Changes Following Black Woman’s Death At Inglewood Hospital Don’t Add Up To Accountability, Family Says

In the months since a Black woman died in childbirth at an Inglewood hospital, that facility has announced the closure of its maternity ward, been investigated and fined by the state, and now faces a lawsuit from the woman’s partner.

April Valentine died at Centinela Hospital in January 2023 from a blood clot. Valentine’s family and friends say her doctor and the hospital failed to treat one of the most common and preventable causes of death during pregnancy.

Those who were close to her have called for accountability from state health care regulators and her providers.

“It gives me more hope and it lets me know that my voice didn’t go unheard,” said Nigha Robertson, Valentine’s partner. “It lets me know that everybody who played a part in the Justice for April [movement], didn’t go unheard.”

Still, Robertson and maternal health advocates say they have not yet seen accountability for Valentine or other families harmed by the Black maternal health crisis.

It gives me more hope and it lets me know that my voice didn’t go unheard. It lets me know that everybody who played a part in the Justice for April [movement], didn’t go unheard.

— Nigha Robertson, April Valentine’s partner

Black Californians die from pregnancy complications at a rate nearly four times higher than the general population. Research shows the factors that contribute to the disparities in Black maternal health stem from systemic racism, including lack of access to high-quality health care and health conditions stemming from chronic stress.

“Real accountability would look like a fix in this system that is, you know, contributing to these situations,” said Sonya Young Aadam, CEO of the California Black Women’s Health Project.

About this story

  • This story is a follow-up on an investigation published in February 2023. Read our initial reporting on Valentine’s death and her family’s fight for accountability.

  • Content advisory

  • This story talks about the death of a pregnant Black woman in childbirth and disparities in maternal and infant health.

  • If you’d prefer, you can also explore resources about how to navigate pregnancy.

  • You might notice this story uses the term pregnant or birthing people. That’s because our newsroom uses language in reproductive health that includes people of different genders who can give birth.

  • To see a full explanation of our language choices, check out Dialogue, LAist’s style guide, and give us feedback.

Where investigators say Centinela Hospital failed

The Los Angeles County Medical Examiner attributed Valentine’s Jan. 10 death to a blood clot, a preventable and well-known cause of death during pregnancy and childbirth.

A Centinela Hospital spokesperson told LAist earlier this year in response to questions about Valentine’s death that “despite the highest standards of care, there are certain medically complex and emergent situations that cannot be overcome.”

But multiple state public health investigations show gaps in Centinela Hospital’s care. Valentine is not named in the investigations, but the narrative of one of the anonymous patient’s care matches the story of Valentine’s death, as shared by her family and partner.

Valentine’s partner and sister both say she complained of pain, numbness, and swelling in her legs for hours while at the hospital.

These symptoms can be the sign that blood has clumped together and is blocking the flow of blood. In Valentine’s case, the Medical Examiner found a clot formed in her leg and traveled to her lungs. This is called a pulmonary embolism.

In July, the California Department of Public Health fined Centinela Hospital Medical Center $75,000 — the maximum financial penalty for a first deficiency that “has caused, or is likely to cause, serious injury or death to the patient.”

The accompanying report describes how the hospital failed to:

  • Assess the patient’s risk for a specific type of blood clot.
  • Notify the patient’s physician when her vital signs became abnormal. 
  • Assess and intervene when the patient complained of “leg heaviness.” 
  • Monitor the heart rate of the unborn baby and notify the physician when that heart rate decreased.

Ultimately, the investigation found the hospital’s “failures resulted in the death of Patient 1 during labor and delivery.”
A separate California Department of Public Health inspection weeks after Valentine’s death found the hospital risked patients’ lives by failing to take preventative measures to reduce the risk of blood clots.

Pregnancy and blood clots

  • Pregnancy increases a person’s risk for clots because the blood thickens and circulation to the legs can be reduced if the baby presses against the blood vessels in the pelvis.

  • Symptoms of a blood clot lodged deep in the body can include swelling, skin redness, warmth and tenderness in the area.

  • Signs that a blood clot has moved to the lungs include shortness of breath, fast or irregular heartbeat, chest pain, coughing up blood and chest pain.

  • Los Angeles OB-GYN Dr. La Tanya Hines said while some of those symptoms are part of a typical pregnancy, physicians need to take a patient’s claims seriously.

  • “The customer is always right and so is the patient,” Hines said. “It is our obligation as physicians and providers to address it and work it up to the extent that we believe either this is a problem or not.”

  • Hines said preventing blood clots starts with identifying factors that may increase a patient’s risk and then intervening with an ultrasound to try and detect a clot, medication that thins the blood, or other treatments.

  • Building trust is also key.

  • “I also believe the connection as a physician to the patient is to really listen to what their fears are,” Hines said. “And then to say, ’These are the things that we are willing to do. Can you go with me to make sure that we can have a safe outcome?’”

The hospital created a plan to fix the deficiencies described in the state’s investigations, including re-training staff and implementing measures to help prevent patient blood clots, but declined to provide further details to LAist.

It’s unclear whether the staff who cared for Valentine or other patients described in the investigations faced any discipline. The Medical Board of California is responsible for investigating complaints against licensed physicians.

“Out of respect and due to privacy laws, we do not discuss the treatment of specific employees,” a hospital spokesperson wrote in a statement.

Inglewood loses maternal health care

Prime Healthcare, which operates the hospital, announced maternity and labor services at Centinela will end in October, citing a decrease in demand for labor and delivery care, and an increase in need for other services, including behavioral health.

“As Centinela remains committed to serving evolving patient and community needs, the decision was made to create capacity for services of greatest benefit,” a hospital spokesperson wrote in a statement.

LAist has requested documents from the California Department of Public Health related to the maternity ward’s closure, but has yet to receive those documents.

Centinela Hospital health care workers protested amidst ongoing contract negotiations in August, saying that understaffing “undermines patient care,” reported the Los Angeles Daily News.

The upcoming closure has left maternal health advocates and Valentine’s family with conflicted feelings. Aadam, with the California Black Women’s Health Project, called it an “ugly catch-22.”

“We can’t afford to lose more places in the community,” Aadam said. “But on the other hand, as a community, we also don’t want to send anyone to a place … they could potentially lose their life or the life of their child.”

Patients who would have gone to Centinela will now be directed to expanded maternity services at St. Francis Medical Center in Lynwood, another hospital in the Prime network that’s 10 miles east of Inglewood.

“Now you’re punishing the community along with the hospital,” said Robertson, Valentine’s partner. ”The community did nothing wrong.”

A recent report from the California Department of Public Health found that more than 40% of Black birthing people in the state lived in neighborhoods with the “least health-promoting conditions” such as crowded, unaffordable housing, environmental hazards and low access to health care.

Family’s fight for accountability continues

Robertson filed a wrongful death lawsuit against Centinela and Valentine’s health care providers in late August.

“I’m doing it because I lost someone I love and I want her to get justice ’cause it was wrong,” Robertson said.

The suit outlines alleged failures in Valentine’s treatment including:

  • Nursing staff’s dismissal of multiple complaints of swelling, numbness and heaviness in her legs. 
  • A lack of communication between nursing staff and her physician despite changes in Valentine and her unborn daughter’s vital signs. 
  • Denying hospital entry to Valentine’s doula, a planned member of her support team. 
  • A “stark bare hospital room” did not match the facility’s advertised promise of a “home away from home” birthing suite.
A woman with brown hair and dark skin tone stands with her eyes closed and holds a white sign with black letters that says

April Valentine’s cousin Alexus Alexandria attends a vigil outside of the hospital where Valentine died.

(Mariana Dale

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LAist)

Medical malpractice lawsuits are often expensive to litigate and require expert legal and medical counsel.

For almost 50 years, California has limited the amount of money plaintiffs can gain from a medical malpractice lawsuit to $250,000. A law passed last year raises that cap to $500,000 effective this year, and to $1 million over the next decade.

One of the advocates for the change was Charles Johnson, whose wife Kira died after giving birth to their son at Cedars-Sinai Medical Center in 2016.

“Although they’ve improved somewhat as of this year, they’re still well behind the curve when it comes to the type of damages that someone can recover in other personal injury, wrongful death claims in the state,” said Robertson’s attorney, Andrew Marton.

Marton also represents the family of Bridgette Cromer, who died shortly after giving birth to a daughter in March.

The timeline for civil lawsuits varies, but Marton estimated it could take two to three years before the case concludes. In response to questions about the lawsuit, a Centinela hospital spokesperson wrote the organization disputes the allegations and “due to pending litigation, we cannot comment further.”

A Black man wearing a white baseball hat, long sleeve white t-shirt and jeans sits on a gray couch while holding a small baby wearing a pink onesie and a headband with a pink flower. Behind him there is a print hanging on the wall of a Black woman with flowers on her face. In the foreground to the left of the man's leg, there are pink flowers.

In February 2023, Nigha Robertson holds his baby Aniya in the Inglewood home he shared with April Valentine, who died during childbirth.

(Samanta Helou Hernandez

/

LAist)

Robertson is now focused on raising his 8-month-old daughter.

Though Aniya Heavenly-April Robertson was born limp and pale by emergency C-section, she is now thriving, her dad said. She’s starting to crawl, has two teeth, and loves the songs from kids YouTube channel Gracie’s Corner.

“It would melt my heart, like, I walk in the room and it’s like she knows,” Robertson said.

Valentine’s cousin Mykesha Mack shares updates about the investigations and media coverage of her death on social media. She hopes to turn Justice for April into a nonprofit that can provide education and resources regarding pregnancy and childbirth.

“So that families, if they do have to go through this, then we can provide them with the resources and the help that they need to navigate this space,” Mack said.

Valentine’s death has also shaped Mack’s work as a life coach focused on helping nurses and health care workers work through trauma and burnout. An upcoming seminar is dedicated to Valentine.

“I hope they walk away feeling refreshed, feeling restored, feeling hopeful again in what they do,” Mack said.

How to take action after a bad pregnancy experience

After a violation

  • If you believe you’ve experienced a violation during pregnancy or labor, it can sometimes be challenging to know what course of action to take. In their resource on birth rights, Pregnancy Justice and Birth Rights Bar Association (BRBA) offer the following options as a place to start.

  • There’s no one right approach, so it’s important to weigh the pros and cons of each of these strategies, and keep in mind that some come with risks or may not be realistic for everyone.

    • Talk about what happened. Find someone you trust to talk openly and freely about what happened. This process can help you understand what happened and decide what next steps you want to take.
    • Write your narrative. It can be helpful to have a record of what happened, from your point of view, written as close to the time of violation as possible. Start by writing freeform, and ask others you trust and who were there to clarify details.
    • Request your medical records: You have the right to see and get a copy of your medical records. These documents can help you understand what happened from the provider’s point of view and could be a key source of evidence. 
    • Give direct feedback. You can write a formal letter to whoever was involved in the violation, which might help the person make a change in how they practice.
    • File a formal complaint. Submit feedback to the official agency or agencies that oversee your providers. In California, the Medical Board licenses doctors and investigates complaints. The state’s Department of Public Health can investigate complaints against hospitals and other care facilities. 
    • Contact a state representative. Sharing your story with a representative can lead to an investigation by another agency or policy change. Find your California legislator
    • Contact the media. Media attention can help raise awareness and lead to others coming forward to help or share their stories.
    • File a lawsuit. Legal action can bring new details to light and may lead to settlement negotiations and monetary compensation. How to find and afford a lawyer.
    • Take direct action. Joining with others can bring attention to your issue, help build community, and can sometimes achieve outcomes that litigation cannot. 
    • Work the system, be creative. Understanding the system you’re in, you may have other ideas for how to get your story in front of key decision makers, through informal or artistic means.

Birth and postpartum resources

Birth and Postpartum Resources

  • These resources were recommended by California birth workers and families. Have a suggestion? Email sritoper@scpr.org.

  • For more on specific topics, see LAist’s pregnancy guides.

  • Mental Health

  • Breastfeeding

  • Doulas / Postpartum Support

  • Doulas provide expecting and new mothers or birthing people with educational, emotional, and physical support before, during, and after a baby is born. Postpartum doulas’ services can include cooking, help around the house, and various healing modalities. Pro tip: many postpartum doulas are available pro-bono while they are seeking certification.

    • What Do Doulas Do? – LAist’s guide to doulas, including a list of resources to find a doula in Southern California.
    • Birthworkers of Color Collective – A collective of birth workers of color providing trainings, workshops, and healing offerings for birthworkers, pregnant people, and their families.
    • DONA International – Doula certifying organization that includes a search tool to find prenatal and postpartum doulas.
  • Support Groups

  • Many support groups and parent and me classes exist throughout Southern California, and the best way to find one is to search online for groups in your area. You might also find these groups through your hospital or places where you find breastfeeding gear. It sometimes helps to look for activities you enjoy (eg. yoga, swimming, dancing) and see if they have “baby and me” classes.

  • A few places to start:

    • Kindred Space – A hub for midwifery care, doula support, lactation consulting and support groups.
    • LOOM – Provides pregnancy, breastfeeding classes, and a doula directory.
    • Lucie’s List – Map of local parent groups.
    • Pump Station – Baby supply store that also offers parent and me classes.
  • For Black Parents-to-Be

  • For Partners / Fathers

    • Black Daddy Dialogues – Support group for dads raising Black children, every second Saturday of the month.
    • Love Dad – Home visits to fathers and their children throughout L.A. County  
    • The Expecting Fathers Group for Black Dads – Support group for Black soon-to-be fathers and provides education, support and navigation tools for the prenatal, labor and delivery, postpartum, and early parenting. 
  • Loss / Grief

  • Social Services 

Early childhood engagement producer Stefanie Ritoper contributed to this story and created the lists of resources.

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