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Errors cited in Lap-Band operation

Mistakes by surgeon and anesthesiologist led to woman's death, autopsy report says.

April 19, 2013|By Stuart Pfeifer, Los Angeles Times
  • Paula Rojeski, 55, died Sept. 8, 2011, shortly after surgery to implant a Lap-Band at Valley Surgical Center in West Hills.
Paula Rojeski, 55, died Sept. 8, 2011, shortly after surgery to implant… (Marni Rader )

A surgeon cut an Orange County woman's aorta during Lap-Band weight-loss surgery in 2011 and an anesthesiologist failed to detect her hemorrhaging, events that led to her death, according to a Los Angeles County Coroner's autopsy report.

The report found that the injury and the failure to respond adequately during laparoscopic surgery at Valley Surgical Center in West Hills constituted "an extreme deviation from the standard of care" on the part of the doctors.

Shortly after surgery, Paula Rojeski, 55, of Ladera Ranch went into cardiac arrest and was rushed to a hospital, where she was pronounced dead.

The autopsy report, by medical examiners Dr. Adrian Marinovich and Dr. Raffi Djabourian, determined that the aorta likely was cut early in the 30-minute surgery, "indicating that prompt recognition of the problem may have prevented this death."

The report, obtained by The Times this week, noted that Rojeski had heart disease, which the medical examiners said was a "contributing factor." However, they said, "but for the surgical injury, the heart would not have given out when it did."

Neither of the doctors involved — Dr. Julius Gee, the surgeon, and Dr. Deming Chau, the anesthesiologist — could be reached for comment.

Rojeski was the last of five people who died from 2009 through 2011 after Lap-Band surgery at clinics affiliated with the now-defunct 1-800-GET-THIN marketing operation, according to lawsuits, autopsy reports and other public records.

The GET-THIN advertisements blanketed Southern California roadside billboards, radio, television and the Internet for more than two years.

The autopsy report cited the conclusion of Dr. Denis Astarita, a surgeon consulted by the coroner's office, that Gee's "gross negligence with incompetence had a role in this death."

A coroner's anesthesiology consultant said in a report attached to the autopsy that Chau "did not meet the standard of care" for a physician because "he failed to identify the problem and inform the surgeon of the patient's deterioration."

"This was a salvageable injury.… If the surgeon is alerted, repair is possible," said the consultant, Dr. Selma Calmes. "Part of an anesthesiologist's job is to inform the surgeon that a patient appears to be losing blood inside the abdomen."

On March 29, Valley Surgical Center sued the coroner's office in U.S. District Court in Los Angeles, seeking to block release of the autopsy report and have the coroner's office removed from the case. The lawsuit also seeks unspecified monetary damages for alleged violations of constitutional rights.

The lawsuit said the autopsy report was "seriously flawed" and that Calmes, the anesthesiology consultant, was biased against outpatient surgery centers.

It also said that Calmes' initial report erroneously criticized the anesthesiologist for cutting off anesthesiology 30 minutes into a two-hour surgery when the surgery itself lasted only 30 minutes. Calmes corrected the mistake in a supplemental report after the surgery center brought it to her attention.

"Far from being an impartial investigative body seeking the truth, the coroner has demonstrated a clear bias against Valley, which disqualifies it from continuing to investigate the Rojeski death," the surgery center said in the lawsuit.

Valley Surgical produced reports from seven independent consultants who said the coroner's report was flawed. Some of the reports said Rojeski's aorta may have been cut by paramedics performing CPR.

"We believe that we will be able to prove that the conduct of the investigation was premised on false information, continues to be premised on false information, was biased and was conducted with a reckless disregard for the truth and Valley's rights," the surgery center's attorney, Barry Litt, said in an email to The Times.

Craig Harvey, chief of operations for the coroner, and Kenneth Maranga, an attorney representing the coroner, declined to comment.

Former employees of surgery centers affiliated with 1-800-GET-THIN alleged in a whistle-blower lawsuit last year that the marketing company put profits ahead of patient safety, hiring unqualified surgeons and failing to maintain sanitary conditions at the surgery centers.

The lawsuit said 1-800-GET-THIN and the surgery centers were operated by two brothers, Michael and Julian Omidi. The lawsuit was settled out of court and terms were not disclosed, according to court records.

In 2011, the Food and Drug Administration sent 1-800-GET-THIN, Valley Surgical Center and other affiliated outpatient clinics a warning that the ads violated federal law because they did not include adequate warnings about the risks of weight-loss surgery.

The company pulled the advertising last year.

Marni Rader, a friend of Rojeski, said she was upset to learn about the coroner's findings. She said she hoped the Medical Board of California would discipline the doctors involved.

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