December 15: Medical Board's Foot-Dragging

"Why trust a nameless intern or resident when you can get all services & follow up under personal supervision of Dr. Nehorayoff?" asked the ad running in Newsday in 1981. For just $145, a woman could head to Plaza Women's Medical Center and entrust her care to Andre Nehorayoff at a facility offering "Pre-Natal Birth Control." 

Odd phrasing, that.

What the kind folks at Plaza Women's Medical Center failed to include in their ad is that their Dr. Nehorayoff  wasn't the most skilled doctor in the city. 

The medical board wasn't exactly going out of their way to alert anybody either. In fact, Dr. Andre Nehorayoff had already killed an abortion patient. The state hadn't even gotten around to investigating.

The First Documented Botch Was Deadly

Nehorayoff

A young woman the medical board eventually calls "Patient F" went to Nehorayoff's office for a safe, legal abortion on December 15, 1979. To avoid the dehumanizing term "Patient F" I will call her Faye. She was 19 years old.

When they finally got around to investigating, the medical board noted that Nehorayoff failed to record any medical history or pre-surgical exam.

Nehorayoff performed a suction curettage at 2:10 pm.  After procedure, at 2:25 pm, moved Nehorayoff moved Faye to recovery. Nehorayoff's staff failed to provide for adequate monitoring. Nobody was consistently visually monitoring Faye and there was no EKG monitor on her. 

Faye was stable when somebody checked on her at 3 pm.  However, by around 3:25, Faye was cyanotic and pulseless. She was transferred to Roosevelt Hospital, where she was pronounced dead.

Cue Crickets. 

The state's failure to take action meant that Nehorayoff was still advertising his supposedly exemplary services in 1983, when "Patient E" entrusted herself to his dubious care November 29. I'll call her Ellen.

Nehorayoff left the medical history of Ellen's chart blank. He didn't to an ultrasound and didn't record that he performed a physical examination. He didn't order an ultrasound. The experts on the medical board -- when they got around to looking into the events -- couldn't decide if they should fault Nehorayoff for failing to use laminaria to safely dilate Ellen's cervix and whether he'd dilated her cervix adequately. They did agree, though, that Nehorayoff should have known that he hadn't completed the abortion. He should have transferred Ellen to a hospital to monitor her and finish the abortion. He sent her home instead, noting that he had advised her that she might pass fetal tissue and instructed her to call if she bled heavily. He got a report from the pathology lab on December 1, indicating that he'd only removed placental tissue. Nehorayoff didn't even notate this in Ellen's chart and didn't document any efforts to contact her. On December 3, at 5:10 am, Ellen was admitted to the emergency room at West Hudson Hospital in Kearney, New Jersey. She was pronounced dead at 6:20 am. An autopsy found a fetal leg wrapped in placental tissue protruding from Ellen's uterus. The incomplete abortion had caused Ellen to bleed to death.

Oddly, the medical board eventually found that Nehorayoff was negligent in many aspects, but concluded that he he was not negligent for failing to follow up on the pathology report because he already knew that the abortion had been incomplete and had been negligent in handling this existing knowledge.

The medical board closed their investigation into Ellen's death in November of 1988. It's unclear whether or not they'd addressed some non-fatal botches at that time as well. I haven't seen evidence that they'd gotten around to investigating Faye's death.

At Least He Stopped Killing Them

Faye and Ellen weren't the only women to suffer complications at Nehorayoff's hands.

Patient D, "Dru", was 27 when she went to Nehorayoff for a mid-trimester abortion on October 18, 1988. Again, if Nehorayoff performed a medical history and exam he didn't record it. He didn't use laminaria. He proceeded to do an outpatient abortion even though Dru's hematocrit was only 26%. (A woman's hematocrit should be from 35.5% to 44.9%.) Nehorayoff sent Dru home after the abortion even though, as with Ellen, he had concluded that he'd performed an incomplete abortion. He told Dru to return for another procedure on October 22, and yet a third procedure on October 26. The medical board -- when they finally got around to paying attention -- faulted Nehorayoff for doing outpatient abortion on anemic patient and for discharging her when he wasn't sure if the abortion was complete. They noted that Dru could have died. They found Nehorayoff negligent but not grossly so and not incompetent.

Patient C, "Coral," was age 22 when she went to Nehorayoff for a first trimester abortion on September 20, 1988. Nehorayoff sent the tissue away for a pathology report but didn't call to get the results. On September 28, Coral returned to Nehorayoff's office complaining of lower abdominal pain. Nehorayoff didn't order a pregnancy test, sonogram, or review of the pathology report. He finally did get the pathology report, indicating that he had not removed an embryo, on September 29, but didn't do anything about it. He finally ordered an ultrasound on October 18, identifying the fact that Coral had a potentially fatal ectopic pregnancy. The medical board does not indicate what care Coral got and from whom to address the ectopic pregnancy. The board found Nehorayoff negligent but not grossly so, and not incompetent

Lucky to Be Alive

Patient B, "Blaire", age 18, went to Nehorayoff's office on November 22, 1989, for a mid-trimester abortion. Nehorayoff's idea of a pre-operative exam and medical history was limited to recording her pulse, blood pressure, and weight. During the abortion, Nehorayoff pulled a loop of bowel out through Blaire's cervix. He poked Blaire's intestine back through the 2.5 cm (nearly one inch) hole he'd torn in her uterus, then continued with the abortion. At last he transferred Blaire to New York Hospital. Exploratory surgery found a 6.5 foot long section of devascularized bowel in Blaire's abdomen, along with portions of her fetus. Doctors removed fetal remains, and the dead portion of Blaire's intestine. The board found that Nehorayoff was negligent, but not grossly so, and that he was not incompetent. (I have to give Nehorayoff credit for not just sending Blaire home to bleed to death like Bruce Steir did with Sharon Hamplton.)

Nearly Fatal Referral

Patient A, "Ariana", age 36, learned from her obstetrician, Dr. Zeinab Fathelbab, that her unborn baby had died. She was in the second trimester of her pregnancy. Dr. Fathelbab referred Ariana to Manhattan Women's Medical Offices so that Dr. Nehorayoff could perform a D&E to remove the dead baby. Ariana went to her appointment on June 23, 1990. At this point I'm sure it's no surprise to find out that Nehorayoff failed to record findings of an adequate history and exam, specifically cardiovascular and pulmonary exams. He failed to do pre-operative tests, including platelets, fibrinogen, and hematocrit. 

Trendelenburg position

Ariana was transferred to the recovery room at noon. He blood pressure was an elevated 130/90 and she was receiving IV fluids. Ariana reported to staff that she was weak and in pain. She was placed in the Trendelenburg position (tilted with her feet higher than her head) and given oral medications and fluids. A patient who might need further surgery should never be given anything by mouth, especially not when in the Trendelenburg position with its increased risk of aspirating the fluids and developing pneumonia.

At 2 pm Ariana's blood pressure had fallen to 80/50. She was also week and unresponsive. The medical board noted that Nehorayoff should have hospitalized her at that point. Instead, Nehorayoff  kept Ariana on site and finally contacted Dr. Fatherlbab to tell him that he was going to transfer Ariana to Central Suffolk Hospital, which was two hours away. Ariana's husband stopped that plan, insisting that they call 911 and have an ambulance bring his wife to the nearest hospital. The ambulance was summoned at around 5 pm. By then Ariana was turning blue and her blood pressure was 80/0. The ambulance brought her to Beth Israel Medical Center. Upon arrival she had a hemoglobin of 7.8 (It should have been at least 12.) and hematocrit of 23.4 (A normal hematocrit should be from 35.5% to 44.9%.). She was fully in shock. Emergency surgery found two lacerations in her uterus. The doctors were unable to repair the damage and ended up having to perform an emergency hysterectomy. As in the other cases, the board found Nehorayoff to be negligent but not grossly negligent, and not incompetent.

Admissions and Excuses

It wasn't until 1991 -- eleven years after Faye's death and eight years after Ellen's death -- that the medical board got around to taking any action. On February 22 they suspended Nehorayoff's license. 

Between March 6 and April 25, they held a hearings over nine separate sessions and decided that it was okay for Nehorayoff to resume practice as long as he stopped doing abortions. On June 10, they decided that it would actually be a good idea to keep Nehorayoff from practicing medicine at all for three years, which they'd reduce to one year if he went into a residency training. 

I'll quote the medical board document verbatim here because it's very telling:

The committee noted that the record indicated that Dr. Nehorayoff had taken shortcuts in his practice of medicine that had contributed to the incidents which led to the revocation of his license and asked Dr. Nehorayoff to respond. He replied that he had a very large practice and did not spend enough time with each patient. He said he tried to make up for his lack of time by taking some shortcuts, which resulted in a lack of sufficient attention to patients as he was overwhelmed by the total practice and the other events that were happening in his life at that time.

Contrast this with his ads, which said, "Your relaxed consultation with Dr. Andre Nehorayoff ... is absolutely free of charge." A man who can't even take the time for a complete medical history or a decent pre-operative exam can hardly be providing relaxed consultations. A man who was offering free consultations on a same-day basis to bring patients in was making the decision to be overwhelmed.

Concerning Ellen's death, Nehorayoff said that there was pending litigation in the case. He said that he had recommended hospitalization but she'd said that it was not necessary and that she didn't want her family to know about the abortion. When he'd tried to call her the day after the abortion she found that the phone number she'd put on the forms wasn't correct.

Good Enough for Planned Parenthood

Nehorayoff said that the problems only occurred with his abortion patients, not his usual obstetric and gynecological patients.  Questioned about his lack of knowledge and skill, Nehorayoff said that since the catastrophes with his patients, he had spent three months volunteering at Planned Parenthood. There he had been trained in the appropriate use of laminaria. 

Promises

Nehorayoff told the board that he'd undergone surgery himself since he'd injured and killed his patients and this had made him appreciate a patient's perspective. He said that he would get help if he had problems in the future, and would get hospital admitting privileges so that he could continue to care for his patients if they had to be hospitalized. 

After the board had decided to put Nehorayoff on probation, Linda Randolph, Director of the Office of Public Health, New York State Department of Public Health, reviewed the case. She expressed astonishment that the committee had suggested a residency. Nehorayoff had been a doctor for 20 years. If they thought he was so unskilled that he needed such intense training as a residency, that showed that they recognized that Nehorayoff was a danger.

She ensured that Nehorayoff's license was finally revoked December 20, 1991.

Sources:

• University of the State of New York Case No. 97-67-60R
• Report of the Regents Review Committee: Andre Nehorayoff: Calendar No. 12342
• "26 dangerous docs: State probe eyes MDs," New York Daily News, November 27, 1991