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Medical Board faults doctor

Oceanside man died after appendectomy in 2003
By David Hasemyer

November 27, 2004

A 54-year-old Oceanside man bled to death after a routine appendectomy at Kaiser Permanente Hospital in San Diego because his doctor made a mistake, according to a Medical Board of California accusation filed against the doctor.

When Alipati Paopao doubled over and died on his living room floor in January 2003, more than two-thirds of his blood had leaked into his belly after the operation.

According to the Medical Board's accusation, the doctor who performed the surgery overlooked critical signs that Paopao, who had recently been diagnosed with leukemia, was at risk for excessive bleeding.

Dr. Archana Kudva faces revocation or suspension of her license by the medical board, which in October accused her of negligence and incompetence in connection with Paopao's death.

Kudva, a 1993 graduate of Tufts University School of Medicine in Boston, declined to discuss the accusation, a Kaiser spokeswoman said.

The medical board will seek an initial hearing for Kudva before an administrative law judge in the next few months.

Paopao was known as "Uncle Buck" in a family of 10 brothers and sisters and 58 nieces and nephews.

"He was one of those kinds of people you naturally turned to," said his brother, Tony Paopao.

Alipati Paopao was born in American Samona and came to the United States as a boy, settling in North County with his family. He played football at Oceanside High School and was a paratrooper in the Army, his brother said.

Once out of the service, Paopao married and had a daughter, who recently enrolled at California State University Fullerton.

He was a roofer by trade and a free spirit by nature, Tony Paopao said.

He also was sick, more ill than either Paopao or his family knew.

Alipati Paopao had an appendicitis attack in October 2002 and was treated for a week at Kaiser Permanente Hospital. He was sent home after being scheduled for a laparoscopic appendectomy in January 2003.

During that initial hospital stay, doctors suspected Paopao may have had leukemia. But it wasn't until mid-January, when Paopao spent another week in the hospital because of persistent pain in his stomach, that the disease was diagnosed, according to the medical board accusation filed in Administrative Law Court.

Paopao wasn't told he had leukemia when he returned for the appendectomy Jan. 30, 2003, according to a San Diego County Medical Examiner's report.

Kudva, who has been licensed in the state since 1995, performed the laparoscopic procedure. A small incision was made in Paopao's stomach and instruments inserted into the abdomen though the small hole.

Kudva told an investigator from the medical examiner's office that she had screened Paopao's blood for its clotting quality and the surgery was performed "without any complications."

According to the medical examiner's report, Paopao experienced "a great deal of pain in his abdomen" immediately after the surgery.

Despite his pain, he was cleared to return home a few hours after the surgery with a prescription for two painkillers. He "continued to experience uncontrolled pain," according to the medical examiner's report, and he collapsed shortly before 11 p.m. He was pronounced dead a half-hour later.

An autopsy revealed he bled to death from where his appendix had been removed.

The medical board accusation, which is posted on the board's Web site, says Kudva should have known Paopao might be susceptible to bleeding because leukemia reduces the body's production of cells that help the blood clot. Paopao's spleen was enlarged to six times its normal size, indicating that it was attacking those cells that aid in coagulation, medical authorities said.

The doctor also was faulted for not keeping Paopao in the hospital for overnight observation.

David Hasemyer: (619) 542-4583;

OCEANSIDE, Calif. (AP) - A Kaiser Permanente doctor has been cleared of allegations that one of her patients bled to death after surgery because she overlooked a medical condition that put him at risk for excessive bleeding.

The Medical Board of California had accused Dr. Archana Kudva of negligence and incompetence in connection with the death of Alipati Paopao, 54, of the Oceanside area, in 2003.

State medical officials said the doctor failed to recognize symptoms and ignored tests that showed Paopao's blood might not clot properly.

After ruling in Kudva's favor, Judge Alan S. Meth ordered the dismissal of the state's accusation, saying the doctor had no reason to believe her patient was in danger of bleeding to death.
The judge's order, which became effective Dec. 12, means the Medical Board will clear Kudva's record of the accusation.

"Dr. Kudva is greatly relieved by having the terrible cloud lifted from her reputation," said her attorney, Russell Iungerich.