Autopsy generates questions
A long-awaited autopsy report on the death of rapper Kanye West’s mother did not determine a precise cause of death but did generate new questions about the medical care she received both before and after undergoing plastic surgery Nov. 9 in Brentwood.
Louis A. Pena, a Los Angeles County deputy medical examiner, wrote that Donda West “died from some preexisting coronary artery disease and multiple postoperative factors following surgery.”
Among the postoperative factors that Pena cited were evidence of pneumonia that possibly had been caused by aspirated vomit. Other factors included her pain-control medication and the tight bandaging of her chest.
West died a day after she underwent breast reduction and liposuction surgery. Her death has generated national attention and sparked debate about the risks of cosmetic surgery.
In a prepared statement Thursday, the coroner’s office said “multiple postoperative factors could have played a role in the death. The exact contribution of each factor could not be determined.”
However, the coroner’s office said there was no evidence that the death had been caused by a mistake in surgery or anesthesia.
Payam Afsharian, administrator of the Brentwood center where West had the surgery, said the autopsy vindicated West’s high-profile surgeon, Dr. Jan Adams, who has appeared on such TV shows as “Oprah” and “Extra” and has hosted his own plastic surgery show.
Dr. Michael F. McGuire, an expert who reviewed the autopsy report for The Times, found several problems with her care.
West should have been connected to equipment that monitored her temperature and the oxygen levels in her blood, among other things, after she had left surgery, McGuire said.
Without such monitoring, it would have been hard to determine whether West was sinking into a fever or was getting enough oxygen to her brain, he said.
“One of the friends that saw her said she felt warm, but we don’t know if she had fevers, chills, or how well she was breathing,” said McGuire, vice president of the American Society of Plastic Surgeons and an associate clinical professor at UCLA.
“If you have this magnitude of surgery . . . you should have monitoring done,” McGuire said. “Going anywhere without proper care and monitoring is inappropriate.”
Afsharian said the Brentwood clinic had arranged for West to be monitored at a postoperative care facility. But West wanted to go home after her 5 1/2 -hour surgery, Afsharian said. The coroner’s report said West had arranged for care by her nephew, a nurse with an advanced degree in public health, and others. West’s nephew and other caregivers stayed with her the first night, the coroner’s report said. She reported pain and took Vicodin. By the next morning, Nov. 10, West reported that she felt better, the report said.
According to the coroner’s report, the nephew said West “appeared to be doing so well he left for the day, with the intention to return and spend the night with his aunt.”
West remained with two other caregivers and a longtime friend.
But by 4 p.m., West’s throat and chest were hurting, which those present thought was the result of the breast reduction surgery and tight bandages, the report said. West was warm to the touch and was given chicken soup, crackers, water and pineapple juice before receiving medication. But West remained in pain and was breathing heavily, the report said.
By 5 p.m., West went to bed, and her friend went to the kitchen. When she had returned, West was cold and clammy, according to the report.
West was rushed to Centinela Freeman Regional Medical Center. She was pronounced dead later that evening.
McGuire, the UCLA expert, said he wanted to know whether West’s doctors and nurses properly screened her before the surgery and asked detailed questions about cardiac problems. He also wanted to know if West was forthcoming about her health problems.
The coroner’s report said West’s coronary arteries were 50% to 70% blocked, and one coronary artery was hardening with plaque -- all risk factors for a heart attack.
The coroner’s office learned that she had been diagnosed with hypertension, which she believed had gone away. She was a borderline diabetic and obese. She had experienced some leg pain but did not see a doctor about it, according to the coroner’s report.
West’s sister died of a heart attack two years ago, and her brother had a history of hypertension, the report said. Before West underwent surgery in Brentwood, she had contacted a surgeon in Beverly Hills about having cosmetic surgery.
But that surgeon said he did not perform the procedure because of an undisclosed preexisting condition that could have resulted in a heart attack.
Given her heart problems -- and that heart disease ran in her family -- West should have undergone specialized cardiology tests to determine whether she was fit for surgery, McGuire said.
The coroner’s report said it could not be determined whether a cardiologist ran tests on her before the operation.
“With the magnitude of procedures done, if you have a history of . . . heart disease and hypertension, then you need to have a cardiac clearance before you undergo that type of surgery,” McGuire said.
“If she said, ‘My sister had a heart attack, my brother has hypertension . . . and I’ve had hypertension,’ well, that’s a big red flag waving,” McGuire said.
In those cases, it is a good idea for plastic surgeons to have a cardiologist clear patients for major surgery, he said.
Afsharian said it was his understanding that both Adams and the anesthesiologist thoroughly questioned West. But she had indicated that she had no major problems, except for a thyroid issue.
McGuire said the fact that West had vomited during intubation should have been a red flag that doctors and nurses needed to pay particularly close attention to her recovery.
The pneumonia found in West’s lung was probably caused by aspirated vomit, McGuire said. “That may have been an additional factor putting stress on her breathing and diminishing her ability to breathe,” McGuire said. “She has a tight dressing on her [chest], and then you’re adding a pneumonia that decreases oxygen. That puts further strain on the heart.”
The report said the amount of painkillers in West’s system was not unusually high. But Pena did not rule out pain control medication as a contributing factor in her death, because the combination of painkillers with other drugs could have triggered breathing problems.
At the time of West’s surgery, the Medical Board of California was seeking to suspend or revoke Adams’ license because of multiple alcohol-related arrests.
Adams could not be reached for comment Thursday.
Times staff writers Scott Glover and Evelyn Larrubia contributed to this report.