'No one would listen'
A TIMES INVESTIGATION
Kaiser doctor is accused of negligence but remains on the job
October 16, 200
Tracy Weber and Charles Ornstein
Los Angeles Times Staff Writers
Late one April night, the first of Sarah Valenzuela's twins arrived with little trouble, but the second stayed put.
Though the baby was not in distress, Kaiser Permanente perinatologist Hamid Safari attached a vacuum extractor to the boy's head to draw him out. Again and again he tugged, but still the baby would not come.
He vigorously shook the vacuum, up and down, side to side, according to government documents and hospital incident reports.
It took 90 minutes and six tries -- the last with Safari on his knees, pulling. Horrified staffers -- and the boy's father -- looked on as baby Devin finally emerged. His skin was a bloodless white, his neck elongated and floppy.
His spinal cord had been severed.
Safari lashed out at a nurse. "What did you do to that baby? I gave you a good baby," he said, according to a complaint letter the nurse sent to her union representative.
Staffers at the Fresno birthing center were devastated and angry -- and not just because of the twin lost that night in 2005.
Over the years, doctors and nurses repeatedly had complained to higher-ups -- including Kaiser's top medical officer in Northern and Central California -- about problems they saw in Safari's skills and behavior, according to interviews and documents.
This is a story not just of tragic medical outcomes, but of a health plan that did not prevent them.
A year before Devin's death, the doctor had waited more than three hours to do a Caesarean section even though the baby girl was in distress and her family said they had been pleading for the procedure, according to interviews and government records. She was severely deprived of oxygen and died months later.
As far back as 2002, a physician review committee at the hospital concluded that Safari provided "inappropriate" care and that his "conduct needed significant improvement," according to a lawsuit later filed by two of his peers.
Still, the doctor continues to work at Kaiser Fresno, practicing under restrictions that staffers say have not been explained to patients.
Regulators acted only recently. This July, the state Department of Managed Health Care fined Kaiser a record $3 million for its haphazard handling of complaints and physician errors throughout the state. Officials said in an interview that the Safari matter played a significant role in their decision to investigate the HMO's practices.
Late last month, the state medical board accused Safari of gross negligence, seeking to revoke or suspend his license.
The board also has faulted Kaiser, the nation's largest HMO with 6.5 million members in California. The health plan made the board's investigation of Safari "protracted and difficult" by providing incomplete medical records, a spokeswoman said.
Kaiser did not allow senior officials to be interviewed for this story -- and warned staffers at Kaiser Fresno not to talk, several said. In a statement, hospital administrator Susan Ryan said the HMO has cooperated with the medical board and is "committed to ensuring the safety of our patients."
In July 2005 -- three months after Devin's death -- Kaiser imposed its restrictions on Safari, barring him from performing vaginal deliveries and requiring him to be monitored by another physician or an advanced-practice nurse, Ryan said. The restrictions became permanent in April 2007. Kaiser and other hospitals typically do not notify patients of such actions, officials said.
Safari, 49, declined to comment. His lawyer, Stephen D. Schear, said the accusations are "completely unwarranted" and that Safari intends to challenge the medical board's action in a hearing. Safari, he said, has the support of many at the hospital and in his department.
"If you're doing thousands of high-risk deliveries over the years, it's almost inevitable that there's going to be some unfortunate cases where children die, where things don't go right," Schear said.
"You're talking about one minute maybe where he pulled too hard to try to extract this baby. . . . Just look at his whole record, 10 years."
But doctors and other staffers allege that Devin's death was the culmination of Safari's troubles, not a fluke.
"We do not feel that our perinatologist is competent," reads an August 2005 petition signed by eight of Safari's peers, about half of the ob-gyn department. "Over and over again he put our patients at risks and most recently with the undeniably terrible outcome."
Kaiser was "misleading our patients and the public" by advertising that it had a perinatalogist on staff even though his practice was restricted, said the petition, which was addressed to the hospital's medical director.
The petition, complaint letters, depositions and other documents used in preparation of this story are part of the ongoing lawsuit by the two doctors and arbitration cases against Kaiser, or have been provided to state regulators investigating Kaiser and Safari.