Friday, June 5, 2009

California Medical Board Withdraws Complaint Against Transplant Physician After Acquittal In Criminal Case

In late May or early June, 2009, the Medical Board of California withdrew its complaint (known as an "Accusation") seeking to revoke or suspend the medical license of Dr. Hootan Roozrokh, a well-trained San Francisco transplant surgeon, who had been accused of trying to speed a potential organ donor’s death. Dr. Roozrokh had faced criminal, civil and administrative actions arising from this unusual case.

The Medical Board's action helps wind up one of the first cases in the nation where a transplant surgeon was charged criminally, which involved a failed attempt to acquire organs from a comatose 25-year-old patient, Ruben Navarro, who suffered from a wasting neurological condition. In December 2008, after a jury trial, Dr. Roozrokh was found not guilty of dependent adult abuse.

The Medical Board said that additional information had come to the attention of the deputy attorney general who filed the accusation and determined she could not meet the burden of proof. This is quite an unusual step for an accusation to be withdrawn.

The incident that prompted the Medical Board's complaint took place on February 3, 2006, when Navarro was close to death at Sierra Vista Regional Medical Center in San Luis Obispo. He had suffered a heart attack at a nearby care home. His mother had given permission for organ donation, and a team that included Dr. Roozrokh flew in from San Francisco on behalf of a regional transplant network.

The Medical Board accusation, filed last year, accused Dr. Roozrokh of being in the operating room before Navarro’s death and of “actively monitoring the patient’s vital signs for a determination of death.” Under state law, transplant doctors cannot direct the care of organ donors before they are declared dead.

This case arose in part due to the differences between brain-death donations and cardiac-death donations. In brain-death donations, the donor is legally dead, but machines keep the organs viable by machines. In cardiac-death donations, after the patient’s ventilator is removed, the heart slows. Once it stops, brain function ceases. Most donor protocols call for a five-minute delay before the patient is declared dead. Generally, transplant teams are not allowed in the room of the potential donor before that.

There were 670 cardiac-death donations through the first nine months of 2007, the most in any year this decade, according to the United Network for Organ Sharing, which oversees organ allocation. Over the same period, there were 12,553 brain-dead donations. Transplanting organs from cardiac-death donations decreased significantly after medical advances like life support and subsequent changes in the legal definition of death made donations from those declared brain dead more efficient. But health officials have encouraged cardiac-death donations in recent years.

Cardiac-death donations are much more rare and the hospital staff in this case was seemingly unclear about how to proceed. Dr. Roozrokh had arrived to supervise a donation after cardiac death, a procedure that had never been performed at the 165-bed hospital.

The Medical Board accusation also accused Dr. Roozrokh of ordering staff to give Navarro pain and anxiety medication even though he did not have staff privileges at the San Luis Obispo hospital. At the criminal trial, Dr. Roozrokh said that the operating room staff was so confused that he had just one ethical choice: step in to ease what pain and terror Navarro might have been silently experiencing. Navarro survived eight hours after he was removed from life support and given the drugs. By that time, his organs were no longer viable and could not be recovered. Navarro's death was found to have been from natural causes.

There was also a civil lawsuit against Dr. Roozrokh by Navarro's family but the status of that case is not known.

Attorney Comment: This was an aggressively prosecuted case from the beginning. The criminal case was unprecedented. It also shows that even if a licensed professional wins an acquittal at a criminal case, there can still be a prosecution by the Board which has a lower burden of proof. We salute the deputy attorney general and her supervisors who made a politically tough and sometimes unpopular decision to dismiss an ongoing accusation.

Any questions or comments should be directed to: Tracy Green is a principal at Green and Associates in Los Angeles, California. They focus their practice on the representation of licensed professionals and businesses in civil, business, administrative and criminal proceedings, with a specialty in health care providers.


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