By the time Cole Hartman arrived at Ronald Reagan UCLA Medical Center, he was in grave condition. The 8-year-old had gone into cardiac arrest after nearly drowning in a washing machine at his Castaic home. Paramedics had gotten his heart beating again, but he remained in a coma and on a ventilator.
Physicians at UCLA’s pediatric intensive care unit told Cole’s family that the child was not brain-dead but “would never recover normal neuro function and … could never awaken,” according to an entry in his medical chart.
The Hartmans decided to take Cole off life support and donate his organs. He was removed from the ventilator and, 23 minutes later with his family at his bedside, pronounced dead by an anesthesiologist.
The seemingly peaceful death four years ago is now the subject of an investigation by Los Angeles police and the district attorney’s office. Homicide detectives are looking into an allegation by a coroner’s investigator that the anesthesiologist gave Cole a fatal dose of the opioid fentanyl to hasten his death and increase the likelihood his organs could be harvested. No charges have been brought.
A lawyer for the anesthesiologist, Dr. Judith Brill, said the allegation was “factually wrong and patently offensive.”
“As you can imagine, this is very complicated,” said LAPD Capt. William Hayes, who oversees the elite Robbery-Homicide Division conducting the investigation. “We need to clearly understand what was done and the implications of those actions.”
Detectives opened the case earlier this year. Denise Bertone, a veteran coroner’s investigator who specializes in child deaths, first flagged the use of fentanyl at the time of Cole’s 2013 autopsy and campaigned for years to persuade supervisors to reexamine the case. Her efforts resulted in the coroner’s office amending Cole’s death certificate in December to add fentanyl toxicity as a “significant cause” of his death.
Cole was born with fragile X syndrome, a genetic abnormality that causes intellectual and physical disabilities.
On July 31, 2013, his father came in from mowing the lawn and found Cole headfirst in a running washing machine, according to the coroner’s report and a recording of a 911 call. By his parents’ estimation, Cole’s head could have been underwater for as long as 25 minutes.
Cole was taken to a Santa Clarita hospital by ambulance and then flown by medical helicopter to UCLA later that night for more advanced care. In the pediatric intensive care unit, the Hartmans met Brill.
A professor emeritus of clinical anesthesiology and perioperative medicine at UCLA, Brill, 65, is a well-regarded expert in the treatment of seriously injured children. She helped write the state guidelines for pediatric critical care and spent much of her free time on medical missions to treat poor children in Africa, Asia and Latin America.
With other members of the medical team, she informed the Hartmans that a brain scan was “markedly abnormal” and suggested extensive damage from lack of oxygen, according to notes she made in Cole’s chart.
The family “unanimously stated that they would prefer to withdraw support” and subsequently decided to donate his organs, Brill wrote.
Because Cole wasn’t brain-dead, the organ retrieval was to occur after the ventilator was removed and his heart stopped beating on its own under a procedure known as donation after cardiac death, or DCD. This type of donation began in the U.S. in the mid-1990s and has become increasingly common in the last decade as the medical community tries to meet the overwhelming need for organ donors. DCD accounted for about 10% of deceased donors last year.
DCD comes with time pressures. Organs can begin deteriorating immediately, and some are not suitable for transplantation after 30 minutes.
Cole was removed from the ventilator at 10:40 a.m. as a transplant team waited outside. He did not stop breathing immediately. What happened next is unclear. The full coroner’s report is sealed from public view pending the outcome of the police investigation, and UCLA declined to comment.
Bertone, who said she reviewed the full medical charts and autopsy records, alleged in her lawsuit that the boy “continued to gasp for air” and that Brill then gave him fentanyl “with the purpose of inducing his death.” Bertone’s suit and coroner’s records state that the administered dose was 500 micrograms.
Cole’s heart stopped at 10:59 a.m. and Brill declared death four minutes later, according to Brill’s chart entry. Transplant surgeons removed Cole’s kidneys and liver, according to coroner’s records.
At the coroner’s office, Cole’s case was assigned to Bertone, the only full-time pediatric death investigator. A registered nurse, Bertone had investigated more than 2,500 cases, including numerous child abuse cases. Law enforcement officers across the county called on her frequently to interpret crime scenes and help interview distraught parents. Reviewing the medical records, Bertone said she had concerns about giving a boy who weighed 47 pounds that quantity of fentanyl.
Bertone approached the then-interim chief medical examiner, Dr. Lakshmanan Sathyavagiswaran, who agreed to reopen the case. A pediatric toxicologist brought in as an expert by the coroner’s office found that the fentanyl “was responsible for the death of this patient” and that the dose was “not consistent with a therapeutic dose for the management of pain and discomfort,” according to excerpts of his findings quoted in a coroner’s report.
As a result, Sathyavagiswaran changed Cole’s death certificate in December to add fentanyl toxicity to the list of causes of death and asked for a law enforcement investigation. The manner of death — whether it was an accident or a homicide — remains listed as “undetermined” pending the outcome of the investigation.
Full story at The LA Times.