By Soumya Karlamangla, LOS ANGELES TIMES

December 27, 2019

https://www.latimes.com/california/story/2019-12-27/self-blinded-man-psych-hospitals-lawsuits

Roman Arustamyan can’t see the holiday decorations surrounding him, or his wife and children shuffling around in sweaters in their Van Nuys home.

Arustamyan, 64, was diagnosed with a severe mental illness more than two decades ago. His family said medicines helped the retired neurosurgeon keep his symptoms in check and stay mostly healthy — until 2013, when he removed one of his eyeballs during a stay at a local psychiatric hospital.

Three years later, Arustamyan badly damaged his other eye during stays at two different hospitals, and it had to be removed, the family said.

Arustamyan is one of hundreds of people across the state who have been injured while admitted to psychiatric hospitals in California over the past decade, according to a Times analysis. Most of the incidents were caused by low staff, staff errors and unsafe facilities, the analysis found.

Patient advocates say these problems continue in part because people struggle to bring lawsuits against hospitals for wrongdoing. Attorneys often won’t take the cases because a California law limits payouts in medical malpractice suits so much that even the most favorable verdict wouldn’t cover the cost of years of litigation, they say.

But the Arustamyans’ attorneys found a way to get around the cap and sued three hospitals for Roman’s injuries.

Instead of suing for medical malpractice, the attorneys tried a different tack: A judge allowed them to sue for dependent adult abuse, freeing them from the malpractice payout cap.

Jeff Rudman, president-elect of the Consumer Attorneys Assn. of Los Angeles, said he had never heard of the strategy being employed before.

Arustamyan’s daughter, Seda, said she hopes the lawsuits will open the door for other families to hold psychiatric hospitals accountable and hopefully will lead to improved patient care.

“How can you put a person you love so much in a hospital like that?” said Seda, 33.

In 1992, Roman and his wife, Karine Arustamyan, left Armenia with their three children after the collapse of the Soviet Union.

Roman, who had been a neurosurgeon in Armenia, began working as a surgical technician in Skokie, Ill. He also started studying to become a licensed physician in the United States.

But in 1995, he was diagnosed with bipolar disorder and had to quit his job. The family moved to Los Angeles to be closer to friends who had also moved from Armenia.

For years, Roman lived comfortably at home with his family. He chatted with Seda about the volleyball team she coached, watched soccer with his son Ernest and played with his grandchildren. He would occasionally be hospitalized for manic behavior, but medicines typically kept his condition — now diagnosed as schizoaffective disorder — under control.

In early 2013, during a trip to Armenia, he stopped taking his pills and became aggressive and agitated. Upon his return, he was hospitalized at BHC Alhambra Hospital, a psychiatric facility in Rosemead.

A week later, Seda said she received a call from the hospital: Her father had removed his eyeball.

“I was so confused by how something so extreme could happen in the care of a psychiatric hospital,” she said.

Removing one’s own eye, known as autoenucleation or self-enucleation, is a rare symptom of psychiatric illnesses, most commonly schizophrenia, according to a 2007 review paper on the phenomenon. A previous Times analysis of self-harm incidents at California psychiatric facilities over the past decade identified at least two patients who removed their eyes while admitted to the hospital.

The Arustamyans decided to sue BHC Alhambra, alleging that it failed to protect Roman.

A 1975 California law placed a $250,000 cap on medical malpractice payouts other than for medical bills and loss of future earnings. The law did not include increases for inflation.

The law’s supporters say it prevents frivolous lawsuits and keeps down doctors’ malpractice insurance premiums. Patient advocates argue the limit has prevented valid cases from being brought against hospitals.

In 2014, an unsuccessful state ballot measure would have increased the cap to $1.1 million — the original amount had it grown with inflation. Advocates are now collecting signatures to try to put a similar initiative on the 2020 ballot.

“California is the most progressive state in America, but it literally has the most regressive medical negligence laws,” said Jamie Court, president of the nonprofit Consumer Watchdog.

During the trial last year, the Arustamyans’ attorneys argued that the hospital had failed to give Roman his medicines the night he harmed his eye. He was not monitored every 15 minutes as had been ordered, they said.

At trial, the eye specialist who treated Arustamyan in the emergency room testified that he had removed his eye with such precision — something that only a trained surgeon could likely do — that it must have taken more than an hour to do so, according to court documents. The clean cut that severed the optic nerve made it impossible to restore his vision, she testified.

“Your whole job is to prevent something like this from happening, that’s what they’re there to do,” attorney Steve Vartazarian said in an interview. “They just didn’t do it.”

In August 2018 a jury awarded the Arustamyans $772,000, according to court documents. The jury did not find that staff had acted with recklessness or malice.

In a statement to The Times, hospital CEO Peggy Minnick said there is video evidence that Arustamyan was checked on every 15 minutes, per hospital protocol. She also pointed out that state officials who reviewed the case did not cite the facility for any violations.

“Every member of our team of professionals is dedicated to supporting the well-being of our patients and their loved ones,” she said. “Our work is driven by our commitment to serving each person with dignity and respect.”

Lawsuits against Adventist Health Glendale and Royal Palms Convalescent Hospital in Glendale are pending.

The Arustamyans’ attorneys say in legal papers that staff members at Adventist did not monitor Arustamyan closely enough, allowing him to severely injure his eye, which then had to be removed. He was later transferred to Royal Palms, where he damaged his eye socket, they say.

Adventist Health spokeswoman Alicia Gonzalez said in a statement that hospital officials “disagree with the alleged facts in this case” and are confident they “will establish that all appropriate measures were provided for patient safety and care.”

“We are deeply committed to the safety and the well being of all of our patients,” she said.

An attorney for Royal Palms said he could not comment on the litigation.

Since he lost his sight, Roman spends most of his time resting. He requires help with almost any activity, including eating and showering. He tried listening to soccer games on TV with Ernest, but he became frustrated. He didn’t like audio books for long either.

Before he became ill, he was a well-respected neurosurgeon. During a major earthquake in Armenia in 1988, Roman performed brain surgery on a 5-year-old girl whom others had declared dead, Karine said. The girl’s family later asked him to be the child’s godfather, she remembered.

Now, Seda and her siblings closely follow scientific trials to restore sight to blind people, and report the developments to their dad.

“He always is like, ‘I hope I would be the first candidate to be able to get that,’” Seda said. “It’s so hard to hear him say that.”

Seda, an administrator at a local school, recently got engaged and is planning her wedding for next year. She begins to cry when she realizes that her dad will never see her children. Her mother, sitting beside her, puts a hand on her shoulder and wipes tears from her own eyes.

But still, Seda said she is grateful her father is alive. On her wedding day, the two of them will ride in a horse and carriage to the wedding venue.

Then he will walk her down the aisle.

Soumya Karlamangla has been a reporter at the Los Angeles Times focusing on health issues since 2013. She was raised in Thousand Oaks and graduated from UC Berkeley with degrees in biology and English literature.