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In a rare move, a Cape Cod grand jury indicted Dr. Rapin Osathanondh on a charge of manslaughter, following the October 13, 2007 death of 22-year-old patient, Laura Hope Smith. While, as Dan Slater noted, “it’s rare that even the most egregious instances of medical malpractice qualify as crimes,” Cape Cod District Attorney Michael O’Keefe told the Boston Globe that during Smith’s surgery, an abortion, “there was an inattention to the kinds of procedures of a lifesaving nature that one would expect in a place where an operation with anesthesia is being performed… There was nobody monitoring her, long enough to result in her death. There were a number of other shortcomings that make up the willful, wanton, and reckless conduct.”

The litany of allegations brought by the Massachusetts Board of Registration in Medicine, claim that among these other shortcomings, Osathanondh failed to have someone present to administer and monitor sedation or to assist in resuscitative measures, failed to monitor Smith’s blood pressure, pulse, or heart rate or have oxygen available, failed to timely initiate a 911 call, and “failed to adhere to basic cardiac life support protocol.” Osathanondh is also alleged to have lied to the Board by stating he administered oxygen to Smith and monitored her pulse, that he and the other staff member present were ACLS certified, and that the procedure took place in a different, better equipped room. He is also alleged to have “fraudulently obtained renewal of his medical license by providing false information.”

Osathanondh, a Harvard School of Public Health research associate who apparently left a previous hospital “under a cloud of threatened nurses,” is expected to plead not guilty. His attorney told the Globe that “this is a tragedy that sometimes happens in medicine, but it happens; patients die inexplicably in the course of even routine procedures . . . . This is not a matter that belongs in the criminal courts.”

Whether it does or not is an extremely close call. That Osathanondh committed malpractice seems to be clear, but where’s the line between medical malpractice and criminal activity? As noted in the comments section at the Wall Street Journal’s legal blog, some facts regarding the type of anesthesia aren’t clear, neither is whether he is charged with voluntary or involuntary manslaughter. Other questions that come to mind: what differentiates this doctor’s conduct from similar egregious forms of medical malpractice? Did the fact that Smith’s death occurred during an abortion play any role in the decision to prosecute? Is the level of care generally lower for these types of procedures? The conclusion that this young woman’s tragic death was avoidable, however, is unquestionable.

Thomas Connell

Summer Intern 2008

J.D. Candidate 2010

University of Colorado

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