Aria said to deny violations in Rivera case

Aria Health executives said yesterday that staff members did not violate protocols in dealing with Joaquin Rivera, the 63-year-old man who died while waiting for care in the health system's Frankford hospital, but added that protocols would be changed in the hope of avoiding another waiting-room death.

City Councilwoman Maria Quiñones Sánchez and State Rep. Tony Payton Jr. said last night that Aria officials made the statements to them at a briefing in her City Hall office.

Representing Aria were Roy Powell, chief executive officer; Linde Finsrud-Wilson, chief operating officer; and Raphael Villalobos, chief financial officer. Payton participated by phone from Harrisburg.

It was the first time Aria officials had described in detail what happened to Rivera on the night of Nov. 28, when his watch infamously was stolen after he lost consciousness in the waiting room.

Aria officials, who could not be reached for comment last night, think Rivera died 11 minutes after walking into the hospital. He was sitting when his "feet kicked out, and that's when they believed he expired," Payton said.

That motion, which can be seen on a surveillance video of the emergency-room waiting area, happened when hospital staff were not present. Sánchez said the video was not shown during Aria's "minute-by-minute account."

About five to seven minutes after he died, a triage nurse came into the room and called Rivera's name, Sánchez and Payton said. A nurse later again came out and called for Rivera. As there was no response, Payton said they were told, the hospital staff then "moved on."

The hospital was not alerted to his death until another person in the waiting room reported that someone had taken Rivera's watch.

Payton and Sánchez said they were told that Rivera had complained of pain in his left side, but not his chest. He sat down, they said, was called to the counter and asked for insurance information, and sat down again.

In an older man, a general description of side pain can mean heart trouble, as it apparently did in this case, doctors say.

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 died a "natural death caused by hypertensive heart disease," according to Jeff Moran, a spokesman for the city medical examiner.

In light of the case, the hospital has implemented new procedures, Payton recalled hospital officials as saying.

One is called "rounding the ER," which means a triage nurse will come out and look for the person waiting to be treated.

Intake personnel will also receive more training, Payton recalled.

The hospital concluded that it did not violate existing protocols, Payton said.

"I take them at their word," he said, "but I'd still like to review the tape and wait for the state [Health] Department review."

Sánchez said that although she was satisfied that the hospital "has taken this case very seriously," she planned hearings to learn more about emergency-room care and whether a similar incident could have occurred at another hospital.

Aria's internal investigation is complete, she said. It is awaiting the Health Department review, which also is complete, she said.

Sánchez urged Aria officials to make the state report public. "I strongly encourage them to develop a better communications strategy," she said.

With the exception of a few brief statements, the hospital has been silent about Rivera's death since the controversy emerged.

Rivera's son, Joaquin Jr., said last night that he was "in no shape to comment. I just buried my father on Saturday."