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Doctor aborts wrong twin

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By Carol Gentry
4/10/2010 © Health News Florida

A Sarasota OB-GYN who was supposed to abort an abnormal fetus in a twin pregnancy but leave the normal one alone made the worst kind of mistake: He got the twins mixed up and injected a killing chemical into the healthy one.

At a weekend meeting in Tampa, the Florida Board of Medicine revoked Dr. Matthew J. Kachinas’ license for that complaint and two others that involved less-serious charges.

After the board’s unanimous vote to revoke his license, Kachinas appeared stunned and confused. “What does that mean, revocation? I don’t understand.”

Department of Health officials told him he could appeal to the courts and suggested he consult a lawyer. But a despondent Kachinas told a reporter after the hearing that he intended to kill himself. Police took him to a hospital for evaluation.

Kachinas, 50, was one of the few OB-GYNs in Florida who still accepted elective abortion patients in the 24th week of pregnancy, according to his testimony during a formal hearing in the case in November before an administrative law judge. That is the last week of the second trimester, and while elective abortion is legal then, testimony in this case showed it is difficult to obtain because many doctors and nurses don’t want to be involved.

The wrong-twin case, which took place in 2006, involved a pregnancy of 15 weeks in a patient identified only by initials, K.M. It was not an abortion per se, in which the uterus is emptied and the pregnancy ends, but a “selective reduction” – a technique that involves reducing the number of fetuses to be carried to term. The physician uses ultrasound to see where the fetuses are positioned in the uterus and then injects a chemical through the abdomen into the one that is targeted for elimination.

The dead fetus is not removed from the woman’s body but tends to shrivel and be partly reabsorbed. The remaining fetuses are usually not affected. (For more information on selective reduction, see a 2007 article in The Washington Post Magazine.)

Kachinas testified in his November hearing that he had never done a selective reduction technique and that the patients knew that. He said they had no option but to go out of state if he didn’t do it, and he hated to tell patients no, he testified, so he went ahead.

(The contention that the patient would have had to leave the state if Kachinas didn’t do the selective reduction is questionable. The state’s expert witness, Jorge Gomez of South Florida Perinatal Medicine in Miami, testified in November that he does the procedure about once a month.)

At the November hearing, Kachinas said he thought he had zoomed in on the male fetus, the one that had Down syndrome and signs of a heart defect. A week later, he learned that he had instead injected the healthy female. He concluded there must have been a problem with the ultrasound machine he was using.

The procedure was performed at Premier Institute for Women’s Health in Sarasota, records show; information on the Internet indicates that it has since closed.

Hearing Officer Susan B. Harrell found Kachinas’ testimony blaming the machine unpersuasive and, in an order issued in late January, she recommended that the Board of Medicine revoke his medical license. Professional boards do not have to follow such recommendations, but to overrule them they must cite specific evidence in the record.

In Friday’s hearing, no one but Kachinas found fault with Harrell’s recommendation.

Most physicians who appear before the Board of Medicine, especially on serious charges, are represented by an attorney familiar with administrative law. But Kachinas acted as his own attorney, both in the November hearing and again at the Board of Medicine meeting.

In a rambling, occasionally inaudible presentation, the pale, lanky physician spent most of his time addressing the less-serious charges. When he got to the twin case, though, he admitted he “screwed up.” 

Kachinas was also charged with two less-serious offenses. Records in those cases show:

--In 2002, when he was working at several abortion centers around Tampa Bay, Kachinas was observed in a restroom taping pharmaceutical vials to his legs so that they would be concealed by his socks and pants. When confronted, he said he took the anesthesia drug Propofol with him when going to his job in Tampa because the clinic didn't keep it in stock and he preferred that drug to others.

He acknowledged later in a letter that his method of transporting the drug was “unorthodox,” but said “foolishness seemed reasonable in that aberrant environment.”

The Department of Health charged Kachinas with violating the medical practice laws by carrying the drugs in that fashion and failing to document the fact that he was doing it in the medical records.

--In 2004, a patient identified only by her initials, B.S., came to the Premier Institute for Women’s Health in Sarasota for an elective abortion at the 24th week of pregnancy. Kachinas said the patient rejected the usual procedure for a termination at that stage and wanted him to inject the fetus with a chemical to kill it and expel the dead fetus through labor. He agreed.

But after many hours, he said, her pain tolerance flagged, and he decided to send her to one of the hospitals where he had privileges for an epidural injection to numb her from the waist down. Kachinas said a medical official at Sarasota Memorial told him she wouldn't be welcome there so he admitted her to Doctor’s Hospital.

At Doctor’s, Kachinas said, a nursing official told him not to let the staff know that the patient had gone through an abortion because she would get better care if they thought the fetus had died naturally. On the death certificate, he wrote that the cause was a problem with the umbilical cord.

The Department of Health cited him for failure to have records showing proper care in the case and for falsifying the death certificate. However, the hearing officer said the prosecution failed to prove that Kachinas knew the statement was false. 

--Carol Gentry, Editor, can be reached at 727-410-3266 or by e-mail at carol.gentry@healthnewsflorida.org.