In a case that raises deep concerns about physician responsibility in today's public hospitals, a former resident at County-USC Medical Center has told lawyers that a senior surgeon left the operating room early when it might have been possible to save the life of a 65-year-old patient who bled to death.
Dr. Dorothy Comeau, who described herself as a third or fourth assistant at the time, said in a deposition taken for a malpractice lawsuit that she and another doctor were the only surgeons in the operating room when desperate efforts were being made to stop the patient's bleeding.
The patient, Vincent Goze, a native of the Philippines, was suffering from liver disease and was undergoing what all the doctors involved concede was an extremely complicated and risky surgery. He was on the operating table for nearly 10 hours.
"What stands out most in my memory is at the end of the procedure, Dr. Guthrie and I were the only surgeons there," said Comeau, referring to Dr. Carol Guthrie, the attending physician during the surgery. "It was a very frightening situation for me to see, despite the fact that I've seen some very severe trauma at County-USC, to see so much poorly controlled hemorrhaging."
One senior surgeon who was supervising Guthrie left for other appointments and another surgeon was there for a limited time before leaving, Comeau testified at her deposition. She added that there were problems with the level of experience of the anesthesiologists present and that an attending anesthesiologist was absent.
Guthrie gave her own deposition, corroborating part of Comeau's statement.
Dr. Steven Stain, the senior surgeon who Comeau said left during the surgery, denied the allegations in an interview and said that although he left for part of the operation, he was present when Goze died. Moreover, hospital officials point out that Comeau was fired shortly after Goze's surgery and has since sued the hospital.
Nevertheless, the case surfaces at a time when the longstanding problems in the county hospital system are in the public spotlight. Prominent among those problems are a lack of adequate supervision by the system's most experienced physicians and doctors who juggle their public and private practice obligations.
Comeau testified that the night before the surgery she was left with the responsibility of explaining to Goze the complicated operation and the risks he faced while asking him to sign a surgical consent form.
But in trying to explain the surgery to the patient, whose primary language was Tagalog, Comeau said she was forced to try to remember what a senior surgeon had told her because she did not fully understand the surgery herself.
She also realized that Goze was having trouble understanding her.
"It was clear to me from discussing these things with Mr. Goze that English was not his first language," Comeau told the lawyers in the Aug. 25 deposition. "As a second-year resident, I was not able to give him all the details or the risks about this particular surgical operation, because it was far beyond my understanding or my abilities at that time."
Hospital officials, while saying they could not comment on details of the case because of a gag order stemming from the litigation, strongly dispute key elements of Comeau's version of the surgery.
They also assert that Comeau may be motivated by a massive lawsuit she has filed against the county for wrongful termination. She was fired about a month after Goze died on Jan. 13, 1994; the firing allegedly resulted from a series of problems that related to her residency, which began in 1993.
Hospital officials said they were confident that Goze's surgery had enough supervision.
They said that Guthrie, a board certified surgeon, was present from the beginning to the end of the surgery, and that Goze had a long history of treatment and care at the hospital, including several prior surgeries.
Stain disputes Comeau's contention that there were only two surgeons present at the end.
"That is blatantly not true," said Stain, chief of the hepatobiliary service within the USC department of surgery. "I remember being there when the patient died. I remember trying to resuscitate the patient."
But Stain, who put on surgical scrubs and participated in the surgery, did concede that he left during the operation to see other patients at the private Kenneth J. Norris Cancer Center, which is affiliated with USC. He could not say how long he was gone.
Stain said that when he left he felt confident the patient was in capable hands with Guthrie, even though bleeding had started. "I think the attending surgeon, Dr. Guthrie, was exceptionally able to handle the complication," he said.
Dr. Ronald L. Kaufman, chief of staff at County-USC, said the second surgeon mentioned by Comeau, trauma surgeon Dr. Peter Vukasin, was not scheduled to be there, but was part of the hospital's trauma unit called in to help save Goze's life.
Efforts to reach Vukasin and Guthrie, who now practices in Spokane, Wash., were not successful. Attorneys for Comeau refused to allow her to be interviewed because of the wrongful-termination lawsuit they filed against the county, which names the medical school, Stain and other top officials of the department of surgery as defendants.
The malpractice lawsuit was filed by Goze's wife and daughter against the county and seven physicians, including Comeau. Comeau subsequently was dropped from the lawsuit by the family's attorney.
Cary L. Wood, the attorney for the county and six remaining physicians, said he and his clients would not respond directly to Comeau's version of the surgery because the case is in litigation.
But he denied negligence and said he thought the county and physicians had "a defensible case."
"When the dust settles, you will find there is nothing here but a bunch of bold allegations that cannot stand up. I can't comment on specifics," he said.
The family's attorney, Aileen N. Goldstein of Los Angeles, said she may drop several other physicians from the lawsuit. But she was adamant about pressing the malpractice case against Stain, Guthrie, the anesthesiology team and the county.
She argues that Stain should have stayed in the operating room with the less experienced Guthrie, who described herself as a "junior faculty member," and that Guthrie should have stopped the surgery when there was still a chance to halt the bleeding.
The family is limited under state malpractice laws to $250,000 in damages.
In her deposition, Comeau painted a picture of chaotic conditions, poor supervision and confusion in the operating room.
Now a licensed physician, Comeau at the time was a second-year resident in general surgery, with at least three more years of residency before she would complete her general surgical training.
She had received a doctorate in molecular biology and biochemistry from the Massachusetts Institute of Technology and graduated from medical school at Columbia University of Physicians and Surgeons in New York City.
As she described it in her deposition, things did not go well almost from the outset of the surgery. She said there was a massive amount of bleeding, which experts say is to be expected in liver surgery.
Comeau also said that instead of a single, attending anesthesiologist, "there were a number of anesthesiologists [coming and going] during the procedure."
Before Stain left, Comeau testified that he said "he was unhappy with the experience level of anesthesiologists in the room. That he wanted an attending staff [anesthesiologist] in the room. That he felt that the anesthesiologist [resident who was present at the time] was not keeping up with the blood loss or reacting quickly enough or . . . anticipating future complications."
Comeau said Stain told Guthrie "two or three times that if she was uncomfortable with the amount of bleeding," she should consider stopping the bleeding, sewing up the patient and "getting out."
Guthrie, in a deposition given a month before Comeau's, was in agreement with Comeau that there was bleeding almost from the beginning. She also agreed that she thought the primary cause of death was massive hemorrhaging. She said the hemorrhaging went on for two or three hours.
She said Stain was there to supervise the surgery and was there at the beginning. She refused to discuss conversations she had with Stain and did not indicate when he left.