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Posted by on Mar 20, 2008 in Ethics

Surgeon Roozrokh to Face 1 Charge; 2 Dismissed

Surgeon Roozrokh to Face 1 Charge; 2 Dismissed

Yesterday, San Luis Obispo Superior Court Judge Martin Tangemen dismissed 2 charges against transplant surgeon Hootan Roozrokh in the failed attempt to harvest Ruben Navarro’s organs in Februay 2006, according to the San Luis Obispo Tribune. Roozrokh will stand trial by jury for dependent-adult abuse at a time yet to be determined.

According to the news report, Tangemen ruled that there was insufficient evidence to proceed with the charge of administering a harmful substance, Betadine, and that the unlawful prescription of controlled substances did not apply in this case. The former dismissed charge was the gravest, with a maximum penalty of 8 years in prison. The maximum penalty for dependent-adult abuse is 4 years in prison.

Roozrokh’s defense attorney, M. Gerald Schwartzbach contended in court that his client “could not have violated the standard of care to merit the dependent adult abuse charge…because no such standard applies to the extraordinary circumstances of this case,” according to the news report. “This is a situation where the entire system failed,” Schwartzbach declared, as quoted by the paper.

The judge’s ruling (found here) provides a number of interesting points:

  • Ruben Navarro most likely had developed a considerable tolerance to morphine. Navarro received an intrathecal pump in 2005 to deliver morphine and the antispastic agent baclofen. During Navarro’s previous hospitalization, attending physician Eric Schultz had prescribed morphine and Ativan (lorazepam) for the patient at dosages up to 10 mg every 15 minutes prn.
  • Accounts from witnesses in the OR at the time of the attempted cardiac-death donation could not be reconciled with respect to the amount or timing of the medications given. No one recorded the administration of medications in the OR, and the vital-sign records for this time period were lost.
  • “There was no credible evidence that Dr. Roozrokh ordered the administration of Betadine,” according to the ruling. The testifying nurses could not identify whether Roozrokh or transplant surgeon Arturo Martinez delivered the Betadine to Navarro; although, Martinez denied ever touching Navarro “in this manner.” The judge adds, however, that Martinez’s claims are suspect given his “natural interest in avoiding civil and criminal liability despite his obvious presence and superior experience [to that of Roozrokh].” A footnote adds that detective Crawford found some of Martinez’s statements “lacking in credibility.” In addition, the amount or concentration of Betadine given to Navarro is unknown, thereby precluding a determination as to whether the Betadine was harmful. Finally the judge relied on the wording of the relevant statute to determine that it did not apply in the context of a medical procedure.
  • The judge made his best guess, based primarily on the testimony of nurse Diane Stevens, as to how much and when morphine and Ativan were administered to Navarro. In the ICU (between 10:05 and 10:30 pm), Navarro received a total of 20 mg of morphine and 4 mg of Ativan, each in 2 separate doses. In the OR (between approximately midnight and 1 am), Navarro received a total of 180 mg of morphine and 80 mg of Ativan, each in 4 separate doses.
  • The judge ruled that an unlawful prescription of controlled substances did not apply in this case, because the relevant statute indicates that “[a]n order for controlled substances for use by a patient in a…licensed hospital shall be exempt…”
bmartin (1130 Posts)

A native East Tennessean, Barbara Martin is a formerly practicing, board-certified neurologist who received her BS (psychology, summa cum laude) and MD from Duke University before completing her postgraduate training (internship, residency, fellowship) at the Hospital of the University of Pennsylvania in Philadelphia. She has worked in academia, private practice, medical publishing, drug market research, and continuing medical education (CME). For the last 3 years, she has worked in a freelance capacity as a medical writer, analyst, and consultant. Follow Dr. Barbara Martin on and Twitter.