Surgeon Testifies About Blood Loss in Liposuction Patient Who Died

SANTA ANA —  A surgeon who cut open the chest of liposuction patient Judy Fernandez in a last-ditch effort to save her life testified Friday that when he tried to massage her heart, it was essentially empty.

“I felt it was collapsed,” said Irvine surgeon Lawrence Malone. “I felt there was practically no blood in it.”

The testimony came in a case brought by the California Medical Board, which wants to revoke the licenses of anesthesiologist Robert Hoo and plastic surgeon W. Earle Matory Jr., who performed more than 10 hours of surgery on Fernandez in Matory’s Irvine outpatient surgery suite on March 17.

The coroner’s office has determined that Fernandez, 47, died of blood loss and had a toxic level of the painkiller lidocaine in her body after the “large-volume” liposuction and other plastic surgery procedures. She had been infused with 19 liters of intravenous fluid as well as 14 liters of tumescent liposuction fluid, which allows the fat to float and be sucked out, according to evidence. She was rushed to Irvine Medical Center when her blood pressure dropped and she did not wake up after the surgery.

An Orange County Superior Court commissioner temporarily suspended the licenses of Matory and Hoo in May, pending the current hearing before Administrative Law Judge Vincent Nafarrete.

Defense attorneys have maintained that Matory and Hoo followed usual procedures in liposuction and that while Fernandez’s swollen appearance seemed abnormal to people not experienced in the procedure, it is standard for such patients immediately after surgery.

“Dr. Matory is on trial for his life and his livelihood,” attorney Lloyd Charton said outside the courtroom. “Maybe this is no one’s fault. . . . Medicine isn’t 100%.”

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Surgeon Malone testified that Fernandez suffered “hypovolemic shock,” in which the patient does not have sufficient blood volume to sustain life.

Lab work showed that Fernandez’s hemoglobin count was 2.1 (a normal count is 12.0 to 16.0) even after she had been transfused with one unit of blood, according to testimony. The low hemoglobin count “implies extensive blood loss,” cardiologist Steven Cohen testified.

Cohen said he tried repeatedly to insert a line into an artery to determine arterial pressure, an indicator of the heart’s activity, but he could not find Fernandez’s arteries and veins because her body was so swollen.

Paramedic Jim Owen, who responded to the 911 call from Matory’s office, said Fernandez’s skin was yellow.

“I’ve seen it before,” he said. “[But] I’ve never seen it on a live person before.” During paramedic training, he said, he worked on cadavers with that coloring.

During transport to the hospital, Fernandez’s body was leaking so much pinkish fluid that the paramedics had to move their equipment off the ambulance floor, Owen said. She dripped about 1 1/2 liters in the vehicle and in the trail she created on the way into the emergency room, he said.

Defense attorneys have suggested that Fernandez’s lost blood was the result of “third spacing”--seepage into tissues and the space left open by removed tissues. The blood did not get sucked out during the liposuction, Charton said outside court.

Richard David Hendlin, deputy attorney general representing the medical board, dismissed the “third spacing” argument as irrelevant. Even if the blood remained in the body, he said, it was not in the arteries and veins, where it was needed to sustain life.

The medical board proceedings will be on hiatus for two weeks while Nafarrete is on vacation, but Charton advised the judge that he will be filing papers in Superior Court in the interim to have the doctors’ licenses restored.

Deputy Dist. Atty. Christopher Evans refused to comment Friday on whether there is a criminal investigation of the doctors, but Evans, as well as an investigator from the Irvine Police Department, attended the trial’s first three days.