Nearly four years ago, a sick young girl arrived in the Cheyenne Regional Medical Center’s emergency room, where two nurses found that she had a fever, trouble breathing and an abnormal heart rate. Hours later, after an examination by a physician’s assistant, she was discharged without being admitted.
Her parents found her dead on the living room couch the next morning.
The 7-year-old girl’s parents filed a lawsuit alleging that she was misdiagnosed and would still be alive had ER nurses and doctors followed hospital procedures. Cheyenne Regional Medical Center contests the claims and has called for the lawsuit to be dropped – but not because CRMC has a different view of the events that transpired.
Attorneys for the hospital are fighting the lawsuit, which now sits before the Wyoming Supreme Court, do not believe the girl received negligible care. Their main argument centers on the fact that CRMC is not liable because the nurses and contractors who saw her were independent contractors of the hospital.
CRMC’s use of contracted medical staff has come under fire in recent weeks. Doctors who have left or are leaving the hospital say the hospital’s reliance on independent contractors in the roles of doctors, nurses and other health specialists has resulted in degraded care, staffing shortages, long hours and a lack of confidence in leadership.
In December, the medical staff issued a no-confidence vote in the hospital’s chief executive. A subsequent internal investigation into the claims by the hospital’s Board of Trustees resulted in the board giving the CEO a unanimous vote of confidence, citing patient satisfaction surveys, their interviews with hospital workers and CRMC’s strong financial outlook.
“We want to reiterate that accountability remains a core value at Cheyenne Regional,” the hospital said in a statement earlier this month. “This includes all employees, clinical and non-clinical alike.”
But Sean Olson, an attorney whose firm has offices in Colorado, New Mexico and Cheyenne, said his clients’ case should call CRMC’s values into question. He represents the family of Amilya Young, a 7-year-old who died in 2021 after being examined and released by the ER medical staff at Cheyenne Regional.
The lawsuit names CRMC; Aligned Providers Wyoming, which is a medical services contractor; a traveling nurse; a contracted nurse; doctor and physician’s assistant; and a nurse who is employed by the hospital.
“When you walk into CRMC there’s no sign saying, ‘Hey, by the way, you know you’re entering this place at your own risk. We’re not responsible for any of the medical care you’re going to receive,’” Olson told Cowboy State Daily.
The attorneys representing CRMC in the case were not available Friday, a representative of their law firm said. A hospital spokeswoman said Chief Executive Tim Thornell was not available, but she provided a statement from Joanna Vilos, CRMC’s chief legal officer.
"Cheyenne Regional Medical Center is subject to the Wyoming Governmental Claims Act, which governs claims against public entities and can involve complex legal interpretations,” Vilos said. “The case currently pending before the Wyoming Supreme Court centers on an issue of statutory interpretation under this Act. As this is ongoing litigation, the hospital is not in a position to comment on the specifics of the case or legal arguments regarding liability."
Emergency Room Visit
Amilya Young, 7, died on Nov. 4, 2021, after doctors failed to diagnose Amilya with tracheitis, an inflammation and infection of the windpipe that can be life-threatening in children, Olson said.
She had checked into the Cheyenne Regional Medical Center’s emergency room the day before, just after 6 a.m. with symptoms that included a high temperature and trouble breathing.
Tammy Swann, a traveling nurse working at the hospital, checked Amilya in, according to the lawsuit. The hospital’s triage policy, according to the suit, requires check-in nurses to do a “focused assessment” on arrivals and assign ER patients a priority level.
Hospital policy requires that a patient’s vital signs be checked upon arrival, but that didn’t happen, according to Olson. After a short chat, Swann assigns Amiliya the second lowest priority of care. Amilya and her father go back to the waiting room. Assessments of patients’ vitals are supposed to be taken every hour but there is no record of one being done on Amilya after her first hour in the ER, the lawsuit alleges.
When a nurse eventually does an assessment, she finds that the girl has a 100.4-degree temperature, abnormal heart rate and trouble breathing. Amilya wheezes when she inhales and exhales. The nurse sends Amilya and her father back to the waiting room. Another hour and 50 minutes go by without a nurse checking on the young girl, the lawsuit claims.
More than three hours after arriving at the ER, Elise Jordan, a contracted physician’s assistant, begins reviewing Amilya’s case – while also creating discharge instructions, Olson said. Jordan examines Amilya at about 9:20 a.m., documenting that she was “well appearing” and not wheezing. She finds that Amilya’s temperature, heart rate and breathing rate are all normal. Jordan enters orders to discharge Amilya from the hospital without further care.
Nurse Jon Best, an employee of Cheyenne Regional Medical Center, begins to discharge Amilya, but not before taking her vitals. He finds the young girl to have an abnormal heart and respiration rate and an elevated temperature. The hospital’s Abnormal Vital Signs Policy requires nurses to notify a doctor or physician’s assistant of these irregularities but, the lawsuit claims, that never happened.
Amilya is discharged and leaves the hospital at 9:45 a.m.
Her parents found her dead the following morning. An autopsy report showed that she died of tracheitis, inflammation of the windpipe, caused by a viral respiratory tract infection. The plaintiffs believe she would still be alive had the medical staff at CRMC followed the hospital’s policies and procedures.
The physician’s assistant and a doctor overseeing that P.A. are employed by Aligned Providers, a hospital medicine contract management services company. A message left for the executive office of the company was not returned Friday.
Legal Arguments
An independent doctor with more than 25 years of administrative experience hired by Olson concluded that the hospital erred in multiple ways.
The plaintiffs claim CRMC had insufficient polices and procedures related to the triage of emergency room patients, completion of complete medical histories, supervision of doctors, credentialing, discharging, communication between patient handoffs, recognition of sepsis and inflammatory responses and other factors.
The failures, Olson said, has nothing to do with whether employees are contracted or not.
“These failures do not rely on the conduct of any other medical care provider within the emergency department,” Olson wrote in a legal brief. “These are choices and decisions made by the Hospital itself, through its employees.”
The hospital’s primary rebuttal is that it cannot be held responsible for the work of its contractor under state law.
“The Hospital argued that it could not be vicariously liable for contract staff's conduct because, under Wyoming law, a government hospital is immune from liability for the acts of its independent contractors,” the hospital’s attorneys wrote in a dismissal motion they filed on May 27.
The hospital said it cannot be liable for claims of “direct” negligence or that it failed to implement policies or procedures that could have prevented “these independent contractors’ alleged negligence.”
The hospital is basing its argument on Supreme Court caselaw that found that contracted workers for public agencies were not considered public employees.
The case has been fought all the way to the state Supreme Court but it’s not clear when the High Court will review it.
But Olson said the arguments CRMC is making, alone, should give patients pause. The hospital is more than a century old and an institution ingrained within the community of Cheyenne.
“When you hire these independent contractors out, they’re not a community or governmental organization who are just trying to provide good medical care,” he said. “They’re a corporation that’s trying to make money. Certainly CRMC is not the only hospital and Aligned Providers are not the only providers to be like this.
“This all comes along with the corporatization of medicine that we see these days everywhere. But I think the incentive for a provider like Aligned Providers is to do everything as cheaply and quickly as you can and obviously that has the potential to create a lot of unwanted consequences when it comes to patient care.”
Justin George can be reached at justin@cowboystatedaily.com.
