Sunday, October 14, 2007

Somebody wanted Gideon Kioko

Or at least they wanted information about him.

Kioko worked at the notorious Hillview abortion mill in Maryland, and performed the fatal abortions on Suzanne Logan and Debra Gray.

Kioko surrendered license his medical license 1991, admittedly in order to avoid prosecution in the cases of Gray and Logan. Less than six months later, he asked to get his license reinstated, but the board denied the request. Kioko continued to practice medicine in Maryland, and in 1993, on Kioko's request, the D.C. board reviewed cases that Kioko himself selected from among his hospital patients. (He submitted no records from patients he cared for in the unsupervised setting of his office.) Based on a review of 20 of those records, the DC board concluded that his practice met the standard of care. He tried again in 1994 to get his Maryland license back, but the board still found him unfit.

Kioko took his petition to the Circuit Court of Prince George's County, and on July 15, 1996, Judge Thomas P. Smith sent the case back to the medical board for further review, having found fault with their handling of Kioko's case. In a twist that shows Kioko was evidently a better conniver than he is a physician, the fact that Kioko voluntarily surrendered his license in the wake of the Hillview cases kept the board from doing a full review and disciplinary action and thus greased the wheels for getting his license back on the grounds that it had never been adequately documented that he was unfit to practice.

With the case kicked back to them under judicial order, the board reviewed Kioko's history and stated that:
When initially considering Dr. Kioko's petition for reinstatement of his suspended license, the [board] was not presuaded that Dr. Kioko expressed true remorse for the Hillview victims, except to the extent that it interfered with his professional career. In fact, it was not clear that Dr. Kioko was even cognizant of his own role in the deaths of two patients. Over the past several years .... [the board] has observed a change. Dr. Kioko appears truly remorseful for the deaths of the Hillview patients, has a better understanding of both his role in those events and the need to take responsibility to insure that they are not repeated.

Dr. Kioko ... now seems to comprehend that his role as a surgeon goes beyond merely performing a technical procedure: he is responsible for overseeing the well being of the patient.

The board noted that Kioko had busied himself with volunteer work.
Dr. Kioko's eventual understanding of the Hillview tragedies and his rehabilitative efforts to correct deficiencies in his judgment and training in life support skills to endure that they will never happen again, persuades the [board] that Dr. Kioko is competent to practice medicine in this State, provided he is placed on probation for a period of time and subject to certain restrictions.

Three patients also testified to the board of their confidence in Kioko. (Wouldn't you like to know who they are so you could ask them what drugs they were on when they defended this quack?) The board gave Kioko his license back in 1997, provided he didn't use general anesthesia or IV sedation unless in a hospital with an anesthesiologist present, and that he not do abortions past 12 weeks, among other requirements such as community service.

The Maryland medical board was far from finished with Gideon Kioko.

The board got a complaint on January 13, 2005, from the Risk Manager at Washington Adventist Hospital. The Risk Manager noted that on December 1, 2004, 26-year-old Patient A had been brought to their hospital by ambulance after an incomplete abortion done at Kioko's office that day. I'll refer to her as Astrid. The board also got an anonymous phone call, and a fax, complaining about Kioko's treatment of Patient B., who I'll refer to as Bethany. More on these patients later.

Kioko had been renting the office in question part-time from a dermatologist. There, Kioko was performing outpatient abortions, including second-trimester abortions, at the rate of about four a month, according to his own admissions.

The carpeting on the floor of the procedure room was described as "stained and unclean." Kioko's staff said that he did not use a new sterile tube for each patient. "The tube is used throughout the day and then washed and reused until it becomes opaque and then it is discarded." When suction is broken, fluid from this tube may backwash into the uterus of the patient.

The printer on the ultrasound machine was broken, so there were no hard copies of ultrasounds in patient records. There was no crash cart, laryngoscope, or equipment for entubating and providing oxygen to a patient who needed resuscitation. On a second site visit, Kioko's staff indicated that his "crash cart" consisted of an empty capped syringe and two vials of epinephrine kept in a rubber exam glove taped to the wall of the procedure room. There were no policies in place for dealing with an emergency.

Kioko also told the inspector that he did not keep appointment logs, and that he destroyed sign-in sheets the day of the appointment, for reasons of "confidentiality." Kioko had three employees: His wife, his niece who was reportedly a nursing student and occasionally worked as a receptionist, and a medical assistant/office secretary. This last employee would take vital signs, perform finger sticks, sterilize equipment, assist in procedures by handing things to Kioko, and cleaned up after procedures. Kioko's wife reportedly performed those tasks when the regular assistant was not there. At times only two staff would be in the building: Kioko and one of the three employees.

Kioko's wife reported that she did not work for her husband. She was a full time administrator of a home health agency. She did say that she occasionally helped with filing, answering the phone, and office duties on the evenings or Saturdays. She also said that she sometimes assisted with prepping patients for abortions, but she would do the charting and sign as if she was the regular medical assistant. Kioko's wife said that she was a registered nurse in the state of Maryland, but was unable to provide her license number. Upon investigation the board verified that Kioko's wife was lying; she was "not licensed by the Maryland Board of Nursing as an RN, or in any other licensure status."

Staff told the board that Kioko would perform an ultrasound to determine gestational age, but with the printer broken no hard copy would be available for the patients' charts. Kioko did not always document the ultrasound findings such as biparietal diameter or crown length. Kioko told the board that he obtains a medical history from all patients, but "does not always document this history." He told the board that he didn't perform physical exams "except if the patient presents with a significant medical history." He did indicate that he performed a pelvic exam on all patients. Staff noted that Kioko did not always complete history and physical exam forms.

Kioko's staff indicated that he administered paracervical blocks to his abortion patients, but did not use sedation, intravenous anesthesia, or general anesthesia in his office. (Thank God for small favors.) A blood pressure would be taken before and after the abortion. The patient would be walked to the other room, and after an hour Kioko would check her for bleeding and discharge her with an aftercare sheet, a prescription for antibiotics, and an appointment for a follow-up exam in two weeks. He did not send tissues to a lab for a pathology exam.

Kioko had no contract for biohazard removal, particularly the bloody fetal remains and sheets. Staff said Kioko would put these biohazardous materials into a red bag and dispose of them himself. "Office staff did not know where." Kioko lacked procedures for cleaning and sterilizing instruments. A refrigerator near the receptionist's desk contained drugs, food, soda, and condiments.

Now, let's get back to Astrid ("Patient A").

The board investigation found that Astrid had come to Kioko's office at 9 a.m. for her abortion. Only Kioko and the receptionist were there. The receptionist called for someone to come to the office. Astrid told Kioko that she believed she was four months pregnant. Kioko told different stories about estimating the gestational age. Initially, he'd said that the electric power had gone out, so he'd not done an ultrasound. But later he said that he'd done an ultrasound and estimated that Astrid was 19 to 20 weeks pregnant. Astrid's chart in Kioko's office didn't contain any ultrasound or documentation that one had been performed.

An unidentified young woman took Astrid's vital signs. No blood work was performed. At about 10 a.m., Kioko started an IV and gave Astrid some Motrin. Kioko said that the power kept going on and off during the aspiration procedure, which he started at about 11:30 a.m. He also stated that there was a "power failure" for about an hour.

At around noon, Astrid started to feel hot and dizzy, and requested her cell phone to call her emergency contact person. Kioko refused to give it to her. Astrid said that Kioko also refused her pleas that he call her emergency contact for her.

At about 2 p.m., Kioko resumed the procedure. He removed the placenta but was unable to remove the head. Astrid was bleeding profusely. Astrid said that Kioko told her that he would have to "cut the baby up" to get it out, but was unable to remove the head.

Astrid told Kioko to call 911 because she was having trouble breathing and kept passing out. She said that nobody was monitoring her blood pressure during this time. Kioko called his wife, and she came to his office to help. She took vital signs and observed Astrid. (Kioko's wife told the board she had no recollection of these events.)

Finally, at 3:50 p.m., Kioko called 911, reporting that an abortion patient was semi-conscious, and bleeding profusely. He asked for Astrid to be taken to Prince George's Hospital. The county ambulance arrived at 3:55. Upon arrival, EMS staff heard a woman screaming from the back of the office. Kioko told them that Astrid was bleeding and that the fetal head was still in her uterus. (At least he gave them some information. Another small favor.) Kioko told them he suspected D.I.C. Here I'll quote the EMS report:
Femal pt. naked from the waist down and rolling back and forth on the table, screaming. Pt. covered in blood, legs bathed in blood, heavy constant stream of blood spurting from pt's vagina, table covered in blood numerous equipment tools on tables covered in blood. Suction unit on table also covered in blood and had blood in it. Pt. had an IV line started by on scene office personnel. IV bag also covered in blood.

Pt. responded to her name but could not answer questions. Moaning and screaming. Pt. Stopped moving. Female attendant on scene tried to arouse pt. No response. (emergency personnel) slid onto cot. Pt. awake as being moved & responded by screaming again.

Astrid was taken to Washington Adventist Hospital because it had the closest emergency department. She arrived there at 4:09 p.m. Surgery repaired the damage to her reproductive organs and removed a 17.5 cm fetal head, consistent with a 20.5 to 22 week fetus.

Bethany ("Patient B") was 30 years old when she went to Kioko on January 29, 2005. She was referred to Kioko by Potomac Family Planning. She completed an intake form noting that this was her fourth pregnancy. She'd had two previous abortions and one miscarriage. Bethany didn't complete the sections of the form about allergies, current medications, or medical history. Kioko didn't chart anything about Bethany's prior pregnancies and abortions.

Kioko did document a pelvic exam, estimating the fetus as 18+ weeks. He said that he also verified the gestational age with an ultrasound examination. Nothing about this was noted on Bethany's chart. Kioko later told the board that Bethany had brought an ultrasound with her that another physician had performed. Somebody charted vital signs.

Kioko administered a paracervical block, and began the abortion using a 16 mm suction tip. The aspiration was performed "with difficulty." Kioko suspected that he had perforated Bethany's uterus and possibly damaged her bowel. He documented the procedure as completed at 3 p.m., and transferred Bethany to Prince George's Hospital. The hospital records indicate that Bethany arrived at about 7 p.m. and that Kioko had brought her in his own car.

Kioko had sense enough to request help with the surgery to fix Bethany's injuries. Bethany had suffered a perforated uterus, and "transection of rectosigmoid colon and extensive lacerations of the left colon and upper rectum and perforated urinary bladder." The other doctor repaired Bethany's bladder and performed a colostomy, while Kioko performed a hysterectomy, removing the uterus and fetus. Bethany was hospitalized until February 6.

Based on those findings, the board noted that "facts regarding [Kioko's] office conditions and procedures in [his] care and treatment of Patients A and B, constitute extraordinary circumstances, requiring immediate suspension of [his] license to practice medicine." The DC medical board has also, finally, suspended Kioko's license.

A patient in DC, Thakerya Drayton, complained to the medical board about him. She'd been referred to him for an abortion. She was in a lot of pain in the recovery room, where she spent about an hour. When she returned home, she was "bleeding out of control". After a few days, Thakerya's mother called an ambulance. Thakerya was treated for an incomplete abortion. The board found that an incomplete abortion was an expected complication and declined to investigate the case.

God only knows how Kioko managed to practice unsupervised for 8 years without, to anybody's knowledge, killing any more of his patients.

Elsewhere on the web:

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