Executives at Sunrise Children's Hospital have been warned not to "destroy, conceal, and/or alter any evidence" surrounding catheter failures at the institution -- failures that led to one infant's death and to a life-saving operation for another.
The warning came in recent letters from attorney George Kelesis, who represents one of two nurses fired by Sunrise in connection with "catheter disruptions" in the hospital's Neonatal Intensive Care Unit.
"Unfortunately, Sunrise has been known to get rid of evidence that may hurt them before they go to court," Kelesis said, pointing to a 2004 decision by the Nevada Supreme Court in a $5 million malpractice case that said Sunrise "had a duty to preserve anesthesia equipment used in patient's surgery" and should not have sold it.
The letters put Sunrise officials on notice of an upcoming lawsuit on behalf of his client, nurse Sharon Ochoa-Reyes. It's the latest twist in the story of problems with infant catheters that began in December 2009, according to the hospital.
Sunrise officials gave information to Las Vegas police last spring alleging that catheter lines had been cut, and detectives made nurses Ochoa-Reyes and Jessica May Rice "persons of interest" in a criminal investigation.
Soon after, the nurses had their licenses summarily suspended by the state nursing board. And Sunrise officials fired them.
In September, however, the nursing board reinstated their licenses, saying its investigation, which was largely based on documents subpoenaed from the hospital, did not provide evidence of wrongdoing. Thousands of hospital documents reviewed by the Review-Journal do not point to either nurse as having deliberately harmed a patient. No hospital employee accuses them of anything in the documents.
Sunrise refuses to rehire the nurses and continues to fight Ochoa-Reyes' attempt to collect unemployment insurance. Metropolitan Police Department officials still say their investigation is ongoing.
So, Kelesis sent letters to Sunrise President Sylvia Young, Vice Presidents Dan Davidson and Robert Eisen and children's hospital Chief Operating Officer Todd Sklamberg in December.
The letters focus on 30 requests for documentation, including electronic and paper records for each patient in which a catheter failure occurred; documents identifying failed catheters; documents identifying who was on duty in the Neonatal Intensive Care Unite when catheter failures occurred; and documents relating to the return of failed catheters.
"They've blamed two nurses for problems they've long had, but there's nothing in the records to support it," Kelesis said. "They want to reduce their financial liability."
Ochoa-Reyes said the hospital had been having problems with broken catheters "for a long time."
"Even though nurses reported the product failures, the hospital administration basically paid no real attention to it until babies got hurt," she said, adding that broken catheters were saved in large envelopes taped to a hospital door. "We had been having problems for months and months."
When the nursing board subpoenaed records regarding broken catheters as far back as 2008, Sunrise denied the request, calling it "irrelevant."
Sunrise officials refused repeated requests for comment for this story.
Kathleen Murphy Jones, the attorney for the other nurse fired by Sunrise, Jessica May Rice, said she will be issuing warning letters similar to what Kelesis filed.
"They made horrible accusations against my client based on nothing," Jones said.
Kelesis sent similar letters warning of pending litigation to Clark County Coroner Mike Murphy, Nevada State Health Department Deputy Administrator Marla McDade-Williams and Las Vegas police officials. Police have been asked to keep polygraph and interview evidence on hand.
"We have a strict evidence preservation policy," Murphy said. "Once we're notified, we make sure all documents are in place. ... It's also important for me to note that we work for the decedent, not the state or defense."
Two-month-old Miowne Obote died at Sunrise in July because of a May catheter failure. Murphy's office, relying heavily on the opinion of a Sunrise-hired expert who concluded the line had been cut, ruled the death a homicide. That expert, W. Don Bunn of Oklahoma based Sherry Laboratories, told the Review-Journal twice that he never tested the catheter for product failure. And he repeatedly said that without more testing, he can't rule out product failure for the failed catheter lines.
Murphy, who said his office did not do product failure tests of its own, has said new information about the catheter incidents could change the homicide ruling to an accident.
A government lab is supposed to test the catheter lines for police. Las Vegas police spokesman Bill Cassell said Wednesday that his agency "must wait in line" to get the catheter line testing done. He also said the police department will provide evidence to Kelesis as required by the law.
Officials with the Nevada State Heath Division were under the impression that Bunn had done a complete product failure test, even saying so in a report that absolved the hospital of fault for the series of catheter accidents.
"An outside forensic expert was also hired by the facility to determine the cause of the PICC line disruptions," the report said.
On Wednesday, McDade-Williams said her office will make documents available to Kelesis that are public. She also said that if anyone has information contradicting information filed by her staff on Sunrise regarding the catheters, they should contact her office.
In early July, the public first began to learn what had transpired at Sunrise. In a news release, hospital officials said they had asked police to investigate 14 incidents of "disrupted catheters." That news release actually deepened the mystery of what happened at the hospital by its reference to "disrupted catheters."
No American medical safety expert contacted by the Review-Journal had ever heard the term "disrupted catheters" used to describe problems with the equipment.
Sunrise provided incident reports for only 10 of the 14 disruptions it reported. Of those, three involved Rice and four mentioned Ochoa-Reyes, either as a witness to a problem or having had a patient with a problem. The hospital has yet to explain why no record of the other four incidents has been put forward.
Though Rice and Ochoa-Reyes were on duty at the hospital when the incident occurred that resulted in the death of baby Obote, Rice was doing charting work nearby, and Ochoa-Reyes did not work on the baby, according to the documents.
Ochoa-Reyes has said she was one of the first nurses to alert supervisors that something had to be done with the failed catheter lines that had plagued the hospital for months. "I helped make sure we saved them so they could be tested later," she said.
As Kelesis prepares his lawsuit against Sunrise, he said he worries about whether he can trust the hospital -- which is part of the largest for profit hospital chain in the country, the multibillion dollar HCA corporation -- to abide by the rules of the legal process.
He and nursing board director Debra Scott have scoffed at some of the replies that the hospital made to board requests for material during the investigations of the incidents with infant catheters.
For instance, Sunrise officials said that "after a thorough and diligent search, no notes, memoranda, transcripts or records were taken during any employee interviews conducted by Sunrise Hospital in the course of its investigation of catheter ... 'disruption' at the hospital."
Ochoa-Reyes and Rice said notes were taken as they were interviewed by hospital officials.
"We always take notes at the nursing board when we do an investigation," Scott said.
"How did the hospital share what it learned with police?" Kelesis said.
Even more disturbing to Kelesis is what the Nevada Supreme Court wrote in 2004 about Sunrise selling equipment that should have been a key part of a malpractice case where a patient ended up in a permanent vegetative state:
"If the equipment had been functioning properly, it is reasonable under any circumstance to infer that Sunrise would have wanted to preserve it in order to protect itself from a false claim of negligence."
Kelesis said he believes he is dealing with an unfeeling corporate giant, not a local hospital that cares about local people.
"They will do anything to protect themselves," he said.
Kelesis said he will do all he can to try and ensure that Ochoa-Reyes gets a "fair shake."
"What's happened to her so far hasn't been fair at all," he said. "As even the nursing board that is charged with protecting the public safety has found, there is no evidence of her doing anything wrong. But the employer she had been loyal to nearly 20 years has made her out to be a monster, has made it impossible for her to work as a nurse again."
Contact reporter Paul Harasim at firstname.lastname@example.org or 702-387-2908.