The death of a woman who suffered respiratory failure after Lap-Band surgery at a Beverly Hills ASC was "an accident due to suboptimal anesthesia care," according to the autopsy report by a Los Angeles County deputy medical examiner.

Tamara Walter, 52, suffered from morbid obesity and sleep apnea when she presented for a hiatal hernia repair and weight-loss surgery at the Beverly Hills Surgery Center in late December 2010. Deputy Medical Examiner Kevin Young based his autopsy findings in part on a report from consulting anesthesiologist Selma Calmes, MD, who concluded that "the expected standard of anesthesia care was not met," in Ms. Walter's case.

Specifically, Dr. Calmes questioned the safety of conducting a "significant operation" under general anesthesia in an outpatient setting when the patient had "known sleep apnea" and used a nighttime breathing machine at home. She also writes that the patient's respiratory problems in PACU, which led to her cardiac arrest, are usually resolved "with prompt, aggressive management," but in this case "there were excessive delays getting the patient to suitable treatment." She specifically calls out the anesthesiologist for being absent for 80 minutes post-surgery, leaving "this critically ill patient" in the care of a CRNA.

While the anesthesiologist is not named in the autopsy report, the Los Angeles Times reports that it was Daniel Shin, MD, of Marina Del Rey, who was on probation with the state medical board at the time of Ms. Walter's surgery after being convicted of assaulting a process server with a meat cleaver in 2006. He completed his community service for that misdemeanor in 2008 and was placed on 2 years' probation by the medical board in 2009, but was allowed to continue treating patients while undergoing a psychiatric evaluation and ethics training as part of the board's ruling.

Dr. Shin has since taken a voluntary leave of absence from the Beverly Hills center and is not expected to seek reinstatement of his privileges there, according to Robert Silverman, attorney for the surgery center and the 1-800-GET-THIN marketing company. In an e-mail sent to the Times, Mr. Silverman also defended Dr. Shin and said the autopsy report unfairly blamed him for Ms. Walter's death. The anesthesiologist had monitored her "the entire time she was in the recovery room," he wrote. "There is no record of any gap in supervision."

Within the past 2 years, 2 other patients also died after Lap-Band surgery at the Beverly Hills Surgery Center, located on Wilshire Blvd., and a fourth patient died at an associated center in West Hills, Calif. All 4 patients had called 1-800-GET-THIN for their weight-loss surgery referrals, according to the Times, which also reports on a number of pending lawsuits against the surgery centers and the marketing campaign. Read the full report here.

Irene Tsikitas