Thursday, November 24, 2022

New to Me: The Death of Kawaida Espenrace at A - Z Women's Center

Kawaida Espenrace was a 27-year-old resident of Las Vegas. She was a widow and the mother of three young children. 

On November 3, 2007, she went to A-Z Women's Center in Las Vegas for an abortion after being referred by Planned Parenthood. Her last period had been on August 25, which would have made her 10 weeks pregnant. The notes at the clinic note her as 14 weeks by ultrasound.

Dr. Adam Vincent Levy began the abortion at 1:03 pm and completed it at 1:32 pm. He noted administration of methergine, which is used to prevent and control postpartum hemorrhage at 1:24.

On Kawaida's chart, Levy circled "yes" for "Extensive Blood Loss?" but "no" for "Any Complications?" After her abortion her level of consciousness was noted as "Confused." An illegible note says includes the word "floppy" in quotation marks and "ie atony" double underlined.

Kawaida's recovery room chart noted checks at 20-minute intervals. Her blood pressure and pulse appeared to be stable in the 120/75 range. Her bleeding was noted as "sm" at 1:40, 2:00, and 2:20. However, "sm" is circled then crossed out and "hvy" circled at 2:40.

At 2:52 pm staff gave Kawaida another dose of methergine.

Adam Levy
At 2:55, per Levy's orders, Kawaida was given 100 mg of cytotec orally. 

At 2:55 pm, A-Z staff finally summoned EMS to transport Kawaida to a hospital for appropriate care. By then it was too late to save her. Kawaida bled to death that evening.

Autopsy revealed that Levy had improperly inserted the suction cannula, punching a hole in Kawaida's uterus and causing a two-inch laceration to tissues, vein, and artery outside the uterus. 

Kawaida's family sued on behalf of her three orphaned children but the case was dismissed due to errors made by the family's attorneys.

Source: Court documents and attachments


Kathy said...

I think the medical note reads, "ut[erus] becomes 'floppy' if not massaged ie atony".

This would make sense considering the circumstances. It happens with some regularity after normal childbirth; I never heard of or even thought of it happening with abortion, but it's reasonable that it could.

With a normal pregnancy, after the baby is born, the placenta/afterbirth disengages from the uterine wall. Because the placenta has been exchanging food, oxygen, and waste via blood along the uterus, the disengagement leaves an open place for a lot of blood to come out into the uterus. Normally, the uterus clamps down and shrinks in size, which greatly restricts continued blood loss, but the uterus can be "boggy" or "floppy" and not restrict on its own. Massaging it externally (pushing/rubbing on the lower abdomen) will often make it contract, but sometimes other measures need to be taken.

With an abortion at that early stage of pregnancy, though, the placenta is small and any blood loss or area for blood loss should also be small. Very likely it should have been an indication of something worse, for the uterus to be floppy with an early abortion -- such as uterine puncture.

Kathy said...

I think the doctor's note reads, "Ut[erus] becomes 'floppy' if not massaged i.e. atony".

This is not uncommon after childbirth, though massaging the uterus usually makes it firm up, and not be a problem. I've not heard of it post-abortion, particularly in an early abortion, and I suspect that that should have been a red flag to the abortionist that something was wrong.