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OHSU oral surgery head, Pamela Hughes, fights state board finding of failure to address clot issues

COURTESY OF BLACK FAMILY - Larry Dean Black was excited to get infected teeth removed at Oregon Health & Science University to allow a liver transplant. He instead bled to death, sparking lawsuits and a state dental board finding of poor treatment.Oregon Health & Sciences University has paid $225,000 to settle lawsuits filed over the treatment of a man who bled to death after getting teeth removed — a case that included accusations of a cover-up.

The money went to the estate of Larry Dean Black, whose case was the subject of a two-part Portland Tribune series last year.

Black's sister, Lenora Houser, declined to comment on the settlement. OHSU largely did as well, issuing only a limited statement:

"OHSU would like to extend again its heartfelt condolences to Mr. Black's family. Under any circumstance, the passing of a patient is devastating to faculty and staff. At OHSU, we do our collective best to heal, save lives and advance health. Patient privacy laws prevent us from discussing the case further."

The ripple effects of Black's death are not over. Pamela Hughes, chair of the OHSU oral surgery department, faces an administrative hearing in February related to an Oregon Board of Dentistry findings that she violated state law and provided "unacceptable patient care" in the case.

Hughes has denied wrongdoing or any role in a cover-up, and is challenging the board's findings.

Death began with hope

Black's death began with a message of hope.

In 2015, he was 52 and was living with his sister in Bend and cleaning up his life, having been into drugs and petty crime as a youth. He needed a liver transplant stemming from hepatitis C, which he blamed on a bad tattoo. He was on the list at OHSU and waiting for approval of a new liver.

But OHSU told him he first needed 12 teeth extracted to ensure no infection would jeopardize a new liver.

"He was so excited to have a liver and go back to building houses again," said Houser, last year.

In October 2015, the university approved removing all 12 teeth at once. But the university staff who performed the surgery and attended to him afterward under the treatment plan approved by Hughes did not use anti-clotting gauze in the area following the surgery, records show, despite a pre-surgery test showing Black might have blood-clotting problems — as are common with liver disease.

Black went home to Bend and woke up early in the morning to realize he was bleeding profusely.

Paramedics rushed him to St. Charles Medical Center in Bend, but no beds were available. So they flew him to Providence St. Vincent Medical Center.

One day later, on the afternoon of Oct. 22, his sister received a phone call from a cheery OHSU staffer.

"I have good news: Larry is on the liver transplant list now," the staffer said, Houser recalled last year.

"I have some not so good news," was Houser's response. "Larry just passed away."

That's when David Lambert, an assistant professor of oral surgery at OHSU, entered the case.

As Black was on the brink of death, Hughes, the oral surgery chair, told Lambert he would be listed as the attending surgeon on the case.

And he was subsequently contacted by the state dentistry board investigator to explain his actions as the supervisor of the surgery at OHSU.

But, Lambert told the state, he had nothing to do with the case other than letting Philipp Kupfer, the resident who performed the surgery, use his clinic when the procedure had had to be postponed.

After learning more about the case, he concluded Hughes was throwing him under the bus and that the university considered him expendable.

He called Black's sister and told her the man never needed to die, causing her to contact a lawyer.

Experts: precautions called for

Three outside experts told told the Tribune that in such cases more precautions are called for to protect liver patients with bleeding issues.

Records obtained by the Tribune showed that Hughes, Lambert's boss, initially did not acknowledge her presence in the clinic while the surgery on Black took place. "I was not scheduled to be in the clinic that afternoon," she wrote.

On Nov. 11 she sent "clarification" that she was "peripherally present" but not in the operating room supervising.

The evidence provided by Lambert satisfied the dentistry board, which after investigating the matter issued a proposed consent decree against Hughes saying her treatment plan of Black constituted unacceptable patient care. It said Hughes' plan did not address liver disease complications such as "life threatening bleeding," and did not include "hospitalization or close follow-up" after surgery.

Lawyers for Black's estate, Jennifer Coughlin and Michelle Burrows, sued in state and federal court.

Recently they reached settlement for $225,000, a fraction of what they sued for. Of that sum, the lawyers will receive $90,000.

Hughes and Kupfer did not comment on the settlement, and lawyers for Black's estate did not either. Hughes and OHSU had earlier denied any cover-up or effort to place blame on Lambert.

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