Monday, September 07, 2009

1996: Sloppy practices kill abortion patient

Tanya Williamson, aka "Patient A", had laminaria inserted at Moshe Hachamovitch's New York abortion facility on September 6, 1996, for an early second-trimester abortion. Hachamovtich estimated that she was almost 14 weeks pregnant. He instructed Tanya to return the next day for her abortion.

Tanya returned on September 7, as instructed. According to medical board documents, "At or about 11:00 a.m. Patient A was given Valium 10 mg." This medication was not noted on clinic documents that were given to Certified Registered Nurse Anesthetist (CRNA) Gori, who then administered 150 mg. of Brevitol at about 1:50 p.m., whereupon Hachamovitch performed the abortion.

The medical board then notes, "150 mg. Of Brevital causes loss of consciousness and also potentially decreases the patient’s respiratory rate and blood pressure. The amount of Brevital administered to this patient would cause respiratory depression for approximately 30 minutes. The majority of that time Patient A was in the recovery room. The level of respiratory depression is tied into the amount of stimulation of the patient. Surgery is a very strong stimulus, once that is removed the respiratory depression increases.

The board noted that Tanya was still totally unresponsive from the effects of anesthesia when she was moved to the recovery room. Staff noted her pulse and oxygen saturation, then removed her pulse oximeter, which monitors pulse and oxygen saturation.

The medical board notes that at 2 p.m., after 5 minutes in recovery, Tanya'’s blood pressure was 96/80, and her pulse 68. This is within normal limits. At 15 minutes (2:10 p.m.), Tanya's blood pressure had fallen to 60/40, her pulse to 52, and her respirations were shallow. Such a sharp fall in blood pressure is an alarming sign that the patient might be going into shock or suffering other life-threatening problems. The falling blood pressure is especially alarming in combination with shallow breathing.

At 2:11 p.m., Tanya's pulse was noted as "thready," which means weak and erratic. Her blood pressure was so low that it could not be measured with a cuff. The medical board noted, "At this point, a patient without an obtainable blood pressure and a barely palpable pulse was functionally in cardiac arrest. Respondent was notified of the problem with Patient A at approximately 2:15 p.m."

Hachamovitch examined Tanya in recovery, started a new IV with D5W and Ephedrine, then told the recovery room nurse to do CPR, and somebody to call Emergency Medical Services (EMS).

EMS Advanced Cardiac Life Support (ACLS) arrived at 2:41 to find Tanya blue and unresponsive, with no pulse or breathing and fixed pupils. ACLS took Tanya's vital signs, attached a cardiac monitor, and properly placed a breathing tube to help get oxygen into Tanya's lungs. An ACLS team member then hooked up Hachamovitch's bag-valve mask (used to pump air into the lungs) and found that it was broken and wasn't working. The ACLS team member switched over to the EMT’s ventilation unit.

The medical board said, "When respondent arrived in the recovery room, he should have immediately ascertained the patient’s pulse, blood pressure, and if there were vaginal bleeding. This should have taken between 20 seconds and, at the outside, two to three minutes. He should have realized that the patient was in cardiac arrest and started ACLS. The cause of the arrest was not relevant at that point; the immediate treatment was the same. Given the clinical picture of this patient at 2:15 p.m. when Respondent was called to the recovery room EMS should have been called immediately and the patient intubated. Even if Patient A were only in a near arrest situation Respondent should have immediately call EMS and instituted the rest of ACLS protocol. Advanced Cardiac Life Support consists of immediate call to EMS for transfer to hospital, intubation, EKG monitoring so that if the patient requires defibrillation, the rhythm and appropriate ACLS drugs are known. This patient’s condition had to be treated in a hospital setting, the sooner the patient were to get to the hospital, the better her chances of survival."

Despite the fact that Hachamovitch had the equipment to put a breathing tube into Tanya, she was being given oxygen with a face mask. There was no note that Hachamovitch had even inserted an airway, which is a small device that keeps the patient's tongue from blocking air from getting into the lungs. Though Hachamovitch had additional, necessary drugs on hand to help restore cardiac function, he didn't administer them to Tanya. Though he had an EKG machine, he never used it. "Such a failure deviated from accepted medical standards."

"A physician who performs surgical procedures, i.e. abortion, under general anesthesia in free standing outpatient facilities, has an obligation to recognize when a patient is in cardiac arrest and to know how to resuscitate the patient. Respondent did not recognize that Patient A was in cardiac arrest. Respondent did not carry out generally recognized resuscitation measures in this patient."

On Saturday, September 7, 1996, the day Tanya died, Hachamovitch had one R.N. in the recovery room, along with a medical assistant, a sonographer and a receptionist from the front who went to the recovery room to help when the recovery room was busy. The sonographer was not trained to observe patients recovering from anesthesia. The receptionist had taken a medical secretary course, and did not have any special training in caring for patients covering from general anesthesia.

At the time Tanya was brought into the recovery room, there were nine other patients in the room, and yet another patient was brought in a few minutes after Tanya. One of those nine patients already in the recovery room was shaking and almost convulsing.

The board noted that Hachamovitch's recovery room was not sufficiently staffed to adequately monitor patients recovering from general anesthesia.

The board also noted, "Respondent’s medical record did not accurately reflect the care and treatment rendered to patient A."

The Committee slammed Hachamovitch for multiple violations of standards of care, particularly in how patients were monitored and cared for after general anesthesia, and the lack of training of the staff attending them. They slammed him for lack of adequate equipment and for failing to use what little equipment he had.

The board suspended Hachamovitch’s license, and added probationary requirements that he was to be supervised by an anesthesiologist who had no conflict of interest, that Hachamovitch maintain ACLS certification, and that he maintain at least one staffer in recovery who is ACLS certified.

How many other patient deaths have been identified at Hachamovitch's facilities? There may be more than one correct answer.
Hachamovitch had two other patients who died before Tanya's death.
A patient died in a Texas facility owned and operated by Hachamovitch, though another doctor actually performed the abortion.
Two abortion patients bled to death after abortions at an Arizona abortion facility owned by Hachamovitch.
Hachamovitch performed a fatal abortion on a patient in Texas.

For more abortion deaths, visit the Cemetery of Choice:

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