Investigators: Questions about clinic's use of common anesthetic



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Posted on February 11, 2010 at 12:06 AM

Updated Thursday, Feb 11 at 12:06 AM

From all appearances, 28-year-old Aura Javellana of Redmond was on top of the world.  But she wasn’t happy about her weight, and with her wedding approaching she turned to surgery as a solution. Without telling her fiancé, Aura went to Sono Bello Body Contour Center in Bellevue for liposuction. Hours later, she was dead.

"It's still unreal,” said Justin Rogers, who was engaged to Aura. “You really don't know what to think or who to blame. At the end of the day you've lost somebody who was your future, your life," he said.

The King County Medical Examiner's Office ruled that Aura died from  “Acute lidocaine intoxication.”

Lidocaine is a commonly used anesthetic that’s mixed into the solution that’s pumped into the body during liposuction.

“It (lidocaine) numbs the area around the fat that’s going to be suctioned,” explains Dr. Phil Haeck, President-Elect of the American Society of Plastic Surgeons. “So it’s just making the patient more comfortable.”

Rogers said Aura knew he was against liposuction.  He even tried to find her and stop her when he discovered where she'd gone. But she had already gotten the procedure done and checked into a Bellevue hotel to recover alone.

“And within a couple of minutes the Medical Examiner called me and told me she had passed away,” said Rogers. “I was devastated. It’s unreal.”

Lidocaine intoxication is a rare but known complication of liposuction. We asked Sono Bello if Aura was given too much.

Chief Medical Officer Thomas Garrison told us Sono Bello’s internal reviews found lidocaine was used “well within accepted guidelines.”

“Strict protocols have and were followed,” he said. “We do not think there was any fault from the clinic.”

Now the KING 5 Investigators have obtained medical records and internal e-mails that raised questions months before Aura's death about Sono Bello's handling of lidocaine. 

Aura died on May 27, 2009.

More than three months earlier, on Feb. 16, the company president, Chris Par, e-mailed Garrison, other corporate managers and staff at clinics in Washington and Utah warning about a mistake by medical assistants preparing solutions containing lidocaine.

"Apparently lidocaine 2% was being used rather then (sic) 1%,” wrote Par. But the calculation table was based on the lesser 1% solution.

"This resulted in doubling the amount indicated and can cause a 'toxicity' issue," Par said. “We did not have any issues with a patient but it is imperative that the MA’s (medical assistants) follow the calculations closely,” he wrote.

Garrison responded: “We have tried to use a standard mixture so that we reduce the potential for this error," he wrote.  “One option is to only stock the 1% lidocaine but let's look at everything else before we consider this."

Sono Bello's Seattle based attorney, E. Pennock Gheen, told us   “These e-mails are part of Sono Bello’s quality assurance process…”

Gheen said that no patient was ever endangered.

“In fact, we are not aware of any instance where our procedures have been insufficient for patient safety,” he said.

Gheen said "There is nothing medically inappropriate about using a 2% lidocaine solution…"

Dr. Haeck agrees with Gheen.  However, Haeck says stocking both strengths of lidocaine does increase the chances of making a mistake.

Haeck showed us the bottles for 1% lidocaine and 2% lidocaine.

“Tiny little print,” he said.  “Tiny little number two, tiny little number one.  You’re in a hurry, it’s too easy to pick up the wrong bottle.”

Haeck said he only stocks the 1% in his clinic, “so we’ve eliminated the ability of making that mistake.”

Pam Andersen of Puyallup had liposuction at Sono Bello in Bellevue in April.  Her medical records, which she provided to KING5 News, clearly show the solution pumped into her body used the higher strength 2% solution.

We don’t know which strength was used when Aura had her procedure done a month later. Sono Bello told us that privacy laws prevent them from discussing her case.

Washington State’s Medical Quality Assurance Commission (MQAC)  is still investigating Aura’s death, which they only learned about last fall, months after she died.

“The Commission did not  know about the death until we received a phone call from KING 5 telling us about the death,”  said Michael Farrell, Legal Unit Manager.

“What action did you take?” asked Linda Byron.

“The commission opened up an investigation immediately," Farrell said.

Since our stories aired in November, MQAC has widened its investigation to include multiple doctors at Sono Bello and the clinic's handling of lidocaine.

"Every health care provider in the state of Washington has the responsibility to provide safe medical care to their patients,” Farrell said. “That  would certainly include providing the right amount of medication to each patient."

Farrell says that MQAC is currently investigating 14 complaints involving 5 doctors at Sono Bello in Bellevue and they have received information that may lead to several more complaints being opened.

Even if state investigators were to confirm a pattern of health and safety problems at Sono Bello they couldn’t simply step in and revoke the clinic's license.  Sono Bello doesn't have a license. They're not required to have one in the state of Washington because they don't use general anesthesia.