Psychiatrist gives up license on charges of incompetence and negligence

February 7, 2014

SAN FRANCISCO — More than four years after a 52-year-old psychiatric patient was left with a broken neck for five hours on the floor of her room at Metropolitan State Hospital, the physician responsible for her care has agreed to give up his license, according to the state medical board.

Dr. Ngoc Le Tuyen, of Fountain Valley, who goes by Tuyen Le, agreed to surrender his license rather than fight an accusation filed last summer by the board. It alleges that Le was incompetent, unprofessional and "grossly negligent" in his treatment of Diane Rodrigues at the Norwalk psychiatric facility.

Rodrigues was paralyzed by the fracture and died six months later of related respiratory complications at another facility.

The Medical Board of California also accused Le of similar failings in the treatment of Metropolitan patient David Gibson, 56, who suffered an acute abdominal emergency and died in late January 2010, two months after Rodrigues' injury. (The accusation refers to the patients by initials only, but The Times confirmed their identities.)

Rodrigues was a former kindergarten teacher who suffered from schizophrenia and often harmed herself during bouts of psychosis. She had been singing, praying and hurling herself from her bed before her injury.

Her case triggered an internal hospital investigation detailed by The Times in May 2012 that spread blame among a dozen staff members, any of whom could have summoned paramedics to help her more promptly.

According to the medical board accusation, made public late Tuesday, Le failed to place Rodrigues in a hard neck collar, immediately order a CT scan, do a proper neurological check, begin intravenous fluids or transfer her immediately by an ambulance with advanced lifesaving certification to a trauma center.

Reached by phone, Le, 72, said he had worked at Metropolitan for 30 years with "no problems" until the cases in question. He declined to discuss them in detail, but said, "It was not only my fault. There were other people involved."

Le retired from the hospital in April 2010, according to state records. He said he has not worked since.

For its story in 2012, The Times obtained six versions of the hospital's internal investigation of Rodrigues' case, which detailed serious lapses in treatment at the height of a court-supervised effort to improve care in the state's psychiatric hospitals. That federal effort has concluded.

Among the findings, Metropolitan caregivers slept on the job, failed to conduct regular patient checks, moved Rodrigues despite what turned out to be a serious cervical injury, failed to summon timely help and lied to protect themselves and one another.

In the end, hospital investigators refused to sign the final draft because the recommendations were diluted by administrators, according to two sources familiar with the investigation who asked not to be identified because the process was confidential.

Ken August, a state hospitals spokesman, said Wednesday that the department launched a "comprehensive investigation" in response to the incidents and "has implemented policies and systems to prevent these types of incidents from reoccurring."

The internal investigation said Le was slow to arrive at the unit to examine Rodrigues. He conceded to investigators that when he did examine her, he moved her neck to check for "range of motion." Despite the fact that she had a gash on her head, was unable to feel her legs, had dropping blood pressure and slow response to light — all signs of severe cervical injury — Le was slow to dispatch her for care.

Instead, he called an ambulance staffed by less experienced emergency medical technicians.

Debbie Coughlin, Rodrigues' twin sister, said she was relieved that some licensing action had been taken.

"Hopefully he now can't harm anyone else from his negligence and who knows how many people he harmed before Diane?" she said. "He worked with one of our most vulnerable populations and did harm. That's so sad to me."

Of the 11 other staff members that the internal investigation named in connection with blunders in Rodrigues' care, six no longer work at Metropolitan; two were promoted.

Among those who left, one psychiatric technician is facing an accusation that could lead to suspension or revocation of his license. According to the Board of Vocational Nursing and Psychiatric Technicians, Maximilian Prieto Nocete was working the night shift when Rodrigues was injured and was assigned to make patient checks every 30 minutes.

Although he signed records indicating he had made those checks every half-hour, he admitted that he had made only hourly checks and had taken an hourlong break instead of the allowable 30 minutes.

A hearing on the licensing action is scheduled for July 10.

Meanwhile, psychiatric technician Vivian Tirona, who was the "shift lede" and Nocete's supervisor that night, was cited and fined $1,001 by the board in December 2011 for initialing Nocete's paperwork without confirming that he had conducted rounds, and for failing to summon timely medical care for a patient she "knew or should have known" had suffered head and spine injuries.

Tirona's license expired last fall, records show.

Source: Lee Romney, "O.C. doctor accused by medical board to give up license," Los Angeles Times, February 5, 2014.