posted
Just a heads-up in case anyone is interested. I have a love/hate relationship with doing live radio. It's the most control of your message you can have in broadcast media, but it calls for very quick and articulate responses.
At least this is a friendly venue.
The show is "The Largest Minority" - a show that airs once a month on New York City's Pacifica radio station. It will start at approximately 11:00 am ET and run for an hour or so. You can listen to it live at:
I'll be one of two guests discussing the death of Ruben Navarro, a disabled man who died a few days before his 26th birthday. A transplant surgeon is facing multiple charges in connection with events leading to Navarro's death. Navarro's mother had consented to organ donation upon removal of the ventilator keeping her son alive, under a "cardiac death" protocol.
The transplant surgeon, contrary to state law and hospital policy, took over "care" of Navarro upon removal of his ventilator. The attending physician let this happen. The transplant surgeon directed a nurse to inject Navarro with 200 mgs of morphine and 80 mgs of ativan. Absolutely no one is defending these dosages as therapeutic - the clear intent was to get Navarro to "die" within the 30-minute window for organ donation.
The fact that the physician is facing criminal charges is no cause for comfort. Neither the attending physician who handed Navarro over nor the nurse who administered the injections are facing charges. In fact, they've been cleared of wrongdoing by their respective review boards.
It brings up a number of troubling questions, mostly ignored in the press, which is now dominated by the possible negative impact publicity this case will have on organ donations.
For more information:
Diagnosis: Murder (this is an outstanding piece of analysis by blogger and advocate Cilla Sluga, who dug out a lot of information ignored in press coverage)
posted
The nurse didn't even get her license suspended or fired? That's shocking to me. If she knew the dosage was fatal I think she should be charged, and if she didn't, I think she should have her license suspended or revoked.
Posts: 21182 | Registered: Sep 2004
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posted
I'm not clear on the legal nuances, but it seems like a coroner should establish a cause of death, and if it wasn't from natural causes, the prosecutor should have charged someone in that room with murder.
It also seems pretty clear that whether what they did caused the death, the people there were TRYING to cause the death to happen on their schedule, so why aren't they at least facing attempted murder charges? If someone has 10 seconds to live and you shoot them dead, isn't that attempted murder? And if it works, isn't that murder? Is this case substantially different from that scenario? If so, how?
Maybe the prosecutor thinks they can't make that kind of charge stick in a case where a decision to terminate life support was already made?
But then we have the lack of consent from his mother for removal of the respirator...
posted
Just a brief note until later today. I am about to leave for work and then prepare for the show.
It's been left out of most mainstream coverage, but Rosa Navarro's lawyer claims (on the Nancy Grace Show and in a formal brief to the court) that Rosa Navarro was told by hospital staff that her son could only stay on a respirator for five days.
This issue obviously deserves some exploration - she gave "permission" on the fifth day, but according to her lawyer, she didn't think she had a choice.
The coroner says Ruben Navarro died of "natural causes" - but at least one person with some medical knowledge is skeptical of that. In addition to the ativan and morphine, betadine was injected into Navarro's intestines -- something typically done after death. Betadine is safe topically but is toxic when taken internally.
It's important to remember that Navarro wasn't brain-dead. He was five days into a coma.
Posts: 4344 | Registered: Mar 2003
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posted
That is horrifying to me. My step-brother was in a coma for two weeks and he came out of it and is mostly okay. Telling his mother he had to be taken off the respirator on day five and then making sure he died would definitely have been murder.
Posts: 1753 | Registered: Aug 2002
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posted
I tried five or six times to write a post in this thread last night.
I can not find words.
After injecting him with overdoses of morphine and ativan and pumping his stomache full of poisionous antiseptic, when he still didn't die in time to take the organs they wheeled him into another room where he died alone eight hours later.
When I did my stint as a hospital chaplain a person had to be brain dead in order to donate their organs. That was very clearly explained, and I helped explain it to families. I'm finding the whole idea of "cardiac death" donation disturbing -- it seems like it opens the door for this kind of thing. Even if the medical team hadn't tried to kill this man medically, by taking him off the respirator when he was not brain dead they would still have been killing him for his organs. Although at least not torturing him and leaving him to die alone.
Posts: 9866 | Registered: Apr 2002
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posted
I wish we knew the actual facts so we could make informed opinions instead of just blathering at one another. These types of cases always seem to pop up in the media and nobody has the facts all together, but they want to get the story out fast. Then while we don't have the whole story, everyone forms instant judgments and starts calling people murderers. Sheesh.
Posts: 3950 | Registered: Mar 2006
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posted
There may be liability issues here, the hospital, nurses, etc. might know actual facts but possibly may not want to release them before a trial in the hopes of not influencing jurors? Just a guess...
Posts: 7593 | Registered: Sep 2006
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posted
But the media can influence jurors with guesses and angry fist-shaking though. I don't know the legal ramifications, but personally, I like to withhold final judgment until I hear the whole story.
Posts: 3950 | Registered: Mar 2006
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quote:It also seems pretty clear that whether what they did caused the death, the people there were TRYING to cause the death to happen on their schedule, so why aren't they at least facing attempted murder charges?
Exactly.
quote:Maybe the prosecutor thinks they can't make that kind of charge stick in a case where a decision to terminate life support was already made?
I don't see any problem making that charge stick under those circumstances, barring some special shield law in California. Most such laws I know of speak only to removal of life support, though, not active measures to hasten death.
quote:I wish we knew the actual facts so we could make informed opinions instead of just blathering at one another. These types of cases always seem to pop up in the media and nobody has the facts all together, but they want to get the story out fast. Then while we don't have the whole story, everyone forms instant judgments and starts calling people murderers. Sheesh.
We know enough to at minimum raise Bob's question:
quote:Prosecutors allege that Roozrokh violated the law on Feb. 3, 2006 when he took control of Navarro’s care before he was dead, and that he mistreated him by ordering excessive amounts of sedatives “to accelerate Mr. Navarro’s death in order to recover his organs,” a statement said.
If the prosecutors have probable cause to support this statement - which it appears they do - then they have probable cause to uphold an indictment for attempted murder.
quote:The coroner says Ruben Navarro died of "natural causes" - but at least one person with some medical knowledge is skeptical of that.
The problem is that the coroner report, in and of itself, is almost certainly reasonable doubt that would provide a successful defense to murder charges, even if another expert makes a definitive finding of causation. Medical experts being "skeptical" of the finding is a non-starter. A prosecutor has a duty not to bring charges he doesn't think he can prove.
I'd still like to see an explanation of why an attempted murder charge was not brought.
Posts: 26071 | Registered: Oct 2003
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posted
I just got email from the producer - they'll be calling me at 11:25 am ET. About ten minutes away.
I'll post with more info and some links.
For some people concerned about the "rush" to judgement on this - statements from the other medical professionals have been made public. As expected, there are some variations in the witness accounts, but they all agree on the major points.
As I said, I'll post some links and excerpts.
I am very angry that the mainstream media isn't asking questions about the "five day limit" claim since it's in the wrongful death brief that can be accessed by just about any reporter. Is it true? Under what conditions? What does that mean about "consent"?
Posts: 4344 | Registered: Mar 2003
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posted
As a mother of a heart transplant recepient I am horrified and so saddened. I can only imagine the pain that mother is having to go through losing her son in such a horrific manner. It is hard enough facing your child's mortality because of an illness but to have him killed like this is beyond imagination.
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posted
I would think that such large quantities of drugs to speed death would also damage the very organs they were hoping to harvest..
Posts: 9538 | Registered: Aug 2003
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quote:SAN LUIS OBISPO – A transplant surgeon charged with ordering excessive drugs to quicken a disabled patient's death last year clashed with a member of his team over whether organ recovery could begin, court documents show.
Dr. Hootan Roozrokh insisted Ruben Navarro, who was born with a neurological disorder, did not have a pulse and wanted to proceed with harvesting his liver and kidneys, transplant coordinator Carla Albright told county authorities in court documents unsealed last week.
Albright countered that organ recovery could not begin because she could still see his heart rhythm on the monitor.
“I could clearly see his heart, he was very skinny, emaciated, and so you could see his heart beating in his chest wall,” Albright said, according to a 68-page transcript of her interview with a coroner's investigator in August last year.
Roozrokh appeared frustrated that Albright challenged his opinion, and he ordered nurses at the Sierra Vista Regional Medical Center to give narcotics to Navarro, Albright said.
At one point, Roozrokh suggested giving another drug, a muscle relaxant called vecuronium. It was then that Albright said she spoke up and told him it was unacceptable.
***
Albright told authorities that Roozrokh never explained why he prescribed the drugs. Although Albright said she knew Roozrokh was not supposed to be in the operating room until the organ donor was legally declared dead, she offered no explanation why she let him stay.
quote:Originally posted by Farmgirl: I would think that such large quantities of drugs to speed death would also damage the very organs they were hoping to harvest.
I was wondering about that.
Posts: 32919 | Registered: Mar 2003
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posted
This is right out of an old George Carlin bit. He said not to put the organ donor sticker on your license, because if you were in an accident, "Do you think the paramedics are going to try to save your life? They're looking for parts!"
If I needed a transplant I'd certainly rather die than hasten the death of another, even if they absolutely would have died just a little bit later.
I'd make a comment about the devaluing of human life, but looking at history, I guess this is actually the return to the status quo from our apparent overvaluing of human life...
Posts: 454 | Registered: Mar 2005
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posted
This is really depressing and disgusting stuff. I get worried sometimes about getting desensitized, seriously. It was clear on today's show that Cilla Sluga, the other guest, was much more emotional about what Ruben Navarro went through. Part of me wonders where my gut-level outrage went, but I know it's really still there but it can't be something that sits too close to the surface or I won't function very well.
Sad to say, in *my* world, this is the "outrage of the week." Gotta save something for the next one.
Jennifer Endsley, a nurse at Sierra Vista Medical Center in San Luis Obispo, told investigators that she spoke up because she was troubled by the behavior of a visiting transplant team as they prepared to harvest the organs of a 25-year-old disabled man last year.
"I don't think this is right," Endsley, one of several staffers in the operating room that February night, recalled saying.
***
On Feb. 1, hospital staff contacted the California Transplant Donor Network, the regional group that procures organs.
Navarro's mother, Rosa, gave her consent to donation, although she now says she was not given complete information about his condition or what would take place.
About 11:20 p.m. on Feb. 3, the two transplant surgeons dispatched by the regional network entered the operating room with Navarro, before Lubarsky even arrived.
Endsley said that at one point, when she asked why the surgeons were in the operating room, she was "stared at and ignored," according to her interview summary.
Around midnight, after Lubarsky arrived, respiratory therapist Mark Winekoff said Roozrokh instructed him to remove the breathing tube. Winekoff told police he "looked at Dr. Lubarsky and without saying anything, Dr. Lubarsky motioned to [him] to go ahead and remove the tube."
Minutes later, Roozrokh asked nurse Diana Dean Stevens, "Do you have the stuff to give him?" according to a police report. Stevens then gave Navarro medication, witnesses said.
About 20 minutes after life support was removed, Roozrokh "was heard to say they needed more 'candy' " and placed an order for another 100 milligrams of morphine and 40 milligrams of Ativan -- the same doses that had been given to Navarro earlier, the police report said.
***
Connely said Lubarsky's conduct was reviewed by the Medical Board and she was cleared of any wrongdoing last year. Roozrokh's conduct is still under review, medical board spokeswoman Candis Cohen said.
posted
Cilla Sluga found the online pdf copy of the wrongful death complaint. This complaint contains the allegations about the "5-day-limit."
Is it just me, or would this be something that might be a good thing for a reporter to ask questions about? We have the allegation, but since no one from the media has asked the hospital about this allegation, we don't have a response.
posted
Farmgirl, I was not trying to be funny. My point is that the original bit, if it was funny at all, was funny because it was utterly ridiculous. But now we're seeing the utterly ridiculous come to pass.
There's nothing funny about that. Rather, I mourn.
Posts: 454 | Registered: Mar 2005
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posted
I think that if I were brain dead, I would want my body's death to be hastened so that my organs could be donated. I thought when I first read about this case that something like this is what happened. I assumed that it was a person who'd been in an accident and was brain-dead and whose body just happened to hang on a little too long after life support was removed. I think it would be at least understandable to want to speed up the death, since the person is not going to ever be conscious again. I wouldn't support the practice in general because I think it's too close to a line that we don't want to cross. But I get why someone would do a thing like that. This case, on the other hand, goes way beyond understandable.
I'm really disgusted and disturbed that someone who wasn't brain-dead and who apparently didn't even have to die was deliberately killed. And why was he just left to die after the organ harvesting didn't work out? Maybe it was too late to save him, but I'd think that they'd try. Murder charges would be entirely appropriate, I think.
Posts: 3546 | Registered: Jul 2002
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quote:Originally posted by sndrake: At one point, Roozrokh suggested giving another drug, a muscle relaxant called vecuronium. It was then that Albright said she spoke up and told him it was unacceptable.
sndrake, for what it's worth, vecuronium isn't a muscle relaxant in the same sense as a muscle relaxant you take for back pain. It is a neuromuscular blockade agent which is used as a paralyzing agent. A standard use is to paralyze the patient so that a breathing tube can be inserted -- and with that standard dose, the patient couldn't have continued to breathe on his own.
----
Edited to add as per discussion below: (I am agreeing this is a bad thing and stating that the people reporting/following this may not realize just how damning (I think) this order/suggestion was. I am certainly not trying to excuse or defend it -- rather, to highlight it as a likely fruitful issue to contend with directly.)
posted
Well, of course. That was why I told sndrake -- it seemed important for him to know, as it might well be a point of issue for him in public discussion.
Why on earth would you think I thought it was better?
Posts: 14017 | Registered: May 2000
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posted
"For what it's worth" as in "this may or may not be of use to you, but I think you should know about it."
For all I know, this has already been noted -- but it sure was weirdly/misleadingly worded to me, and it explains why *that* was the point where she put her foot down. That, to me, was what spoke unequivocably (if truly reported) as to his intentions, and that they were well far beyond the pale. A cold shudder for me to read:
quote:[Apparently after the man had already been taken off the ventilator:] At one point, Roozrokh [the transplant surgeon] suggested giving another drug, a muscle relaxant called vecuronium. It was then that Albright [the transplant coordinator] said she spoke up and told him it was unacceptable.
---
Edited to add: That is, I would have been highly suspicious beforehand, but that order was (for me) the difference between pushing a car to roll over a person -- and standing on top of the accelerator, head out the window, yelling "Hey y'all, watch this, I'm totally going to crush this guy to a pulp! Watch me! Look, look!"
Unmistakeable. You don't give vecuronium if you aren't expecting to have to breathe for somebody, and it isn't a drug for comfort (in the usual sense***). It has a very limited use.
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***That is to say, if a baby is struggling against a breathing tube that is necessary to be maintained, we may paralyze them and sedate them into a coma "for comfort." But -- unlike morphine -- you don't give vecuronium *just* for comfort. You give it to stop someone from breathing on their own and to stop their bodies from being able to resist, even unconsciously. (i.e., vecuronium is what keeps the abdominal muscles from going hard as stone when you cut into them for surgery)
posted
Ah, now I understand. It was in terms of her actions a "for what it's worth."
I'm sorry, I'm slow today. I told someone a few hours ago that 470 + 390 was more than 1000. And then couldn't figure out why she was staring at me . . .
Posts: 32919 | Registered: Mar 2003
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posted
No problem. Perhaps others would have misread me as well.
What a ghastly thought.
I generally wonder (like MightyCow) if there are parts of the story we don't know yet, or what other interpretations there might be of various actions, etc. That particular action isn't one I can think of any other interpretations for than the one ascribed.
Posts: 14017 | Registered: May 2000
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quote:Vecuronium is also used by a doctor on Law & Order before extracting an organ on an alleged brain dead patient. McCoy catches it and uses it against the doctor on the stand to convict him of murder.
I can't vouch for it, as it's Wikipedia, but it would be a plausible use as a storyline.
quote:[Regarding this class of drugs] Neuromuscular blocking agents produce skeletal muscle paralysis by blocking neural transmission at the myoneural junction. The paralysis is selective initially and usually appears in the following muscles consecutively: levator muscles of eyelids, muscles of mastication, limb muscles, abdominal muscles, muscles of the glottis, and finally, the intercostal muscles and the diaphragm. Neuromuscular blocking agents have no known effect on consciousness or the pain threshold. ...
[Regarding this drug in particular] Onset of action: Initial effect within 1 minute; intubation conditions in 2.5–3 minutes. [i.e., if you give it, you have to be ready to intubate and ventilate mechanically almost immediately -- but they had just taken this guy off the ventilator] ... May increase incidence and severity of bradycardia and hypotension when used together with opioid analgesics. [i.e., more likely to cause the heart to fail when used in conjunction with drugs like morphine] ... Caution required in patients with cardiovascular function impairment. [see above]
posted
Even though these stories aren't the norm, it definitely makes me second-guess the little heart on my drivers license.
Posts: 1314 | Registered: Jan 2006
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I got your intent the first time. It was clear that a paralytic agent for someone who *wasn't* getting a ventilator tube inserted was nontherapeutic, to say the least.
Now that I killed Farmgirl's thread, I figured I'd add just one more little bit of scary context - it's about one of those organizations that have a lot of impact on our lives but most of us have never heard about.
And the person who sounded the alarm on this was Art Caplan, who is not known for being an alarmist:
quote: Recently, a private but influential legal group, the National Conference of Commissioners on State Laws, revised the Uniform Anatomical Gift Act (UAGA), which is the model that many states have followed to legislate organ donation. The commissioners know there are too few organs available for those in need. Their proposal, which is under consideration by states, is that organ donation consent (on a driver's license, for instance) be allowed to override a person's living will, advance directive or even physician orders. The proposed language in the revision states, "measures necessary to ensure the medical suitability of an organ for transplantation or therapy may not be withheld or withdrawn from the prospective donor." What this means is that if you say you are willing to donate your organs, your advance directive, living will and physician's orders are in trouble.
The revised UAGA, which is under review by the California Department of Health Services and the state Legislature, in one fell swoop nullifies the advance directive of people who have consented to organ donation. If California and other states adopt the revised UAGA as written, advance directives will have to make clear whether the person gives more importance to organ donation or to directions about their end of life care. That is too much to ask.
BTW, I checked the website of the National Conference of Commissioners on State Laws and found that the revised guidelines on organ donation had been endorsed by the AMA, United Network for Organ Sharing, the National Kidney Foundation, the Eye Bank Association of America, the American Association of Tissue Banks, the American Academy of Ophthalmology, the Cornea Society, and the Association of Organ Procurement Organizations.
Evidently their policy analysts didn't see the problems that Caplan sees. Once he pointed it out, I agreed with him, too.
Posts: 4344 | Registered: Mar 2003
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posted
Wow -- that change would make things very, very complicated (from the perspective of having worked on an ambulance.)
So we get a call to a house, terminal patient, but their family calls because said patient appears to have stopped breathing. (yes, lots of families do this). You get there, and the family shows you their DNR order (advance directive) so you know that if there is no pulse, etc. you have permission to NOT perform CPR until your state EMICT protocols. BUT if they are an organ donor -- we will have to attempt to revive to keep organs alive? It takes precedent OVER the DNR?
I can see all kinds of complications if that NCCSL changes the UAGA model.
It's MP3 format and the segment on Navarro begins (as far as I can tell) about a third of the way into the show.
Posts: 4344 | Registered: Mar 2003
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posted
All this complication makes me hope that tissue engineering will let us grow whole organs soon.
Posts: 3546 | Registered: Jul 2002
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