Friday, January 11, 2008

Autopsy suggest cardio-pulmonary event led to Kanye West's mothers death

The autopsy report on Ms. Donde West, mother of hip-hop star, Kayne West has been released. You can read it here. On November 9th, 2007 Ms. West underwent breast augmentation/mastopexy, belt-lipectomy ("around the world" tummy tuck), and liposuction of her trunk.

Her autopsy report noted that West had moderate coronary artery disease (CAD), with blockage between 50 to 70 percent in her right coronary and left circumflex arteries. The 5-foot-2-inch, 188-pound woman also was moderately overweight and had developed several complications after surgery, including fluid in her lung. The investigation found nothing unusually high in the level of her narcotics and no signs of internal bleeding, infection, or pulmonary emboli.

According to West's autopsy report, she underwent cosmetic surgery on Nov. 9 and went home that day, "even though she was advised that she receive postoperative care at another facility." (That advice in her record may become very important for Dr. Adams defense when this is investigated)

Her first day home she was walking around and appeared fine according to the interviews with some of her care takers . She did complain of pain as you'd expect from such a huge series of procedures. The next day she developed mild trouble breathing and was found in full arrest when left alone for a short period of time.

A separate report by a coroner's investigator said it couldn't be determined whether West underwent any type of pre-surgical screening before her plastic surgery. She apparently had a stress test in January 2007 after experiencing vague chest and shoulder pain, but those symptoms apparently never returned and she seemed to be on only modest medications.

I'm 100% convinced after reading her full autopsy report that the explanation is pretty simple. It is very likely that she vomited and aspirated and then went into respiratory arrest. You see this frequently in hospitals and nursing homes in older and younger patients. I'm not sure why her pathologist was obtuse in his language about this. I take that back.... I know exactly why he is so guarded! He knew this case was going to be scrutinized and probably later litigated. This is defensive medical language 101 to me in all honesty.

To me, Dr. Jan Adams comes off a little better with this information in hand. This wasn't a surgical complication at all per se, and she apparently did not have any evidence of a heart attack (read the autopsy description of the heart itself - it was normal). Even if he'd kept her overnight in the hospital (which I think most people might do for this), it still would not have prevented this as it happened well after 24 hours post op. You can argue the wisdom of such a complex set of procedures as an outpatient surgery on a nearly 60 year old overweight woman with borderline hypertension, but I'm not sure that she would have been medically excluded from surgery all together by her internist. (Remember, she apparently had a fairly unremarkable cardiac stress test earlier in the year that did not trigger further work-up with a cardiac cath study.)

It will be interesting how this plays out. I will be surprised if the logic I'm outlining is not exactly how this plays out in front of the California Medial Board review of this episode.

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