The sound of taps has long faded from the cemetery where Los Angeles County Sheriff's Deputy Nelson Yamamoto was buried last year after undergoing surgery for gunshot wounds.
But the case is far from closed. For 18 months, a high-stakes criminal investigation has quietly focused on whether Yamamoto's death was caused by the gross negligence of doctors at Martin Luther King Jr./Drew Medical Center.
Although the county coroner concluded that Yamamoto died of gunshot wounds, the district attorney's office is examining allegations that the deputy received excessive amounts of blood and other fluids and was given inappropriate cardiac drugs shortly before his death.
"We're looking at the care that was provided (and) . . . whether it was a proximate cause of the deputy's death," said Deputy Dist. Atty. Brian Kelberg, head of the office's medicolegal division, who is working with investigators from the California Medical Board and the sheriff's homicide division. "Was it such an extreme departure from the standards of medical care to warrant a charge of involuntary manslaughter?"
Dr. James G. Haughton III, former medical director at King, said the physicians did their best to save the rookie deputy from very serious injuries to his groin and thigh. He said Yamamoto's medical records have been reviewed by three local experts who agreed in confidential reports that the care met acceptable standards of practice.
"This is such a volatile situation," said attorney William C. Moore of Beverly Hills, who is representing six doctors. "It's a medical malpractice case with criminal consequences. It's very very complex."
The Yamamoto investigation has reverberated through the highest levels of county government. The sheriff, district attorney and a county supervisor have taken an interest in the case, which climaxed last week with the hospital's vice chairwoman of surgery appearing before a criminal grand jury.
Now the county counsel has stepped in to defend the surgeon. And the family of the slain officer is preparing to file a malpractice lawsuit, based partly on facts unearthed by the investigation of Yamamoto's medical care.
"My understanding is that it is very possible he'd be alive today but for mismanagement that took place," the deputy's father, Henry Yamamoto, said Thursday.
The investigation pits a beleaguered county hospital against watchdogs at the state medical board who have been accused of ignoring problems at King in the past.
This year, the state medical board reopened six cases at King after auditors charged that they had been closed prematurely. One case involved a patient with an ovarian cyst who died after a series of surgical mistakes summed up by the county coroner as a "therapeutic misadventure." Another patient died after a hernia operation.
King officials said the 480-bed county teaching hospital just south of Watts has made great strides since 1989, when state health inspectors found serious patient care problems and federal officials threatened to withhold funding.
King's administrator, Edward J. Renford, said the investigation into Yamamoto's death is frustrating because "we've been working very hard at King to provide high quality service, and the reports and reviews that have been done show our success."
The hospital is renown for its heavy load of trauma patients and a medical staff that is skilled at treating multiple gunshot wounds. The Army once sent doctors to train at King because the wounds treated there resemble combat injuries.
In Yamamoto's case, his gunshot wounds were serious enough to cause death, even with excellent medical attention, the coroner's office said. An autopsy found excess fluid in the deputy's body and lungs but concluded that Yamamoto died from his wounds, which caused massive hemorrhaging leading to shock and lung damage.
Kelberg has challenged the coroner's report, saying the deputy coroner lacked important information about Yamamoto's care. The coroner declined to comment.
During the long investigation, top county officials, including Sheriff Sherman Block, have received periodic updates. County Supervisor Yvonne Brathwaite Burke, whose district includes the hospital, said she has discussed the investigation with Block and recently asked the office of the county counsel to advise the surgeon summoned by the grand jury.
Noting improvements in patient care at the hospital, Burke said she is confident there was "no intentional maltreatment or gross negligence" in Yamamoto's death.
County health services director Robert Gates, who was briefed on the case several months ago by Dist. Atty. Gil Garcetti, said of the investigation: "It's potentially extremely serious."
At the vortex of the storm is Nelson Yamamoto, buried in April of 1992 with a hero's funeral that drew nearly 4,000 uniformed officers from all over Southern California.