No one in the courtroom Wednesday suggested that Ruben Navarro could have avoided death for long.
But whether the severely retarded, comatose 25-year-old was nudged into it by an impatient transplant surgeon is at the core of a legal proceeding unprecedented in the United States.
Dr. Hootan Roozrokh, 34, has been charged with three felonies in Navarro’s 2006 death. His case is being watched intently by medical professionals and ethicists across the country who fear that a conviction will discourage prospective organ donors and their families.
San Luis Obispo County Superior Court Judge Martin Tangeman heard just a little more than two hours of testimony Wednesday, the first day of Roozrokh’s preliminary hearing. He has pleaded not guilty to charges of dependent adult abuse, administering a harmful substance and prescribing controlled substances without a legitimate medical purpose.
Exactly what happened in Operating Room 3 of the Sierra Vista Regional Medical Center has yet to be untangled. But on Wednesday, a prosecution witness described strained interactions between hospital staffers and a team of outside transplant specialists that included Roozrokh. She also said she wasn’t aware of any hospital procedures for the uncommon form of organ harvesting planned for Navarro.
At issue was whether Roozrokh, a San Francisco specialist on leave from Kaiser Permanente, improperly administered massive doses of morphine and Ativan, an anti-anxiety drug, in order to speed Navarro’s death.
Dr. Laura Lubarsky, a San Luis Obispo critical care specialist, testified that she saw Roozrokh order more morphine and Ativan for the already medicated Navarro.
She said she would not have ordered the drugs, which can slow respiration, for a man whose ability to feel pain or anxiety at the time was debatable. But she said she didn’t interfere because her role with the transplant team that had rushed to the hospital was simply to monitor Navarro and determine whether he could be considered legally dead.
“I was like a technician,” said Lubarsky, who was one of at least half a dozen medical personnel in the room. “I deferred to the experts who were there, who were presumably following protocol.”
Lubarsky last week was granted immunity from prosecution by the San Luis Obispo County district attorney’s office -- a status that Roozrokh’s lawyer, M. Gerald Schwartzbach, pointed to in an attempt to cast doubt on her testimony.
Navarro was taken to the hospital from a nearby nursing facility Jan. 29, 2006. The victim of a wasting neurological disorder, he was in a coma when he arrived and never emerged from it, Lubarsky said.
Although organ donations usually involve patients who are brain-dead, Navarro still had minimal brain function. That’s why the transplant team opted for a procedure called “donation after cardiac death,” in which -- with the family’s consent -- a patient’s life support devices are removed.
The heart ordinarily stops beating in minutes -- well within the half-hour window in which organs still are viable for transplant. Navarro, however, lived seven more hours after his breathing tubes were taken out and the drugs administered. That time period was too long for prosecutors to consider murder or attempted murder charges.
Lubarsky testified that at one point, Roozrokh took Navarro’s pulse and suggested that electronic monitors may have been showing “pulseless electronic activity” -- an indication that the patient had died. But, she said, she saw Navarro’s heart beating in his thin, uncovered chest and heard it when she examined him.
In the courtroom’s front row sat the dead man’s mother, a disabled former machinist from Oxnard.
“I just want to get justice,” she said outside the courthouse.
Rosa Navarro has settled a lawsuit against the hospital for $250,000. That civil case continues against other defendants.
The preliminary hearing is expected to conclude next week.