Lead physician says transplant standards not followed

Thursday, Nov. 06, 2008

Doctor testifies that Roozrokh was not supposed to be present until after patient's death
Lead physician says transplant standards not followed

Leslie Parrilla - lparrilla@thetribunenews.com

Had attending physician Laura Lubarsky known what she does now, she would have done things differently the night two transplant surgeons stood beside her patient hoping to harvest his organs in an operating room at a San Luis Obispo hospital.

Had she known that she was in charge, things would have changed, she told a jury in a San Luis Obispo courtroom on Wednesday.

Had she known that the surgeons should not have been in the operating room with her nor prescribing medications, things would have been different.
Hootan Roozrokh

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But they weren’t, leaving comatose patient Ruben Navarro, who later died, at the center of a precedent-setting criminal case against surgeon Hootan Roozrokh.

The 34-year-old surgeon is accused of hastening the 25-year-old disabled man’s death by ordering excessive amounts of painkillers and sedatives to harvest his organs on Feb. 3, 2006, at Sierra Vista Regional Medical Center.

“After I was in the operating room, I subsequently—feeling this was an unusual situation— I went home” and researched protocol for organ procurements, Lubarsky testified.

“I realized things had occurred that evening that should not have — transplant surgeons should not have been in the room. Transplant surgeons should not have ordered medication. … Had I known that, I would have done things differently,” she added.

No one involved in the case disagrees that Navarro was dying. What remains in question is when he died.

Deputy District Attorney Karen Gray alleges the drugs ordered by Roozrokh accelerated Navarro’s death.

Defense attorney M. Gerald Schwartzbach of Marin County claims Roozrokh was trying to prevent Navarro from suffering before dying, and that the drugs did not harm him.

A coroner’s investigation concluded that Navarro died of natural causes about eight hours after being removed from life support.

His organs were never used because he did not die within an hour after his breathing tube was removed.

According to California law, transplant doctors cannot direct treatment for a potential organ donor until the attending physician declares the patient dead.

Then the surgeons can enter the operating room and harvest the organs.

Transplant experts say that practice prevents a conflict of interest.

Lubarsky was the attending physician on call that night, and one of about eight people involved in the failed organ harvest.

But according to Roozrokh’s defense, she was also part of an entanglement of inexperienced, untrained and uninformed hospital staff unfamiliar with the uncommon type of organ donation attempted on Navarro.

In what is known as “cardiac death donation,” the deceased’s organs are harvested within minutes after the patient’s heart stops beating.

“The whole situation is very unique to me,” Lubarsky testified in San Luis Obispo Superior Court on Wednesday.

“I didn’t feel like I was supposed to be the person managing the case,” she added. “I had never experienced anything like that before, and I assumed they were following some sort of protocol.”

The hospital, however, had no protocol for this type of procedure.

Protocols for organ donation after cardiac death were not developed until a year after the failed organ harvest at Sierra Vista, according to testimony by medical experts called by the prosecution at Roozrokh’s preliminary hearing earlier this year.

Roozrokh and nurse Carla Albright — both dispatched from the Oakland-based California Transplant Donor Network — had each observed one such donation.

And no one else in the operating room that night had been trained in or participated in one.

Surgeon Arturo Martinez, also sent from the network, was head of the San Francisco Kaiser Permanente kidney transplant program but had never done a donation after cardiac death, according to the network’s chief executive officer, Phyllis Weber. He planned to observe Roozrokh, who had performed one.

Lubarsky recalled walking into the operating room last, and seeing Martinez scrubbing Navarro’s abdomen and chest.

The prosecution plans to continue its case at 8:30 a. m. today at the Veterans Memorial Building at Grand Avenue and Monterey Street in San Luis Obispo.

Leslie Parrilla can be reached at 783-7645.

http://www.sanluisobispo.com/news/local/story/519963.html