The Memorial Sloan-Kettering Cancer Center in New York notified its chief neurosurgeon yesterday that it intended to dismiss him, charging that he had mishandled a brain operation on the mother of one of India's best-known film actresses last May and another brain operation on a patient last December.

The hospital said the neurosurgeon, Dr. Ehud Arbit, who had been suspended from surgical and administrative duties since June, was to be dismissed -- after exhausting appeals -- on the basis of a review that concluded he had "violated Memorial Hospital's standard of care" in the two cases. 

"This action is painful but necessary," said Dr. Joseph V. Simone, the hospital's physician-in-chief.

A lawyer for Dr. Arbit, 48, who has been a neurosurgeon at Sloan-Kettering for 10 years and its chief of neurosurgery since January 1993, denied the allegations yesterday. The lawyer, David Hoffman, said his client would appeal the dismissal to the hospital's physicians' grievance panel, its Board of Managers and a state agency.

"The hospital is attempting to make Dr. Arbit a scapegoat for what is an unfortunate situation, but there is no evidence of unprofessional conduct or a lack of competence," Mr. Hoffman said.

The hospital and Dr. Arbit's lawyer gave conflicting versions of what happened in the two operations.

With the two cases under investigation by the State Health Department and other agencies and by Sloan-Kettering itself, the hospital has never identified the patients involved, but one -- Rajeswari Ayyappan, the mother of Sridevi, a popular Tamil-language star in southern India -- became known after her family made public statements about what happened.

In the operation on Mrs. Ayyappan on May 26, Dr. Arbit was to remove a malignant tumor from the left lobe of her brain but operated on the healthy right lobe instead after mistaking her for another patient, the hospital said. Mr. Hoffman said Dr. Arbit had expected another patient from India the same day for a right-brain operation and, in a meeting with Mrs. Ayyappan and her family, used the name of the other patient and was not contradicted.

In the other case, the hospital said, Dr. Arbit was to remove a cancerous lesion on the left side of the patient's brain but entered the brain on the right side and "did not locate the lesion." That, in turn, necessitated "an unplanned return to the operating room," Sloan-Kettering said.

But the lawyer said Dr. Arbit had not mistaken lobes but had deliberately entered the right lobe as a safer approach for a small tumor just left of the brain's midline. He also said the exact location of the tumor had been difficult to establish because the patient was obese and standard imaging procedures had not been useful.

Son of Cancer Patient Says Family Sought the Best Care

By The New York Times
Published: November 16, 1995

Rajeswari Ayyappan has been in a listless and disconnected state since returning to India, sleeping long hours and unable to read or conduct meaningful conversations, her son said today. Mrs. Ayyappan is the cancer patient who underwent a botched operation in May for a brain tumor at Memorial Sloan-Kettering Cancer Center.

"We thought it was the best hospital, and we thought they would take good care of our mother," Satish Ayyappan, 27, a computer engineer, said when he was reached by telephone at the family home in Madras. "It was a great blunder done by such a big hospital."

Mr. Ayyappan spoke shortly after the State Health Department issued a report sharply critical of Sloan-Kettering's handling of Mrs. Ayyappan, which culminated in September with an announcement by the hospital that it was dismissing its chief neurosurgeon, Dr. Ehud Arbit. In an operation on May 26, Dr. Arbit, 48, was to have removed the tumor from the left lobe of Mrs. Ayyappan's brain, but instead operated on the healthy right lobe, according to an account given by the hospital when it announced his dismissal.

Mrs. Ayyappan, 59, returned to Madras from New York in July, two months after she was told by doctors in Madras that her best chance of surviving the malignant tumor was surgery in the United States. Her son said she left for New York within two weeks of suffering the seizure in early May that led to the discovery of the tumor.

"We talked to all the top doctors in Madras, and they told us it would be better in the United States," Mr. Ayyappan said. "My mother would get a better treatment."

With his father dead for several years, Mr. Ayyappan said that he had discussed his mother's condition with his sisters, Sridevi Ayyappan, 28, one of India's top film stars, and Srelatha Ayyappan, 25, before deciding to seek medical care in the United States.

"We thought, 'Why not go there? Why not get our mother the best?,' " he said.
Mr. Ayyappan said that when his mother returned to India, after undergoing the mishandled operation at Sloan-Kettering and a second operation in which the tumor was removed by an Indian-born doctor at New York Hospital-Cornell Medical Center, she was a shadow of what she had been before the tumor developed. He said his mother spent most days sleeping, could walk only with difficulty, and had lost her memory, to the point where she had no recollection of her time in New York.

"She doesn't understand what happened," he said. "She talks not frequently, not relevantly."

The tens of thousands of dollars in expenses involved in flying her to the United States and paying for her medical care were paid by Sridevi Ayyappan, who has a large following in India. Starting at the age of 4 with appearances in Tamil-language films produced in Madras, Sridevi Ayyappan had graduated by her late teens to India's Hollywood, Bombay. There she has starred in hundreds of Hindi-language films.

Mr. Ayyappan said that his sisters had remained in New York through their mother's ordeal. He said that Sridevi Ayyappan had returned to work, acting in five films that are being shot concurrently on different locations across India, and was remaining in contact with lawyers in New York who are representing the family in the wake of the operation at Sloan-Kettering.

From The New York Times


News
BRAIN BOTCH SPURS REFORM
By Joe Nicholson / NEW YORK DAILY NEWS
Saturday, June 24, 1995, 12:00 AM

Memorial Sloan-Kettering Cancer Center has revamped its surgical procedures after a brain surgeon botched an operation on the mother of India's biggest movie star, Sridevi. Now, to keep doctors from repeating the same mistake, the hospital will force them to sign a checklist to make sure that the right medical records, X-rays and other data needed are brought into the operating room. "We immediately strengthened the pre-surgery assessment procedures within the neurosurgery service," hospital spokeswoman Christine Westerman said. "While the lead surgeon continues to bear full responsibility for insuring that the appropriate X-rays are brought into the operating room, we have also instituted a formal hospitalwide procedure. "A checklist must be signed by an operating surgeon and senior nurse to insure that surgery is performed on the correct side of the body," she said. The foulup occurred during the May 26 operation on Sridevi's mother, Rajeswari Ayyappan. She had come to Sloan-Kettering to have a brain tumor removed. But the doctor in the case, whom the hospital has declined to identify, took the wrong X-rays into the operating room. He then opened the wrong spot on Ayyappan's head. When Ayyappan's family was told of the mistake, they transferred her to New York Hospital-Cornell Medical Center, where a surgeon removed the tumor. Dr. Lalitha Masson, an Indian community leader here who knows Sridevi, said the star has has been staying on Long Island and spending time at her mother's bedside. "It's a huge trauma to her," said Masson, a gynecologist who said Indians "consider America a heaven or miracle place for medical cures.

" A Sloan-Kettering spokeswoman declined comment on whether the medical error resulted in memory loss or other harm. "We're not commenting about the patient's condition primarily because she is no longer in our care," said Christine Westerman.

From NY Daily News
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