Thursday, July 15, 2010

Two dead patients and a lot of lame excuses

Thirty-four-year-old Debra M. Gray went to Hillview Women's Medical Center for a safe and legal abortion on July 8, 1989. She went through their conseling procedure and underwent lab work.

Debra returned for the actual procedure on July 12. An ultrasound was performed and she was estimated to be 16.5 weeks pregnant. Debra signed an undated consent form for the abortion and anesthesia.

The records don't indicate who initiated IV Brevitol for anesthesia, nor do they document the dosage or concentration, nor Debra's weight or the amount of fluid given. There was also no record of a physical exam or any exam to determine if Debra was an appropriate candidate for this type of anesthesia.

The abortionist, Gideon Kioko, indicated that the nurse and other staff expected the drug to induce "twilight sleep" rather than general anesthesia. There was no anesthesiologisst on duty, and no physician supervising the administration of anesthesia medication.

Kioko initiated the abortion. There was no documentation of the effect of the medication, nor of Debra's vital signs. A hospital note indicated that Debra had "responded rather rapidly to the anesthesia" and that three minutes after Kioko had started the abortion, Debra's blood was noted to be "very dark" and she was having trouble breathing. Kioko spent five minutes completing the abortion.

A code note dated July 12, 1989, by a Dr. Raymond Taylor, indicates that Debra was unresponsive, with a low blood pressure and sluggish pulse. Dr. Taylor's note indicated that after fifteen minutes of CPR and advanced cardiac life support, Debra was transported by ambulance to the hospital.

When paramedics arrived, they estimated that Debra's brain had been deprived of oxygen for twelve minutes. Debra had a racing heart, then went into ventricular fibrillation. She was resuscitated, but never regained consciousness. She was pronounced dead on July 15.

The autopsy found traces of heroin in Debra's bloodstream. There was no evidence that the facility had screened Debra for possible drug use.

Hillview staff also allowed Suzanne Logan to suffer an eventually fatal lack of oxygen during an abortion that same year. Suzanne languished in a nursing home for three years before her death.

Kioko made the following excuses to the medical board regarding the fatal abortions:

In the first two cases where Brevital was given, I did not give it, nor did I consent to it. I was not consulted or asked about it. I did not even start intravenous fluids. The decision to administer Brevital was made by the patient and the clinic, and during those [sic] time, I would be called in. I would be notified that "the patient is now asleep, Doctor. You may start the procedure." ....

I, therefore, had nothing to do with the Brevital administered to these two patients. Other contract physicians were also working under similar terms, and, like me, they had nothing to do with the administration of Brevital. I suppose that I was just unlucky at that time and happened to be there when this incident happened.

....

[Regarding Debra Gray]. I understand that [the Brevital] was given by Dr. Barbara Lofton-Clinical Practitioner. My initial contact with the patient was the initial sizing evaulation and to determine the gestational age of the pregnancy. The next contact by me was when the patient was already asleep. As I was finishing the procedure, I called the attention to the administers [sic] of the anesthetic, that the patient's blood was getting unusually dark. At that time, in my view, adequate resuscitation efforts was [sic] immediately instituted with airway established and 911 was called. EKG and oxygen were available and were used. Dr. Taylor, a Cardiology fellow headed the resuscitation effort. It is just not true that adequate resuscitation was not done and that the equipment was not available. Indicenttally, this patient had recently used Opium [sic], though the patient had denied this in her medical history.

The case of [Suzanne Logan] is similar. The patient was put to sleep, with Brevital. I was not in the Operating Room at the time. Once again I was called in to do the procedure once the patient was deemed asleep. I was not consulted, nor did I participate in the decision to give the agent, but once again, I know there was immediate and adequate resuscitation effort. (Please refer to the letter from Dr. [sic] Barbara Lofton). The only case I directly had complete responsibility for is that of ... [Patient C].


The medical board noted that Kioko, as the physician performing the procedure, was still responsible for ensuring that the patient was being provided with appropriate care, regardless of how the clinic chose to assign tasks. The board also noted that nobody was monitoring either woman's vital signs while Kioko was operating on them.

The board noted that "In the above cases, [Kioko] performed surgical procedures under conditions that failed to meet appropriate standards for the delivery of quality medical and surgical care. .... In the event that [Kioko} was unable to correct these conditions, the appropriate standard of care required that [he] not perform these procedures at this facility until these conditions were so corrected."

The board also noted that "Kioko demonstrated a serious lack of judgment.... Kioko assumed that his role was limited to performing technical procedures upon anesthetized patients, leaving overall management of the patients to others. Dr. Kioko's gullibility in this regard proved fatal."

Debra's sister, Tam, who had known her sister was going to Hillview that day and had been planning on meeting her for dinner that night, told 60 Minutes, "It's sad to think that people can go in and have a safe procedure, what they think is safe, and die. The outcome was just like a back-alley abortion."

For more abortion deaths, visit the Cemetery of Choice:



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24 comments:

OperationCounterstrike said...

The patient's sister was wrong. This was not "like a back-alley abortion".

If this had been an illegal abortion, there would have been no investigation, no way to hold the doc accountable if the deaths had been his fault.

Cases like this show why we need to keep abortion legal. So there can be professional oversight.

GrannyGrump said...

"If this had been an illegal abortion, there would have been no investigation, no way to hold the doc accountable if the deaths had been his fault."

WHAT? Haven't you noticed that before legalization came along to protect women, the quacks who killed them were PROSECUTED? They'd get sent to freaking SING SING instead of just letting their insurance take care of it.

What makes this case unusual for a legal abortion death is that people actually paid attention. But NOBODY went to prison.

OperationCounterstrike said...

From your description of the cases, it doesn't sound as if anyone SHOULD have gone to prison. These two cases sound like individual surprise reactions to anaesthesia, which can happen to anyone. There is no way to predict who will react badly to anaesthesia. There is no such thing as--how did you put it-- "a physical exam or any exam to determine if Debra was an appropriate candidate for this type of anesthesia."

Two cases of bad luck, that's all.

I agree that Dr. Kioko was wrong to deny his responsibility for everything--he's the doc, so he's responsible--but these two cases are not good grounds even for yanking his licence, let alone prison.

Regarding your other comment, about holding people responsible, in most cases where women died from illegal abortions, no one ever found out who had done the abortion.

OperationCounterstrike said...

Illegal abortion means no paper-trail.

GrannyGrump said...

OC, NOBODY WAS MONITORING THEM! They were improperly resuscitated when people finally noticed that they weren't breathing. If you consider this just "bad luck" -- well, bad luck in that they walked into a nasty abortion mill.

And illegal abortion meaning no paper trail? You've not done any research, have you? Dr. Timanus and Dr. Spencer kept perfectly ordinary medical records on their abortion patients. Timanus even reported to the 1955 PP conference on abortion. And you don't need a "paper trail" to nail the guy who did it. Read some of the illegal abortion deaths I post. There are cases where the cops got an anonymous tip after the funeral and they caught the perp. You seem to think that if you do something illegal, somehow you can't get caught because you're not reporting it. I'd like to know who are in our prisons, then.

OperationCounterstrike said...
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OperationCounterstrike said...

Christina, the large majority of illegal abortions were done anonymously, with the patient never learning the name of her doctor, or even seeing his face, and the doctor not keeping any records, except in a few rare cases.

Today, there's always a paper trail. You can FIND OUT who did the abortion, and hold them responsible. This was not true for illegal abortions, except in rare cases they were entirely anonymous. This is again the problem with your method of research, focusing on individual cases and passing over the general picture.

D&C with twighlight anaesthesia does not require individual monitoring. Just as you don't need individual monitoring when you recover from having a wart removed. Emergencies are so rare that individual monitoring would be a waste of someone's time. Like posting a traffic cop at the entrance to a mine.

These deaths were not the doc's fault. If they had been his fault, the board would have found more severely against him.

You don't know enough about abortion to make these judgements. You need to spend six months or so volunteering at an abortion clinic, see how it's done. Except of course they wouldn't let you in. Well, enroll in med school, and do a rotation at a clinic. THEN you'll be on the road to qualification for making these judgements.

OperationCounterstrike said...

"Anonymous tips" Sure, in some tiny fraction of cases.

GrannyGrump said...

Your "paper trail" for legal abortions isn't all that great. You should see the lawsuits when they're filed. The woman has to sue every doctor in any way affiliated with the facility because she doesn't even know who was poking around her insides.

And a botched abortion now is purely a civil matter, not a criminal matter. Nobody gives a rat's ass any more how many women these quacks injure or kill. Or at least nobody who is ostensibly in it (with proper catch in the voice) "for the women!"

Rachael said...

D&C with twighlight anaesthesia does not require individual monitoring. Just as you don't need individual monitoring when you recover from having a wart removed. Emergencies are so rare that individual monitoring would be a waste of someone's time. Like posting a traffic cop at the entrance to a mine.

Bzzt!! Wrong! It is not dependent on the type of the procedure, but rather the anesthesia and according to the American Association of Nurse Anesthetists (AANA):
"Because patients can slip into a deep sleep, proper monitoring of conscious sedation (also known as twlight anesthesia) is necessary. Healthcare providers monitor patient heart rate, blood pressure, breathing, oxygen level and alertness throughout and after the procedure."
http://www.aana.com/ForPatients.aspx?id=298

Also, it was not just "bad luck" but neglect on the part of the clinic staff to not document the dosage or concentration, nor Debra's weight or the amount of fluid given, nor obtain whether the patient has any medical allergies or history substance abuse.

Rachael said...

There is no such thing as--how did you put it-- "a physical exam or any exam to determine if Debra was an appropriate candidate for this type of anesthesia."

Bzzt! Wrong again!!

According to the Encyclopedia of Surgery, in an article, entitled, "Conscious Sedation," written by
Laith Farid Gulli, M.D.,M.S. Alfredo Mori, MBBS:
"If the patient is to undergo a minor surgical procedure, screening and assessment of medical conditions that may interfere with conscious sedation must be explored. These potential risk factors include advanced age, history of adverse reactions to the proposed medications and a past medical history of severe cardiopulmonary (heart/lung) disease."

And again,
"Patient monitoring during conscious sedation must be performed by a trained and licensed health care professional. This clinician must not be involved in the procedure, but should have primary responsibility of monitoring and attending to the patient. Equipment must be in place and organized for monitoring the patient's blood pressure, pulse, respiratory rate, level of consciousness, and, most important, the oxygen saturation (the measure of oxygen perfusion inside the body) with a pulse oximeter (a machine that provides a continuous real-time recording of oxygenation). The oxygen saturation is the most sensitive parameter affected during increased levels of conscious sedation. Vital signs and other pertinent recordings must be monitored before the start of the administration of medications, and then at a minimum of every five minutes thereafter until the procedure is completed. After the procedure has been completed, monitoring should continue every 15 minutes for the first hour after the last dose of medication(s) was administered. After the first hour, monitoring can continue as needed."
http://www.surgeryencyclopedia.com/Pa-St/Sedation-Conscious.html

OC, you ought to learn to be more honest, it's starting to make you look unreliable and dishonest.

OperationCounterstrike said...
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OperationCounterstrike said...

Rachel, RE: ""If the patient is to undergo a minor surgical procedure, screening and assessment of medical conditions that may interfere with conscious sedation must be explored. These potential risk factors include advanced age, history of adverse reactions to the proposed medications and a past medical history of severe cardiopulmonary (heart/lung) disease.""

That's not a physical exam, that's taking a medical history and screening for counterindications. There is no evidence that anyone failed to take a medical history in these two cases.

OperationCounterstrike said...

RE: Monitoring the patient

There are different levels of monitoring. You put an infra-red sensor on the patient's finger and keep someone in the recovery room with all the patients, and that's enough. You DON'T have an individual doc or nurse monitoring each patient individually; that would be way overkill.

Rachael said...

There are different levels of monitoring. You put an infra-red sensor on the patient's finger and keep someone in the recovery room with all the patients, and that's enough. You DON'T have an individual doc or nurse monitoring each patient individually; that would be way overkill.

Yes, I know what a pulse oximeter and oxygen saturation is.
Really? Not according to the consenses of medical professionals.
"Patient monitoring during conscious sedation must be performed by a trained and licensed health care professional. This clinician must not be involved in the procedure, but should have primary responsibility of monitoring and attending to the patient.
and
Vital signs and other pertinent recordings must be monitored before the start of the administration of medications, and then at a minimum of every five minutes thereafter until the procedure is completed.

Why are you being dishonest here and why are you advocating neglegence and riskier practice, rather than prudence during the use of anesthesia? We're not talking about cadaviers here, we're talking about living, breathing human beings!

OperationCounterstrike said...

There are FOUR different levels of twighlight anaesthesia, which require different levels of monitoring. For early abortion, the minimal level is used.

You are getting your info off a web site. I am getting mine from real-world experience in a world-class hospital.

Rachael said...

OC, so physicians shouldn't preform a basic physical screening (blood pressure and heart/respirations) in addition to taking a medical history before preforming a elective surgery and administering anesthesia?

OperationCounterstrike said...

RE: "And a botched abortion now is purely a civil matter, not a criminal matter. Nobody gives a rat's ass any more how many women these quacks injure or kill."

That's your stupid fantasy. If you malpractice and kill someone you face a strong liklihood of prison time, IF THE DEATH IS REALLY YOUR FAULT (unlike these two cases, which were NOT the doc's fault.)

OperationCounterstrike said...

Providing abortion is no different from any other surgical specialty in that regard.

OperationCounterstrike said...

Rachel, RE: "OC, so physicians shouldn't preform a basic physical screening (blood pressure and heart/respirations) in addition to taking a medical history before preforming a elective surgery and administering anesthesia?"

Yes, of course they should. But "basic physical screening" is different from "physical exam to determine whether this type of anaesthesia is appropriate" which is what GG said.

Bah. You are not interested in serious discussion, only in word games.

Rachael said...

Yes, I am aware there are 4 levels of twilight anesthesia. In standard practice, physicians may use a minimal level. However, in cases such as these, where the staff was keeping inadequite records, including ommiting the dosage of the anesthesic medication administered, it was of been difficult if not impossible to know how deep of sedation of the patient was in.

Rachael said...

*Correction
However, in cases such as these, where the staff was keeping inadequite records, including ommiting the dosage of the anesthesic medication administered, it would of been difficult...

OperationCounterstrike said...

Rachel, the staff may well have been keeping inadequate records. They may even have been monitoring the patient less intensely than they should, strictly speaking. But they did not cause these deaths.

There is no way to predict who will suffer a rare bad response to anaesthesia, and there is very little you can do for a patient once the response is in progress.

It's just one of the risks you assume when you go in for ANY procedure requiring anaesthesia. Just as you assume a certain risk of having a car accident when you drive.

OperationCounterstrike said...

If the staff had done everything perfectly, these two patients would still have died.