Fat Clots, Diet Drug Blamed in Patient Death

San Diego County’s chief deputy medical examiner testified Tuesday that liposuction patient Judy Fernandez died because microscopic globules of fat blocked blood circulation, complicated by preexisting heart disease associated with use of the diet drugs fen-phen.

The testimony of Dr. Harry Bonell, hired by attorneys defending two Orange County doctors who operated on the La Habra woman for 10 1/2 hours, contradicts the official cause of death as determined by the Orange County coroner’s office.

Further, the defense attorneys accused lawyers for the California Medical Board, which is trying to revoke the doctors’ licenses, of trying to intimidate Bonell from testifying.

Plastic surgeon W. Earle Matory Jr. and anesthesiologist Robert Hoo have been accused by the medical board of gross negligence in connection with the March 17 death of Fernandez, 47, after outpatient surgery in Irvine for liposuction, a brow lift, a mini-face-lift and laser resurfacing of her skin. An administrative law hearing at the Chet Holifield Federal Building here is being conducted to determine the physicians’ fate.

Last month, a doctor who performed the autopsy for the Orange County coroner’s office testified that Fernandez died of severe blood loss, with a secondary cause of lidocaine toxicity.

During Tuesday’s licensing hearing, defense attorney Lloyd Charton displayed poster-size photographs of microscopic studies conducted by Bonell, who testified that the pictures showed fat clots in Fernandez’s heart, lungs and kidneys, leading to his conclusion that she died of “fat embolism syndrome.”

The photos also reveal that Fernandez had pulmonary hypertension, Bonell said. That is consistent with the use of the now-banned fen-phen diet drug mixture, he said. Fenfluramine, one of the two drugs, was pulled off the market this year by the Food and Drug Administration because of its connection to coronary disease.

Dr. Aruna Singhania, who performed the autopsy, testified last month that she did not perform microscopic studies to search for fatty emboli, but she insisted that fat clots did not cause Fernandez’s death.

Outside court, widower Ruben Fernandez said his wife used fen-phen for three or four months and stopped using it 11 months before the liposuction, on Matory’s orders. He said his wife had never been diagnosed with heart or pulmonary disease.

Deputy Atty. Gen. Richard Hendlin said a state’s witness has testified that it is not surprising to find dislodged fat cells in the bodies of patients immediately after liposuction, but they do not cause death.

Bonell’s testimony was preceded by a heated exchange between attorneys, because Deputy Atty. Gen. Richard Zeigen had contacted Bonell’s boss to inquire whether his appearance on the stand would violate the coroner’s conflict-of-interest code.

The code prohibits employees from testifying against the state, county or city in criminal matters. Bonell said the county counsel told him there was no conflict because this was not a criminal proceeding.

Hours after Bonell’s testimony, the defense asked a Superior Court judge in Santa Ana to dismiss a temporary restraining order that prevents the two doctors from practicing medicine.