Heart doctor in civil trial testifies patient wasn’t abandoned on operating table

Fresno surgeon Pervaiz Chaudhry testified Wednesday in his medical malpractice civil trial that he didn’t abandon his patient in the operating room during open-heart surgery in 2012, but stuck around to supervise the closing of the patient’s chest by his physician assistant and another surgeon.

Chaudhry told a Fresno County Superior Court jury that he left the operating room at Community Regional Medical Center at 12:17 p.m. April 2, 2012, for a business meeting at a northeast Fresno restaurant. Chaudhry testified that when he’d left, his patient Silvino Perez, then 70 years old, was in stable condition with no surgical bleeding.

But jurors on Wednesday, Chaudhry’s second day on the witness stand, got a different account from a member of the operating team.

According to a court exhibit shown to the jury, perfusionist Aaron Schreur, who operated the heart-lung machine during Perez’s surgery, wrote in his notes that physician assistant Bella Albakova and general surgeon Kalwant Dhillon were done closing the patient’s chest at 12:35 p.m., nearly 20 minutes after Chaudhry said he left the operating room. “Patient bleeding,” Schreur wrote.

On the witness stand, Chaudhry said Schreuer’s notes were incorrect. But several members of the operating team, including Albakova, have already testified that Chaudhry left her in charge to close the chest so he could attend a business meeting.

Minutes after the chest was closed, Perez began losing a massive amount of blood that starved his brain of oxygen. Perez subsequently went into a permanent coma. Perez’s stepson, Cristobal Arteaga, has sued Chaudhry and his Valley Cardiac Surgery Medical Group for negligence. Arteaga also sued CRMC for negligence, but the hospital reached a confidential settlement before the trial began in Judge Jeffrey Hamilton’s courtroom.

Chaudhry disputed claims he abandoned Perez after surgery, telling jurors the blood loss wasn’t significant, but did prompt him to order the operating team to give Perez blood products like plasma and platelets. Chaudhry said he also asked to be posted of Perez’s condition.

In one bizarre sequence of testimony, Chaudhry denied being Perez’s attending physician. In general, under hospital rules, if the attending physician leaves the hospital, he must find a competent replacement for his patient.

But Chaudhry insisted he wasn’t the attending physician during Perez surgery. Instead he described himself as the “consulting surgeon” or “consulting physician.” He said he didn’t become Perez’s attending physician until later that night, when Perez was admitted to the intensive care unit. He testified he didn’t know for sure who was Perez’s attending physician during the surgery, nor did recall if he consulted with this person before the surgery.

Supporters describe Chaudhry as a brilliant, hard-working heart surgeon who performs high-risk surgeries to save lives. In fact, over a two-year period from April 2010 to March 2012, Chaudhry did 749 surgeries, according to court documents that were shown to the jury on Wednesday.

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 and Rebecca Cachia-Riedl of San Francisco

In defending Chaudhry, Goodman has told jurors his client isn’t at fault because Perez suffered “an extremely rare complication” during surgery. Before he went into a coma, Perez, a retired field and packing house worker from Sanger who is now 76, was the primary caretaker for his wife who suffers from symptoms of dementia.

A CRMC record said Perez had “no significant past medical history” when he was admitted for intense chest pain. At the time of the surgery, there were several people in the operating room, including Albakova, Dr. Ashwin Bhatt, an anesthesiologist, Dhillon, and three nurses. They were there to replace an aortic heart valve and repair an aortic aneurysm.

On Tuesday, Chaudhry testified that in a post-operative report, he wrote that Perez tolerated his open-heart surgery well and was being transferred to the intensive care unit at CRMC. He dictated the report on April 2, 2012 around 12:15 p.m. But he also admitted on the witness stand that his post-operative report was not true. “It was dictated in anticipation,” Chaudhry told the jury.

Chaudhry denied being negligent. But he admitted that he did not close Perez’s chest. He told the jury that Albakova and general surgeon Kalwant Dhillon closed Perez’s chest. “I was there,” he told the jury. “It was closed under my supervision.”

But Albakova has already testified Chaudhry left the operating room, leaving her in charge of closing Perez’s chest. She testified that Dhillon helped her wire Perez’s sternum back together and stitch up fat and muscle tissue, but he had to go somewhere, so she was left alone to stitch the skin. Schreur’s notes, and Chaudhry’s phone records, conflict with Chaudhry’s account of what happened to Perez.

Chaudhry testified Wednesday that doctors are not required to remain at the hospital as long as they answer their phone within 15 minutes and can return to the hospital within 30 minutes. He said he left the operating room at 12:17 p.m., after dictating Perez’s post-operative report. He said he remained on the hospital grounds to meet with Perez’s family and talk to hospital officials. According to his phone records, Albakova called Chaudhry on his cell phone at 12:25 p.m.

Albakova testified that she had no recollection of the two-minute phone call. But after the phone call was made, the operating team ordered a series of tests on Perez’s blood, court documents show. Echeverria told the jury the test was ordered because Perez exhibit signs of abnormal breathing.

Chaudhry testified it was routinely done. But in his 2015 deposition that was played to the jury, he said the blood test is done “only when you have a concern” about abnormal blood clotting.

Chaudhry’s phone records say he called a lawyer about a matter unrelated to Perez’s surgery at 12:36 p.m. It was a 19 minute call that was interrupted temporarily by a one minute call from a nurse in the operating room at 12:39 p.m. Chaudhry testified that the operating team noticed 200 milliliters of blood oozing out of Perez. Chaudhry said that amount wasn’t significant, but he ordered plasma and platelets for Perez.

Echeverria asked Chaudhry if he was still at the hospital during the 12:39 p.m. call from the nurse or headed to the business meeting at Campagnia Bistro near Woodward Park. Chaudhry said he couldn’t recall.

Chaudhry’s next call, according to his phone records, was at 12:59 p.m. when he was told that Perez had “coded” from a loss of blood, meaning his heart had stopped. Chaudhry said he had just arrived at the restaurant when he got the call and had to tell his associates that he had to return to the hospital.

By then, Perez’s lost about 1,500 cubic centimeters of blood and fluids, according to Schreur’s notes. His account is backed up by others in the operating team, Echeverria told the jury. But Chaudhry testified that Perez never lost 1,500 cubic centimeters , even though he admitted that he was not in the operating room at the time Perez coded. After the call, he called his partner, Dr. Robert Stewart, and Albakova, asking them to get to Perez’s operating room.

The operating team administered several shocks to Perez’s chest to start his heart, Dr. Ashwin Bhatt, an anesthesiologist, has testified.

Chaudhry testified that on the drive back to the hospital, he called the operating team and gave orders to Albakova to reopen Perez’s chest, hook him up to the lung and heart machine and massage his heart.

Schreur’s notes say Chaudhry and Stewart arrived in the operating room at 1:29 p.m. Chaudhry testified he operated on Perez in an attempt to stop the bleeding. He said he remained in the operating room with Perez until about 5:25 p.m.

Perez was still bleeding at 5:45 p.m,. when he left the operating room, Chaudhry said. Perez’s chest was left open to find the bleeding, he said.

Around 7 p.m., Stewart was able to stop the bleeding, Chaudhry testified. Perez was later transferred to intensive care.

Chaudhry testified Albakova is competent and capable of closing a patient’s chest. He also said he never told Perez’s family that he allowed a physician assistant to close up Perez’s chest. He testified that he also didn’t tell them about leaving the hospital to attend a business meeting to meet a new doctor and “shake his hand.”

“I was not hiding it,” he said. “It didn’t cross my mind that I needed to tell them.”

After Perez’s surgery, Chaudhry said, CRMC suspended his privileges for two weeks. Reflecting on that day, Chaudhry told the jury: “I still don’t believe I did anything wrong.”

Pablo Lopez: 559-441-6434, @beecourts

This story was originally published January 31, 2018 at 7:56 PM with the headline "Heart doctor in civil trial testifies patient wasn’t abandoned on operating table."