The Wrong Call
For all the irony of Jonathan Larson's death on the eve of meteoric success, even more tragic is the possibility that his life might have been saved. In the final four days of his life, Larson had been rushed to two New York City emergency rooms complaining of chest pains, only to be sent home without learning what was wrong. "Had they moved aggressively toward diagnosis, there might have been treatment options available that could have saved his life," says New York State Health Commissioner Barbara DeBuono, whose department fined both hospitals after an investigation.
The probe was an outgrowth of Al Larson's desire to be sure that everything possible had been done to save his son. But what started as a search for closure has ended, he says, as a nightmare. "We wanted to be told it was like a strike of lightning," says Larson, 71, a retired business executive who lives with his wife, Jonathan's mother, Nan, in Albuquerque. "But the more we learned about the fact that this shouldn't have happened, the more it keeps the wound open."
"There was a time bomb ticking in his chest in both emergency rooms, and neither heard it," says David Taback, the lawyer handling the Larson family's $250 million malpractice suit against the hospitals. "They turned a deaf ear and sent him home."
Jonathan Larson's fateful encounter with New York City's medical establishment began the evening of Jan. 21, 1996, at the beginning of the final week of rehearsals for Rent, the show Larson had labored over for six years. At about 6:45 p.m., Larson was watching a rehearsal at the 150-seat New York Theatre Workshop when he was suddenly struck by intense chest pains. "You'd better call 911, I think I'm having a heart attack," he told an actor just before he fell to the floor between the theater's last two rows. An ambulance brought him to the ER of Cabrini Medical Center, the hospital nearest the theater. "He was pale and clammy," says best friend Jonathan Burkhart, who met him at the hospital. "You've never seen a person breathe as hard as he was breathing." But an electrocardiogram and an X ray appeared normal. A doctor diagnosed food poisoning, pumped Larson's stomach, prescribed a powerful painkiller, Toradol, and sent him home.
The next morning, feeling no better, Larson phoned Cabrini to inquire whether tests showed evidence of food poisoning. "They couldn't find the results," says Jonathan's friend Eddie Rosenstein, who spent that day nursing him. "But he was told they were sure if there was something wrong he would have been notified." That evening, Larson's roommate Brian Carmody returned to their apartment near Greenwich Village to find Jonathan in bed, short of breath and speaking in a quiet mumble. He tried to eat but was only able to get down some Jell-O and tapioca pudding.
The following afternoon he called his father in Albuquerque. "His chest still hurt, his lower back hurt, and he had a low-grade fever," recalls Al Larson. "Frankly, I didn't think it was a life-threatening situation."
But by that evening, Larson's chest pains had again become so intense that he decided to return to the hospital. After Carmody called Cabrini—where, he recalls, an attendant said the hospital would be unable to get access to the records from Larson's previous visit—he took Larson by cab to St. Vincent's Hospital and Medical Center, which was closer than Cabrini. There, when Larson rated his chest pain at seven on a scale of 10, a nurse labeled his case urgent, but it was more than 90 minutes before a doctor could examine him. "I don't know," Burkhart recalls Larson saying. "I don't feel right, but I just want to get out of here." The doctor who finally saw Larson ordered an X ray and an EKG. Both were read as normal. Told he had a virus, Larson was advised to go home and rest. "They can't find anything. Nothing has changed," he told Carmody.
The following evening, Jan. 24, Larson had two items on his schedule—to watch the final dress rehearsal of Rent and, afterward, to be interviewed by a reporter for The New York Times. Arriving at the theater that evening, "he was happy to be there, though you could tell he was conserving energy," recalls Rent director Michael Greif. "He was moving slowly and didn't speak loudly. Jonathan was usually an exuberant guy, and he was behaving gently." After the rehearsal—the first time Rent was ever staged in its entirety—he met with Times reporter Anthony Tommasini in the only quiet space available, the theater's tiny box office. Toward the end of their talk, sometime after midnight, Larson, who had been working for 10 years as a waiter in a SoHo diner, told Tommasini, "I think I may have a life as a composer."
The remark would later haunt the reporter. When Carmody returned from a night out at 3:40 a.m., he discovered Larson's lifeless body on the kitchen floor, a gas flame still burning under a scorched tea kettle. "I was roaring at the top of my lungs, 'Wake up! Wake up, Jon!' " recalls Carmody. "I still thought he'd be okay." But police arriving shortly afterward told Carmody that Larson was dead. An autopsy later in the week revealed the aneurysm—an uncommon disorder, particularly in such a young person.
At first Larson's family and friends assumed he had been the victim of a freakish, unpreventable calamity. But as Rent's fortunes soared, the case attracted more attention. A report on ABC's PrimeTime Live raised serious enough questions that the New York State Health Commissioner launched an investigation. The results were stunning. "That chest pain was just not vigorously pursued as it should have been," says Commissioner DeBuono. It is difficult to diagnose an aortic aneurysm—particularly in young and otherwise healthy patients such as Larson. But the hospitals, says DeBuono's report, failed to carry out even the most basic tests, such as checking blood pressure and vital signs before he was discharged. Nor did they administer CAT scans or MRIs, tests that might have shed light on his condition.
X rays taken at both hospitals raised questions. At St. Vincent's, a radiologist noted that "heart size is at the upper limit of normal." "You'd jump all over that X ray," says New York Hospital cardiologist Dr. Richard Devereux, who, at PrimeTimeLive's request, looked at the film taken at St. Vincent's and found the heart to be overly large and the aorta unusually wide. "Without even seeing the first X ray for a comparison, you'd call up and say, 'Is this guy having any chest pain?' It wasn't subtle. It was a very abnormal X ray." A cardiologist examining the EKG wrote "? lat M"—for lateral myocardial infarction, the technical term for a heart attack. Yet there is no evidence that either hospital contacted Larson to follow up.
At Cabrini, concluded DeBuono's report, Larson had shown none of the usual symptoms of food poisoning—nausea, diarrhea or vomiting. So there was little basis for the diagnosis and even less for pumping his stomach, a procedure that might have aggravated Larson's condition. "Even for the diagnosis they had him labeled for, pumping his stomach was an unusual therapy," says DeBuono. "It didn't compute." And Toradol, the painkiller, might have dangerously masked symptoms. "It didn't allow doctors to investigate his pain," says DeBuono.
As a result of the findings, the state took the rare step of issuing fines—$10,000 against Cabrini, $6,000 against St. Vincent's—noting that the collaborative process necessary in emergency rooms broke down. "You're a team—we're not pointing a finger at one individual," says DeBuono. "We're saying to the hospitals, 'You could have done better.' "
But well enough to save Jonathan Larson's life? Perhaps. "It's pretty unlikely someone will survive this sort of thing without surgery," says Devereux. But if the aneurysm had been detected soon enough, doctors could have performed a graft to replace part of the aorta and perhaps undertaken a valve replacement. The survival rate for such a procedure would be over 80 percent, Devereux says.
Still, the hospitals maintain they did nothing wrong. "Our exhaustive review indicates that Mr. Larson's evaluation was medically thorough and appropriate," St. Vincent's said in a statement. (The doctors implicated in the case have declined to comment.) Echoed Cabrini: "The care rendered to Mr. Larson did not constitute malpractice and was not causally connected to his subsequent demise."
Jonathan Larson's family has reached a different conclusion, and depositions in their malpractice suit will be taken starting this month. Any money the family might win from the suit will go to a new foundation that, Al Larson says, will work to "shake up the medical community and make doctors remember there's a human being in their hands." What he has learned since losing his son, he says, is that hospitals are so concerned with the bottom line that they frequently lose sight of their mission. "I'm going to push this for all it's worth," he says. "I want every hospital administrator in the country to know that in the long run, it's going to be cheaper to take care of people properly than it is to let them die needlessly."
CYNTHIA WANG and HELEN! STAPINSKI in New York City, KAREN RRAILSFORD in Los Angeles and BRYAN ALEXANDER in London