Two California doctors have been charged with murder for allegedly cutting off food and water to a patient, brain-damaged after routine intestinal surgery, who failed to die as expected when his respirator machine was turned off.
Deputy Los Angeles District Attorney Nikola M. Mikulicich, head of a special medico-legal section and the prosecutor who filed charges against the doctors, said the case appeared to be an unprecedented.
It marked one more bizarre and possibly legally significant development in the growing debate over how to handle patients who have little chance of regaining consciousness but can be kept alive indefinitely by modern machines.
Arthur Avazian, an attorney for surgeon Robert J. Nejdl, 56, said Nejdl and his colleague, internist Neil L. Barber, 49, both acted "within accepted standards of medical practice."
Mikulicich said a nurse at Kaiser Permanente Hospital in Harbor City complained to the county health department. A grand jury began to investigate, but was handicapped because six physicians at the hospital refused, exercising Fifth Amendment rights, to testify.
According to Mikulicich, patient Clarence LeRoy Herbert, 55, a former employe of the security department at Hollywood Park race track, underwent routine intestinal surgery in June, 1981.
He was released, but returned for follow-up surgery on his large intestine on Aug. 26, 1981. In the recovery room, for a still-unexplained reason, Herbert suffered a lack of oxygen and his heart stopped.
Hospital staffers got him breathing again and revived his heart, but he remained in a coma and was diagnosed as having severe brain damage. The doctors told Herbert's family that, in effect, his brain was dead.
Three days after the operation the family permitted Barber to disconnect the respirator machine that had helped Herbert breathe while in a coma.
Two days later, Herbert was still breathing on his own. According to a statement released by the attorney general's office, "Barber and Nedjl gave orders to disconnect both the intravenous and nasal-gastric tubes which were keeping Herbert alive by supplying him with food and liquids. They also denied him any medication. Herbert was transferred from the intensive care unit to a private room. He passed away on Sept. 6."
Mikulicich said, "I'm not sure that the family ever realized" that the food and water had been cut off.
District Attorney John K. Van de Kamp, the Democratic nominee for state attorney general, said in the statement that his department was prosecuting the doctors not over the cutoff of the respirator but over the denial of food and liquids.
"This is far removed from the proper practice of medicine," Van de Kamp said. "They followed a course of conduct designed to take the person's life. That's murder."
A joint committee of the Los Angeles County medical and bar associations last year recommended that a patient should be removed from a respirator only if his coma were irreversible, he had expressed no wish for artificial life support and his family agreed.
Mikulicich said that he did not feel that Herbert's brain was dead at the time the respirator was cut off and that it was medically possible he could have recovered.
Mikulicich declined to discuss the doctors' possible motives in the case. Avazian declined further comment and Barber's attorney could not be reached.