Florida Cheerleader’s Mom Not Satisfied with Insurance Settlement

Two years after her 18-year-old daughter died from a rare genetic condition during plastic surgery, Joanne Kuleba can talk about her without crying.

The devastating sadness has been replaced by new emotions: Anger. Frustration. Determination.

While she has settled a lawsuit with the plastic surgeon and the anesthesiologist who performed Stephanie’s ill-fated breast surgery, Kuleba said she feels no satisfaction from the $250,000 she received from each of the doctors’ insurers.

“I can’t even describe the frustration,” the suburban Boca Raton woman said.

She and her ex-husband, Tom Kuleba, hoped to turn the tragedy of their daughter’s nationally publicized death into a triumph for others by making sure the doctors involved were punished. They also wanted to educate the public about malignant hyperthermia. The rare condition caused their daughter’s death when the cheerleader for West Boca High School was undergoing plastic surgery for an inverted nipple and asymmetrical breasts. They planned to push for stricter regulations of office surgery centers.

Instead, Kuleba said, nearly everywhere she turns, doors slam shut.

“My daughter’s dead and everyone’s protected or has connections to the legal system that go all the way to the state,” she said.

Kuleba said she had little alternative but to accept the $500,000 to end the lawsuit because of caps the state legislature imposed to protect doctors from skyrocketing insurance rates. Then the Florida Board of Medicine cleared the doctors before she and Stephanie’s father even knew an investigation had been launched. And, she said, it appears no one at the agency that regulates medical professionals is interested in cracking down on the surgical suites that have grown from 287 to 375 over the past five years.

Attorneys who represent plastic surgeon Dr. Steven Schuster and anesthesiologist Dr. Peter Warheit said they sympathize with Kuleba. But they said, unfortunately, Stephanie’s March 2008 death was a tragic accident, not medical malpractice.

Doctors’ Work Defended

The doctors were cleared roughly a year later by the Florida Board of Medicine because they did nothing wrong, said attorney A. Russell Bobo, who represented Warheit. The records are confidential.

“Everything was done by the book,” he said. “Unfortunately when you have malignant hyperthermia, whatever actions are taken aren’t guaranteed. Both of the doctors were pretty courageous. They had to deal with a situation that was pretty dire.”

Had the civil case gone to trial, he said, he is confident a jury would have shared his view. However, he said, recognizing the publicity the case attracted and the sympathy generated by a young woman’s death, Warheit’s insurer made a business decision to settle the case.

Dr. David Glener, a Port St. Lucie anesthesiologist who reviewed the case for the board of medicine, used the word “exemplary” to describe Warheit’s response when Stephanie’s temperature spiked uncontrollably as her muscles contracted after she was administered the anesthetic.

“His treatment was 100 percent appropriate,” said Glener, who is used as an expert witness by the medical board and isn’t hesitant to criticize fellow doctors.

Warheit administered the antidote, dantrolene, as quickly as he could, Glener said. Further, in an attempt to avoid allergic reactions, he asked before surgery whether Stephanie or anyone in her family had ever had an adverse reaction to anesthesia.

Trained in medical school to recognize and treat malignant hyperthermia, few anesthesiologists will ever have to deal with a case, he said. The state requires all surgical centers to keep 36 vials of dantrolene on hand, just in case.

Better regulation of surgical centers wouldn’t have prevented Stephanie’s death, Glener said. “She could have been in the center of a Level 1 trauma center and been just as dead.”

Strict Regulations

Largely as a result of a 1998 botched surgery and death of a 51-year-old man in a Boynton Beach plastic surgeon’s office, Florida has some of the strictest regulations in the nation, said Dr. Hector Vila, a Tampa anesthesiologist who chairs a committee for the American Society of Anesthesiologists that deals with ambulatory surgical care.

In 2003, he and colleagues published a study that found patients died nearly 12 times more often in surgery at office surgery centers as opposed to ambulatory clinics. Patients also suffered injuries 12 times more often. Problems were blamed mainly on procedures being performed by doctors who weren’t board certified.

Since then, any doctor who performs a surgical procedure that lasts longer than five minutes has to register with the state. Doctors have to be board certified or prove they have necessary training. Further, office surgical suites have to be inspected by national accrediting bodies or by state health officials.

Florida Department of Health records show the number of deaths at doctor’s offices and medical facilities has dropped. There were nine deaths in 2007, 12 in 2008 and three last year. So far this year, two people have died.

Kuleba and Stephanie’s father have said that they believe invasive surgical procedures using general anesthesia should be performed only in hospitals.

Dr. Alan Pillersdorf, a plastic surgeon and former president of the Palm Beach County Medical Society, said he doubted such a regulation would be realistic. “I don’t think we have enough hospitals,” he said, noting the large number of procedures that are done at outpatient surgery centers and office suites.

Given the rarity and severity of malignant hyperthermia, he said he doubts beefed-up regulations would have saved Stephanie’s life. “The fact that it happened with two seasoned doctors is what scares me every day,” he said.

But, he said, Stephanie’s death had a wide impact. It was discussed by doctors locally and at national medical meetings, he said. Patients, he said, now ask him about malignant hyperthermia and the risks.

“She did raise awareness of hyperthermia, not just in the state of Florida but throughout the country,” he said.

But Kuleba said she’s not finished fighting. She said she is working with the Malignant Hyperthermia Association of the United States to prevent deaths.

Further, Kuleba said, she will continue to fight for better regulations. If the state Board of Medicine continues to turn a deaf ear, she said she plans to contact a local legislator to champion her cause.

“It’s discouraging,” she said. “But I’m not done.”