Last Dance, Last Chance

been so tragic, her description might have been humorous. But it was all too clear that Anthony Pignataro not only hadn’t hired an anesthesiologist or a nurse-anesthetist, he was operating with an L.P.N. who had never had the proper training or experience to do the job he expected of her.
    The only other people in that surgical suite were a 17-year-old boy and Debbie Pignataro. Until now, the investigators hadn’t realized they were there.
    Janie said that Dr. Pignataro had sent Tom scurrying to find an Ambu-Bag, but all he could find was one for a child. Then the doctor had tried to use a flat piece of metal to open an airway, and finally had screamed for a coat hanger.
    The detectives winced. They weren’t medically oriented, but they could see that Pignataro hadn’t been at all prepared for an emergency. They wondered if indeed he had caused the emergency.
    Finally, Janie said, he had given up and told Tom to call for help. Once Tom called 911, Janie thought that the rescue workers had arrived in about five minutes.
    Finnerty and Craven thought it would be a good idea for Janie Krauss to talk directly to the assistant district attorneys on the case, and she went with them willingly. On the way, she became animated as she told them about her exciting weekend.
    “She told us that she went to a concert and she got to go backstage and meet Mick Jagger,” Chuck Craven said. “There’s a young mother with two little kids dead, and she’s excited about Mick Jagger…”
     
    Debbie Pignataro was considerably more affected by Sarah Smith’s death. She looked at Lauren and Ralph and thought how she would feel if anything happened to her and they were left without a mother. She went over the operation again and again in her mind.
    Her only assignment had been to keep an eye on the pulse-ox device and the blood pressure cuff, but she always watched the patient, too, whenever Anthony asked her to help him during operations. She wasn’t familiar with the dosage of anesthetics. She had worked in the pharmacy so many years ago, and there they filled prescriptions—not doses of anesthesia.
    “But I was watching her face,” Debbie would say a long time later. “And I could see that her skin was getting gray. I tried to tell Anthony, but he was too busy with what he was doing. When the pulse-ox started to sound, he told me to take her fingernail polish off, so I could see the nail bed better. And he said to jiggle the pulse-ox because it was probably just some loose wires.”
    Debbie had become more and more concerned, but Anthony ignored her until the other alarm went off—the blood pressure alarm. Only then did he look up at his patient. And, at that point, he realized that she was comatose. But Debbie realized to her horror that he had made no preparation whatsoever to have the instruments needed present in his “surgical suite.”
     
    On September 9, Chuck Craven and Pat Finnerty met with representatives of the New York State Department of Health, the Vigilant Fire Company in West Seneca, and attorneys from the Erie County District Attorney’s Office. Other than Pignataro’s staff and his wife, the fire department’s rescue squad personnel were the only people in Anthony Pignataro’s office on the day Sarah Smith stopped breathing. They were able to reconstruct the scene of panic they encountered when they answered the 911 call.
    Dave Koehler, the first assistant chief, had been the first to respond. He drove to the fire station to pick up the Life-Pak that would trace the heart’s rhythm and send it to a doctor in the ER, and could also be used to shock a heart into beating. When Koehler arrived at the Center Street office, he was met by a young man, who pointed toward the basement steps.
    Koehler told them that he knew the doctor socially and recognized him. He knew Debbie Pignataro, too. She was wearing surgical scrubs but was standing off to one side as Pignataro tried to open an airway and a young woman was doing closed chest compressions.
    “She just went out,” Pignataro had gasped. “She had no history of medical trouble.” He asked Koehler if he had a stylet for an intubation tube. He seemed to be having a great deal of trouble getting a breathing tube down the patient’s throat.
    At the time Koehler arrived, he saw three leads hooked up to an electrocardiogram in the room, but the screen was blank. He himself attached two pads from the Life-Pak to try to obtain any sign of heart activity.