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Witness says chaos erupts after surgeon leaves patient following open-heart surgery

Physician assistant Bella Albakova, right, takes a break during her testimony Wednesday, Jan. 17, 2018, in the medical malpractice civil trial of Fresno heart surgeon Pervaiz Chaudhry. She told a Fresno County Superior Court jury that Chaudhry left the operating room during open-heart surgery, leaving her to close the chest of a patient in April 2012.
Physician assistant Bella Albakova, right, takes a break during her testimony Wednesday, Jan. 17, 2018, in the medical malpractice civil trial of Fresno heart surgeon Pervaiz Chaudhry. She told a Fresno County Superior Court jury that Chaudhry left the operating room during open-heart surgery, leaving her to close the chest of a patient in April 2012. plopez@fresnobee.com

Testimony in Fresno surgeon Pervaiz Chaudhry’s medical malpractice civil trial began Wednesday with his former lover, who was his physician’s assistant, telling the jury that the doctor left the operating room during open-heart surgery.

Because Chaudhry left, Bella Albakova testified in Fresno County Superior Court that she had to close the chest of 70 year-old Silvino Perez at Community Regional Medical Center .

What happened next to Perez, Albakova told the jury, has scarred her forever. “It was horrific. It has been absolutely traumatic for me even to this moment,” she testified.

He’s screaming that the patient has coded and something bad is going on.

Physician Assistant Bella Albakova

Perez lost so much blood during the April 2, 2012, surgery that his brain was starved of oxygen and now he’s permanently comatose, say the lawyers representing Perez’s stepson, Cristobal Arteaga, who has sued Chaudhry and his Valley Cardiac Surgery Medical Group.

Arteaga also sued CRMC for negligence, but the hospital reached a confidential settlement before the trial began.

Arteaga is represented by the legal team of Jeffrey S. Mitchell of San Francisco, Steven A. Heimberg of Los Angeles, and Ricardo Echeverria of Claremont. Chaudhry is represented by James M. Goodman of San Francisco.

Supporters describe Chaudhry as a brilliant heart surgeon who performs high-risk surgeries to save lives.

Goodman has told the jury that a review of the evidence by medical experts shows Chaudhry was in the operating room until Perez was stable. He also said Chaudhry was not guilty of negligence because Perez suffered “an extremely rare complication” during surgery.

Goodman asked the jury to be wary of Albakova’s testimony because she could have “hard feelings” against Chaudhry.

On the witness stand, Albakova gave a different account, one in which Chaudhry left the operating room to go to a business meeting at Campagnia Bistro near Woodward Park. Once Chaudhry found out that Perez had developed problems, he called Albakova and ordered her to return to the operating room, open up Perez’s chest, and start massaging his heart.

“He was extremely panicking,” Albakova said. “He’s screaming that the patient has coded and something bad is going on.”

And when Albakova asked him where he was calling from, she testified that Chaudhry never answered her question.

The surgery happened April 2, 2012, at Community Regional Medical Center in Fresno.

Albakova told the jury she had a three year “personal relationship” with Chaudhry, even though he had a family in Pakistan. She said she broke off the relationship around June 2012, when she left Valley Cardiac Surgery.

Albakova was a doctor in Russia specializing in obstetrics. She came to Fresno in 1997 to live with family friends.

In 2005 she completed a physician assistant program at the University of California Davis. She then began to work for Valley Cardiac Surgery in Santa Cruz, assisting in heart surgeries.

During her career with Valley Cardiac Surgery , Albakova said she had helped in more than 800 heart surgeries, and during her testimony, she described in detail how open-heart surgery is performed.

In general, she said, closing the chest of a heart patient is done in three phases. First the sternum that had been cut to get to the heart is wired shut. Then the fatty tissue and muscle tissue is sewed shut. Then the skin is sewed.

Albakova said she worked for several heart doctors in Santa Cruz, including Chaudhry. But she testified that she never wired shut the sternum; the doctors always did that part because it required skill and strength, she testified.

In 2010, she moved to Fresno to work with the medical group. The workload was different, she said, because the Santa Cruz office was doing two to three surgeries a week, while the Fresno office was doing seven to eight a week.

She testified she worked nearly exclusively with Chaudhry and they put in long hours because sometimes he would do two surgeries in one day.

Prior to coming to Fresno, she said she had never closed a sternum, but had performed the other stitching.

At the end of 2010, Albakova said Chaudhry began teaching her how to wire the sternum under his supervision. Within months, Albakova said she was closing sternums under his lead about 80 percent of the time.

In 2011, Albakova noticed that Chaudhry would sometimes depart the operating room, leaving her unsupervised while she closed the sternum. He would then come back.

Then he started leaving her to close the chest, and “not come back,” she testified.

Prior to the trial, CRMC reached a confidential settlement to resolve a negligence claim against the hospital.

By the time of Perez’s surgery, Albakova estimated that Chaudhry would leave the operating room and not come back 60 to 65 percent of the time.

A CRMC record says Perez was “a 70-year-old male with no significant past medical history” who was admitted for intense chest pain.

Albakova testified other doctors were in the operating room with Chaudhry, including Dr. Ashwin Bhatt, an anesthesiologist, and Dr. Kalwant Dhillon, a general surgeon. There also were several nurses.

They were there to replace an aortic heart valve and repair an aortic aneurysm. During the surgery, Perez was put on a heart-and-lung machine. Albakova testified that soon after she overheard Chaudhry talking to someone about a business meeting that he wanted to attend. She said it was her impression that Chaudhry was “rushing to complete the operation so he could go to the meeting” but was “not cutting corners.”

Once Chaudhry repaired Perez’s heart, Chaudhry took the man off the heart-and-lung machine. But he had to shock Perez’s heart twice to get it pumping correctly, she testified. She recalled asking Chaudhry: “You’re not leaving are you?” Chaudhry said no. “But then he left,” Albakova testified.

Perez appeared stabilized when Chaudhry exited the operating room, Albakova said, leaving her to shut the chest. She testified she wired the sternum and Dhillon helped her with the closing of the fatty tissue and muscle tissue. Albakova said Dhillion then had to go somewhere, so she was left along to stitch the skin.

Albakova said after closing the chest, Perez appeared stable, so she left the operating room. She said she went to the women’s locker and changed clothes. Then she went to the ICU to check on Perez. She was going to check on other patients when Chaudry called.

In an panic, Albakova said she ran to the operating room. She recalled it was crowded with emergency staff. She described it as chaos.

Albakova testified that Chaudhry was on a speakerphone, barking orders at her. She said Chaudhry ordered her to open Perez’s chest, something she had never done, and massage his heart. Once she did that, she testified, she saw lots of blood and clotted blood. She also recalled massaging Perez’s heart and finding a hole in it.

Albakova said Chaudhry ordered her to hook Perez up to the heart-and-lung machine, also something she had never done in the past.

Chaudhry finally showed up and helped stabilize Perez, Albakova said. Afterward, Albakova said Chaudhry told her to go home and rest. “You did good. Don’t worry about it,” he said, according to Albakova. “I have your back.”

Albakova told the jury that she didn’t like the tone of Chaudhry’s voice.

“I wanted to save this man,” she said.

Pablo Lopez: 559-441-6434, @beecourts

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