Dr. Guedes ordered heparin to be infused via an arterial line at a dosage of 1095 IUs every five hours. Dr. Guedes suspected Alan had closed head injury. Heparin is absolutely contraindicated in cases of DIC (diffuse intravascular coagulation) secondary to suspected closed head injury or any CNS bleeding otherwise, according to authoritative medical texts such as The Merck Manual 17th edition, page 917.

Not until five hours after initiation of the heparin was a CT scan performed. The CT was eventually performed at 7:50 p.m. on 24th November. The CT report noted a “tiny” echogenicity in the subdural space, indicating a unilateral subdural hematoma (SDH).

Alan spent 75 hours in his terminal hospital stay. He was not declared brain dead until 48 hours into the hospital course. During the 48 hours prior to brain death certification, Dr. Guedes ordered no neurological assessment for shunting of the SDH, which has excellent prognosis and, often, an outcome free of clinical sequelae.

As stated above, Dr. Guedes administered contraindicated heparin prior to CT-scan confirmation of intracranial hemorrhage (ICH). Moreover, the dosage ordered, and continued throughout Alan’s terminal hospital course, was approximately 8.8 times the recommended maximum allowance of 125 IUs every five hours, as stated in the Physicians Desk Reference 2002 and 1997 editions.

It appears Dr. Guedes monitored little or nothing following the first coagulation test after he started the heparin line at 2:45 p.m., 24 November 1997, and failed to order additional coagulation tests per monitoring protocol for heparin.

In interpreting laboratory values from the admitting hospital, Dr. Guedes notes show that he mistook the hemoglobin (Hgb) value for the hematocrit (Hct) value. Thus, in comparing these to subsequently taken values, saw a Hgb drop from 25.3 to 6.3 which is significant, if not impossible, since Hgb values virtually never reach 25.3.

Dr. Guedes appeared to administer heparin as treatment for DIC; however, platelets were abnormally high, at 571,000, when he prescribed it at 2:45 P.M. The next platelet labs were not known until 30 minutes after his prescribing of heparin, and were shown to be 553,000 which is still abnormally high. DIC, a consumptive pathology, needs laboratory confirmation of abnormally low platelets for its diagnosis. Moreover, even if consumptiveness can be construed from a drop of 571,000 to 553,000, Dr. Guedes prescribed heparin 30 minutes before he knew the latter comparative value. When viewed with the fact that heparin is absolutely contraindicated in DIC secondary to closed head injury and/or suspected CNS bleeding, and that he administered an egregious overdose while ordering no neurological intervention for an otherwise treatable subdural hematoma, these data make it clear that Dr. Guedes was copiously negligent.

Also, Dr. Guedes was negligent in failing to perform any differential diagnosis. In other words, he did not attempt to eliminate or corroborate, by use of all available evidence, any of the several possible causes of my son's health problems before announcing a diagnosis.

It also appears that Dr. Guedes had no intention of saving my son's life. He and his staff eagerly and persistently tried to get my husband and I to release my son’s organs for harvesting. Dr. Guedes’ treatment of Alan from square one appears to have been to save his organs, not his life.

Heparin was administered at 2:45 P.M. At 7:50 P.M., approximately 5 hours later, CT scan revealed a tiny SDH. Instead of attributing this to over-heparinization in a contraindicated setting, Dr. Guedes attributed it to child abuse. Consequently, my husband was wrongfully convicted and sentenced to life in prison.

To compound the negligence noted above, Dr. Guedes also administered bicarbonate (NaHCO3) to my son in an attempt to control acidosis. However, Dr. Guedes did not monitor, perhaps purposely, the continuous NaHCO3 administration despite pH levels of 7.2, 7.3, 7.4, 7.5, 7.6, and 7.7 during Alan’s 75 hours in his care. This is another example of egregious negligence, and further indicates that Dr. Guedes forsook saving my son's life for the harvesting of organs.

Autopsy revealed multiple, massive ICH which, during the hospital stay, became independently bilateral. One can easily conclude that not only did over-heparinization and excessive bicarbonate administration spawn the initial SDH seen on CT scan post heparinization, but the continued dosages during the 75-hour hospital course fulminated, spawned, and exacerbated the multiple and massive cerebral and CNS bleeding shown upon autopsy. Unfortunately, Orange County Medical Examiner Shashi Gore, MD testified in my husband’s trial that he did not review my son’s hospital/medical records. Therefore, the bleeds were attributed to child abuse assumed by Dr. Guedes.

Numerous experts have reviewed the medical records and trial testimony pertinent to Ben Guedes, MD and his treatment of my son. Included in Appendix A of this Complaint are the names of a few of the professionals willing to testify to these and other findings involved in this case.

Included with this Complaint is a compact disc with Alan’s medical records (prenatal to post mortem, including TransLife records) and a copy of the full trial transcripts wherein Dr. Ben Guedes testified.

Based on the above facts supported by the attached records and backed by the medical professionals in appendix A, I believe that this Complaint warrants full investigation and review by independent experts. Not only are ethics, basic competence, and rules in question, but laws have been violated with potential criminal ramification. Moreover, an innocent man has sat in prison for well over five years due in part to the treatment Dr. Ben Guedes provided in this case, treatment that I believe killed my son.

Francine Yurko
PO BOX 585965
Orlando, FL 32858-5965

Enc: Complaint
       Notarized Release
       Appendix A
       Compact Disc/records, transcripts

CC:   Loren Rhoton, Esq.
        Mohammed A. Al-Bayati, PhD, DABT, DABVT
        Harold E. Buttram, MD, FAAEM
        Michael Innis, MB.BS, FRCPA, FRCPath, DTMH
        File