Saturday, August 4, 2007

Diagnosis: Murder

Note: At the end of this article is a link to a site that talks about the medical ethics regarding this case posted on Aug 17, 2007.

The early part of the 21st century, like the middle of the last, may be remembered as a series of horrific events perpetrated on a particular group of people. The exterminations and mutilations of people with disabilities must stop.

Ruben Navarro is the latest person with a disability to lose his life to murderers disguised as doctors and caregivers. To Dr. Hootan Roozrokh, Ruben's life and body were little more than an organ donor factory.

Who was Ruben Navarro?

He was a California native, and just five days short of his 26th birthday when he was murdered. His mother, Rosa Navarro, had planned a little party and bought a Lakers' jersey as a gift. He was her only child.

Rosa told reporters in her Oxnard California home town that Ruben was a cheerful person. He loved comedy, music, Kobe Bryant and all the Lakers. He was an impish tot. Her apartment is full of pictures of Ruben; from a toothless first-grader to his 1998 high school graduation photos.

When Ruben was 10, Rosa noticed he was falling frequently. “Watching Ruben play with other 10-year-olds was like watching Bambi on ice,” she said in a March 2007 interview.

He had adrenal leukodystrophy (ALD). It is a progressive genetic disability that over time breaks down the padding around the nerves throughout the body. That padding is called myelin and without it, nerves can't function normally, or at all. The 1992 movie "Lorenzo's Oil" raised awareness about Ruben’s rare disability. It’s a horrible illness; but it is not nearly as horrible as the atrocities he suffered at the hands of a morally corrupt doctor and an apathetic medical establishment.

Losing A Life

Life wasn't easy for Ruben and Rosa, but they were doing all right. Other than the onward progression of ALD, Ruben was happy. His downward cycle started, a few years after Ruben graduated from high school. Rosa also became disabled and could no longer care for him; with no resources she made the difficult decision to institutionalize him at Casa de Vida, a “skilled” nursing home over one hundred miles away in September, 2005. Five months later, he would be dead.

First he developed bed sores, a sign of neglectful care. Then he had a dangerous seizure, as the direct result of not getting his needed seizure medication. Then on January 29, 2006, staff at the institution found Ruben in his bed, not breathing. At Sierra Vista Regional Medical Center the ER department revived his heart and put him on a respirator to aid his breathing.

When Rosa arrived at the hospital soon after his cardiac arrest, a doctor told her Ruben would die, nothing could be done, and they would “pull the plug” after five days; that was their policy. They asked if she wanted to be in the room when they did it.

That is standard way the medical establishment treats people with disabilities. The rationale seems to be, “He’s got a progressive disability that’s going to kill him eventually, maybe not right now, but it will. Why go through it all? Let’s just withhold treatment."

No doctor informed Rosa of any other options. No one ever told her that Ruben might be able to live without the respirator, or while he had some brain damage, he was far from brain dead. The next few days at his bedside, Rosa thought she saw signs of recovery, but the doctors told her, "no".

Then the ghouls … Hootan Roozrokh and the California Transplant Donor Network entered the picture. Rosa believed the doctors when they told her Ruben would die as soon they removed the respirator. She did not give authorization to remove it; but they already told her they didn’t need her permission and it would be removed in five days. Period. She was ill-informed, grieving and deeply depressed by the loss of her beloved son when the Donor Network called and asked for permission to take his organs.

There is a window of opportunity for harvesting organs. They must be removed within 30-60 minutes after the removal of the respirator. If they are not removed then, the organs are not fresh enough and must be rejected.

At 11:00 pm on February 3, 2006 they wheeled Ruben Navarro into operating room 3, removed his respirator and started watching the clock. He wasn’t dying fast enough.

Violating the hospital's protocol and a state law, Roozrokh took over caring for Navarro before he was declared dead. He ordered a nurse to give Navarro two abnormally high doses of morphine and Ativan to hasten death, according to an investigation by the U.S. Centers for Medicare and Medicaid Services. Still Ruben hung on.

Roozrokh said, “Let’s give him some more candy,” and the nurse complied once again. Six nurses, doctors and technicians who were in the operating room, made not one move to intervene on Ruben’s behalf. Later in a police investigation interview, one nurse reported that at that point, Ruben was "frothing from the mouth and shivering." And still, he struggled to stay alive.

When the “window of opportunity” passed and Roozrokh could no longer take his organs, Mr. Ruben Navarro was of no use to them. They wheeled him into another room and left him. He died the next day at 8 a.m. apparently alone.

What Happened?

He received between 200 to 220 milligrams of morphine, depending on the source. A dose of 120 mg is often fatal. The recommended dose to anesthetize a 1200 pound horse is 136 mg. Reaction to the drug starts almost immediately, and include: drowsiness, nausea, the face swells, the patient feels cold and cyanosis occurs. (Cyanosis is when the extremities turn bluish-gray because the blood vessels in the extremities close down. The body sends the blood to the brain and the heart, trying to protect them from damage). The eyes dilate to pinpoints and do not react to light and dark. Breathing slows down and becomes noisy. The pulse slows and becomes weak. Death is by respiratory failure.

At the same time Ruben was getting Morphine, he also received 80 mg of the very powerful drug, Ativan. Since Ativan suppresses the central nervous system (CNS), the manufacturer advises against its simultaneous use with CNS depressant drugs; including morphine. Morbidly overweight people can safely receive intravenous doses around 2 mg. Ruben weighed 80 pounds.

In his haste to get the prized booty, Roozrokh inserted a nasal/gastric tube down Ruben’s throat and poured Betadine, an iodine solution, into his stomach. This is a normal sterilization procedure when getting a donor stomach; only, the procedure is supposed to happen after a person dies.

Betadine is not to be taken internally. If it is, the stomach will digest it, causing acute iodine poisoning and the following symptoms: kidney failure, burning the stomach lining, fever, nausea, vomiting, diarrhea, circulatory collapse, and strangulation because the throat swells, or fluid fills the lungs.

Crime & Punishment

You’d think the state of California would throw the book at them. You’d be wrong.

Roozrokh is charged with dependent adult abuse, administering a harmful substance and prescribing controlled substances without a legitimate medical purpose. If he is found guilty of all the charges, the maximum sentence for this gruesome murder will be eight measly years.

State law and the network's rules prohibit transplant doctors from getting anywhere close to the potential donor before a declaration of death by an attending physician. Why were no state charges filed for breaking that law?

Prosecutors did not charge Roozrokh with murder because they said the drugs did not cause Ruben's death. Seriously, Ruben received three times the recommended dose of morphine, 40 times the safe dose of Ativan, and had poison forced into his stomach on top of that, how could that NOT cause Ruben’s death?

He did not die of adrenal leukodystrophy; his disease had not progressed that far. Ruben could have enjoyed many more years to watch Kobe dazzle fans on the court. He did not die of the cardiac arrest that sent him to the hospital; he was recovering from that before Roozrokh, et al, got a hold of him.

Now, a year and a half later, the others in operating room 3 say they were very concerned about what Roozrokh was doing. If they were that concerned why didn't they stop it? After the organs could no longer be ripped out of Ruben’s body and Roozrokh left, why didn't just one of them try to undo what the doctor had done? They are as guilty as Roozrokh, but cleared of all charges.

Ruben died at the hand of a sadistic, cold-hearted murderer and six other people watched and/or aided in the administration of massive doses of medication and poison.

Ruben died because the medical establishment thinks a life with disability is not worth living; we’re better off dead. He died because policies make it impossible to get adequate in-home services and supports. He died because we have a for-profit healthcare system where every decision is based on the bottom line.

What are medical ethicists talking about as a result of this case? They are saying people might stop donating organs for fear the same thing might befall them. They ignore the unspeakable crime perpetrated on a 25 year old. If Ruben was able-bodied, he’d be alive. And, if by some great travesty of justice, it happened, one doctor and six others attending the doctor would be up for first-degree, premeditated murder.

How many more like Ruben will be tortured and murdered before the 21st century actually lives up to its promise of equal treatment and enlightenment?

Related article on the medical ethics concerning this murder: Botched organ harvesting: 'Clearly wrong' By R. W. Dellinger

Arnquist, Sarah. Claims In Transplant Case Detailed. The (San Luis Obispo, CA) Aug 7,

Arnquist, Sarah. Civil Suit In Donor Attempt Broadens. Tribune, The (San Luis Obispo, CA) Page A1, 2007-08-03.

Hoops, Stephanie, He Lives in Her Heart. Ventura County Star, March 2007.

Navarro, Rosa v Hootan Roozrokh, M.D., First Amended Complaint. Case No.: CV070471. July 30, 2007.


MM said...

This is excellent, Cilla--moving, thorough, and very well written! Thanks for sending it. MM

FlyKimmie said...

Is it going to take someone going "postal" for our country to "wake up" and pay attention to what's happening to our loved ones with disabilities?

I was baffled at my son's abuse case being thrown out...but I throw my hands up with this case...

How can this be happening? I think you should email and mail your article to everyone possible... Does CA's governor have a copy of this? If not, he needs one.

You are an amazing writer, Cilla. Are you published yet?

Kay Olson said...

Well done Cilla. Thanks. I've linked to this at my blog. Everyone should be talking about this. EVERYONE.

Penny L. Richards said...

The utter disregard that Rosa and Ruben faced is disgusting. Ruben died from neglect by paid 'care' staff, and from a lethal overmedication and poisoning, by a doctor who knew full well what he was doing. Rosa was not given complete or correct information about Ruben's status. And once again, a medical mess where NOBODY was allowed to speak for the victim's rights.

This could happen to anyone. This should never happen to anyone.

Gary said...

Thank you for acknowledging my related post, Cilla.

I read the Estrich column in our local Gannett publication, and I was simply astounded at the concluding paragraph.

My amazement was amplified by the knowledge of what would have happened had a doctor entered her mother's room and attempted to give her sufficient drugs to kill her so that her corneas or other usable parts could be harvested.

Would Estrich cried "Murder!" then?

I think so.

We are descending toward a utilitarian society, I fear. It evident that people with disabilities are only the first targets.

Lene Andersen said...

Yet another reminder that our human rights are merely privileges.

Thanks for writing this. It made me sick, but thanks for writing it.

Valerie Brew-Parrish said...

Kudos to you Cilla for bringing this horrendous story of Reuben's murder to the attention of people with disabilities. In the last few years, though it's not reported nearly enough, people with disabilities are continuously being murdered by their parents and medical staff. I have long thought that we PWD's need to become more aggressive in addressing the medical community about our quality of life issues. The late Margaret Pfrommer, a dear friend and polio quad, used to visit her friends in the hospital. Once she over heard a doctor whisper that it would be a true blessing if the friend she was visiting would die. Margaret immediately lectured him about quality of life. Her friend Augie Christmann and mine too, testified in congress about accessibility & was so pro-active in disability rights! We need peers to protect us when we are hospitalized. We need to change the public's perception that we are better off dead. We have watched with horror the sanctioned killing of Terri Schiavo, Katie McCarron was killed by her physician mom because she couldn't handle autism, Reuben was murdered for his organs & what a strong will to live he had, Dylan, the little boy in Denver also killed by his family (they had a going away party for him) and countless others. Kevorkian & his followers get their message out loud and clear to the media. We must do the same as we are on that slippery slope of no return!

AlisonH said...

I recently read a doctor's blog wherein he and his commenters were debating the meaning of "quality of life." What if the patient can do this, but not that. It was all so mindbogglingly clueless.

I promptly added in my story of being in my hospital bed dying and my doctor coming into my room just at that moment. Everything in his soul called out for me to stay, and I saw in that moment that if I let go, he would blame himself for the rest of his life for not hospitalizing me sooner before my Crohn's had gotten to that point. And it wasn't his fault!

I told them, I am alive now because he cared about me. Because I made myself keep breathing when it seemed just far too hard to do, because I cared deeply about him in return. And THAT is quality of life.

They had nothing more to say after that. While I thought, you doofuses, you work with life and death and did you never realize what the essence of it is? Love, or the lack of it. Those are life. And death.

Anonymous said...

I was one of Rueben's caretakers about six months before he died. I became friends with him as well. Rueben was fun to be with. He was smart and funny and well aware of everything that was going on. Despite his disease he was a normal 25 year-old man. The last time I saw him was after I had moved and come back to visit him In Casa da Vida. He was alone in a room with no one to socialize with and nothing to do. Rueben had a life, he wanted life. There was absoulutely no reason for him to die the way that he did. Thankyou for posting this article. I miss him.

Big Noise said...
This comment has been removed by the author.
Big Noise said...

Thanks so much for writing.

Have you thought about calling the reporter at the San Luis Obispo paper who wrote the stories about Ruben and tell her what you said here? Public sentiment is that Ruben was on his very last leg. They need to know he was aware, smart and funny, just like you said. Please consider calling.

Thanks again for writing. It means a lot from some who knew and loved him. --Cilla

Tim said...

Excellent article; you did a superb job at exposing this travesty. As a registered organ donor myself I've sometimes worried about what would happen if I would get into an accident and someone needed a heart or something--if the doctor would make some sort of arbitrary judgement on what my quality of life would be if I were to survive.

Ethics based on arbitrarily defined utility cease to be ethics at all.

Stephanie said...

Thank you for posting this.

bint alshamsa said...

Oh God, this just fills me with such fear.

Rent Party said...

Good God. I am not really surprised, but ... !!!

Suzy said...

This is but one reason many good nurses are leaving the field- too many horrible things going on by horrible people.

Sadly, this will leave more openings for people who should never be in the field to start with, but there isn't much choice on a one by one solution for the good nurses.

I am so sorry that this happened, and so angry that the recourse is so poor.

Anonymous said...

how could people do that...thats so horrible....these a@@holes must be killed before they kill....!

Anonymous said...

This mis-informed account of the events serves only to scare people about modern medicine. This is clearly evidenced by comments left in response to the blog. The physician in the case was aquitted of the charges. He has been unfairly villified, and poorly thought out arguements, such as the one posted here, only serve to further disparage his name. You should be ashamed for not removing this blog.

Anonymous said...

People who write stuff like this need to be held accountable for the destruction they cause to people's lives and families. This includes not only the misinformed like this author, but also main stream media who can apparently repeat any popular rumour they come across with impunity.

Anonymous said...

For anyone reading this, it is extremely important for you to know that the author of this blog post has blatantly lied! The information provided is full of holes, myths, and twisted logic. As another commenter alluded to, it has since been shown that, among some others, an irresponsible, fame-hungry DA fabricated the fiction that Cilla has, even more irresponsibly, propagated here. In fact, Cilla has disgustingly embellished and exaggerated the fiction to make it even more untruthful and horrifyingly cruel to everyone involved--including Ruben and his family. How dare you Cilla! And how can you not have at least enough courage to admit you were wrong and stop the spread of these lies you scare unknowing visitors with by withdrawing this blog post or, at the very least, by simply responding to this comment (which you found easy enough to do for a comment praising you)?

Anonymous said...

I just watched the Dateline NBC program concerning Dr. Roozrokh and the case of Ruben Navarro. I believe this case demonstrates the grave concern that most people have when signing up to be an organ donor.

Personally I used to be have my Florida drivers license issued to show that I was signed up for organ donation. I withdrew this last summer, long before watching this program, due to serious concerns I had developed since we have gotten to know an EMT in our area very well. The stories I have heard about deciding to "let the more seriously injured go because their organ donors" horrifies me and I wouldn't at all be surprised if this is actually happening.

After watching the Dateline program, it just confirmed my belief that my family and I have made the right choice in opting out of the organ donation program. While we may take much needed organs to our graves at least we'll die without the medical vultures standing at the foot of our beds or, god forbid, hastening our deaths.

Pamela from Florida

Big Noise said...

The comments removed were ads for various products.

To the anonymous people who commented on how I lied and twisted facts. I stand by each word I wrote. I researched the quantities of medication administered to Ruben and made exact comparisons on the results of when they were given and in what doses.

I was especially careful to reference where I got my facts to in include in the blog. I didn't hide behind anonymous veil either. I didn't spew accusations, without quoting sources (as you did).

Dr. Roozrokh was indeed acquited; this says to me that law has not kept up reality.

The blog will not be removed.

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Kirk Long said...

I think Ruben Navarro was a victim of medical malpractice.

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