Doctor rushes to take donor organs

Police probe death in organ donation case
Authorities investigate allegations that a Kaiser surgeon in San Luis Obispo hastened a possible donor's demise.
By Charles Ornstein and Tracy Weber, Times Staff Writers
February 28, 2007

Police are investigating whether a Kaiser Permanente transplant surgeon attempted to hasten the death last February of a 26-year-old San Luis Obispo man on life support in order to harvest his organs more quickly.

The allegations, if true, would constitute a grave breach of the nation's organ transplant rules, as well as a public relations setback for those promoting organ donation, experts in transplantation said.

San Luis Obispo police and the Medical Board of California are looking into the conduct of Dr. Hootan Roozrokh, who was a surgeon at Kaiser's now-defunct kidney transplant program in San Francisco.

At issue is whether he ordered excessive doses of powerful pain medication to speed the death of Ruben Navarro, according to several sources familiar with the case who spoke on condition of anonymity because investigations are ongoing.

Roozrokh could not be reached for comment. His attorney, M. Gerald Schwartzbach, acknowledged that his client may have made some mistakes but said that "he certainly wasn't the only one."

"I just don't think that Dr. Roozrokh ought to be crucified as a result of this incident or his career destroyed," said Schwartzbach, who declined to address specific allegations.

Medical board spokeswoman Candis Cohen said her agency is also investigating the conduct of a second physician present during the incident. That person, Kaiser officials confirmed, is Dr. Arturo Martinez, who at the time was the surgical director of Kaiser's transplant program. Martinez declined to comment Tuesday.

Neither surgeon was attempting to recover the organs on behalf of Kaiser; rather, they were working on behalf of the group that procures and distributes organs in much of Northern and Central California. Transplant surgeons commonly perform such duties.

Dr. Timothy Pruett, president-elect of the United Network for Organ Sharing, called the allegations "horrific."

He worried that they could scare people away from donating organs to help the 95,000 people awaiting life-saving transplants nationwide. UNOS is the federal contractor charged with ensuring the safety and equity of the nation's transplant system.

"We have to guarantee to the public that we're not going to go out and kill people to get their organs," said Pruett, chief of transplant surgery at the University of Virginia. "That's the worst of those cheap sci-fi books: 'The ghoulish docs are out pulling the plugs on these poor defenseless people, trying to snatch their organs.' "

According to San Luis Obispo police, Navarro was near death after being found unresponsive at Casa de Vida, a long-term care facility. He was taken to nearby Sierra Vista Regional Medical Center and placed on life support. When it became clear he would not live, his family agreed to allow his organs to be harvested, and transplant surgeons were summoned Feb. 3, 2006.

State law specifies that transplant doctors cannot direct the treatment of potential organ donors before they are declared dead. This restriction is designed, in large part, to assuage concerns that organ retrieval might take priority over patient care.

In this case, however, Roozrokh entered the operating room at Sierra Vista and was directing the administration of drugs to Navarro, the sources said.

When the patient didn't die, Roozrokh allegedly told nurses: "Let's just give him some more candy," according to a person who was briefed on what took place but spoke on condition of anonymity because of the ongoing investigations.

Navarro was still alive about 30 minutes after being taken off life support — the time limit set to ensure the viability of the organs.

He was then returned to the intensive care unit, where he died early the following morning. His organs were not retrieved, police said in a statement.

Within days, nurses at the hospital — alarmed about what had taken place — alerted their superiors, Sierra Vista spokesman Ron Yukelson said. An investigation was immediately launched, and regulators and the coroner were notified.

Yukelson said that outside physicians are not authorized to treat patients at the 165-bed hospital. In this case, "the transplant surgeon began to direct care in the operating room," he said.

Schwartzbach said Navarro's treating physician was also in the operating room at the time, along with a coordinator from the organ procurement group. Both could have asked Roozrokh and Martinez to leave, he said.
"I cannot imagine that anybody … did anything in that room, in that operating room, over the objection of the patient's attending physician," Schwartzbach said.

In addition, he said, there's no proof that Navarro would have lived any longer had the situation been handled differently.

Kaiser placed Roozrokh on administrative leave May 18, after learning of the allegations against him, spokesman Matthew Schiffgens said, stressing that Roozrokh was not representing Kaiser during the incident. The doctor was reinstated in January when there were "no new developments" in the investigations, Schiffgens said.

Martinez was not placed on leave, the spokesman said.

As a result of the hospital's own inquiry, an operating room nurse has been reassigned to administrative duties pending the outcome of the investigation. Yukelson would not discuss her role in the alleged incident.

San Luis Obispo Police Capt. Ian Parkinson said his agency is close to finishing its inquiry and will give the results to the district attorney's office in two or three weeks. "It's a sensitive case," he said. "I don't think we've run across this in our lifetime."

Parkinson declined to speculate on possible charges. The cause of death is pending.

The case has also prompted probes by UNOS and the state Department of Health Services, which regulates hospitals.

The type of organ retrieval at issue in this case, known as "donation after cardiac death," is somewhat controversial. But it has become more prevalent in recent years as doctors have sought to expand the donor pool beyond the limited number of people who are brain dead.

These donors have suffered a devastating brain injury and have no hope of recovery, but still have minimal brain function. Removal of life support ultimately causes their hearts to stop.

Sierra Vista officials said this case was the hospital's first experience with "donation after cardiac death."

In such cases, said Dr. David Mulligan, chairman of transplant surgery at Mayo Clinic Hospital in Phoenix, he tells transplant surgeons to "have nothing to do" with potential donors until they have been pronounced dead, which is typically five minutes after their heart stops beating.

"The surgeons are supposed to be completely out of the room and not involved in the care of that patient," said Mulligan, who also sits on the UNOS board. "Any interference with the patient management prior to the patient being declared dead is not really appropriate. It's a setup for problems."

In a statement, UNOS said it has taken steps to ensure that nothing like the alleged actions in San Luis Obispo happens again. "The greatest tragedy resulting from this story would be if altruistic Americans lose faith in organ donation processes and choose not to become organ donors," the statement said.

The allegations against Roozrokh come in the wake of a scandal at Kaiser Permanente's Northern California kidney transplant program.

The giant HMO announced in May that it would close the fledgling program in San Francisco after The Times reported that hundreds of patients had been endangered after its start-up in late 2004.

Kaiser had forced patients to leave established programs at two outside hospitals and join its own waiting list. In the process, Kaiser lost track of many patients and delayed critical surgeries.

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charles.ornstein@latimes.com

tracy.weber@latimes.com