Health and Science

A hospital's mistake paralyzes a designer. He got $20M, and an unusual promise

August de los Reyes
Source: Rein Ewerth

Most people wouldn't want to have anything to do with a hospital after suing it for paralyzing them, and winning a $20 million settlement.

August de los Reyes isn't most people.

A former top Microsoft designer, de los Reyes became a paraplegic after a visit to Overlake Hospital Medical Center in Bellevue, Washington. His repeated warnings that he might have suffered a back fracture weren't properly heeded by doctors and others at the institution, which left him confined to a wheelchair.

The hospital itself told CNBC was "the result of tragic circumstances related to communications breakdowns between members of his care team."

As part of his new legal settlement with the hospital, which agreed to pay him $20 million, de los Reyes also got Overlake to agree to work with him on analyzing how and why things went wrong for him, conducting what he said would be "a case study."

"For selfish reasons I just want to know where this broke down and why this happened," de los Reyes said. The 45-year-old was hired by Microsoft in 2003. He spent seven years at the technology behemoth before departing, only to return in 2013 to head Microsoft's Xbox design team. Last month, de los Reyes left Microsoft to become design manager at Pinterest, the web and mobile application company.

The ultimate goal of the case study, which has already seen two meetings between de los Reyes and top Overlake brass, is to take the lessons learned and develop solutions that can be applied at Overlake — and potentially other hospitals.

As part of that effort, he is tapping a network of designers to bring their expertise at identifying problems in systems, and crafting solutions.

Among them is with Allen Sayegh, principal at Invivia design firm and an associate professor at Harvard Graduate School of Design, where he taught de los Reyes.

"As a designer ... I think there's a lot of possibilities and potential in this because things have been the same for a long time in health care," Sayegh said. "We can translate what we've learned from design, designing systems, projects and running experiments and translating them into health care."

Sayegh added: "If there's anybody that can do it, it's August."

De los Reyes told CNBC that in the aftermath of becoming paralyzed, he said to his sister, "All I want is to make sure that this doesn't happen to anyone else."

"It would be a mistake to treat this as an isolated incident limited to a single provider," de los Reyes said. "Let's take all of the lessons we've learned and use them to make hospitals everywhere safer for patients."

The project is unusual, and possibly unique.

Other medical malpractice settlements have included promises by hospitals to make specific changes in practice or policies in response to a case. But de los Reyes' lawyer Robert Gellatly said he is unaware, after 30 years of malpractice litigation, of another one in which the hospital's top executives are collaborating with the injured patient after the settlement to investigate and propose possibly sweeping changes.

'every single time'

De los Reyes suffers from an autoimmune disorder known as anklylosing spondylitis, or AS. The disorder causes the spine to become brittle and susceptible to fracture from even minor trauma.

On May 11, 2013, de los Reyes slipped off of his bed while shifting around, an accident he attributes to some luxurious new sheets and bedding. A day later, suffering from severe back and abdominal pain, he went to Overlake Hospital.

De los Reyes said that during that first visit, as well as during two other ones within the next 24 hours and then another visit two weeks later, "every time — every single time" — he told doctors he had AS and that he feared he had suffered a back fracture from the fall.

"I was very explicit ... about concerns about a back fracture," he said, noting that his physician father had made a point of telling him repeatedly that he should withhold no information from a doctor.

During his first visit, he received an imaging scan after he voiced those concerns. The doctor "reassured me that I didn't have a fracture and sent me home," he said.

De los Reyes' lawyer Robert Gellatly said that scan actually had detected a hairline fracture in his back. But the break went unnoticed by doctors because the image was focused on his abdomen, the attorney added.

Gellatly also said that the first emergency room doctor who dealt with de los Reyes "didn't make a note until five days later" that documented de los Reyes had said he had AS, and feared he had a back fracture.

As a result, "Critical information was not available to the health-care team, even as August returned to the ER time after time," Gellatly said.

On May 25, 2013, de los Reyes returned to Overlake's emergency department in what he said was "unspeakable pain," and tingling in his waist and legs. Doctors doctors had him undergo both a lumbar MRI and a thoracic MRI scan.

While medical staff moved him around into position for the MRI scanning, de los Reyes suffered severe pain and lost feeling in his legs, according to his account and court documents.

The scans detected a fracture in his back—which ended up leaving de los Reyes paralyzed.

De Los Reyes was unconscious when he was transferred to another facility, the Harborview Medical Center.

'Everything will be OK'

When he woke up, he saw his sister in his room, along with a doctor.

"He told me that I had broken my back, and my spinal cord had been damaged, and I would no longer be able to walk again," de los Reyes said.

"My sister started to cry," he said. "My first reaction was [to tell her] that 'everything was going to be OK.'"

The 2014 lawsuit that de los Reyes filed against Overlake says that records from Harborview "state that his back was likely broken while being positioned for the MRI at Overlake."

After the phases of grief

In the aftermath of becoming paralyzed, de los Reyes said "I did go through all of those phases, including anger," particularly after learning that the initial spinal break had been exacerbated during the preparation for the MRI.

"But I don't know if I was angry so much as a particular person or the institution," he said. "I was really angry about the situation under which all of this had happened."

De los Reyes added: "If this had been a different set of circumstances, I'd still be walking."

His sister, while searching for a law firm to represent him, kept in mind his stated desire to prevent the same set of circumstances from happening to someone else.

The firm he chose, the Luvera Law Firm, has a policy of not accepting requests by doctors and hospitals for putting confidentiality agreements in settlements the firm obtains for medical malpractice clients, Gellatly said.

"It does not serve the public interest," said Gellatly, who argues that transparency in cases involving medical errors is necessary to drive reform in the health-care industry.

Gellatly pointed to a recent study that estimates that medical errors are the third-leading cause of deaths in the United States, with more than 250,000 fatalities each year.

Despite being a legal adversary in the case, Overlake ended up being open to the idea of boosting transparency. The institution was also interested in potentially instituting reforms at the hospital, with the help of de los Reyes and other designers.

In a prepared statement, Overlake said, "The organization is saddened by what occurred with Mr. de los Reyes in May 2013, and our hearts go out to him and his family."

Overlake CEO J. Michael Marsh, who has already met twice with de los Reyes, said, "Mr. de los Reyes' willingness to participate with Overlake Medical Center to improve patient safety is a great asset."

"Overlake's unwavering commitment to patient safety and quality transparency has been lauded by multiple government and health care monitoring agencies, including The Joint Commission and Leapfrog," Marsh said.

"Activating de los Reyes' direct perspective as a patient and as an expert on systems design and design processes will help Overlake with innovative ways to achieve even greater heights with safety and quality," Marsh added. "I look forward to learning from and working with him."