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Vickie Burton et al v. Psychiatric Solutions

October 24, 2012


(Super. Ct. No. 34200900034345CUMMGDS)

The opinion of the court was delivered by: Duarte , J.

Burton v. Psychiatric Solutions CA3


California Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or relying on opinions not certified for publication or ordered published, except as specified by rule 8.1115(b). This opinion has not been certified for publication or ordered published for purposes of rule 8.1115.

Steven Burton (Burton) voluntarily admitted himself to Sierra Vista Hospital for treatment for alcoholism and depression; he died the next morning from polysubstance intoxication. His wife Vickie Burton and his adult daughter Erin Bradshaw (plaintiffs) brought suit against the hospital and its parent corporation Psychiatric Solutions, Inc. (defendants) for medical negligence and wrongful death.*fn1 The trial court granted defendants' motion for summary judgment.

On appeal, plaintiffs contend it was error to grant summary judgment because defendants failed to negate allegations that certain physicians were agents of the hospital and there was no evidence that the physicians did not breach the standard of care. Further, plaintiffs contend triable issues of material fact remain as to whether the hospital's staff breached the standard of care. We reject these contentions and affirm.


Burton's Stay at Sierra Vista Hospital

Accompanied by his wife, Burton presented at Sierra Vista Hospital the afternoon of February 16, 2008, for a voluntary psychiatric evaluation. He stated he felt depressed, hopeless, and helpless. He had a family history of alcoholism and self-medicated for pain with alcohol. He drank a bottle of wine each day and had done so for the last four years. He was admitted for an alcohol detoxification protocol.

Burton was admitted by Okechukwu Nwangburuka, M.D. Nwangburuka ordered certain detoxification medicine, including Ativan, which was given upon admission. The doctor also ordered staff to call the attending or on-call physician if Burton had a severe alcohol withdrawal syndrome score (AWS), or his vital signs or withdrawal symptoms did not respond to the regimen.

An initial assessment was performed by Pearl Ngo, R.N. Burton told her that he used a continuous positive airway pressure (CPAP) device every night while sleeping. Ngo told Burton the hospital did not have CPAP devices. Burton replied that his wife had already left, but he would call her to bring the CPAP machine the next day.

After 9:00 p.m., Burton was examined by Martin Ramirez, M.D. Ramirez's notes do not indicate that Burton had sleep apnea or used a CPAP machine. Ramirez ordered several of Burton's pre-admission medications to begin the next morning at 8:00 a.m.

Burton retired after 10:00 p.m. Hospital staff checked on him every 15 minutes. At 2:00 a.m. the next morning, Burton was resting comfortably. At 4:25 a.m., Burton was found on the floor. He claimed he did not fall, but because his legs felt like jello, he was crawling. Burton was returned to bed. His AWS was 14, which is moderately high. He was given another 2 mg. of Ativan. By 4:55 a.m., his AWS was 10. By 5:00 a.m., Burton was feeling better. He was given more medication for alcohol withdrawal. Shortly thereafter, his AWS was 6; it fell to 4 by 5:45 a.m. Nursing notes indicate that Fayez Romman, M.D. was paged twice during this period, but did not respond. At 6:35 a.m., Burton was sleeping with no sign of distress. A few minutes later, Burton got up to use the urinal.

About 7:00 a.m., Burton was found in bed, not breathing and non-responsive. A Code Blue was activated, CPR initiated, and 911 called. Burton was transferred to the Kaiser Emergency Department. He was pronounced dead at 7:36 a.m.

An autopsy report stated the cause of death as polysubstance intoxication. Levels of two prescription medications, amlodipine (Norvasc) and duloxetine (Cymbalta), were "notably elevated." Both medications are metabolized by the liver. Burton had moderate to severe steatosis of the liver. According to the autopsy report, it appeared his "liver impairment prevented his body from properly flushing medications from ...

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