Roozrokh Prelim Hearing: Who Ordered What When?

ICU nurse Diana Stevens testified yesterday that transplant nurse Carla Albright and transplant surgeon Hootan Roozrokh ordered morphine for potential organ donor Ruben Navarro on the night of February 3, 2006. Stevens has been granted immunity from prosecution in the criminal case against Roozrokh. The following items are based on Stevens's testimony, as reported today in the San Luis Obispo Tribune:

• Albright, despite the fact that she cannot legally prescribe controlled substances, ordered Stevens to administer 20 mg of morphine to Navarro while he was in the ICU (before he was transported to the OR for the cardiac-death donation procedure). Stevens evidently complied.
• Stevens also gave Albright 20 mg of morphine before the procedure. It is unclear when or whether this dose was administered to Navarro. According to Stevens, all of the morphine vials "were empty and accounted for" after the attempted cardiac-death donation.
• Roozrokh gave 3 orders that night to Stevens, who testified that she administered a total of 180 mg of morphine and 80 mg of lorazepam (Ativan) to Navarro in the OR. Today's Tribune report does not break down the relationship between Roozrokh's orders and the medication amounts or times.
• The attempted cardiac-death donation was terminated by Roozrokh just before 1 am on February 4, 2006.

More (and somewhat different) details of the events of February 3, 2006, at the Sierra Vista Medical Center are described in a Tribune article from October 14, 2007.

9:30 am: Albright arrives at Sierra Vista to coordinate the donation. She speaks with Navarro's doctors, examines Navarro, and books the OR for the donation process. Albright claims that, despite having reviewed Navarro's chart, she never saw a note from the patient's physician (not Laura Lubarsky) claiming that Navarro was not a good candidate for cardiac-death donation.

7:00 pm: Stevens starts her ICU shift. She reviews paperwork describing the donation procedure and administers "small" doses of morphine and lorazepam to Navarro, allegedly for comfort. 

9:00 pm: Fog delays the arrival of transplant surgeons Roozrakh and Arturo Martinez from San Francisco.

10:30 pm: Roozrokh and Martinez arrive at Sierra Vista and examine Navarro in the ICU (against transplant state law and protocol). Roozrokh asks Stevens to bring morphine and lorazepam to the OR. Stevens brings 100 mg of morphine and 40 mg of lorazapam.

~11:00 pm and later: After Navarro is transported to the OR, Roozrokh and Martinez surgically prep the patient for organ harvesting. The surgeons then remain in the OR, again against protocol, and no one asks them to leave. Immediately after a respiratory therapist removes Navarro from ventilatory assistance (another report indicates that Roozrokh gave this order, with Lubarsky tacitly approving), Roozrokh tells Stevens to give Navarro 50 mg of morphine and 20 mg of lorazepam. Navarro is breathing spontaneously, and after a few minutes, Roozrokh asks Stevens to administer another 50 mg of morphine and 20 mg of lorazepam.

At this point, an OR nurse, Jennifer Endsley, allegedly asks Stevens what she is giving to Navarro, and reports later that her question is ignored. She also claims that she asks Albright at this time, "Do you think this goes against God?" After several more minutes, Navarro continues to breathe spontaneously, and Roozrokh orders Stevens to administer more "candy." However, Stevens has no more morphine or lorazepam left and calls a nursing supervisor for another 100 mg of morphine and 40 mg of lorazepam.

The supervisor tells nurse Suzanne McDougal to bring the requested medication to Stevens in the OR. McDougal confirms the medication amounts with Stevens by phone and, although McDougal is uncomfortable with collecting so much morphine and lorazepam, she nevertheless finds a total of 30 vials in 2 hospital areas and delivers them to Stevens. Stevens then reportedly fills syringes with the medications and administers them to Navarro (it is assumed here that this third administration of medication in the OR provides 100 mg of morphine and 40 mg of lorazepam). Navarro continues to breathe spontaneously after a total of 40 minutes have elapsed in the OR, and Roozrokh cancels the donation procedure. Endsley, Stevens, and Martinez transport Navarro from the OR to the ICU. (In this particular Tribune article, it is not stated when Roozrokh allegedly injected Betadine into Navarro's feeding tube.)

Back in the ICU: Stevens retrieves all 20 empty morphine vials and 40 empty lorazepam vials and counts them with another (unnamed) nurse. (Basic arithmetic indicates that a total of 20, 10-mg morphine vials and 40, 2-mg lorazepam vials were used.)

Endsley evidently reports the events to hospital administrators a few days later (presumably on Monday, February 6, 2006). She has been described as the whistleblower in this case.