NBC Universal Anchors and Correspondents
By Keith Morrison Correspondent
Dateline NBC
updated 1/24/2010 7:27:19 PM ET 2010-01-25T00:27:19
transcript

This aired on Dateline NBC on Sunday, Jan. 24, 2010. Read a producer's blog about the story here.

A small hospital, the central California coast. A massive heart attack. The patient was still alive, though barely. He was in a deep coma; only a ventilator kept him breathing. His name was Ruben Navarro.  Just 25 years old. And in this perilous state, he was about to make medical history because, 200 miles up the coast in San Francisco, a phone call.

Hootan Roozrokh: It's like bein' a fireman.  You slide down the pole, and go the airport.

But he's not a fireman.  Doctor Hootan Roozrokh is a brilliant surgeon, the call - a plea to save a life.

Hootan Roozrokh: The operation I had done hundreds of times.

Now, there was no time to lose.  Dr. Roozrokh and his highly skilled medical team raced to the airport, boarded a chartered plane and took off down the coast toward San Luis Obispo. And then... the fog.

Hootan Roozrokh: The fog was very bad in San Luis Obispo. 

Roozrokh's flight was rerouted to a distant airport.  Cars had to be located, a caravan formed, time lost.

Hootan Roozrokh: All in the fog, you know.  Middle of the night.  Friday night.

By the time Dr. Roozrohk arrived, most of the hospital staff had left for the weekend.

Hootan Roozrokh: No one was prepared.  No one knew what to do.  No one knew what the next step was.  Nothing was ready.  Nothing.  No one was there.

But by now, the dye was cast; a real-life medical drama was reaching its climax. But this much we know before the drama begins: Hootan Roozrokh did not come here to save Ruben's life.  His mission was to wait for Ruben to die, and then harvest his organs.

Hootan Roozrokh: For 98 percent of these cases to go forward, someone has to die.   

Hootan Roozrock was a transplant surgeon.  The life he'd been called to save was that of a woman, desperately waiting for a new liver: Ruben Navarro's liver. A young man whose impending death was about to sow chaos in the lives of those around him.

Ruben's journey to the final night of his life began long ago, in second grade.

Rosa Navarro: He was always happy. He was a very perfect person.

Keith Morrison, Dateline NBC correspondent: Perfect person.

Rosa Navarro: Perfect.

Keith Morrison: Nobody's perfect.

Rosa Navarro: Well. he was--

Keith Morrison: Really.

Rosa Navarro: I know, but when it come to do the homework, he want it to be perfect. 

He was unusually bright, little Ruben.  His teachers told his mother Rosa he could go far, her bright star of a son.

Rosa Navarro: I'm a single mom.

Keith Morrison: So--

Rosa Navarro: And I'm proud of it.

Keith Morrison: --he was all you had in the world.

Rosa Navarro: That's it.  He was the world to me and my inspiration.

Keith Morrison: Love of your life.

Rosa Navarro: Exactly.  Perfect.

But within a year, perfection gave way to mysterious flaws in Ruben's behavior.

Keith Morrison: When did you first notice that something was wrong?

Rosa Navarro: When he was eight.

That's when Ruben, who loved math, began struggling with simple arithmetic.

Rosa Navarro: And I would say, Why you forgot to do time tables and divisions? Yesterday you did great, and now you-- you don't know how to do.

Keith Morrison: Just like that.

Rosa Navarro: Exactly.

And as his mind slipped, Ruben also began losing control of his body.

Rosa Navarro: He would be walking and he would be bumping onto the chair. Or the furniture, or whatever.

And he was overcome with unbearable pain. As his limbs degraded, and his brain slowed.  It was, said the doctors, a rare neurological disorder.

Rosa Navarro: Devastating.

Keith Morrison: Comes out of the blue, doesn't it? 

Rosa Navarro: (tears up) Exactly.  And I think to myself, "Why me?" and "Why him?"

By the time he was a teenager, Ruben was taken far away to live in one group home after another, on constant medication. Finally ending up in a nursing home, likely unaware of the idyllic town around him:  San Luis Obispo, along California's central coast.

It was here on January 29, 2006, that Ruben, just 25, had a massive heart attack and was taken to Sierra Vista Hospital in a coma. Rosa, without a car of her own --took the train from her little apartment hundreds of miles to the south to be by Ruben's side. But soon after she arrived, she said, the calls began. From the organ transplant network.

Rosa Navarro: And they say if I wanted to donate his organs, and I said, "No," (sniff) several times.  But they kept on calling and calling and calling (sniff)--

Then, she says, a doctor began to hound her.

Rosa Navarro: And he goes, "The only thing I can do for patients like him, just disconnect him and that's it."

Keith Morrison: Did he say how-- whether or not Rueben would survive?

Anna Navarro: The only thing, he goes, "Five days on the machine, I have to disconnect him, and there's nothing I can do for him."  That's what he said, and he walked away.  Like he didn't care. Now they wanted to sign a paper to donate his organs.  'Cause they said, He's gonna die.

But Rosa, deep in her grief and unable to accept her son would die, says she refused. 

Rosa Navarro: I didn't sign no paper, no nothing.

But events were now in motion, and nothing would stop them.

It was the night of February 1, 2006, 10:50 p.m. when the whole fateful business began. That's the moment when the name Ruben Navarro was placed on the list of possible organ donors. The next morning, February 2, Rosa went to the hospital, as this video she provided shows, to pray at Ruben's bedside.

Keith Morrison: When did you realize that your son was going to die?  That he was not going to come back from this?  Did you understand that right away when they called you?

Rosa Navarro: No, he didn't look like he was gonna die. He was trying to open his eyes.  Like he wanted to speak.

Keith Morrison: But he couldn't speak.

Rosa Navarro: He couldn't speak, he was so doped up. (crying) that's why I knew he wasn't ready to go.  'Cause he was crying.

She was poor, her money was gone, and so she couldn't stay to keep watch over her son.

Rosa Navarro: I was broke 'cause I needed to pay the-- the hotel, to eat. 

And so, heartbroken, exhausted, alone, she said goodbye to Ruben. At noon she boarded a train for the long ride home to southern California.

Keith Morrison: So, if you had been able to afford to stay with your son--

Rosa Navarro: Yes. I woulda stay.

It was 1:15 p.m., there on the home-bound train now well underway, when her cell phone rang.

Rosa Navarro: Hello?

Kathryn: Hi Rosie.

Rosa Navarro: Hello.

Kathryn: It's Kathryn.

The caller was from the California transplant donor network--a non-profit group that acts like a placement center for patients in need of organs. Rosa said she thought she had fended off earlier donation requests. But this time it seemed more official.

Kathryn: OK. So what I'm going to do is I'm just going to read some things to you and you don't need to say anything. OK? You're thinking about doing--you're going to do cremation?

Keith Morrison: So when you were getting those calls on the train--

Rosa Navarro: Yeah?

Keith Morrison: --he was still alive?

Rosa Navarro: Yes.

Keith Morrison: And they said he was still alive, but he's going to die very soon.

Rosa Navarro: Yeah.

Rosa Navarro: (crying) The thing is, they lie.  He wasn't ready to go. 

Or at least, that's what Rosa thought. Grieving, alone, surrounded by strangers on the train, Rosa was confronted again with a request: Would she agree to make Ruben's organs available for transplantation?

Kathryn: With him being so young, you know, he could save seven people's lives.

Rosa Navarro: I'm going to miss him.

Kathryn: I know. I know. Can I have your address Rosie so we can send you the letter about the recipients?

Keith Morrison: What were you thinking when you got off that phone call?

Rosa Navarro: Well-- I got in shock.  I became blurry. I was confused.

Four minutes into the phone call Rosa found so confusing, she gives what sounds like implicit consent to have Ruben's organs donated.

Rosa Navarro: If we can, the organs are okay, why not use them, you know, for, for a people that really need them.

And indeed, the need for donated organs is real and urgent.  Without question, Ruben's organs had the potential to save lives now hanging in desperate balance. So, soon after the phone call to Rosa, the transplant network contacted Ruben's doctor with the news:  Your patient is a candidate. So, what the doctor wrote later in his medical chart was, to say the least, curious: "I doubt Ruben will succumb immediately upon extubation."

Meaning? Once Ruben was disconnected from the ventilator his organs would not be getting enough oxygen and would slowly degrade. And by the time he died, perhaps hours later, they'd be useless for transplantation. Did anyone notice? By then, the drama had commenced. And up in San Francisco, 6 p.m., night of February 2,  Dr. Roozorkh got the call to harvest Ruben's organs.

Hootan Roozrokh: The recipient surgeon said, "Are you available?  Can you go down and do this procurement?"  I said, "Yeah."

The organ procurement procedure could get complicated, the caller said. Why?  Because Ruben was not brain-dead like most donor patients, but instead in a coma.

Hootan Roozrokh: So their brain is still alive.  The legal requirements for brain death have not been met.

Most organ donors are accident victims - they've suffered a fatal brain injury, they've been declared legally dead by the time the transplant team arrives. But Ruben had been placed in a somewhat controversial category called DCD, or donation after cardiac death, medical jargon of course, but very rare.

What happens in a case like that is the patient is still alive on an operating table when the transplant team arrives, connected to a ventilator, the hospital must disconnect the ventilator, the transplant team waits for the patient to die and then the operation can proceed.

The procedure is so rare that even though Dr. Roozrokh had participated in 300 transplant operations, only 1 had been a DCD case. As Ruben Nararro drifted in the netherworld between this existence and whatever awaits beyond. He was, or may have been,  unresponsive to the outside world. But he was technically alive.  How much so? That will be a question asked many times throughout the coming night.

It was the fog. On the afternoon of February 2, 2006, a great white bank of fog advanced along the California coast from San Francisco south to a town called San Luis Obispo, where the life of Ruben Navarro was slowly slipping away. It was the fog that delayed Hootan Roozrokh's team on their mission to save a patient in desperate need of a liver transplant. A mission which, over and over, presents difficult choices for grieving families - and some new hope for potential recipients.

Hootan Roozrokh: There is such a gap right now between people on the list.  And people who actually donate.  And there's so much fear and misconception out there, that this gap, instead of getting smaller, it's getting larger.

Keith Morrison: So anytime some possibility comes up of organs becoming available, that's a big deal.

Hootan Roozrokh: Absolutely.  Absolutely.

This time, or so it seemed, as Roozrokh flew south to harvest Ruben Navarro's organs, the biggest issue was simply the fog.

Hootan Roozrokh: We had to reroute. We found, and got clearance to land at Paso Robles.

Keith Morrison: So, then you had to go by car up to the hospital?

Hootan Roozrokh: Correct.  And, you know, you don't have, like, chauffeurs waitin' for you.  You're doin' all this stuff yourself.  You know, you're emptyin' the plane.  You got your duffel bags.  You're takin' everything.

It was late, almost 11 p.m., when they pulled into the parking lot of Sierra Vista Hospital. Roozrokh's brief and life-changing encounter with Ruben Navarro was just minutes away. Ruben's own doctor had left town for the weekend and a back-up had to be called.  It would be that back-up doctor's job to be Ruben's "attending physician" - look out for him alone, see to his medical needs, especially including any prescriptions which might be needed for pain or anything else.  But when Roozrokh looked in on Ruben at the ICU, that doctor was not around.

Hootan Roozrokh: That person didn't want to come in until we were in the operating room.  She refused to come in.

Keith Morrison: I don't get it.

Hootan Roozrokh: I don't either.  You knew we were coming.  We were actually late.

Ruben was comatose, but still alive, still on a ventilator. And could possibly experience pain once the ventilator was removed.

Hootan Roozrokh: They're suffocating for all intents and purposes.  They're gasping for air.  They're suffering. 

At  11:20 p.m. Ruben was wheeled from ICU to the operating room and in his wake, further confusion.

Two O.R. nurses were asked to help with the procedure, an ICU nurse as well. There was, in addition, a transplant coordinator, a transplant assistant, the respiratory therapist, an assistant surgeon, there was Hootan Roozrokh, and Ruben's own backup doctor. An ad hoc group of individuals thrown together late on a Friday night to perform a rare type of harvesting procedure full of ethical dilemmas.

Once in the O.R., a nurse administered the painkillers - the morphine and Atavan - which had been prescribed earlier by Dr. Roozrokh.

Hootan Roozrokh: Basically, to prevent his suffering. The least we can do as physicians is make them comfortable.  It's the only humane thing to do.  And that's why I felt it was important that those medications were available.

Then they disconnected his ventilator. But Ruben continued to breathe.

Hootan Roozrokh: The part of his brain that will control breathing was alive. 

But without the ventilator to fill his lungs with oxygen, Ruben's organs would degrade and be worthless within an hour. At that point, according to suggested protocols, Dr. Roozrokh and the transplant team should have left the operating room to wait outside.  But they did not.

Keith Morrison: There is-- a feeling by some people that it may be a conflict of interest for the transplant surgeon to be in the operating room while the patient is still viable.  In essence, you know, you're waiting for him to die.  Maybe it's not such a good thing to be in the room.  Isn't that what some of the protocols suggest?

Hootan Roozrokh: Yes.

Keith Morrison: And yet you were there, why?

Hootan Roozrokh: We were in the room that particular night because we were asked to be in the room.

Keith Morrison: By whom?

Hootan Roozrokh: By Carla Albright.

Nurse Carla Albright was the transplant coordinator; you'll hear more about her later. She had actually been in San Luis Obispo a couple of days to lay the groundwork for the procedure. If Roozrokh was the star of the team, Albright was, say, the quarterback the one actually calling the shots. When Roozrokh decided he would stay in the operating room that night, it was because he and presumably Albright, felt things were starting to slip out of control.

Hootan Roozrokh: in the operating room, no one knew what they were doing. These people had never seen a DCD procurement before.  And it's midnight in a small town, they don't know us from anything.

Keith Morrison: Right.

Hootan Roozrokh: you could just get that sense that people were tense.

In part because Ruben was still very much alive. 

Hootan Roozrokh: When we put him on that table that night-- and we stretched his arms out, we felt resistance.  He was aware of what was going on.  We put his arms out like this, and he didn't want that done.

Keith Morrison: Why would he not want his arm--

Hootan Roozrokh: It's uncomfortable. He didn't like it.  It was painful for him.

Keith Morrison: How do you know it was painful?

Hootan Roozrokh: I put myself where he was.  If that was me, how would I react?  What would I be feeling?  I thought I could feel pain. 

So Dr. Roozrokh directed that more morphine and Atavan be given to Ruben. And since Ruben was still a living patient, his vital signs were closely monitored and recorded. That job fell to the transplant coordinator, Nurse Carla Albright.

Hootan Roozrokh: As part of a D.C.D., the coordinator's responsibility is minute by minute, to document heart rate, blood pressure, respiratory rate, oxygen saturation, essentially, his vital signs.

Those vital signs would be clear indicators if Ruben was feeling pain or panic.

Hootan Roozrokh: As a human being, you would want the person not to suffer, to go as peaceful as possible.

Yet something in Ruben fought to stay alive. Each time he was given an injection of morphine and Atavan his heart rate slowed, his breathing eased, but within minutes both would shoot up again, indicating the drugs were having little effect. By midnight, forty minutes into the procedure, 20 minutes remaining of organ viability, Ruben had been given 100 milligrams of morphine and 40 milligrams of Atavan. Despite the heavy dose of pain killers, Dr. Roozrokh was worried that Ruben was still suffering, so another 100 milligrams of morphine and 40 milligrams of Atavan were brought to the O.R. Minutes ticked down. Soon Ruben's organs wouldn't be usable. 

Hootan Roozrokh: No one said anything.  They were silent. It was just waiting and watching.  And when that reached approximately one hour, that's when I said, we've waited-- you know, long enough, he hasn't died.  Let me call the recipient surgeon and inform him.

And while ruben stayed alive, another patient now had to prepare to die - for back in San Francisco the operation to save a life--to transplant ruben's liver into a dying woman-- was aborted.

Keith Morrison: So then, what did you do?

Hootan Roozrokh: Thanked everyone for coming in and left.  That's it.

Keith Morrison: And--

Hootan Roozrokh: It seemed like--

Keith Morrison: --Reuben was still alive?

Hootan Roozrokh: Correct.

But not for much longer. Ruben was returned to ICU. A "do-not-resuscitate" order was placed in his chart. A nurse who sat with him as he died said later that whenever she held his hand, his heart rate would increase.  Finally, at 8:15 in the morning on February 3, Ruben Navarro's painful journey came to an end. But Hootan Roozrokh and Ruben Navarro's lives were still very much entwined. Because four months later, one of the operating room nurses, Jennifer Endsley, walked into the San Luis Obispo police department with a story to tell.

Jennifer Endsley: I knew something was dreadfully wrong. That this was just not right...

Endsley, seemed sure something sinister occurred that night in the O.R.  And the mastermind behind it all?

Jennifer Endsley: Hootan is what they called him.

In San Luis Obispo, Nurse Jennifer Endsley unloaded on police--telling them everything she could about Ruben Navarro's final hours. She poured over photos and sketched out diagrams of the O.R., and laid out a very disturbing tale.

Jennifer Endsley: It just did not feel right to me.

Nurse Endley told them that Ruben was alive when they rolled him into the E.R., told them how the transplant doctor ordered massive quantities of potentially lethal drugs. How he refused to leave the O.R.

...And how he seemed a little too anxious, to her, to dismiss Ruben's faint heartbeat as nothing more than post-mortem twitching. 

You could see his heart beating through his chest.

Jennifer Endsley: You could see his heart beating through his chest.

Endsley thought it wise to conduct her own investigation as the night unfolded.

Jennifer Endsley: I want to know what's going on and they're not sharing and so I'm going to be nosy and I'm kind of peering over and I'm walking over there and I want to see and that's -- I mean I was being nosy. I'll fully admit it. I wanted to know. I was being sick of being ignored.

She says she even confronted another nurse about the amount of drugs being injected.

Jennifer Endsley: I said, "What and how much did you give?"...and she said, "220 morphine and 84 Atavan." I said, "Are you kidding me?"

Endsley said she was the only one to ask questions or raise concerns.

Jennifer Endsley: I did not feel as if I could do anymore--does that--besides sprawling myself across the patient and going, "No! Stop!"

Detective: Out of everybody in the room, who ran the show?

Jennifer Endsley: That's such a loaded question.  Officially? 

Detective: No.

Jennifer Endsley: Or who was--?

Detective: By actions, by actions.

Jennifer Endsley: Dr. Hootan.

Nurse Endsley was very persuasive. So much so, that after her two-hour interview, detectives filed a report suggesting charges could be laid. One of the charges they considered? California Penal Code 664/187: Attempted murder.  Back in San Francisco, Hootan Roozrokh and his wife Sherry were  unaware that police were investigating  the Navarro case until the day detectives came knocking at their door.

Hootan Roozrokh: They showed up to my house on my wedding anniversary, my front door on a Sunday.

There were endless questions.  It was obvious charges were possible.  Perhaps even attempted murder.

Hootan Roozrokh: The first reaction is, "They're gonna do what? I mean, these were people that thought I tried to murder somebody. 

Sherry Roozrokh: We were terrified.  What do you do?  What do you do?  Where do you go?  We didn't know any attorneys.

Suddenly, in the course of an afternoon, an immensely promising career came crashing down.

Keith Morrison: What was that time like for you?

Hootan Roozrokh: Shame.  Prodigal son does wrong.

Prodigal?  Roozrokh grew up in the Midwest, the enormously gifted son of Iranian immigrants. He was accepted into a combined undergrad/medical school program at the University of Wisconsin when he was just 16 years old. By 24, he had his M.D. And by his 31st birthday, he was the youngest transplant surgeon in the country. 

Sherry Roozrokh: He wanted to be at the forefront of saving as many lives as he possibly could. His mother actually died needing a liver transplant. 

Keith Morrison: Before all of this happened, what was your sense of and his of where he was in his career what he achieved?

Sherry Roozrokh: On track, ahead of schedule. Just living at the top of the world.  Everything was perfect.          

And now, apparently, it was all over.

Sherry Roozrokh: Oh, everything changed.  Everything changed.  Absolutely everything changed.

Hootan Roozrokh: My colleagues weren't calling me. I was alone.  On an island.

And then, the word came. On July 30, 2007, Dr. Hootan Roozrokh was charged. Not with attempted murder, but with "dependent adult abuse," and "administering a harmful substance," and "prescribing a controlled substance without a legitimate medical purpose."

In essence, the D.A. was alleging that Roozrokh tried to force or hurry Ruben's death just so that he, Roozrokh, could have access to those organs. It was the first case of its kind in the country and if convicted, Dr. Roozrokh could spend years in prison. And then the whole world seemed to know and this young transplant surgeon was made to look very guilty indeed. His lawyer advised: Don't respond to any of it. The initial media attention soon migrated to the Internet. And there, in an online stew of invective and invention, Roozrokh was said to be a possible Islamic terrorist, or an angry Muslim who had not the slightest concern for an American patient's life.

Hootan Roozrokh: I was just amazed, you know?  I was-- it's like, "These people don't even know me.  I'm not even Islamic." 

I've never seen hate like I've seen hate in the last three years.

Sherry Roozrokh: People were giving us dirty looks. There were people throwing stones at our windows. 

Something dark, perhaps frightening, about the case of Ruben Navarro and the surgeon Hootan Roozrokh.

Hootan Roozrokh: It was so sensationalized.  It was so-- for lack of a better word, made for TV movie.  It was just so transplant surgeon tries to kill somebody for their organs.

Criminal charges weren't his only problem. Remember how Rosa Navarro said she was hounded by a doctor who lied to her, who tricked her into thinking there was no choice but to remove Ruben from his ventilator, and let him die? Now Rosa filed a lawsuit in which she charged that the doctor who told her those things was Hootan Roozrokh.

Hootan Roozrokh sat at home in San Francisco and worried.  He was in very serious trouble and perhaps more serious, life-saving organ donations - in the wake of such negative publicity - were also in trouble.

Gerry Schwartzbach, attorney: This is an extraordinarily-- not just interesting case, but important case. Because of its profound effect upon organ transplantation.

Which is why attorney Gerry Schwartzbach called it the most important case of his long career.

Gerry Schwartzbach: The D.A.'s office knew that if they filed-- charges against Dr. Roozrokh, they would be the first such charges ever filed in the history of law. 

Schwartzbach's a big gun attorney. Most recently, he won an acquittal in actor Robert Blake's murder trial. And now? Well, a man accused of trying to hasten a patient's death just so he could, like some visiting vulture, harvest his organs… It looked bad. And perhaps it was. Early on, the judge had thrown out two of the charges. But he let the dependent adult abuse allegation stand. And issued a gag order, so the public didn't know at all what sort of evidence Prosecutor Karen Gray had. Not until the first day of the trial, when the silence was finally broken...and the prosecutor made her case. 

Karen Gray: I'm Karen Gray, Deputy District Attorney, appearing on behalf of the people in this case.

And within the first minute of her opening statement, she left no doubt what she thought happened in the operating room that night.

Karen Gray: The defendant a transplant surgeon administered excessive amounts of narcotics and tranquilizers to a young man in order to hasten his death so that he could harvest his organs.

Prosecutor Gray is a former registered nurse. And as she placed one ampule of morphine and Atavan after another on the table, she explained how significant, how deadly, that amount could be.

Karen Gray: So what we have is a situation, where a transplant surgeon who was there to harvest organs, is prescribing large doses of potentially fatal medications, for a patient he didn't know anything about. The fact in this case that Ruben Navarro did not die in the operating room does not mean that he wasn't abused.

Really? That's not at all how defense attorney Gerry Schwartzbach described it. He told the jury that all that morphine actually had very little effect on Ruben because he'd been on big doses of morphine for years. It went right to the heart of the case. While the amount of morphine administered that night would have been lethal for most people, it was insignificant for Ruben who'd long ago developed a high tolerance. So, Schwartzbach asked, where was the abuse?

Gerry Schwartzbach: If the amount of medication was excessive it would have caused him injury or death... and it didn't.

Keith Morrison: So, during--

Hootan Roozrokh: Yes.

Keith Morrison: --the time he's in the operating room and you're waiting for him to die, he is getting Morphine.  You were just giving him more of it, is that correct?

Hootan Roozrokh: Correct.

Keith Morrison: In some sense, was that in order to hasten his death?  To make it quicker and easier?

Hootan Roozrokh: It wasn't to hasten, it was simply to just make him comfortable.

But what about that nurse, Jennifer Endsley? In her police interview, and later in court, she claimed her memories of that night in the O.R. were very clear. Really?  Listen, said the defense, to this description of Dr. Roozrokh.

Jennifer Endsley: He had a very thick accent.

A very thick accent? In fact, she repeated that same point nearly an hour later.

Jennifer Endsley: He just had an accent.

Roozrokh was raised in Wisconsin and--as you've heard for yourself--has an American accent. Wary of all that negative pre-trial publicity, Schwartzbach knocked down allegations that weren't even brought up at the criminal trial, Ruben's mother Rosa, remember, filed a lawsuit against Roozrokh, an early version of which claimed Roozrokh hounded Ruben's mother in the days before his death. Turns out, Dr. Roozrokh was in San Francisco that week, hundreds of miles away, hadn't even heard of Ruben Navarro.

Gerry Schwartzbach: As of February 1, 2006, Dr. Roozrokh had never been to Sierra Vista Regional Medical Center. He had never seen Rosa Navarro. He had never spoken with Rosa Navarro.

Schwartzbach even provided an aggressive defense against disturbing rumors that Roozrokh had something personal to gain from Ruben's organs.

Gerry Schwartzbach: Did he have a financial incentive?  Yo, we'll pay you per organ? He had no financial incentive.  Did he have an incentive to rush things along? Quite the contrary, he was being paid by the hour.

In fact, Roozrokh was an employee of Kaiser-Permante Hospital--and was only on loan to the transplant network as a courtesy service. Roozrokh had been dispatched to San Luis Obispo that night to get a liver for a patient he didn't even know.

Gerry Schwartzbach: The potential recipient wasn't Dr Roozrokh's patient. The potential recipient wasn't even a Kaiser patient. Dr. Roozrokh's motive was to save somebody's life.

The trial continued for weeks, much of the evidence and the testimony complicated, often tedious. While the jury waited for Ruben's vital signs chart to be admitted by the prosecution that would be the forensic evidence that might tell them what happened in the E.R.

The chart would show that the morphine Ruben was given either had little effect, or came close to killing him. But, Prosecutor Gray told the jury, Ruben's chart was nowhere to be found.

Karen Gray: There are missing records in this case. We do not have the documentation of Ruben Navarro's vital signs, which, according to the testimony the transplant coordinator was apparently writing on a clip board. But we don't have those, uh, and that's very unfortunate.

And the person in charge of the chart? Carla Albright, remember her? She was the transplant coordinator, the one who set everything up, the quarterback so to speak. If anyone knew what happened to that chart, it would be Albright. But the prosecution never called her as a witness. By the time the judge instructed the jury, Schwartzbach was all but certain he had taken the prosecution's case apart.

But he had one nagging concern. Had the jurors heard all that heated pretrial publicity, and the way it characterized Hootan Roozrokh? 

Gerry Schwartzbach: This kind of completely false, horribly unfair information was disseminated nationally.  And if you Google Dr. Roozrokh's name, you'll find that-- there's somebody out there who refers to him as a Muslim jihadist who-- kills patients for their organs. 

If convicted, Roozrokh would be a felon. Maybe even sent to prison. His brilliant career would be finished. To Schwartzbach, a quick verdict meant success. A long deliberation meant problems.

Hootan Roozrokh: I thought they were gonna come back in 30 minutes.

But by the end of the first day, nothing.

Hootan Roozrokh: After the first day, "Did I miss something?" Did they not get something? 

...And no verdict by the end of the second day.

Hootan Roozrokh: You got your fate in the hands of 12 people you've never met. They didn't know what we did.  They didn't understand half the words, medical terms that were used, not because they weren't intelligent, but just-- they're not your peers.  And that's what scared me. 

And every day just a short distance from the defense team, and unpersuaded by their case, Rosa Navarro kept a lone vigil.

Rosa Navarro: It was wrong what they did to my boy.  He didn't deserve to die like that.  (sniff) He died without dignity.  No respect.

And then on the third day, at noon, there was news.

Judge: I will ask the clerk to read the verdict, please.

Clerk: Superior Court of California, County of San Luis Obispo. The people of the state of California, plaintiff vs. Hootan Roozrokh, defendant...

In a small courtroom in San Luis Obispo, California the jury had finally reached a verdict in the trial of Dr. Hootan Roozrokh.

We the jury find the defendant, Hootan Roozrokh, not guilty of the crime of dependent adult abuse. 

Hootan Roozrokh was embraced by relieved lawyers. Almost unnoticed, Prosecutor Karen Gray, without comment, quietly slipped out of the courtroom. And Rosa Navarro, still without the answers she sought, prepared again for the long trip home.

Rosa Navarro: I don't wish what's happening to me to nobody.

And though the jury sympathized, they could not find evidence that Hootan Roozrokh committed any crime.

Don Lumsden: I think the evidence certainly demonstrated that it was a mess.  I don't think the evidence demonstrated it was a criminal mess.  

But they were puzzled, too, in their jury room, about what they did not hear.

Keith Morrison: If there's one person you really wanted to hear from and didn't.  Who would that have been?

Jurors: Carla Albright.

Keith Morrison: And why do you say that?

Male juror: She had all the records.  She was the one who had passed on instructions to each of the other members of the team.  She was the quarterback, as they referred to her.

Keith Morrison: So why didn't you hear from her?

Male juror: That's what we were wrestling-- (laughter) with after-- after the fact.  Where was she?

Living in Florida, we found out. Why was she never called as a witness? We don't know. Carla Albright declined to be interviewed on camera but she did issue a short statement over the telephone: "Dr. Roozrokh had nothing to do with that boy's death."

Gerry Schwartzbach: They filed a prosecution that, based on all my experience, no competent, ethical prosecutor ever would have filed,

Keith Morrison: If this was, um, a series of misunderstandings--

Gerry Schwartzbach: You're--being very generous, Keith. 

Keith Morrison: Well-- how did it even get to trial?

Gerry Schwartzbach: I just can't answer that question.  I have-- I have suspicions-- you know, I know people refer to him as-- you know, an Iranian doctor.  They-- they-- they don't really focus on the fact that he came--

Keith Morrison: Surely, you don't think-- racism is-- is at the heart of this?

Gerry Schwartzbach: I don't know what-- that was at the heart of it.  I was quoted early on as saying if his j-- "If his name was Joe Smith, I'm not sure that he would have been prosecuted."

So why were charges ever filed against Dr. Roozrokh in the first place? Karen Gray declined our repeated requests for an interview, as did her boss. In fact nobody from San Luis Obispo D.A.'s office would comment on the case beyond this brief written statement: "The jury concluded that the case was not proven beyond a reasonable doubt." After its verdict, though, the jury did ask to read a statement recommending that a common set of rules be put in place to govern DCD organ procurements.

Refining the nationwide protocol for DCD organ procurements will be an important part of Ruben's legacy.

What the jury couldn't know, of course, is that because of Ruben Navarro's case, new national protocols governing DCD cases had already been put in place to guide hospitals and doctors alike. Before the prosecution of Hootan Roozrohk, even before a misinformed media, helped derail his career. 

Keith Morrison: Do you have your reputation back?

Hootan Roozrokh: I don't think so.

Keith Morrison: Will you get it back?

Hootan Roozrokh: I hope so.  It's gonna take a lot of hard work.  I lost it in a minute.  And it's gonna probably take me a lifetime to get it back.

After the trial, the California medical board, which had also launched an investigation of Dr. Roozrokh, quietly withdrew it. And Rosa withdrew her lawsuit. And this is rare.  Her lawyer attached a letter of apology: "We believe you acted ethically and in good faith society will be best served if you are allowed to apply... your talents as a transplant surgeon and continue saving lives. "

But what happened also to that long, desperate, list of patients hoping an organ donation will save them? According to the Organ Procurement And Transplant Network, organ donations in the united states" dropped for the first time ever when news of the case became public. 

Gerry Schwartzbach: Now, people die every day for lack of organs.  This prosecution may well have caused more people to die than should have died.

Perhaps it did.  But the woman waiting for Ruben's liver did eventually get a transplant, and survived. And there is a little more hope now for others, because, this month, Dr. Hootan Roozrokh joined a new hospital, and is once again performing transplants, and saving lives. Finally emerging from that one night, in the fog, in California.

© 2013 MSNBC Interactive. Reprints

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    >> in "a matter of time."

    >> narrator: good evening and welcome to "dateline." i'm ann curry . it's a giant question mark . what will happen to health care reform in america? this past week's election in massachusetts has forced the president, the congress, and the country to take another hard look at what's broken and what's not. if you think you don't have to worry because you have health insurance , think again. tonight an intimate picture of families who all had insurance and assumed they'd be covered when an emergency hit. turns out the battles they faced are a lesson to us all.

    >> how we doing?

    >> narrator: pat gannon is fighting a war on two fronts.

    >> let's get that leg and try it just a little bit right now.

    >> narrator: one is the daily struggle against his son patrick jr .'s debilitating illness.

    >> doing well.

    >> narrator: the other is a frustrating battle to get him the care his family says he needs. hi. this is pat gannon .

    >> i don't want to miss this therapy. we're overwhelmed with fighting with the insurance companies . i'm so confused. a lot of it is calling people who are in the business of saying no. we don't want anything we don't have coming. we don't want anything that he hasn't worked for his whole life. he had health insurance and now when he needs it the most, we want just a chance.

    >> narrator: the gannons' odyssey through the american health care system began late one november night when their son was rushed to an emergency room .

    >> patrick was on a ventilator and he was gravely ill. i immediately called good samaritan hospital at san jose and found a treating physician in the emergency room .

    >> i thought the odds of survival were very low. i really didn't expect him to make it.

    >> narrator: patrick gannon jr ., an easy going i.t. tech, who was about to become a father at 41, had suffered a massive heart attack . patrick had flat lined, was revived, and now was clinging to life.

    >> he told me he was probably going to pass away .

    >> narrator: the hospital was a nine-hour drive north.

    >> i kept telling myself, this can't happen. he's going to be alive when we get there. he can't die before we get there.

    >> narrator: the gannons arrived to find patrick in a coma with no brain function but still alive.

    >> just about every device was hooked up to him. when they opened his eyes to check his pupils i saw a death mask there, so i knew it was bad.

    >> narrator: the delicate work of keeping patrick alive was under way. a team of emergency room specialists -- surgeons, neurologists, cardiologists -- tended to him around the clock. no one was thinking about it at the time but the several weeks of life saving care came with an enormous price tag -- a million dollars and rising. but patrick had insurance and blue shield of california picked up most of the tab for his emergency treatment . not only did he defy the odds and survive, he awoke from his coma and progressed better than expected.

    >> he was eating and speaking and he was -- actually stood up at the bed side with two therapists at good samaritan hospital.

    >> i remember running back to the icu and telling some of the nurses you need to go up and see patrick , because he is doing amazingly well.

    >> narrator: but patrick was far from out of the woods. the young man who once helped build houses for habitat for humanity would now need intensive and expensive rehabilitation to have a chance at a normal life . his hospital doctors wanted to move him to an acute rehab facility right away for a period of aggressive therapy.

    >> the quicker we can get patients who are medically stable to an acute rehab facility, the better chance they have of making a recovery.

    >> narrator: acute rehab would include intensive therapy but the insurer blue shield approved a less expensive treatment in what's called a skilled nursing facility . skilled nursing would provide patrick some therapy but it would be less aggressive and would not include neurological rehab.

    >> he needed to go to an advanced acute brain injury hospital.

    >> narrator: from that point forward the gannons would become front line combatants in a war that plays itself out in homes, hospitals, and doctors' offices across america each day.

    >> most people say i love my health insurance . that's because most people are healthy and they don't use their health insurance .

    >> narrator: regina is a harvard business school economist who has spent her career researching health care systems around the world. she says the american system is fraught with obstacles that most patients are unaware of until they need care the most.

    >> when you or someone you love gets sick you assume it's going to be you and your doctor who's going to make the decision about the course of your care.

    >> hardly so. if you talk to doctors, they say, i cannot practice medicine anymore because there is a third person at the table. it's the insurer.

    >> narrator: the question of who decides what's best for a patient is an ongoing source of contention. insurance companies and their maze of rules and regulations , delays and denials, can wear down doctors, not to mention people in crisis. it's a system that can breed anger and distrust.

    >> it's a battle. and it should not have to be a battle.

    >> narrator: tonight families confront life-and-death decisions involving the people they love. this woman is fighting with her insurer while her husband waits for treatment that could extend his life.

    >> this is urgent. we don't have time on our side. make a decision.

    >> why?

    >> narrator: and this mother is demanding answers. after the worst possible outcome.

    >> deny, deny, deny.

    >> narrator: but it may not be that simple for the patient or the insurer.

    >> what is covered? if something is questionable, if it's not standard medical care , those decisions are not black and white kinds of decisions.

    >> narrator: as for the gannons patrick jr . has survived his heart attack , but the second battle was just beginning.

    >> i had no idea what i was going to be in for.

    >> narrator: coming up --

    >> $6,000 a month to rent.

    >> narrator: home foreclosed, retirement plans on hold. will the gannons get what they need to help their son?

    >> they give you wrong numbers to call back. they give you wrong fax numbers.

    >> narrator: when "critical condition" continues. it's the only scented oil

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