Christopher Jones arrived at Olive View-UCLA Medical Center in Sylmar on Sunday complaining of chest pains.
Jones, 33, was told to sit in the waiting room until it was his turn. He didn't receive a simple test to determine whether his heart was functioning properly, a measure that is standard practice nationally in cases of chest pain, Los Angeles County officials said.
After more than three hours, Jones got up, walked outside, collapsed face down on the pavement and died within minutes.
The incident, which is being investigated by state regulators, is the latest case of questionable patient care delivered at Olive View, a public hospital run by the county. The California Department of Public Health has cited Olive View for medical and other problems five times this year.
The county's Department of Health Services has launched its own investigation into Jones' death and placed on administrative leave the nurse who initially assessed him, county officials said.
County coroner's officials said they need to conduct more tests before determining the cause of death. The county health department declined to comment, citing patient confidentiality, but other county officials confirmed the details of the case to The Times.
Medical records reviewed by The Times show the Olive View triage nurse never wrote down basic details about Jones' complaints, including the location of his chest pain or how bad it was. Those symptoms are key to determining how the hospital should respond.
Jones had his pulse, blood pressure and blood sugar levels tested. The medical records do not show he was given an electrocardiogram, a test used to diagnose heart attacks.
The American College of Cardiology strongly advises hospitals to conduct an EKG within 10 minutes of a patient's arrival at an emergency department if he or she complains of chest pain or has other symptoms associated with a heart attack.
"The protocol is just about anybody that comes in with chest pain gets a rapid EKG at triage," said Dr. Robert Goldweber, assistant director of the emergency department at Huntington Hospital in Pasadena.
But Goldweber cautioned against drawing conclusions about the case before the coroner determines a cause of death. He said Jones may have died from something other than a heart attack, such as a massive stroke, that an EKG might not have detected.
Among the most serious incidents of the five earlier cases cited by the state was the burning of a patient during surgery Sept. 24, when a fire broke out in the operating room.
In addition, state investigators are probing the death of a patient who sought help earlier this month after eating highly toxic oleander leaves. In that case, a county police supervisor allegedly refused requests to pick up doses of an antidote from a nearby hospital.
Supervisor Mike Antonovich, whose district includes Olive View, released a statement Tuesday saying his office was "investigating this case to determine whether it requires isolated disciplinary action against one individual or a more systemic approach."
The hospital's latest problems come just months after the county closed Martin Luther King Jr.-Harbor Hospital after it failed for years to meet federal patient care standards. Medical experts said Olive View's current problems do not compare to the long history of medical lapses at King-Harbor.
"Olive View-UCLA Medical Center has a stellar reputation and track record," said Jim Lott, executive vice president of the Hospital Assn. of Southern California. "We need to give them time to look at these cases and have independent reviewers look at these cases."
Jones was returning from a weekend in Las Vegas with a friend, John Carlson, when he began experiencing chest pains Sunday afternoon. By the time they reached Sylmar, Carlson said, his friend was complaining about pain down his left arm.
"That's the sign of a heart attack," Carlson recalled saying.
Carlson, who was driving, got off the freeway and dropped Jones off at the Olive View emergency room. When he returned from parking the car, he said Jones was standing at the counter, completing paperwork. A woman behind the counter told Jones to sit down.
"He's like, 'My chest hurts, my arm hurts, and I'm shaking uncontrollably. And you need to see me right now,' " Carlson recalled.
Jones was shown to a room and told Carlson to leave, reassuring him he would be fine.
Medical records show that Jones was first assessed at 1 p.m. He told a triage nurse he had arm pain, chest pain and chills. His last alcoholic beverage was the previous afternoon.
He told the nurse he was a heavy smoker -- 1 1/2 packs a day -- and drank a couple beers a day. His blood pressure was high but not what doctors would consider alarming, the records show.
It was three more hours before Jones was seen again by a nurse. This time, his blood pressure had gone down but his pulse had gone up. Still, he was not given an EKG.
Twenty-five minutes later, Jones was found on the ground outside the emergency room. He was vomiting and appeared to be having a seizure. CPR was unsuccessful, and he was pronounced dead, the records show.
Jones' mother, Cathy Waters, said she was devastated and angered. She said he had kicked a drug habit 10 years ago and had just fulfilled a goal to join the Teamsters Union as a carpenter working on studio sets.
"He was just the sweetest guy in the world," she said. "I'm very upset if this turns out to be that they didn't do what they were supposed to."