A San Francisco transplant surgeon was criminally charged Monday with excessively prescribing drugs to a 25-year-old disabled man last year in order to hasten his death and harvest his organs sooner.
The felony charges are believed to be the first in the nation against a physician for his role in a transplant.
Experts said the case is likely to raise uneasiness among potential organ donors and could prompt doctors to shy away from a somewhat controversial practice of retrieving organs before a patient is brain dead.
The San Luis Obispo County district attorney's office accused Dr. Hootan Roozrokh, 33, of dependent adult abuse, administering a harmful substance and prescribing controlled substances without a legitimate medical purpose.
The surgeon allegedly ordered massive amounts of narcotic painkillers and sedatives for Ruben Navarro, a physically and mentally disabled man, on Feb. 3, 2006. In addition, Roozrokh is accused of administering the antiseptic Betadine through a feeding tube into Navarro's stomach, a sterilization procedure typically done after a donor is dead.
"The law and the facts indicated that Dr. Roozrokh ... tried to accelerate [Navarro's] death to facilitate the harvesting of his organs," said Chief Deputy Dist. Atty. Stephen Brown.
Navarro survived for more than seven 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.
Roozrokh's lawyer, M. Gerald Schwartzbach, called his client an "extremely dedicated and accomplished organ transplant surgeon" and said the charges filed against him were "unfounded and ill-advised."
"Dr. Roozrokh did not commit any crime," Schwartzbach said in a written statement.
If convicted of the three counts, Roozrokh could receive up to eight years in state prison and a $20,000 fine, the district attorney's office said. A warrant has been issued for Roozrokh's arrest, and he is expected to turn himself in this week. He will be required to post a $10,000 bond.
Roozrokh was a surgeon with Kaiser Permanente's now-defunct kidney transplant program in San Francisco when he and a Kaiser colleague went to Sierra Vista Regional Medical Center in San Luis Obispo to retrieve Navarro's organs. However, the two surgeons were not working on behalf of Kaiser when they went to Sierra Vista but for the group that procures and distributes organs in much of Northern and Central California.
Navarro had been on life support after being found unresponsive Jan. 29, 2006, at a nearby long-term care facility. His family agreed to donate his organs.
Late in the evening of Feb. 3, he was taken to the operating room and removed from life support. As at least six people stood by, including Navarro's treating physician, Roozrokh ordered a total of 200 milligrams of the narcotic morphine and 80 milligrams of the sedative Ativan for him, according to a report by federal inspectors. Those were many times the normal doses of the drugs, experts have told The Times.
After Navarro had been off life support for about 30 minutes -- the time limit set to ensure the viability of organs -- the process was ended. Navarro was returned to the intensive care unit, where he died early the next morning, five days before his 26th birthday. (Authorities and The Times have sometimes said incorrectly that Navarro was 26 at the time of his death.)
The case came under scrutiny by medical and law enforcement authorities after the operating room staff expressed concerns about the actions of the doctor and of the nurse who was administering the drugs. Under state law, transplant doctors cannot direct the care of organ donors before they are declared dead.
The San Luis Obispo County coroner's office ruled this March that Navarro died of natural causes. But "the central issue of the case was the mistreatment of a severely disabled adult," said Brown of the district attorney's office.
Brown said it would have been difficult to pursue a more serious charge of murder or attempted murder because Navarro survived for hours after being given the drugs. No one besides Roozrokh has been criminally charged.
Schwartzbach said Monday that Roozrokh is blameless.
"Nothing that Dr. Roozrokh did or said at the hospital that night adversely affected the quality of Mr. Navarro's life or contributed to Mr. Navarro's eventual death," he said.
Roozrokh was placed on administrative leave by Kaiser in May 2006 after HMO officials became aware of the allegations against him. He was reinstated in January but the next month voluntarily agreed not to see patients, Kaiser spokesman Matthew Schiffgens said. With the filing of criminal charges Monday, the surgeon once again has been placed on leave.
"The case did not involve a Kaiser Permanente patient, or a Kaiser Permanente hospital," Schiffgens said in a written statement, adding that Kaiser was cooperating fully with the investigation.
