Sunrise Hospital fights malpractice suit

Molly Ball

Thursday, April 7, 2005 | 10:52 a.m.

If Sunrise Hospital had treated a homeless man's illness instead of ejecting him from the emergency room, he would not have collapsed and died on the hospital's lawn, lawyers for the dead man's family told a jury on Wednesday.

The medical malpractice lawsuit brought by the children of Rodolfo Anguiano alleges that Sunrise's doctors, nurses and security guards fell short of their duty to care for the Las Vegas resident as he died 10 years ago.

"On July 28, 1995, Rodolfo Anguiano died," Steve Baker, the lawyer for Anguiano's children, Sophia and Rudy, said in his opening statement. "He died face down. He died face down on the lawn of Sunrise Hospital."

Anguiano died surrounded by hospital personnel, Baker said. "He died after being refused emergency medical services on two separate occasions. ... He suffered and died because Sunrise considered him too dirty and too poor to receive medical treatment."

But Sunrise's lawyer, Mike Prangle, told the jury that nothing was discernibly medically wrong with Anguiano, and the hospital staff acted appropriately. Anguiano's death resulted not from an obvious and prolonged illness but from a sudden attack, Prangle said.

"I think you will all agree that this was an unfortunate thing that happened to Mr. Anguiano," Prangle said. "But I think you will also conclude that what the nurses and security guards did was everything they were supposed to do under the circumstances."

In 1995, Anguiano was 34 and had recently moved to Las Vegas from California. He had divorced his wife and fallen on hard times.

When paramedics were called on the morning in question, they found him lying on the ground near Paradise Road. He said he hadn't eaten in three days but had been drinking alcohol and smoking marijuana, according to the paramedics' report.

Anguiano told paramedics he thought he might have had a seizure and his ribs ached, possibly from a fight a few days before. The emergency workers noted that his pulse was racing at 130 beats per minute -- anything over 100 is considered dangerous -- and his breathing sounded faint.

Upon admission to Sunrise, a triage nurse recorded the elevated pulse and also a fast rate of breathing. She noted that his blood oxygen was low, there was a cloudy film over his eyes, and he smelled bad.

When Dr. Susan Meyer came to examine Anguiano, she also noted that he was "filthy dirty" and "foul smelling." She diagnosed him with "acute homelessness, alcohol and drug abuse."

Meyer did not administer intravenous fluids or an oxygen tube, nor did she order any X-rays or blood or urine tests. She ordered that Anguiano be given juice and crackers and discharged.

The hospital's attorney pointed out that none of the assessments of Anguiano noted any complaint of difficulty breathing or other respiratory distress.

All he told the hospital staff was that he'd been drinking and in a fight, Prangle contended, so they had no way of knowing that his lungs were filling up with fluid. Rather, they thought he just wanted a bed for a few hours to sleep off his drunkenness.

But to the plaintiffs, the medical staffers' repeated reference to Anguiano's external appearance and their reluctance to give him a complete work-up was clear evidence of bias.

When an autopsy was conducted on Anguiano's body, Baker said, no alcohol was found in his system, and the only drug in his body was ibuprofen -- the active ingredient in Advil.

Security guards ushered Anguiano, who had previously been docile, out of the emergency room less than an hour after he had arrived at the hospital. A nurse who was surprised at the discharge asked Meyer about it, but the doctor responded, "He's out of here," and the nurse didn't pursue it further.

The guards had to escort Anguiano to the edge of the property twice as he continued to insist he was sick. When his lips began to turn blue, a guard supervisor asked, "What's our liability here?"

The guards then took him around the corner to another part of the hospital grounds, where he collapsed and lay face down. As Anguiano moaned and writhed on the grass, the supervisor told another guard to call Metro Police and have him charged with trespassing.

The guards watched as Anguiano stopped moving. It was an unidentified hospital employee on a smoke break who thought to check his pulse and found he had none.

A gurney was rushed out and Anguiano was readmitted, but it was too late. The attempts to resuscitate him failed, and he was pronounced dead about an hour and a half after being ejected from the emergency room.

Anguiano's autopsy report said he died of lobar pneumonia -- his right lung filled up with fluid and he suffocated.

To the hospital staff, Anguiano appeared to be a basically healthy man who never showed signs of such an illness, Prangle said. His collapse and death came suddenly and without warning, and they could not have been prevented, he said.

But Baker said the doctor failed Anguiano by not treating him more thoroughly; the nurses failed him by not pursuing their concerns over the doctor's head; and the guards failed him by neglecting to help as he deteriorated.

Expert witness Dr. Jonathan Blair, a California emergency-room doctor for 32 years, testified for the plaintiffs that the care Anguiano received was "appalling."

"This man was not well," Blair said. "Getting testing done to narrow it (his illness) down really was required."

Las Vegas homeless advocate Linda Lera-Randle El, director of Straight From the Streets, said she was saddened by what allegedly happened to Anguiano. The same thing could easily happen today, she said.

"People don't understand how disrespected homeless people are," she said. "This is just one example. He had an army of people against him and not one on his side."

Lera-Randle El said many of the homeless people she knows have been tossed from emergency rooms when their health was perilous. What struck her about Anguiano's case, she said, was how strenuous the hospital's efforts were to keep him out.

"They went to that much trouble not to help him?" she said. "I don't think we'd do that to a dog we found by the side of the road."

A second defendant in the lawsuit, Wilson-Fischer Emergency Medicine Ltd., contracted with Sunrise to provide doctors. Its attorney, Tom Davis, contended that Wilson-Fischer's role was limited and the company was not liable, whether or not wrongdoing occurred.

Meyer, the doctor, and Wilson-Fischer subcontractor Coastal Emergency Services of Dallas, Inc., are also named in the lawsuit but did not appear to defend themselves.