Surgeon accused of hastening death to harvest organs

SAN LUIS OBISPO, Calif. — On a winter night in 2006, a disabled and brain-damaged Ruben Navarro was wheeled into an operating room at a hospital here. By most accounts, Navarro, 25, was near death, and doctors hoped he might sustain other lives by donating his kidneys and liver.

But what happened to Navarro quickly went from the potentially life-saving to what law-enforcement officials say was criminal. In what is believed to be the first such case in the country, prosecutors have charged the transplant surgeon, Dr. Hootan Roozrokh, with trying to hasten Navarro's death to retrieve his organs sooner.

A preliminary hearing will begin here today, with Roozrokh facing three felony counts relating to Navarro's treatment as a donor. At the heart of the case is the question of whether Roozrokh was pursuing organs at any cost or had become entangled in a web of misunderstanding about a lesser-used harvesting technique known as "donation after cardiac death."

Roozrokh has pleaded not guilty, and his lawyer said the charges are the result of overzealous prosecutors. But the case already has sent a shudder through the field of transplant surgeons — if convicted on all counts, Roozrokh could face eight years in prison — while also worrying donation advocacy groups that organ donors could be frightened away.

Cardiac-death donations

There were a decade-high 670 cardiac-death donations through the first nine months of 2007, according to the United Network for Organ Sharing, which oversees organ allocation. In all, there were 13,223 organ donations over the same period, the vast majority with brain-dead donors

In brain-death donations, the donor is legally dead, but the organs are kept viable by machines.

In cardiac-death procedures, after the patient's respirator is removed, the heart slows. Once the heart stops, the brain function ceases. Most donor protocols also call for a five-minute delay before the patient is declared dead. Transplant teams are not allowed in a prospective donor's room before that.

Cardiac-death donations can make some doctors and nurses skittish if they have not previously witnessed one, said Dr. Robert Sade, the former chairman of the American Medical Association's Council on Ethical and Judicial Affairs.

"It all works exactly the same, the cuts and the procedure," Sade said. "But the circumstances are quite different."

Several days after Navarro was hospitalized at the Sierra Vista Regional Medical Center here, a decision was made to remove his ventilator. According to the criminal complaint, Roozrokh ordered excessive doses of morphine and Ativan, an anti-anxiety medicine, both of which are used to comfort dying patients. In the most shocking accusation, the complaint said Roozrokh introduced Betadine, a topical antiseptic, into Navarro's system; Betadine, the complaint said, is "a harmful substance that may cause death if ingested."

Navarro died about eight hours later of what the coroner later ruled as natural causes. In the end, because the death was not more immediate, his organs had deteriorated too much to be transplanted.

Prosecutors have charged Roozrokh with felony counts of dependent adult abuse, mingling a harmful substance, and unlawful controlled substance prescription. The doctor's lawyer, M. Gerald Schwartzbach, said Roozrokh, a 34-year-old Iranian emigre and academic All-American swimmer who grew up in Wisconsin, did "nothing that adversely affected the quality or length" of Navarro's life.

"Dr. Roozrokh is a brilliant young surgeon, who has dedicated his life to saving lives," Schwartzbach said. Neither police nor prosecutors would comment on the case.

The patient

Navarro was diagnosed with adrenoleukodystrophy, a neurological disorder, when he was 9.

By his early 20s, Navarro's mental and physical condition had deteriorated to a point where he was placed in an assisted-care facility.

On Jan. 29, 2006, his mother, Rosa, a Guatemalan immigrant, received a call from the facility that her son had been found unconscious, in cardiac and respiratory arrest, but that he had been revived and transported to Sierra Vista. His brain had been damaged from lack of oxygen.

Several days later, with no sign of improvement in her son, Rosa Navarro said she was told by a doctor that he would never recover and that he would be disconnected from life support.

Rosa Navarro, a disabled machinist, said she did not have enough money to stay another night near her son. She said that shortly after leaving the hospital, she received a call from the California Transplant Donor Network, a nonprofit organ-procurement organization. On a tape recording made by the transplant network, Rosa Navarro agreed to donate her son's organs.

Late on Feb. 3, a transplant team including Roozrokh arrived at the hospital.

According to a police interview with Jennifer Endsley, a nurse, Roozrokh stayed in the room during the removal of the respirator and gave orders for medication, something that would violate donation protocol. Endsley also told police that Roozrokh also asked an emergency-room nurse to find and administer more "candy" — meaning drugs — after Navarro did not die after his respirator was removed.

Schwartzbach, the lawyer for Roozrokh, said he would address the allegations in court.

Several months after the incident, federal health officials cited the hospital for a series of lapses. Last February, the United Network for Organ Sharing reprimanded the California Transplant Donor Network, for breaking "established protocol" in the case. The donor network declined to comment.