From seizures to paralysis

The first time Steve Martinez had a potentially fatal seizure at Saticoy Elementary in North Hollywood, a visiting Marine began CPR, then the school nurse took over — it was one of her two days a week on campus. The alert, skilled response allowed Steve to survive without a disabling injury.The next time he wasn't so lucky.The CPR was ineffective and administered by someone who later testified that she lacked qualifications, even though at least 17 people on campus had the required training.Now the 13-year-old lies paralyzed in a minimally conscious state, requiring around-the-clock care.

A jury last week found the Los Angeles Unified School District liable, awarding the Martinez family $7.6 million.The sizable verdict is the second this year in the wake of a tragedy involving a child. In February, a jury awarded $10.3 million to the family of a first-grader who died in 2005 when struck by a van that jumped the curb of a school parking lot. The school district intends to contest the parking-lot damage award; no decision has been made about the Martinez litigation.

Before Steve's final seizure at school, district staff "never appreciated the severity of the child's problems and the level of supervision and attention needed," family attorney Philip Michels said. "They never understood it despite multiple talks and documents from the mother and physicians. This was a failure of communication among the local school staff, the principal and the nursing supervisorial staff."A lawyer for the district disputes that, saying staff members not only discharged their legal responsibility, they reacted heroically as well. They tried to save the fourth-grader, general counsel Kevin Reed said, but good-faith efforts to administer CPR were simply unsuccessful."These are really, really hard cases," Reed said.

"Any time a kid is hurt it's a tragedy. The people who responded tried to do their best." No one contests that Steve brought serious health problems to school. As a baby, he required heart surgery. Then, in preschool, in another school system, he suffered a seizure, eventually leading to a diagnosis of epilepsy. Even worse, his seizures had a rare, especially dangerous element: They could stop his heart. Still, when the seizures appeared to subside, doctors tried to wean the boy off medication that had undesirable side effects.

Then on May 28, 2003, Steve, then 9, suffered a seizure at Saticoy that led to cardiac arrest. On that day, the Marine and nurse saved his life. But Steve had fallen on the playground atop a metal utility plate that had been heated by the sun. The boy suffered second- and third-degree burns.The family sued successfully over those injuries, which resulted in prolonged hospitalization, skin grafts and extended time away from school. The jury's award was $361,237. While discussing Steve's return to school, the family requested constant one-on-one supervision by someone trained in CPR. Steve's mother, Ana Martinez, notified the school of two additional seizures, at home, that had required CPR.

She declined an offer of free transportation to a school with a full-time nurse. She testified that the other facility was "too far from our home and had too many students." California law does not require schools to have nurses full time, so they frequently have to travel between schools. Ultimately, said Michels, the family attorney, Saticoy staff assured the family that the "school would have an adequate safety plan in place."At first, in January 2004, Steve came to school only on the two days that a nurse was present.

And he stayed in the office for recess, lunch and P.E. "All of his seizures were associated with running or vigorous play," his mother said in a sworn deposition.

Over time, Steve was allowed to join his classmates in the play yard. The school's plan to protect Steve included identifying at least 17 staff members who had or soon would obtain CPR certification so a qualified adult would always be close at hand.On April 18, 2005, Steve fell to the ground while playing on the basketball court.

The family contends that five to 10 crucial minutes passed before CPR began, because no adult was supervising the child and the subsequent response was inadequate. The first adult on the scene did not know about the child's health issues."They were panicked because they were not prepared," Michels said. "But they had every reason to be prepared because of their own experience with Steve, because of the mother and doctors cautioning them, and because they had already been through a lawsuit."L.A. Unified lawyers contend that the adults responded almost immediately.

The school district acknowledges that the CPR did not succeed.Both sides concur that the playground supervisor, who administered CPR, made a heroic effort. She later acknowledged that she lacked specific CPR training. She testified that she had attended most of a one-day first aid course in the late 1960s and had some knowledge of CPR from watching cable TV. The school district pointed out in court documents that another staffer, with CPR training, was assisting her.

The efforts to protect Steve also included training the playground supervisor and the principal on how to recognize a seizure. But no one certified in CPR stepped forward to take charge at the moment of crisis, Michels said.The jury award, he added, includes portions for pain and suffering, loss of future earnings and medical care for a life expectancy that the jury estimated would be about 10 years. Steve was initially diagnosed as being in a persistent vegetative state.

The upgraded diagnosis is "minimally conscious," meaning that the boy can respond, for example, to a request to squeeze a hand. He remains paralyzed, unable to speak or eat and incapable of breathing without assistance. What happened to Steve was a horrible tragedy, said Reed, the district's counsel, but "an adult was at this child's side in seconds. We think school-site staff acted valiantly, with total compassion and a great sense of urgency."