Doctor’s action defended

SAN LUIS OBISPO -- —  A transplant surgeon accused of illegally hastening the death of a prospective organ donor acted properly when he ordered sizable doses of pain and anxiety medication for the comatose man, the physician’s attorney suggested in court Thursday.

Gravely ill, Ruben Navarro “was going to die shortly, whether in minutes or in hours,” said attorney M. Gerald Schwartzbach as he asked a question of a witness. “In that situation, you err on the side of ensuring that he’s pain-free.”

The attorney also said that Navarro, a chronically ill 25-year-old with a neurological disease, may have required large dosages of the medications because he had lived with pain -- and with pain treatments -- for so long.

The statements came during the second day of a preliminary hearing for Dr. Hootan Roozrokh, a San Francisco transplant specialist who was part of an organ-procurement team that was summoned to Sierra Vista Regional Medical Center in San Luis Obispo in February 2006. The criminal proceeding is the first of its kind in the United States against a transplant surgeon.

Roozrokh, 34, is charged with dependent adult abuse, administering a harmful substance and prescribing controlled substances without a legitimate medical purpose. Convictions on the charges, all felonies, could result in an eight-year prison sentence and a $20,000 fine.

The case’s central issue is whether Roozrokh ordered that morphine and the sedative Ativan be pumped into Navarro’s body in quantities so large that they cost the man his ebbing life, clearing the way for the team from a regional transplant organization to harvest his organs.

On the witness stand, Dr. Laura Lubarsky, a critical-care specialist on call at the hospital that night, said there was no indication -- either through vital signs or symptoms such as sweating -- that Navarro was in pain or distress. Granted immunity by prosecutors, she said she did not step forward to halt the infusion of drugs because her role at the time was merely to keep watch over Navarro and pronounce him dead at the appropriate moment.

In her testimony Thursday, Lubarsky was shown articles about end-of-life care from two medical journals. The publications both noted that appropriate dosages of morphine and Ativan for dying patients can vary by as much as 1,000%, depending on a host of factors including patients’ varying degrees of tolerance to the drugs. One study said the variance could be even greater during the withdrawal of life support.

“It depends who you’re looking at,” Lubarsky testified. “Some patients don’t need anything, and others get very agitated.”

A critical-care expert contacted by The Times last year said Navarro’s dosages, described in a report by federal investigators, were 10 to 20 times the usual amounts.

As the severely disabled Navarro lay unresponsive after six days in the hospital, his family gave permission for his breathing tube to be removed. He died seven hours later -- long after his organs could be of use in transplants.

The hearing is expected to continue into next week.

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steve.chawkins@latimes.com