The medical license of a Tustin OB/GYN was placed on probation for three years over the prenatal care she gave a patient who died after delivering a baby, according to the Medical Board of California.
Dr. Yuki Kashiwabara and her Irvine attorney, Raymond J. McMahon, signed a letter on Nov. 14 accepting the discipline, which went into effect on Feb. 2. Click here to read the facts of the case.
You will discover that at the center of the medical board action was a 36-year-old patient identified as K.T., who began seeing Kashiwabara starting on Jan. 13, 2011. At that first appointment, the OB/GYN estimated the fetus was 9 weeks and four days old with an Aug. 14, 2011, due date. But an ultrasound performed the same day more precisely gave the gestational age at 8 weeks and three days with an Aug. 22 due date.
Kashiwabara failed to correct the eight-day discrepancy in her notes, and that omission contributed to the troubles with proper prenatal care to come, according to the medical board, which also faulted the doctor for failing to correct the height of the fetus as confirmed by multiple ultrasounds over the pregnancy.
The board also knocked Kashiwabara for failing to adequately deal with K.T.’s blood pressure, which seemed to rise with every test she was given, as well as fetal growth abnormalities discovered by a maternal medicine specialist the board identified as Dr. M.K. That physician was called in to consult when an ultrasound indicated K.T. may have been carrying a child with Down Syndrome.
After Kashiwabara examined K.T. on July 14, 2011, the patient was admitted to the hospital around 5:40 p.m. the same day. She suffered from a low platelet count and elevated blood pressure and liver function studies. By 9 p.m., the fetal heart rate revealed distress with minimal variability. The boy was born via an outlet vacuum-assisted delivery at 9:35 p.m. He weighed 3 pounds, 12 ounces.
K.T. was given medication to mitigate postpartum hemorrhaging after the placenta was delivered at 9:36 p.m. Due to the continued bleeding caused by internal tears and lacerations, she was taken from labor and delivery to an operating room around 10:40 p.m. The hemorrhaging could not be controlled so a hysterectomy was performed. The vaginal bleeding was finally stopped, but K.T. had lost a lot of blood.
After K.T.’s surgery ended around 2:20 a.m., she was transferred to intensive care, where at 7:44 a.m. her pupils were noted to be “unequal, fixed and dilated.” She was pronounced dead at 9:53 a.m. The causes of death were cardiac arrest, cervical-uterine laceration and severe pre-eclampsia, a dangerous pregnancy complication associated with high blood pressure.
The first cause of discipline for Kashiwabara was gross negligence for failing to accurately assess gestational age and due date during prenatal care. The second cause was gross negligence for failing to appropriately assess fetal growth. Failure to properly evaluate and manage the rising blood pressure during the pregnancy was considered a third example of gross negligence, and the board also disciplined her for repeated negligent acts throughout K.T.’s care.
During the probationary period, Kashiwabara is ordered to: obey all laws; enter a clinical competence assessment program; complete medical-education, prescribing-practices and record-keeping courses; make herself available for interviews by board investigators; notify hospitals and clinics where she has privileges of her probationary status; refrain from supervising physician assistants and advanced practice nurses; and present quarterly declarations to the board about her progress with the imposed conditions.
Failure to abide could lead to medical license revocation proceedings.