Under doctor's care, tragedy strikes a woman and her family

Kim Jones seems eerily alive against the hospital-white sheets of her bed. Her skin is warm. Her eyes fly open when she's startled. Sometimes she cries.

STARTLING RECOMMENDATION

In March, 2001, Dr. Lee Berry was fired in Mandeville, La., for reporting to work in an “impaired” condition. View a P-I graphic showing a copy of the termination letter and subsequent recommendation letters, signed by the same two doctors who terminated him less than three months before (PDF, 250K).

But her eyes are like a doll's eyes. Unseeing. Her tears are a primitive reflex triggered deep in the part of the brain that controls the autopilot functions of breath and heartbeat.

Doctors say the 31-year-old mother will never recover from her "persistent vegetative state."

Whatever life she experiences today, lost in this landscape of oblivion, is her secret. What may have made her that way was the hospital's secret.

What happened to Kim Jones?

It's the first question her family asked her doctors and administrators after she went to a Richland hospital a year ago to deliver her third child and never came home.

Her family didn't get an answer. They were told no one knew.

The anesthesiologist who presided over what should have been a routine 10-minute tubal ligation following the birth disappeared. Hospital staff said they couldn't reach him.

In fact, they knew.

They knew something was very wrong with the anesthesiologist. They knew where he had "disappeared" to.

But because of the way the medical profession investigates itself, and the laws that protect it, no one outside the hospital -- not the public, not the state, not even the organization that accredits hospitals -- is entitled to know what really happens when something goes awry.

The culture of secrecy in medicine began for noble reasons. One surgeon likened it to a priest's confessional. Secrecy provided a way for doctors to speak candidly of their own mistakes -- to each other.

But as the Jones family would eventually discover through a lawsuit against the hospital and the doctor, secrets also perpetuate lies.


		Scott Eklund / P-I
	Calvin Jones kisses his daughter, Kim Jones, who has been in a coma since Nov. 12, 2002, when she had what was supposed to be routine surgery.

Her final decision

"She has my eyes!"

A year ago, Kim, then 30, gazed in amazement at baby Kadence, born just minutes earlier at the low, sandstone community hospital just down the street from the municipal pool in their hometown of Richland.

Her other children -- 4-year-old Essence and 9-year-old C.J., danced around the room. Kim and Chris Mirisciotta, the children's father, looked at each other. They had wanted three children. Their family was complete.

The couple had met 12 years earlier when Chris walked up to her parents' front door in Lansing, Mich., to sell magazine subscriptions.

"She bought Sassy magazine," Chris recalled. "We just hit it off."

Kim, home on spring break from college, was 20. He was 19. She joined him on the road selling subscriptions and eventually they settled in Richland near his family. They had planned to marry last April.

After Kim got pregnant for the third time, they decided she'd get a tubal ligation -- a simple operation to "tie her tubes."

"Are you sure?" her mother asked her on the phone a few hours after the birth. Kim had called to let her know the hospital had an opening and could do the operation that afternoon.

"I just want to get it over with," Kim told her.

Shortly after 3 p.m. on Nov. 12, 2002, Kim was wheeled into the operating room at Kadlec Medical Center for the procedure. Afraid of needles, she wanted to be "knocked out" so she opted for general anesthesia. It would be the last decision she'd ever make.

For Dr. Lee Berry, it would finally end a lie.


	Family Photo
Kim Jones and Chris Mirisciotta met 12 years ago. They planned to marry last April.

A glowing recommendation

Berry, big and affable, was known both for his compassion and his skills as an anesthesiologist. A doctor who worked with him said Berry would spend longer than most doctors talking to patients when they were in the recovery room.

He'd been at Kadlec as a temporary anesthesiologist for a year. He'd made friends, occasionally socializing with Annie Fluke, one of the nurses.

He was a proud man, she would say later.

But no one seemed to know much else about his history, or why he'd come across the country from his home state of Louisiana to work as a "traveler," or temporary doctor, in a small Eastern Washington town. He'd come highly recommended.

Dr. Mark Dennis, chief of anesthesia at Lakeview Regional Medical Center in Mandeville, La., where Berry had practiced for four years, offered this in a letter dated June 3, 2001: "He is an excellent clinician with a pleasant personality. I am sure he will be an asset to your anesthesia service."

The morning of Nov. 12, Berry reported to the hospital and picked up his usual "tackle box" full of anesthesia drugs -- most of them narcotics -- from the pharmacy. He had a full day of surgery ahead.

At 8:34 a.m., he started on his first case, a prostatectomy that would last two hours. By the end of his first surgery, four of his five ampules of Demerol were gone. By the end of the second, his supply was exhausted. He would still have three cases to go.

"The thing that's atypical is the heavy withdrawals of (Demerol) in the first two cases," said David Pearson, director of pharmacy at Kadlec, when he later reviewed the records. "That's not a typical pattern for him, or really for any anesthesia provider."


		Scott Eklund / P-I
	Chris Mirisciotta and his children Essence, 4, left, Kadence, almost 1, and C.J., 10, watch television at their grandparents' home near Richland. Chris' family is helping care for the children. Chris is working two jobs to support his kids, who are adjusting with the rest of the family to life without mom. It's been especially hard on Essence, who, Chris says, was always at her mom's side.

Demerol is a potent narcotic used to control pain. The drug, which is injected, produces feelings of euphoria similar to heroin. It's highly addictive.

Other, shorter-acting narcotics are more typically used during surgery, experts said.

"Demerol affects judgment, reasoning, the ability to act promptly and make effective decisions," said Dr. Lynn Hankes, who runs a confidential substance-abuse treatment program for Washington physicians. "Cognitive impairment can happen when (people are) actively using, or when they are withdrawing."

By midafternoon, Berry didn't look good. At least four nurses asked him whether he was feeling ill.

According to Fluke's deposition in the Jones family's lawsuit, he was flushed and sweaty, and complained of being hot. He was also congested.

When she asked him about it, he seemed irritated, and brushed off Fluke's concern.

Rebecca Reeves, the circulating nurse in the OR that day, and Cindy Stefanski, the scrub nurse, also noticed he looked sick and was perspiring profusely. Reeves asked him if he was OK.

He told her he was tired of people asking him that.


		Scott Eklund / P-I
	Kadence Mirisciotta reaches out for a picture of her mother, Kim Jones. Kim was pregnant with Kadence when the photograph was taken. Whenever Kadence see this picture of her mother she reacts and grabs at the photo. Kim held her newborn daughter on Nov. 12, 2002. A few hours later, Kim had surgery, during which something caused her heart to stop and her brain to sustain a massive "insult."

'Her nail beds are blue'

Kim's surgery went smoothly, according to her OB surgeon, Neil Rawlins.

Finished, he stepped out of the room, leaving Berry as the only physician in the room.

At that point, "she looked fine," Rawlins said in depositions.

At 3:30 p.m., the oxygen-saturation level of her blood was reading 100 percent. Perfect.

Berry, working behind a sterile drape out of sight of the nurses, also claimed it had been a routine case. But according to his records, he gave her an injection of 300 mg of Demerol. That would be "a very large amount of narcotic for this very short procedure," said Dr. David Cullen, professor of anesthesiology at Tufts University School of Medicine in Boston, who reviewed Kim's anesthesia record.

Berry also gave her two doses of Rocuronium, a drug used to paralyze the patient so she doesn't fight the ventilator. Typically, doctors give patients a reversal agent called Neostigmine at the end of the operation to ensure they're not paralyzed when they wake up. And as a further precaution, they do an electrical test on the patients' nerves to make sure they are firing properly.

There is no evidence in the written record that Berry took either precaution before he removed Kim's respirator.

Berry would later call his own, nearly illegible written record of the day's events "grossly substandard." He insisted in depositions, however, that he did take both actions, but didn't write them down.

If he hadn't, it would have been a patient's worst nightmare. She would have been paralyzed, helpless to breathe as she was coming to. Deprived of oxygen, she could have suffered a heart attack.

At the end of the operation, the two nurses -- Reeves and Stefanski -- prepared to move Kim off the operating table to a gurney to move to the recovery room. Berry noticed her pulse oximeter -- the monitor that detects her oxygen levels -- didn't seem to be recording properly.

Berry asked Reeves to double-check that the oximeter on her finger was still attached. As Reeves picked up her hand, she saw something disturbing.


	Scott Eklund / P-I
Gloria Jones wipes a tear from her daughter Kim's eye. Gloria and her husband, Calvin, flew to Seattle after Kim, who was in a coma, was transferred to Harborview Medical Center last November. They spent every day with her until they were able to transfer her to a facility near their home in Lansing, Mich., in June. Ultimately, they hope to be able to care for Kim in their own home.

"Her nail beds are blue," she said. She checked for a pulse.

There was none.

Reeves' eyes got big. She looked at Stefanski.

"We may need to call a code," she said.

"Hang on," Berry told the nurses. He replaced the monitors. Still no pulse. At 3:40, her oxygen levels were recording zero.

Stefanski raced down the hall to get the crash cart. Within seconds the room filled with nearly a dozen people. At 3:41, Kim Jones had officially flat-lined.

For nearly 40 minutes, the resuscitation team worked frantically to get her back. They shocked her heart twice, and pumped her with epinephrine to send an adrenalinlike jolt to her heart.

In the midst of the commotion, Reeves did an unusual thing. She grabbed the "Tabular Trends" printout from the anesthesia machine that recorded exact oxygen levels, heart rates and blood pressures and stuck it in Kim's medical chart. The printout isn't typically saved. But it was the one record that couldn't lie.


		Scott Eklund / P-I
	Tears well up in the eyes of Chris Mirisciotta as he watches a video about Kim and their three children. Chris is working two jobs to support his family since Kim lapsed into an irreversible coma after routine surgery at Kadlec Medical Center in Richland. After the family filed a lawsuit against the hospital, they discovered that Kim's anesthesiologist had been diverting narcotics from patients and was sent to rehab.

A doctor's tears

The first sign Kim's parents had that something was wrong came when her father, Calvin Jones, called from Michigan to check how the surgery had gone. He got Chris, who seemed to be in shock.

"He was rather hysterical. He wasn't making a lot of sense," Calvin recalled. "He kept saying, there's an empty stretcher and they won't let me see her."

Calvin hung up and turned to his wife, Gloria. "Something's happened," he said.

Gloria felt her stomach clench. Mother's instincts. She called the hospital right back and demanded to speak to a doctor.

There was a scary moment, she was told. But they "got her back."

But with each subsequent call, the situation sounded worse. Kim was having violent seizures.

"She was practically elevating off the bed," said Chris.

Unable to get the seizures under control, the hospital sent her by air to Seattle's Harborview Medical Center. Before she could even reach her husband at work to let him know, Gloria got on a plane. It was the first time she'd ever flown by herself.

"I was scared to death," she said. "But I was scared not to get there in time." Calvin got on the next flight.

When they arrived at the intensive-care unit, their young and vibrant daughter lay bloated and still. The hollow wheeze of a mechanical ventilator filled the room.

She was in a coma.

The following days were a blur. Her family peppered doctors with questions about her chances of recovery, fending off veiled suggestions they let her die.

"I just feel she's fighting. The only way I can explain it. I don't think she's ready," said Gloria, whose natural warmth and good humor has given way to a steely determination. "I'm certainly not ready."

It would be the same response they'd give for months to come.

Fifteen days later, however, they had other questions to ask. They requested a meeting with Kadlec Medical Center staff.

"Our objective was to go there just to find out what happened," said Calvin.

Slow to anger, meticulously organized, Calvin has the kind of easy demeanor that comes with 25 years of working as a lobbyist for the Lansing Board of Water and Light. Gloria, devastated by what had happened to the second-oldest of her four children, wanted an explanation.

In a short, tense meeting with the hospital's risk manager, Rawlins, and a neurologist, the staff said they couldn't give them one. Her heart had stopped. They didn't know why. Berry was on "medical leave" and unreachable, they said.

Only Rawlins, who had delivered Kadence, showed any emotion.

He said everything had gone fine up until he left the room, said Gloria.

And then he cried.


Connect to a database listing the 199 "adverse events" reported between 2000-2003 at Washington hospitals.

The Pandora report

By that time, hospital staff knew more than they were telling.

The day after Kim's surgery, Reeves went to her supervisor and suggested someone do a "stand-back evaluation" of how much narcotic medication Berry was getting from the hospital. The nurse was worried Berry might be using the drugs himself.

"I wondered why he used high doses of medication on the patients," she said later in depositions. "He explained to me that he narcotizes the patients, and his patients are always comfortable in recovery."

In other words, doctor knows best.

But Reeves wasn't so sure. She had experience with another co-worker at Kadlec who was caught diverting drugs and thought she saw a similar pattern.

Independent of Reeves' recommendation, Pearson, the pharmacy director, ran a routine check on drugs used in the recovery room to see whether anyone with access to narcotics was getting unusual quantities. Called a "Pandora report," it's an exercise he tried to do about once a month, but he hadn't gotten around to running the October numbers until Nov. 14, two days after Kim was injured.

Anesthesiologists get access to narcotics in hospitals two ways. They go to their individual tackle boxes, which are replenished each morning. And if they need more, they go to a PYXIS dispenser, essentially a vending machine for drugs. To access the drugs, they put in identifier codes for themselves and their patients.

What Pearson saw in his Pandora report stunned him.

It showed that Berry had withdrawn 100 units of Demerol in October when the typical use for an anesthesiologist should have been about 9. He ran more numbers in November, and Berry's use had skyrocketed even further. "The closer I looked, (what I found) told me that we had something going on that we really needed to look into pretty quickly," he said in court records.

Pearson immediately took his findings to Risk Manager Patricia Lacey and Dr. Michael Hannan, chief of anesthesiology. What was said at that meeting, and the hospital's subsequent "root cause analysis" of Kim's case, is privileged under law. No one will ever know.

Later that day, Hannan pulled Berry out of surgery and confronted him -- accusing him of taking hospital drugs for his own use.

He denied it at first.

But within hours, Berry confessed to stealing and using drugs to treat his own back pain. In a signed confession, he wrote: "I have diverted drugs from my patients. ..."

It may not have been the first time.

Ready access to drugs

The partners of Lakeview Anesthesia Associates were especially pleased to find the young Dr. Berry when he turned up at a meeting of the American Society of Anesthesiologists in 1997. The meetings were a place doctor groups hoped to find promising recruits. They needed someone to expand their new pain clinic, and to share duties at the hospital where they provided anesthesia services.

A native of New Orleans, Berry had gone to the Louisiana State University School of Medicine, graduating in 1991. The son of an air-conditioning businessman and an executive secretary, Berry was the only one in his family to go to med school.

In depositions, he said he knew after his first year that he wanted to practice anesthesiology. And he was interested in pain control, a subspecialty that many considered especially difficult since it meant dealing with patients who were awake and at their worst.

"You've got to have patience, and so that was one of the reason we hired him," Dennis, Lakeview's anesthesia chief, would say later in depositions.

It's also a field that gives doctors ready access to pharmaceutical-grade controlled substances.

In fact, recovery specialists will tell you that anesthesiologists have one of the highest rates of substance abuse in the medical field, in part because of access.

In December 2000 -- two years before the Kim Jones tragedy -- Lakeview Medical Center officials were sufficiently alarmed by Berry's apparently excessive use of Demerol to alert Dennis.

Dennis confronted Berry with the suggestion he was using too much, and Berry defended himself. He said "he was the physician and he was taking care of the patients and that what he was doing was what the patients needed," Dennis said in depositions. He urged Berry to "back off a bit."


		Scott Eklund / P-I
	Calvin and Gloria Jones get ready to take their daughter Kim home to Michigan. Members of Mount Zion Baptist Church came to see them off.

Berry did cut back. But then one night around 4 p.m., Dennis got a call at home from a nurse.

Berry, who was on duty that day for 24 hours, had passed out and was unable to perform anesthesia on a patient, she said. Dennis rushed to the hospital and found him slumped in a chair.

"When I got there, he was definitely not right," he said. Berry later told Dennis he'd taken Valium for back pain.

Two weeks later, Berry was fired "with cause."

In Berry's termination letter, Dennis wrote: "As we have discussed on several occasions, you have reported to work in an impaired physical, mental and emotional state. Your impaired condition has prevented you from properly performing your duties and puts our patients at significant risk."

License in good standing

Berry's partners in Lakeview Anesthesia Associates never reported his questioned drug use to the hospital.

No one reported it to the state of Louisiana's medical licensing board. His privileges at the hospital were never revoked. He voluntarily withdrew them a few months after being fired. Two of his Lakeview partners even wrote him glowing letters of recommendation. Dennis did not return repeated phone calls to his office; his attorney refused to comment.

Berry quickly found work through an employment agency called Staff Care Inc., based in Irvine, Texas. After several short stints elsewhere, he landed the position at Kadlec.

On his application for a license to practice in Washington, he checked "No" where he was asked whether he had used substances in a way that "impaired or limited his ability to practice medicine with reasonable skill and safety" within the previous two years.

Washington's licensing board routinely checks license requests, sending out a form for previous employers to return that specifically asks for information regarding potential substance-abuse concerns or other problems.

Lakeview Medical Center didn't return the form. Instead, they sent a letter merely confirming the dates Berry was on staff.

Brenda Strama, the hospital's attorney, said she could not comment on what the hospital knew when it sent the letter, citing attorney-client privilege. It's standard practice, she said, for many hospitals to send form letters in response to background check queries to avoid lawsuits by doctors over their references.

Washington officials didn't follow up. They issued Berry's license.

Today, despite Berry's confession to stealing drugs, his license to practice is still in good standing in both states.

'She hears us talking'

On a good day, Kim will sometimes say "Mom" or "ouch," says Gloria as she combs her daughter's hair at Providence First Hill Care Center in Seattle.

She reports this piece of information about her daughter with equal parts defiance and wishfulness. Nursing home staff are careful not to encourage or discourage these observations. It's painful to watch families struggle to accept someone in this condition. In the process, they tend to see things they want to see, doctors say.

This is not a good day. Kim has been heavily sedated to control her ongoing seizures. Her parents head to Mount Zion Baptist Church, their refuge away from home.

The pews are filling with women in bright dresses and hats. Children in Sunday best scoot underfoot, and men compare cheerful notes about "mama drama" in their lives.

It's Mother's Day. Gloria sways slightly during the prayer, eyes closed, crying silently. Calvin clutches her hand. The sermon celebrates mothers who keep trying, no matter what, even when nothing seems to work. Mothers who hang in there. Mothers who have faith.

"Amen," says Calvin.

Later they gather in Kim's room with Chris and the kids. As the room fills with the voices of her children, Kim's face screws up. Doctors say it is an involuntary response.

Gloria disagrees. "She hears us talking," she says. "She's trying to cry."

Chris, watching Kim's agitation, whispers something to her. He strokes her cheek, kisses her forehead. She falls back asleep.

A dream-catcher, placed there by the family, dangles just above her head.

Investigations under way

The full extent of Berry's drug history may never be known.

Kadlec Medical Center officials said they gave Berry a choice: go to rehab or lose your privileges. Berry chose rehab.

In doing so, the hospital entered into a confidentiality agreement with the rehab program whereby hospital officials couldn't disclose to anyone where Berry had gone, or what he was in treatment for.

Berry himself is providing no answers. To every question posed in court proceedings, he pleaded protection under the Fifth Amendment. Any information, including whether the hospital or any other agency did a drug test to see whether he actually had drugs in his system, is privileged. All quality assurance and peer-review processes engaged in by hospitals are privileged and confidential, and not subject to discovery in a lawsuit.

Fluke, the nurse, helped him get to the rehab center in Oregon after he signed his confession. She said in depositions that Berry told her he began diverting drugs after a single-car, rollover accident in Montana in summer 2002 that put him in the emergency room with an injured back. He told her he thought he could control the drug use, and was surprised at how rapidly it got out of hand.

Berry, who refused to talk for this story, completed rehab and returned to Louisiana. He has stated in depositions that he doesn't plan to practice medicine again. He told Fluke he may do some commodities trading.

His attorney, Jim King, said Berry is shattered by what happened.

"It's a dual tragedy," said Seattle attorney Ron Perey, who is representing the Jones family. "He should have been reported and sanctioned out of fairness to him. Maybe it would have saved his career and my client's life."

The family has filed a multimillion-dollar lawsuit against Berry, Kadlec Medical Center and others in Benton County Superior Court. The case is scheduled to go to trial next March.

It's unknown whether Berry will be charged with a crime for stealing drugs. In depositions, pharmacy director Pearson admitted the hospital did not report the thefts to the U.S. Drug Enforcement Administration, as required by law. He said he discussed Berry's diversion with the State Pharmacy Board, and the board told him he didn't have to report it.

Perey, however, did alert Benton County prosecutors, who are investigating.

Perey also notified the state Medical Quality Assurance Commission, which has opened an investigation. The hospital never notified the commission of Berry's case.

Hospital officials now say they satisfied their reporting requirements by referring him to rehab. Hankes, who runs the rehab program, however, said it is still a hospital's responsibility to report "quality of care" issues to the state.

"Rehab can't be used as an umbrella to hide under," he said.

Kim's family wants Berry stripped of his license and charged with a crime.

"This man should go to prison," Chris said. "If he pulled a gun on someone when he was high on crack, it's exactly the same thing. If anything, he should be punished worse because he had that license to put someone's life in his hands."

Life without a mom

Today, Kim lies in limbo between life and death. Doctors can say little other than a person's chance of recovery from this state dwindles the longer they are in it.

Berry continues to insist he doesn't know what happened to her and that she was only without oxygen for the briefest of periods before he discovered it.

Other doctors say for Kim to have suffered the kind of brain damage she has, she would have had to be without oxygen for 8 to 10 minutes, something the "Tabular Trends" record bears out.

Her parents, who have moved her to a care facility near their home in Michigan, continue to hope she will one day recover. They spend their days trying to elicit some kind of response from the young woman who wrote poetry and dreamed of owning an espresso stand. Her mother rubs her skin with fragrant oils -- a daily anointing ritual.

Her brain sometimes "storms," the electrical conditions going haywire, a condition that will send her temperature soaring to as high as 108 degrees Fahrenheit. Doctors suggest Calvin and Gloria consider signing a "Do Not Resuscitate" order.

"We're not giving up on her," said Calvin Jones. "We're the only voice she's got."

Back in Washington, Chris, now 31, works two sales jobs in Kennewick to support his family.

Sometimes, before Kim was moved to Michigan, Chris would place their crying baby on Kim's chest. Even in a coma, something about her presence calmed Kadence.

The children are adjusting to life without a mom.

"Essence is having a real hard time," he said. Determined and stubborn, like her mother, "she was stuck to Kim's hip. They were never apart."

C.J., the oldest, comforts his father when he cries.

"I believe in miracles, but I also have to be realistic," Chris said. "Sometimes, I want to picture Kim walking through the door. It's amazing that something so simple could just be taken away."

Kadie is still too young to know what happened to her mother. But Chris knows the day will come for questions.

"I'm gonna tell her the truth," he said. "I'm not going to lie to her at all."

KNOW THE FACTS

Anesthesiologists appear to have a higher substance-abuse rate than some other specialties because of their access to addictive drugs.

The American Society of Anesthesiologists estimates that 12 percent to 15 percent of doctors in rehab are anesthesiologists, even though they make up only 4 percent of the doctor population.

The national group has worked to raise physician awareness about the problem, and many hospitals now train their staff to be on the lookout for problems. Others have installed computerized tracking systems to better identify patterns of drug use among doctors with access to narcotics.

Doctors with substance-abuse problems can and do continue to practice with no notification to licensing boards, as long as they complete specialized rehab programs.

The confidential programs continue to monitor physicians through random drug-testing, behavioral reports and ongoing counseling. About 80 percent of doctors who go through rehab are there voluntarily. The rest are referred by courts or the state Medical Quality Assurance Commission.

Experts say patients can protect themselves by taking these simple steps:

Find out who your anesthesiologist will be and schedule a pre-surgery interview.

Ask your surgeon whether he or she is comfortable with the anesthesiologist, and whether the surgeon has worked with the anesthesiologist before.

Ask the anesthesiologist whether he or she has done numerous cases like yours. Some anesthesiologists specialize in obstetric or cardiac cases.

Find out whether your anesthesiologist has been certified by the American Association of Physician Specialists, passing a rigorous written and oral exam.

Check with the state licensing board to make sure the anesthesiologist's license is in good standing, and whether the anesthesiologist is the subject of any open complaints.

Ask other doctors who they'd recommend as an anesthesiologist.

To report a physician, call the state licensing board's complaint line: 360-236-4700

-- Carol Smith