The Medical Board of California is reviewing the care that a surgeon provided to a Lawndale woman who died in late December shortly after she was implanted with the Lap-Band weight-loss device, according to board records.
Tamara Walter, 52, went into cardiac arrest Dec. 23 after surgery at a Beverly Hills clinic and was rushed to nearby Cedars-Sinai Medical Center, where she died three days later, said her sister, Betty Brown.
The surgery was performed by Dr. Atul Madan, who is now the subject of two medical board investigations related to patients who died after Lap-Band procedures he performed, according to medical board correspondence with surviving relatives. In letters to the dead patients' families, the board said it was reviewing the "quality of care" that Madan provided.
The other case involved Ana Renteria, a 33-year-old office worker who died in February 2010, days after Lap-Band surgery performed by Madan at the same facility, the Beverly Hills Surgery Center. The Los Angeles County coroner's office concluded that Renteria "died due to complications from laparoscopic gastric band placement" and hernia repair, according to an autopsy report. Diabetes was a contributing condition, the report said.
The coroner's office has not yet determined Walter's cause of death, said Ed Winter, the county's assistant chief coroner.
A spokeswoman for the medical board declined to discuss the investigations, citing privacy restrictions. However, the medical board disclosed the investigations in letters that it mailed to relatives of the two deceased patients.
Madan declined to comment on the investigations, saying in an e-mail to The Times: "It would be highly inappropriate for me or any physician to discuss the medical care received by any specific patient with any journalist. But more importantly, I believe that it is equally inappropriate for any journalist to request protected confidential medical information about any patient from any physician."
Walter is the third patient to have died shortly after undergoing Lap-Band surgery performed at the Beverly Hills clinic, which is located in Suite 106 at 9001 Wilshire Blvd. and has operated under different names in recent years.
Willie Brooks, a 35-year-old school custodian, died in June 2009, three days after his operation there by surgeon George Tashjian. The Riverside County coroner attributed Brooks' death to "peritonitis due to Lap-Band procedure due to obesity." Brooks' family is suing the clinic and the doctor. The lawsuit is scheduled for trial June 21. The defendants have denied wrongdoing.
The Beverly Hills Surgery Center is one of several clinics that receives referrals from patients who call a toll-free number, 1-800-GET-THIN, advertised on billboards throughout Southern California.
Those billboards, as well as television spots, had attracted Walter, who was 5-feet-2 and about 240 pounds and had struggled for years to lose weight, said the woman's longtime friend, Patti DenBesten.
"They did free insurance checks. They made it sound very easy," DenBesten said. "I said, 'You should call. Go for it.' She had tried diets, but no matter what she did she couldn't lose the weight."
The Beverly Hills Surgery Center so far has refused to provide Walter's family with records about her treatment, said Kathryn Trepinski, an attorney representing Walter's family.
Robert Silverman, an attorney who represents the surgery center, said the clinic had released the records to the coroner but would not release them to Trepinski until she can prove that Brown is "the party entitled to the medical records." Walter was divorced and had no children. Brown has applied to become administrator of her estate, Trepinski said.
Silverman added that Madan is a "world-renowned surgeon" who educates colleagues about weight-loss surgery through courses and publications. Madan performed 660 Lap-Band procedures in 2010 and has done more than 2,000 of the surgeries since 2002, Silverman said.
"There are no facts to connect Ms. Renteria's death to the surgery performed by Dr. Madan," Silverman said in an e-mail. "There are also no facts that connect the death of Ms. Walter's to the surgery of Dr. Madan."
Silverman said he expects the coroner to conclude that "the death of Ms. Walter is solely related to an adverse reaction to the general anesthesia, an unfortunate but known risk associated with its use."
Coroner's officials have said that Walter's Lap-Band device appeared to have been implanted correctly and did not contribute to her death, Trepinski said. In a complaint to the medical board on behalf of Walter's family, Trepinski focused on Walter's post-surgery recovery at Beverly Hills Surgery Center. Walter removed her breathing tube twice and then went into cardiac arrest, according to the complaint. Walter was brain dead when she arrived at Cedars-Sinai, Trepinski told The Times.
Madan told Walter's family in a meeting at Cedars-Sinai that Walter had twice removed her breathing tube at Beverly Hills Surgery Center following her procedure, Trepinski said.
Trepinski said she believes that Beverly Hills Surgery Center medical staff should have restrained Walter's arms after reinserting her breathing tube the first time.
"She may have been insufficiently sedated or not monitored," Trepinski said. "My understanding is there should be monitoring. After the first extubation, there should have been restraints."
Mark Dershwitz, a professor of anesthesiology at the University of Massachusetts Medical School in Worcester, Mass., said doctors should take several steps to make sure a patient who has removed a breathing tube does not remove it again, which could include restraining patients' arms with cloth straps or sedating them. Nurses should also closely monitor recovering patients, he said. Dershwitz said he was not familiar with the Walter case and was speaking only about generally accepted practices.
"Obviously, restraints are used when it's necessary to protect a patient from themselves," Dershwitz said.
Walter, an assistant manager at a Vons supermarket in Torrance, was thrilled about the pending surgery and was looking forward to improving her health and appearance, said Brown, her sister. Walter suffered from sleep apnea and had high blood pressure but was otherwise in good health, her sister said.
"Her weight, she wasn't happy with it. It made her feel ugly," Brown said. "Things were finally going well for her. She bought a house. She was looking forward to traveling. The last thing was losing the weight."
Caroline Van Hove, a spokesman for Allergan, the Lap-Band manufacturer, said the company's "deepest condolences go out to the family of Tamara Walter." The company will investigate to determine whether the device in any way was a contributing factor, Van Hove said.
She said studies have shown that the mortality rate from Lap-Band surgery is 0.05% or 1 in 2,000.