Starkman: Medical Examiner Conducted Autopsy of Beaumont Colonoscopy Patient After Concern Raised

The columnist, a Los Angeles freelancer, is a former Detroit News business reporter who blogs at Starkman Approved.

By Eric Starkman

Richard Curbello and fiancee Connie Strong

The Oakland County Medical Examiner’s Office on Friday conducted an autopsy of Richard Curbelo, the 51-year-old man who died undergoing a colonoscopy nearly two weeks ago at Beaumont Health’s flagship Royal Oak Hospital, according to a lawyer for the Curbelo family.

John Alexander, the lawyer, said that when his office called the medical examiner’s office on Wednesday it was told that there were no plans for an autopsy. After later asking Beaumont to release Curbelo’s body for an independent autopsy, the county medical examiner informed Alexander’s office that an autopsy would be conducted after all.

Alexander said the second autopsy will be conducted this week by Dr. Bader Cassin, whom the family has hired to conduct an independent examination.

David St. Germaine, an investigator with the office, told me that the circumstances surrounding Curbelo’s death initially didn’t warrant an autopsy. Germaine said subsequently “there was a question” that warranted investigation. He said he couldn't elaborate and referred me to another source in his office who wasn’t immediately available.

Germaine said the medical examiner’s office generally conducts autopsies involving accidental deaths, homicides and other “non-natural” causes.

Beaumont spokesman Mark Geary ignored a request for comment. 

Routine Procedure

A patient dying undergoing a routine colonocropy, particularly because of complications relating to anesthesia, is almost unheard of. Since I first reported about Curbelo’s death last week, I’ve been contacted by doctors from across North America providing input as to what possibly went wrong.

Several medical experts advised that Beaumont’s significant turnover of anesthesia staff was cause for alarm, and that it would be wrong to immediately assume that fault entirely rests with the anesthesiologist and Certified Registered Nurse Anesthetist (CRNA) who administered to Curbelo. They said that having a significant number of anesthesia providers unfamiliar with each other and the hospital’s procedures was a safety issue in itself. 

In a communique last week signed by Jeffrey Ditkoff, Beaumont Royal Oak’s patient safety officer, and about a half-dozen other Beaumont administrators, the hospital notified employees that it was investigating how news of Curbelo’s death leaked out and warned them there’d be serious consequences for those responsible. The communique, without naming Deadline Detroit, said my reporting was “false” but claimed patient confidentiality rules prevented the hospital from setting the record straight.

Undisputed Facts

Here are the salient facts that aren’t open to dispute.

Beaumont COO Carolyn Wilson

Beaumont COO Carolyn Wilson last summer awarded NorthStar Anesthesia, a controversial Texas-based outsourcing firm, a contract to provide the pain management and anesthesiology procedures at Royal Oak and seven other Beaumont hospitals. While Wilson and CEO John Fox encouraged Beaumont’s Royal Oak fellowship trained anesthesiologists to join NorthStar, about half of them resigned. (Beaumont claims that only 25 percent bolted, a number multiple sources dispute, but say even 25 percent is excessive turnover.)  About 50 CRNAs bolted as well.

The co-heads of Beaumont Royal Oak’s cardiology department in September sent a letter to Beaumont’s board chairman John Lewis warning him they had “serious concerns” about NorthStar’s capabilities and practices. Robert Safian, a Harvard-trained cardiologist, sent multiple letters to the board warning directors the medical staff had no confidence in CEO Fox, Chief Medical Officer David Wood Jr., and COO Wilson. Leading donors called for their termination.

NorthStar took over anesthesia at Royal Oak on Jan. 1. The anesthesiologist who tended to Curbelo was from another Detroit-area hospital where NorthStar provides services. The CRNA worked at Beaumont Dearborn. Prior to NorthStar taking over, Beaumont Royal Oak didn’t rely on anesthesiology staff from outside the flagship hospital to work on procedures involving sedation.

Notably, the communique warning employees of dire consequences awaiting those who possibly leaked information of Curbelo’s death offered no assurances that Beaumont’s management still had faith in NorthStar and its capabilities. The communique only paid lip service that patient safety was the hospital’s number one priority.

I’m not an expert on patient safety, but I’ve read Dale Carnegie’s “How to Win Friends & Influence People." If I was Jeffrey Ditkoff, Beaumont Royal Oak's patient safety officer, I’d want to foster the impression I was highly approachable to share concerns, rather than lending my name to disciplinary threats from management.

Reach Eric Starkman at eric@starkmanapproved.com. Beaumont employees and vendors are encouraged to reach out, with confidentiality assured.

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