State officials have agreed to a $1.4 million settlement with the family of a patient at the Oregon State Hospital who died in his room but wasn’t discovered for hours.
Moises Perez, 42, died in October 2009, of coronary artery disease and had recently complained of chest pains. Records obtained by The Oregonian in 2010 showed that he was last seen at breakfast at 7:15 a.m. He didn’t show up for lunch, for scheduled medications or for dinner. Staff found him dead in his room across from the nursing station at 7:35 p.m. when they tried to wake him for medications.
Dr. Karen Gunson, Oregon state medical examiner, said the death likely occurred six to eight hours before the Marion County medical examiner saw the body at 8:30 p.m.
The Perez family filed a wrongful death lawsuit in January 2011 naming Oregon state officials and a long list of hospital staff. The complaint detailed years-long attempts by Perez’s mother to alert doctors and others about his deteriorating condition.
READ – Complaint by Perez family (PDF, 2.2MB)
The family agreed to drop the lawsuit as part of the agreement. State officials did not admit any liability.
The agreement was reached on May 20, but state officials did not publicize it. It was first reported by the Associated Press Wednesday following a public records request.
An investigation by The Oregonian in 2010 uncovered serious problems that persisted at the Oregon State Hospital despite multiple outside reviews, the threat of a federal lawsuit and millions spent on hiring and other improvements.
An internal review conducted after Perez’s death found hospital staff failed to provide him with adequate medical care. Fallout from his case led to the resignation of the hospital superintendent and increased scrutiny from the U.S. Department of Justice.
Hospital staff have made improvements since Perez’s death, said Rebeka Gipson-King, a spokeswoman for the Oregon State Hospital. Officials have increased medical staff, improved training and policies for patients who refuse critical medical care, implemented a policy for nurses to check on the patients at least hourly, and established guidelines for routine monitoring and treatment for certain patients.
Perez had spent 15 years at the state mental hospital after being found guilty except for insanity of attempting to murder his mother, Dora Perez, during a psychotic break. Records showed he later asked a police officer to shoot him and say that he tried to get away.