The eye operation was supposed to be routine, but the paitent died.
That was the second of two surprises. The first was the discovery that the patient was pretending to be someone he wasn't.
Now, two weeks later, Alexandria police, hospital officials and the family of the deceased, 22-year-old Christian Reindorf, who traveled from his home in West Africa to Virginia for the operation, are still aruging over who did what to whom.
"They killed my brother," said an anguished Carl Reindorf, 31, a native of Ghana now living in Fairfax County, whose name and insurance card were used by his brother to register at Alexandria Hospital.
Reindorf has hired a lawyer to investigate his brother's death, which hospital records indicate may have been connected to a malfunctioning respirator that went unnoticed until after the patient suffered respiratory failure and cardiac arrest.
"For anyone to speculate regarding the occurrence would be prejudging what actually happened," said hospital official David Norcross. "The hospital regrets and is gravely concerned about the severity of the situation." h
Because the exact details of what happened two weeks ago in the operating room may become the subject of a lawsuit, officials, doctors and employes at the hospital are reluctant to discuss the incident.
In a postoperative report, however, Dr. Michael D. Delaney, an anesthesiologist who was summoned to the operating room after Reindorf's heartbeat was observed to be abnormally low, wrote that he noticed the respirator connections carrying oxygen to the patient were undone.
Respirators are used to keep patients breathing while immobilized under general anesthesia. Later in the same report, Delaney used the word "accident" when referring to Reindorf's medical condition.
In another report, Dr. Juan L. Jammes, a neurologist, wrote that Reindorf suffered from three to five minutes of anoxia, a condition of abnormally low oxygen in the body.
"Any involvement in this case is very traumatic," said one doctor who is among the approximately two dozen physicians, nurses and other hospital staff who were involved in the operation and postoperative care of Reindorf, who died after 10 days in a coma. "The thought of your good name going up in smoke is a very upsetting thing." Another doctor put it more bluntly: "A guy comes in and he dies. It puts a lot of people in a bad situation."
With everybody tight-lipped, few details have emerged about Christian Reindorf's reasons for coming to the Washington area.
Family members and the hospital say he suffered from lesions, or growths on his corneas, an affliction usually associated with living in hot, dry equatiorial areas.
Although the necessary surgery can be done in Africa and Europe, Carl Reindorf said his brother wanted the operation performed in the United States.
"You'd be surprised how many people come to the United States for operations that local surgeons could do just as well," said one Washington eye surgeon. "There is a mystique about American medical care."
Whatever the motive, Christian Reindorf traveled alone to New York via London without first informing his brother. Carl Reindorf learned his brother was in the country when he was contacted by telephone by the Ghanian consulate.
Sometime later arrangements were made for the operation at Alexandria Hospital, and on the morning of Nov. 20 Christian checked in, using -- for yet unexplained reasons -- Carl's name and Carl's Blue Cross/Blue Shield insurance card.
The expense involved was relatively little, compared to the cost of traveling from Africa to Northern Virginia. Alexandria Hospital officials refused last week to put a price tag on the operation, but medical experts in the area said surgeon's fees for the procedure range from $100 to $500 per eye, depending on the severity of the leisons.
Christian Reindorf was given general anesthesia and was unconscious during the operation, which sometimes is performed using only local anesthetics.
Carl Reindorf said he could not say why Christian registered under his name. Hospital officials did not discover the deception until five days later, when the real Carl Reindorf informed them that the comatose patient in an intensive care unit was actually his younger brother.
Carl Reindorf also said he doesn't know how his brother got his card. His Arlington attorney, Robert Alexander, has advised him not to answer questions about the identity switch from Alexandria police who are investigating the case. In a letter to the hospital, Alexander wrote: "Only Christian Hackensburg Reindorf can explain how this matter came about."
Hospital officials refuse to comment on specifics of the case, including a report that a respirator malfunctioned during the operation, and complaints by the family that they were not promptly told about it.
"They just told us he went into a coma during the operation," said Annie Reindorf, Carl's wife.
The Reindorfs said they were shocked, and suspicious, when doctors at the hospital told them Christian had not regained consciousness after his operation, known as bilateral pterygia surgery.
It wasn't until this week, when Carl Reindorf and Alexander asked to read Christian's medical chart, that they found evidence they believe supports those concerns.
Neither Delaney nor hospital official Norcross would comment on the written report referring to the respirator connections being undone. Dr. Kenneth Fox, the surgeon who performed the eye operation, said he could not talk about the circumstances of the surgery.
In Fox's postoperative report, there is no reference to faulty respirator connections.
"The patient apparently suffered a respiratory arrest acutely, and subsequently a cardiac arrest and needed resuscitation which was accomplished over a period of time by the anesthesiology dept.," Fox wrote. He had finished removing the lesions from Reindor's left eye and had just begun working on the right when, he wrote, "there was an anesthesia problem."
Dr. John O'Connor, the anesthesiologist who initially was responsible for supervising the administration of anesthesia to Reindorf and his attachment to a respirator, had no comment on the operation.
Dr. Ronald Karpick who helped attend to Reindorf during the 10 days he lay in a coma, noted that operating rooms generally do not have alarms on respirators to signal when a patient's vital signs become irregular.
"That doesn't make a lot of sense," said Karpick, a specialist in pulmonary care. "The machines I work with have alarms."
Hospital officials in the Washington area argue that alarms are not necessary in the operating room because nurses are assigned the duty of monitoring machines.
Immediately after Reindorf's heartbeat was stabilized, he was taken to a coronary care unit. Three days later he was removed to intensive respiratory care. He was kept on a respirator until a physician, Dr. Michael Friedman, interpreting one of several brain scans, noted, "This pattern is compatible with brain death."
Shortly after noon on Nov. 29, the respirator was turned off and approximately 15 minutes later Reindorf was declared dead.
Early last week, Carl Reindorf and his lawyer sat together reading the medical chart that traced Christian's condition from a preoperative examination, which noted a heart murmur, to his eventual death.
For the first half of the report, the poor prognosis referred to the name Carl.
"11/23 -- Deep coma not changed."
"11/24 -- Patient remains unchanged."
"11/25 -- Cortical silence [no brain activity]."
Reindorf and his lawyer had come to the hospital to look at the chart and to sign a release so that Christian Reindorf's body could be flown back to Ghana where his father, Carl Sr., four brothers and three sisters live.
Before he left the hospital, Carl Reindorf insisted on being shown his brother's body. When a nurse questioned the necessity of further identification, Reindorf told her: "It will cost a lot of money to send the body back to Ghana. I want to make sure we get the right one."