Although county attorneys claim that Olive View Medical Center did not overlook a birth defect that caused the death of a newborn child last year, the hospital changed several procedures shortly afterward to prevent such incidents.
Medical personnel in Olive View's maternity wing said this week that soon after the Sylmar hospital learned of the February, 1990, death, nurses were instructed to perform an additional exam to be sure babies' bowels are functioning normally.
Nurses were told to use a tiny plastic tube to make closer inspection of newborns' anuses and were also told to ask all new mothers to save dirty diapers for inspection.
The baby who died was born with a sealed anus that prevented it from eliminating wastes, a condition that medical experts said could have been corrected by surgery had it been discovered earlier.
Carolyn Rhee, assistant administrator at Olive View, confirmed that nurses now do the extra anal exam, but because of the pending litigation she would not comment on whether the examination was related to the newborn who died.
Steven Ruiz died Feb. 5, 1990, and his parents--Patricia Chavez, 17, and Reynaldo Ruiz, 21--have filed a medical malpractice lawsuit against Los Angeles County, which operates the hospital.
A Pasadena law firm representing the county, Torres & Brenner, has argued that the hospital is not responsible for the death because the baby who died during emergency surgery at Northridge Hospital Medical Center was not the one born to Chavez at Olive View on Jan. 31.
A doctor and a nurse who worked in the Olive View maternity ward when Chavez's baby was born and a nurse who began working at the hospital three weeks later said the changes in procedures were made in response to the death.
The county has said the baby was healthy when it left Olive View.
K. Joy Kemper, who was hired as a labor and delivery nurse at Olive View at the end of February, 1990, said she was surprised to notice a nursery nurse performing the anal exam.
"I asked her why and she said apparently a baby had died and so we were checking extra carefully," Kemper said.
The doctor and the other nurse refused to be identified.
Attorney Leonard E. Torres of Torres & Brenner said the litigation prevented him from commenting on any procedural changes that have occurred at Olive View as a result of the Chavez baby's death.
In another change after the death, the hospital's administration reportedly refused to rehire the three temporary nurses who cared for Chavez and her baby.
Diane Whittaker, one of the nurses, said that the next time she was assigned to Olive View by her nursing employment agency, a staff nurse told her to leave.
Asked about that decision, Thomas V. O'Hagan, an attorney representing the employment agency, said he could not confirm that such a move occurred, but said it would not be uncommon under the circumstances.
O'Hagan has said he has proof that Chavez brought someone else's gravely ill baby to Northridge Hospital the day the child died.
Torres and other attorneys for the county also have claimed in court papers that there were two babies, although county officials acknowledge that this theory has not been fully investigated.
Chavez's attorney, Aileen Goldstein, is arranging for the baby's body to be exhumed so that DNA tests can be performed in an attempt to genetically link the dead baby to Chavez and her boyfriend.
After the allegations about a baby switch surfaced in the case earlier this month, County Supervisors Mike Antonovich and Gloria Molina asked the county Department of Health to conduct an internal investigation of the incident.
Both said they were concerned that the county's legal protocol, which calls for turning some cases over to private firms, may have prevented close scrutiny of the incident.
"I'm concerned as to how we just kicked this off to private attorneys," Molina said earlier this week.
Antonovich's health deputy, Kathryn Barger, said county health administrators told her this week about the procedural changes.
She said Antonovich also will ask the hospitals to begin footprinting all babies, so that identities can easily be proven.
"It's something that whether we were right or wrong, we need to put this in place," Barger said. "We live in a time where the hospitals are facing a lot of patients coming in. . . . We're going to see a lot more changes."
Administrators from other hospitals differed in their views of the new procedures.
All babies born at the county's Martin Luther King Jr.-Drew Medical Center have their temperatures taken rectally at birth to ensure that the anal passage is open.
Also, said Janine Rooney, director of nursing at the hospital, babies "are not released until the nurse actually visualizes the stool."
But a supervisor of the intensive care nursery at the University of California Medical Center at San Francisco said the practice of inserting a tube was abandoned in the mid-1970s because it often caused injuries.
Olive View's maternity ward has struggled to keep pace with an exploding birth rate since it opened in November, 1987.
It has averaged 600 births a month, although it is officially licensed for 300.
The overflow led to citations by the state Department of Health Services in November and caused doctors and nurses to openly worry about the potential for serious mistakes.
In an interview last fall, Dr. Sue Hall, a neonatologist, said: "I've seen residents miss very important physical findings because it's 5 a.m. and they were too tired to examine babies."