Doctor negligently treats seriously ill man who refuses hospitalization, later dies. $2 million. Los Angeles County.

Facts and Background

• Facts and Background:

  Plaintiff's decedent, Hua Yang, was a Chinese immigrant. He and his wife, Li Tong, operated a small but successful Chinese restaurant. On May 12, 2012, at 55 years old, Mr. Yang went to the medical clinic of respondent, Po-Long Lew, D.O., an osteopathic physician and family medicine doctor. The patient complained of abdominal pain. His blood pressure was 134/102 with a heart rate that had increased to 113 beats per minute, and markedly elevated blood sugar of 324. The presenting symptoms that day (high blood pressure, increased heart rate, elevated blood sugar and the abdominal pain) were indications of dehydration and possible diabetic keto acidosis.

  Dr. Lew said that he advised the patient to go to the hospital because of his elevated blood pressure and blood sugar, but that the patient refused, stating that he couldn’t afford it. The medical chart did not document that Dr. Lew counseled the patient about why hospitalization was essential. Dr. Lew administered intravenous sodium chloride with 40 mg of Pepcid (a drug used to reduce stomach acid secretion) and 4 mg of Zofran (a drug used to treat nausea). He also gave the patient a bottle of Jentadueto, which is contraindicated in patients who might have diabetic ketoacidosis. Dr. Lew instructed the patient to return in two days.

  Two days later, on May 14, the patient returned with a critically elevated blood sugar of 570, which is more than five times the normal upper limit. Dr. Lew diagnosed him with uncontrolled diabetes and dehydration. Dr. Lew did not advise that his patient be hospitalized. Instead, he administered intravenous saline with Pepcid and Zofran, and gave an injection of insulin. He then told the patient to increase the dosage of Jentadueta and told him to return the next day. However, the next morning, the patient was taken to the hospital ER with a severely abnormal heart rhythm. He died in the ER of cardiac complications from diabetic keto acidosis.

• Plaintiff's Contentions:

  Claimant’s internal medicine expert testified that the patient’s elevated blood sugar of 324 on May 12 required immediate transport to the hospital. If the patient resists, the standard of care requires the doctor to explain that the patient’s life is in danger and hospital treatment is mandatory. If the patient is concerned about cost, a referral to a County hospital should be made. If the patient still refuses, the discussion must be documented thoroughly in the chart. No such documentation was done.

  The prescription of Jentadueta was negligent and likely worsened the patient’s condition. On May 14, when the patient returned with an elevated blood sugar of 570, the standard of care required that 911 be called with immediate hospitalization. Claimant’s expert testified that it was so serious, he would have ridden in the ambulance with the patient. The failure to have arranged for hospitalization and the increased dosage of a contraindicated medication was gross negligence.

• Defendant's Contentions:

  That the care and treatment was within the standard of care and a doctor can’t force a patient to go to the hospital.