Executive: Hospital ignored policy in Rivera death

A senior executive from Aria Health, owner of the Northeast Philadelphia hospital where Joaquin Rivera died in November as he waited for emergency treatment, said yesterday that staff did not follow company policy requiring periodic checks on patients in the waiting room.

Chief operating officer Linde Finsrud Wilson, testifying at a City Council hearing on Rivera's death, said the hospital had since trained staff to keep better tabs on waiting patients. She said it also had added a second full-time security guard in the 25-seat waiting room, where Rivera's watch was stolen after he died.

The three-hour hearing in Council chambers was the first public forum devoted to the events of Nov. 28, when Rivera, 63, walked into the waiting room at Aria's Frankford campus, formerly called Frankford Hospital. It included testimony from an attorney for the family and a senior official from the state Department of Health, who elaborated on state findings - announced last month - that Aria had failed to deliver adequate care.

"There were policies and procedures that, if they had been followed, might've given us a different outcome," said Stacy Mitchell, the department's deputy secretary for quality assurance.

Wilson, the Aria executive, said an examination of a security video showed Rivera died 11 minutes after he arrived at 10:45 p.m., complaining of pain in his left side.

She said a triage nurse first called his name 14 minutes after he arrived, though an earlier state investigation suggests his name was first called after 18 minutes. Wilson said that in Pennsylvania, the average wait for a triage nurse was 17 minutes; afterward she could not immediately provide the source for that information.

Thomas R. Kline, a lawyer representing the Rivera family, sharply criticized Wilson for citing that statistic. Average wait times represent the entire range of ailments, of varying severity, and are irrelevant for someone with heart disease like Rivera's, he said.

"You must prioritize patients," Kline said outside the hearing. "When you go to the emergency room, it's not like going to a bakery. If you have a left-side pain, you need to be evaluated immediately."

For someone with nontrauma chest pain, an EKG is recommended within 10 minutes, according to the American Heart Association's 2008 Handbook of Emergency Cardiovascular Care for Healthcare Providers. Rivera was not examined until nearly 50 minutes after he had slumped in his chair.

Council lacks power to act against the hospital. The hearing was intended for educational purposes, said Councilwoman Maria Quiñones-Sánchez, who mourned the loss of Rivera, a popular musician and high school guidance counselor.

The hospital has until March 1 to implement a plan of correction in response to the state Health Department's findings - much of which is already in place, Aria officials said.

Wilson listed numerous measures she said had been implemented. Among them:

Nurses must go out into the waiting room to call patients' names. If they get no response, they must walk to the other end of the room and call again.

If there is still no response, they must ask each person individually if he or she is the one being called. The hospital also has met with experts about improving patient flow and has discussed redesigning the waiting room so staff can keep a better eye on people there.

"We don't want anything to happen to anyone while they're waiting for care," Wilson said.

She was accompanied by Aria medical personnel, including physician Robert Danoff, who said the hospital treats many uninsured or underinsured patients. The number has gone up since the closure of nearby Northeastern Hospital last year, requiring the hospital to add staff, he said.

Hospital officials also spoke of the training that staff had received in dealing with patients from different ethnic backgrounds.

Afterward, Kline said he was puzzled by the length of time that Aria officials spent testifying about their increased patient volume and their improved awareness of ethnic issues. Rivera, who was born in Puerto Rico, spoke perfect English. And the patient volume on the night he came in was not high, Kline said.

"There was no language barrier," he said. "There was no volume issue there."

Wilson did not say Rivera had trouble communicating. But she did say his complaint might have been dealt with more quickly if he had come in by ambulance.

"If I could shout this from the rooftops, anyone who is experiencing chest pain should immediately call 911," Wilson said afterward, adding that such patients are triaged in the field.

Kline said he had drafted a wrongful-death lawsuit and had given it to the hospital, though he had not yet filed it.