Thursday, March 20, 2008

Organ Surgeon Faces Felony Trial

That horrible case in San Luis Obispo, in which Dr. Hootan Roozrokh, an organ transplant surgeon is accused of attempting to hasten the death of Ruben Navarro, a dependent adult to harvest his organs, is going to trial. From the story:

A judge dismissed two charges against a Bay Area transplant surgeon Wednesday but ordered him to stand trial on one felony charge related to the failed harvest of a disabled San Luis Obispo man's organs at a local hospital in 2006. A jury will decide whether Dr. Hootan Roozrokh is guilty of dependent-adult abuse.
I believe in the presumption of innocence in criminal cases, and so I won't comment on whether Dr. is criminally liable. But seems undisputed that he utterly violated the most important organ procurement ethical protocols and should face professional discipline. And he's not the only one who should face such consequences, as described by the defense attorney M. Gerald Schwartzbach:
No transplant surgeon in the world, he said, has ever been in similar circumstances, in which the hospital had no cardiac-donation protocol; its staff hadn’t been trained; the attending physician didn't understand her role; and the surgeon and coordinator had only observed one such donation. "This is a situation where the entire system failed," Schwartzbach said.
No doubt, but that doesn't excuse abuse. And this comment from Schwartzbach seems outrageous to me:
"Nothing this man did, nothing this man said, adversely affected the quality of Mr. Navarro's life," Schwartzbach said, gesturing to Roozrokh.
Trying to speed death up so the patient can be an organ donor--and perhaps not coincidentally, Roozrokh would not be paid otherwise--is abuse regardless of the patient's condition. Otherwise, no dying person is safe.



At March 20, 2008 , Blogger Canda said...

You clearly are wholly unfamiliar with the facts of this case. There is no financial incentive for either the doctors in these cases. This poor kid was removed from life support with his mother's permission. He died of NATURAL CAUSES many hours AFTER the ALLEGED administration of these drugs. Did you know there are no records of what was administered? That EVERY witness gave a different account of what happened? That this poor kid had high tolerance to morphine and ativan from his - in fact had a pump that was giving him morphine continuously before he even was admitted. I dare you to find out the truth and quit pontificating on the myths continually perpetrated by the media about this case.

At March 20, 2008 , Blogger DPA said...

I am an anesthesiologist with more than 37 years experience and have participated in a few organ procurement procedures. I would like to comment on two elements of this case and any similar cases:

1) The press shows a high degree of ignorance and irresponsibility when they constantly refer to a transplant donor as dying after life support is discontinued. For example, a motorcyclist who sustains irreversible brain damage from head vs. pavement injury and is declared brain dead is legally dead. You cannot withdraw ventilation and fluid administration and "kill" the patient. Yes, withdrawing "life" support (a term which needs to be improved to reflect what it is really doing), will result in cessation of cardiac activity, but it is not "allowing the patient to die" or "killing the patient." The patient is already dead (brain function has irreversibly ceased). The term ventilatory (or perhaps respiratory) support would be much more precise and acceptable than "life" support.

2)Unless, in this case against Dr. Roozrokh, the patient had not been declared dead when the organ harvesting process (notifying surgical team, etc.) had started, and therefore the doctor took action by administering drugs, I fail to understand the case against him for hastening his death or abusing him in any way. If the patient were already declared dead (brain dead), then nothing the doctor did would have affected that status.

At March 20, 2008 , Blogger Wesley J. Smith said...

Canda. The doctor drove down from SF to SLO for the organ surgery. To receive compensation, an organ had to be procured. Otherwise, no compensation.

Regardless of his criminal culpability, which a jury will decide, he unquestionably broke some of the most important ethical protocols for non heartbeating donor donations. He should have nad ZERO contact with the patient until after death.

At March 20, 2008 , Blogger Wesley J. Smith said...

DPA: Thanks for dropping by. You are confusing a heartbeating cadaver donor (brain dead) from a non heartbeating cadaver donor (porocurement after cardiac arrest).

In the former, you are right, that removing life support does not cause death, because the patient has already exprired and been declared dead by neurlogical criteria.

But THIS CASE WAS NOT A BRAIN DEATH case. It was a non heartbeating cadaver donor case in which AN ALIVE patient is brought into the surgical suite and all life support removed in the expectation that he or she will go into cardiac arrest. IF the arrest happens, after 5 minutes, the organ procurement begins. This approach is sometimes called the Pittsburgh Protocol.

You have mixed apples and oranges, doc.

And your # 2 point is exactly the allegation that has been made in this case, that the doctor sought to cause a patient to die after his life support removal did not result in prompt cardiac arrest.

At March 20, 2008 , Blogger Canda said...

Again, you completely ignore the facts. "The doctor drove down from SF to SLO for the organ surgery. To receive compensation, an organ had to be procured." This is simply an outright lie - on what information do you state this "fact"? The doctors involved harvest organs - and yes, they do it as a job and are compensated for that - and that's all. Whether an organ is retrieved is irrelevant to their amount of compensation - it simply doesn't work that way, although I know it makes nice fodder for your lying blog. Your ignorance is unmistakeable in this case. Again, take some time to get the truth before you continue to print outright fabrications like this. You might want to bother reading the judge's brief dismissing two of the charges to get yourself caught up on what really happened. Having read it in its entirety I speak with confidence that you should be ashamed of what you've posted, especially regarding alleged compensation.

At March 20, 2008 , Blogger Wesley J. Smith said...

It was reported in the San Luis Obispo paper as I recall. If I am mistaken, I would certainly correct, but I am not lying.

So, Canda, what is your personal connection to this case?

At March 20, 2008 , Blogger Wesley J. Smith said...

It was reported in the San Luis Obispo paper as I recall. If I am mistaken, I would certainly correct, but I am not lying.

So, Canda, what is your personal connection to this case?

At March 20, 2008 , Blogger Canda said...

I don't believe I need a personal connection to this matter to be incensed at the media's treatment of this case. I'm merely a watchful member of the legal community who is sick of this type of press manipulation. It's something that goes on everyday. The prosecution may have alleged compensation was at issue, but that does not make it true. Although I wouldn't be surprised that some media report stated something about "no organ, no compensation", it doesn't make it factually true, and indeed, it is not. In fact, testimony at the prelinminary hearing was VERY clear on that. Again, this kid was a donor before the harvest team was called; he had a high tolerance for morphine; the attending physician was not there when the team arrived; orders were made for comfort care, not to speed death - but you know, it's clearly more interesting to believe the more salacious fantasies of the media than the truth. The patient was never cut open - no surgery of any kind even took place, yet people think he "murdered for organs". Go to google and search "hootan roozrokh" - and see what you get - that he's a murdering jihadist? THAT's what irresponsible journalism is doing and yeah, my personal interest is that such slander is disgusting and I'm fed up with it. I just think it's time to fight back.

At March 20, 2008 , Blogger Wesley J. Smith said...

Canda. Did you read where I said I wouldn't prejudge his criminal culpibility? And I never said he did what he did for the money. I was stunned to learn that contract transplant surgeons aren't paid if the procurement doesn't take place. Now, if that is not true, show me where to access that. That kind of a compensation system give the appearance of a potential conflict of interest. So, if media reports were wrong, what was the compensation agreement between the doctor and the California Organ Donor Network?

This case is very much about a lot of things, including inadequate training.

I agree calling him a jihadist is riduculous. I don't know his religion, and could care less.

Well, those things you are mad about have nothing to do with me. And, you seem to have prejudged the case yourself.

But, please. Keep fighting. Underdogs always need good advocates.

At March 20, 2008 , Blogger Canda said...

Wes - Your entire post re this story is filled with your prejudgment!! Oh the irony! Don't let the facts get in the way, eh? It's so much easier that way isn't it?

At March 20, 2008 , Blogger Wesley J. Smith said...

Pot calling the kettle black, Canda. There is no question that this was a botched process. None. There is a question whether the good doctor is criminally culpable. I have not prejudged that at all.

Did you notice I featured a quote from HIS lawyer saying that the "entire system failed?" Indeed it did. And Dr. Roozrkh was part of that system's failure.

I am content to let the jury decide guilt or innocence. I am not content for travesties such as this to happen again. As I have written elsewhere, much better training is required and mandatory uniform standards need to apply in all transplant centers.

At March 20, 2008 , Blogger Lydia McGrew said...

I gather there is no controversy about the fact that he was in the room making prescriptions for this patient who was still alive and who was not his own patient. He was a transplant doctor, period. The whole carrying out of the case was incredibly unprofessional, which is putting it mildly. If he's claiming (which I gather from an earlier story he is) that this patient was in horrific pain or something--a point the attending physician is said to deny--that was a matter for the _live patient's_ doctor or doctors to care for, the hospital doctors. Not the transplant doctor. It is just entirely non-kosher. Absolutely so.

And that's setting aside the question of whether this story about ordering these quantities of morphine because of patient pain is true or not.

At March 20, 2008 , Blogger Lydia McGrew said...

I just read the judge's ruling. Wesley, there's something I don't get that maybe you can explain: The judge dismisses charge 3 regarding prescription of a controlled substance, because of a paragraph in the law that says prescriptions in a hospital are exempt from the provisions of the law. But that paragraph goes on to say that such prescriptions in a hospital must be made in writing with the amount prescribed being written down. That wasn't done in this case; that is actually a point of some importance earlier in the opinion as far as the difficulty telling how much morphine and atavin were given. So why isn't there still a charge under that law to the doctor for not writing down or having written down the amount of those drugs that he orally ordered?

I also note from the opinion that apparently at this point in the proceeding the transplant doctor did _not_ say that the patient was showing signs of pain, and multiple other witnesses are saying that he wasn't. It looks like the doctor's whole defense is, "Nobody knew who was in charge. I got left in charge of the patient's final care by default in all the confusion. And it doesn't matter how much morphine and atavin I ordered, because he was going to die anyway, so nothing I did made any difference."

Not, I must say, the most compelling of defensive arguments!

At March 20, 2008 , Blogger Wesley J. Smith said...

The judge clearly felt the evidence was too weak to go forward with the other charges.

We don't yet know the full extent of the defense. From the defense lawyer's quote in the paper, it would seem that since the charge is abuse of a dependent adult, the defense will be he was already so far gone he couldn't be abused because his condition would not permit him to perceive the problem. I don't think that will fly. Clearly, someone in a coma can be abused. But we will see.

At March 21, 2008 , Blogger Lydia McGrew said...

That would be a very bad precedent--someone in a coma can't be abused.

I'm struck by the fact that apparently no one even tried to prosecute this as attempted murder. Perhaps someone far gone also can't be murdered?

I think the medicalization of all of this is what throws people. It used to be that people understood clearly that morphine could be abused by doctors, and prosecution for deliberate overdose was not only possible but plausible. Now it seems that morphine is always treated as "comfort care" even if you stand in front of a bunch of witnesses and order morphine dose after morphine dose while everybody waits for the patient to stop breathing. And whatever else, you aren't prosecuted for trying to kill the person. If he'd stood in front of the same witnesses and held a pillow over his face, stopping from time to time to see if he'd stopped breathing, would _that_ have gotten an attempted murder charge, or still only "abuse"?


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