, or a collection of blood outside of a blood vessel, that resulted in airway obstruction and respiratory failure. A post-operative hematoma is considered a common complication of the surgery, medical experts told the Business Times. It is the second most-common complication of the procedure Taylor underwent, occurring in 5.6 percent of patients, according to a 2007 study by the Medical Center of Central Georgia and Mercer University’s School of Medicine.

Sara Taylor was not informed of this complication, but was instead told by hospital staff that the cause of her husband’s death was undetermined and an autopsy was needed, according to the court decision.

Sierra Vista’s risk manager visited Taylor twice at her home in an effort to obtain consent for an autopsy, which was given several days after the death of Taylor’s husband, the ruling stated.

The autopsy was performed by Dr. George LaPointe Vandermark, a pathologist who has what Judge Crandall described in his 2012 ruling as a “checkered past.” The autopsy concluded that Taylor’s husband died from natural causes related to a fatty liver.

Taylor herself hired a pathologist to perform a second autopsy, which determined the cause of death as a post-operative cervical hematoma — in line with the original findings of Cader.
Vandermark, who changed his name from George Bolduc, according to the Medical Board of California, has been accused in the past of botched work in several counties within the state, according to an investigation by the San Joaquin County district attorney’s office related to another case. He is still licensed to practice medicine in California, and there are no legal or disciplinary actions noted on his record. Vandermark, whose address with the medical board is listed as a post office box in Kansas, could not be reached for comment.

“We are limited in our ability to comment on ongoing litigation,” Sierra Vista said in the statement sent to the Business Times. Hieatt, the hospital’s attorney, said he could not comment on pending litigation.

The hospital said a physician services group recommended by the county coroner’s office — which declined to perform the autopsy — selected Vandermark. “The hospital verified that the selected physician was in good standing with the State [Medical] Board by confirming on its website that his license was not suspended and that there were no disciplinary actions listed,” the hospital said.

Before the autopsy was performed, Taylor said she tried to meet with Ramberg, the performing surgeon, but the doctor allegedly refused until Vandermark’s report was completed. According to the court ruling, Ramberg listed the cause of death on the death certificate as cardiac arrhythmia and an enlarged heart, a different natural cause than the fatty liver Vandermark mentioned in his autopsy report. Phone messages left for Ramberg by the Business Times were not returned.

The court decision said this evidence raised enough questions to allow a jury to decide whether Ramberg “participated in a conspiracy to cover up the true cause of death in order to head off a potential lawsuit and to avoid personal liability.” The ruling also stated that questions were raised as to whether Sierra Vista “deliberately hired a pathologist who would muddle the causation waters in order to head off a potential lawsuit.”

Uncommon ruling

The 2012 ruling on punitive damages is uncommon in California, according to legal expert Feingold. “Punitive damages are very difficult to plead and there is, from my perspective, a judicial reluctance to let them stay in a case against a hospital,” the Ventura attorney said.

Vartazarian, one of the plaintiff’s attorneys, said that he knows of no other instance in California in which a hospital involved in a medical malpractice case has been subject to punitive damages. Such damages reach beyond necessary compensation for losses and are intended to punish those convicted.

The case will be tried before Judge Barry LaBarbera.

Less than two weeks before the court date, Vartazarian said he couldn’t comment on the trial itself. “I’ve been advised to say nothing until in the middle of trial or after we get a verdict,” he said. When asked if Sierra Vista or parent company Tenet had offered to settle, he said, “It looks like we’re going to try the case as of right now.”