Drug was fatal in '88 abortion

Anesthetic also used in death last week

Wednesday, April 30, 1997
St. Louis Post-Dispatch
By Jo Mannies
Of The Post-Dispatch Staff

The anesthetic used with the abortion on the St. Louis woman who died Friday was blamed nine years ago for the abortion-related death of a woman in Springfield, Mo.

The family of the Springfield woman, Stacy Ruckman, was awarded $25 million in damages after a jury ruled that she had been given an overdose of the local anesthetic, lidocaine. The state revoked the license of the physician, Dr. Scott R. Barrett Jr. of Chesterfield.

Whether lidocaine was a factor in the death Friday of Nichole Williams at Reproductive Health Services, 100 North Euclid Avenue, won't be known until toxicology studies are completed. The St. Louis medical examiner's officer says the studies could take several weeks.

The clinic staff reported "a drug reaction" in its 911 call for an ambulance five minutes after the abortion was begun.

The physician was Dr. Robert Crist of the Kansas City area. He is one of four physicians who provide abortions at Reproductive Health Services.

A spokeswoman for the clinic and its owner, Planned Parenthood of the St. Louis Region, said lidocaine "is a commonly used drug in first-trimester abortion procedures across the country."

Williams also was given an anti-bleeding drug, vasopressin, that is used "in approximately 50 percent of the abortion facilities around the country," the spokeswoman said.

Paula Gianino, chief executive for Planned Parenthood, said Monday that Crist "unfortunately knew how serious this was" when Williams began having breathing difficulties. Planned Parenthood officials declined further comment Tuesday on the Williams case.

Speaking in general, a spokeswoman said the emergency equipment on hand at the clinic includes a suction machine, emergency lighting, intravenous fluids, an oxygen tank and mask, a pulse-oximeter to monitor the pulse rate and hand-held respirators.

Lidocaine "is the most widely used local anesthetic in the country," said Dr. Mark Norris, a professor of anesthesiology and obstetrics and gynecology at Washington University.

Lidocaine often is used as a topical painkiller, even in some over-the-counter products such as sunburn creams. One of its trade names is Xylocaine.

For first-trimester abortions, lidocaine would be administered by shot directly into the cervix, Norris said. Vasopressin also is administered by a shot, probably into the cervix, he added.

Both drugs, in particular lidocaine, have reputations as safe drugs with virtually no side effects, Norris said. Allergic reactions are rare, he said.

While emphasizing that he was not commenting directly on the Williams case, Norris said press accounts indicated "that she had an allergic reaction to something."

Acute allergic reactions "require an aggressive resuscitation," he said, often using adrenalin and intravenous fluids "to bring the blood pressure back." Cardiopulmonary resuscitation also would be necessary, Norris said.

Gianino said Monday the staff administered oxygen to Williams and used resuscitation methods. The spokeswoman Tuesday declined to say if adrena lin had been administered.

Overdose Tied To Death

In the Springfield case, the jury ruled that Ruckman had been given an overdose. No criminal charges were brought against the doctor. It's unclear how much of the $25 million award the family collected, because the physician carried no liability insurance.

A lidocaine overdose, Norris said, "can cause seizures" if the drug is injected directly into the bloodstream.

Ruckman's death in 1988 was the second of two deaths in Missouri attributed to abortions since the procedure became legal 24 years ago. Anti-abortion activists cited Ruckman's death in their push last year for legislative approval of a bill putting new restrictions on abortion clinics and abortion providers. Gov. Mel Carnahan vetoed the bill, which some supporters called the Stacy Ruckman Memorial Bill.

Missouri's other abortion-related death, in 1981, was at Reproductive Health Services. It involved a St. Louis woman who died two days later of a reaction to Sublimaze, a painkiller.

Before the state Board of Healing Arts revoked Barrett's license, an administrative hearing commissioner found him guilty of malpractice in Ruckman's case and causing injuries to three other women, including one who had to have an emergency hysterectomy.

He also was found guilty of eight violations of state medical practice laws. Abortion rights supporters, as well as anti-abortion activists, praised the board's decision as necessary to protect women.

Lidocaine overdoses have been at the center of several well-known cases in the last 20 years where nurses were convicted of administering overdoses of lidocaine to kill patients in nursing homes or hospitals.