A Prince George's County physician has handed in his Maryland medical license after being accused of unprofessional conduct during two abortions in which one woman died and another was left brain-damaged.
Anesthesia accidents during two 1989 operations at the Hillview Women's Medical Center in Forestville led to the charges against Dr. Gideon M. Kioko of Adelphi.
Kioko told the state Board for Physician Quality Assurance that he "had nothing to do" with the administration of anesthesia in either case. His role, he said, was merely to perform the abortion and monitor the patient for any post-surgery complications.
Nevertheless, he said, "I have decided to surrender my license . . . to avoid further prosecution" by the board.
The board's investigation of the incidents concluded that, as the surgeon in the two abortions, Kioko failed in his responsibility to examine the two women to establish their suitability as candidates for the planned general anesthesia.
He also allowed unqualified personnel to administer the anesthetic drugs and failed to assure that qualified personnel were on hand to monitor the patients' responses to the drugs, the board concluded.
Kioko also was held responsible for failing to ensure that the abortion clinic had trained medical personnel and adequate equipment on hand to respond when the two women went into cardiac arrest in reaction to the anesthesia.
Earlier this year, Hillview was the focus of a CBS News "60 Minutes" report in which the clinic's owner, Barbara Lofton, was accused of having posed as a physician and administered anesthetics to patients.
A subsequent investigation by the state Department of Health ++ and Mental Hygiene found numerous violations at Hillview, most of which have since been corrected, according to Charles Tregoe, chief of the DHMH drug control program.
Tregoe said no evidence was found that Lofton had posed as a physician. But she was subsequently charged in Prince George's County District Court with five state health code violations, including operating a medical laboratory without a state permit and employing a nurse unlicensed in Maryland.
No action was taken against the clinic itself, Tregoe said, because, while doctors, nurses and labs are licensed by state authorities in Maryland, medical clinics and their non-physician owners are not.
The investigation of Kioko by the Board for Physician Quality Assurance revealed that he was employed to perform abortions at Hillview between April and November 1989.
On July 12, 1989, a 34-year-old woman arrived at Hillview for the abortion of a 16 1/2 -week-old pregnancy. The woman was given an intravenous dose of an anesthetic called "IV Brevital," and the operation began, investigators found.
Within minutes, the woman's blood pressure plummeted. She went into respiratory distress and her heart went into ventricular fibrillation. Although she was resuscitated by an ambulance crew, she had suffered brain damage and was pronounced legally dead three days later at the Malcolm Grow U.S. Air Force Medical Center at Andrews Air Force Base.
The medical center's records listed the cause of death as "brain death" due to a lack of oxygen, and speculated that the woman may have taken illegal opiates before the operation and suffered a fatal drug interaction with the anesthesia.
In a second incident, a 26-year-old woman named Susanne Rene Logan consented to an abortion at Hillview to end a 13-week pregnancy. On Sept. 9, 1989, she, too, was given an intravenous dose of Brevital.
Soon after the abortion was begun, a nurse noticed that Logan's lips were turning blue and she was found to be in cardiac and respiratory distress. Resuscitation efforts were begun by clinic personnel and continued by Prince George's County rescue personnel.
Logan survived, but had suffered severe brain damage. According to papers filed in a negligence suit by her parents against Kioko and others in the case, Logan is conscious but is unable to talk, swallow or move her limbs. She is in a nursing home.
Board investigators found that Hillview's records in the two cases failed to show who administered the anesthesia, or at what dosage, although Kioko told the board he believes the drug was given by Barbara Lofton, who is not a physician.
The investigators found that Kioko was "not qualified in the administration of IV Brevital," and was unfamiliar with its effects. No medical personnel qualified to administer the drug were present at the clinic.
There also was no documentation in the clinic's records that Kioko examined the patients before the operations to determine their suitability for the anesthetic. Kioko told the board that the first patient, when her medical history was taken, had denied using opiates.
The investigators found that no qualified personnel were present to monitor the patients' reactions to the drugs, and there was no evidence they were connected to monitoring equipment.
Although Kioko described the clinic's resuscitative efforts in the September incident as "immediate and adequate," board investigators agreed with allegations by Logan's attorneys that much of the clinic's emergency equipment was broken, incomplete or missing.
In February 1990, after Kioko left Hillview, he was hired by the CYGMA Health Center, an abortion and family planning clinic in Kensington. In November 1990, he was named CYGMA's medical director, a post he held until surrendering his license this month.
Kioko has been named as a defendant in two other malpractice suits involving his work at Hillview. Both are pending before the state Health Claims Arbitration Office.
Kioko is accused of perforating the uterus of a woman during an unsuccessful abortion attempt in February 1990. He is a co-defendant in a suit in which a woman complained of severe swelling and pain in her arm after the administration of anesthesia before an abortion in September 1989.