California medical board to investigate 2-year-old’s death at John Muir Medical Center

The Medical Board of California has launched an investigation into whether doctors at John Muir Health failed to properly care for a 2-year-old girl with liver cancer who died on an operating table at the organization’s Walnut Creek hospital in 2019.

The inquiry comes in response to a Chronicle investigation that found John Muir leaders had dismissed warnings from staff that the community hospital was not equipped to handle such a specialized operation, known as a liver resection, on a child as young as Ailee Jong.

“The Board is saddened to hear about the loss of the young girl mentioned in the story,” spokesperson Carlos Villatoro said in a statement to The Chronicle. He declined to comment specifically on Ailee’s case, but confirmed last week that the board has begun an investigation. “The Board is aware of your story and will be looking into it.”

The medical board is the state’s oversight agency for doctors with the power to license physicians, investigate complaints made against them, and discipline those who are negligent or unprofessional or are otherwise found to have provided substandard care.

In a statement, John Muir Health said it “welcomes the review by the California Medical Board, as do all of the physicians involved in this case” and believes the board will find that “the clinical team provided expert care to an extremely ill child.”

“We are saddened that the outstanding clinicians who treated Ailee Jong are being unfairly maligned and now harassed,” reads the statement provided by a John Muir spokesperson. “The care team worked tirelessly on Ailee Jong’s behalf, including several physicians and staff who joined in the fight to save Ailee Jong’s life.”

In interviews with reporters and a lawsuit filed last week, Ailee’s parents, Truc-Co and Tom Jong, said John Muir did not tell them that their daughter’s pediatric liver resection would be the facility’s first or that hospital staff had warned leaders against the operation. They said John Muir doctors and executives instead highlighted the hospital’s partnership with Stanford Children’s Health in Palo Alto, promising them Stanford-level care closer to their Danville home.

The Jongs said they were encouraged that the medical board would be looking into their daughter’s death.

“We really hope the outcome will bring some meaning to these tragic events by preventing them from happening again and save children’s lives,” the couple said in an email.

Villatoro, the medical board spokesperson, would not specify which John Muir physicians involved in Ailee’s care were under investigation.

The lawsuit filed by the Jongs names Dr. Jeffrey Poage, medical director of pediatric surgical services at John Muir Health; Dr. Jay Michael Balagtas, Ailee’s pediatric oncologist; Dr. Thomas Hui, the lead surgeon in her liver operation; and Drs. Wayne Lee and Romerson Dimla, the anesthesiologists who were in the room.

In 2012, John Muir, a multibillion-dollar community health system in Contra Costa County, joined Stanford Children’s Health in announcing a partnership that would bring Stanford pediatric specialists to the Walnut Creek medical center. In 2015, they opened a pediatric intensive care unit there to handle more urgent and complex cases.

The Jongs allege that the hospital took on the surgery to make money and a name for itself as a destination for pediatric care. In interviews and in their lawsuit, the Jongs said doctors misrepresented John Muir’s capabilities and knowingly put their daughter in an operating room with inexperienced anesthesiologists who ultimately transfused Ailee with too much blood and killed her.

Poage, Balagtas, Hui, Lee and Dimla did not respond to requests for comment. Dr. Wendy Su, the assistant surgeon on Ailee’s operation, who is not named as a defendant in the Jongs’ lawsuit, also did not respond to requests for comment.

Medical Anesthesia Consultants, which contracts with John Muir and employs Poage, Lee and Dimla, declined to comment. Representatives with Stanford did not respond to requests for comment.

Truc-Co and Tom Jong hold a picture of their daughter Ailee, 2, who died at John Muir Medical Center in Walnut Creek.

Truc-Co and Tom Jong hold a picture of their daughter Ailee, 2, who died at John Muir Medical Center in Walnut Creek.

Brontë Wittpenn / The Chronicle

John Muir Health leaders have previously defended the care given to Ailee and denied allegations that they risked patient safety for profit and prestige. They said that extensive internal reviews of the case by John Muir physicians uninvolved in the surgery found “no concerns with the clinical care provided.”

Villatoro said a case like Ailee’s would be reviewed by a medical expert hired by the board who specializes in a similar field. These experts then look to see whether a patient’s care deviated from the “level of skill, knowledge, and care in diagnosis and treatment ordinarily possessed and exercised by other reasonably careful and prudent physicians in the same or similar circumstances at the time in question.”

If the expert determines that there has been a “departure from the standard of care,” the case is sent to a state investigator for further review, which can include interviews with the physicians. Ultimately, the state Attorney General’s Office decides whether charges should be filed against a doctor.

The entire process can take years, and rarely results in serious discipline. Last fiscal year, the state medical board received more than 10,000 complaints, almost half of which were considered quality-of-care complaints, like Ailee’s. In such investigations, the state board restricted or suspended doctors’ licenses 10 times.

The Chronicle’s investigation found that in the weeks leading up to Ailee’s surgery, a medical director at John Muir had warned Poage and a top executive that John Muir was not ready for such a difficult and risky operation, telling the executive it would be a “clean kill” if they moved forward.

Although Stanford has a renowned pediatric liver center, current and former medical staff told The Chronicle that John Muir had never performed a liver resection on a child.

Such procedures require not just experienced surgeons, but also top-flight anesthesia teams who must decide when and how to give blood transfusions to a patient who bleeds, according to experts in pediatric liver surgery and pediatric anesthesia who spoke to The Chronicle and reviewed Ailee’s medical record.

The experts said that Ailee’s medical record spoke to the inexperience of the team as a whole with this type of operation, expressing specific concern with how many units of red blood cells the anesthesia team gave Ailee — significantly more than the estimated amount of blood she had lost.

In Ailee’s medical record, the anesthesia team noted that it stopped logging the amount of medications given to Ailee. The medical report indicated that syringes had already been thrown away by cleaning staff, making documentation impossible.

The Jongs’ lawsuit echoes these concerns, stating that although Hui had successfully performed liver resections at Stanford and at UCSF Benioff Children’s Hospital in Oakland, the anesthesiologists were not affiliated with Stanford and had only recently finished fellowships in pediatric anesthesiology.

John Muir Health leaders have acknowledged that a former medical director, Dr. Alicia Kalamas, raised questions beforehand about the liver resection, but they dismissed these concerns as typical discussion among physicians. They said the decision was ultimately up to Ailee’s care team, which had the knowledge and expertise to move forward with the surgery. After John Muir let her contract lapse, Kalamas sued the hospital in January.

The Jongs’ lawsuit alleges that Kalamas was not the only staff member to sound alarms: Nurses who were asked to staff Ailee’s procedure had expressed “a barrage of objections,” stating that the operation “could not and should not be done.”

Shortly after their daughter’s death, the Jongs filed a complaint with the California Department of Public Health, and an investigator made a surprise visit to the Walnut Creek facility, interviewing staff and reviewing documents. The state agency — which focuses on state and federal law compliance, but has no oversight over any individual patient’s medical care — found no deficiencies.

State regulations for hospitals like John Muir, which the public health officials told the Jongs they were enforcing during their visit there, require the “recording of all events taking place during the induction of, maintenance of and emergence from anesthesia, including the amount and duration of all anesthetic agents, other drugs, intravenous fluids and blood or blood fractions.”

A health department spokesperson said this requirement cannot be waived even in emergency circumstances. The spokesperson declined to answer questions this week about whether the agency might reopen its investigation after The Chronicle found potential violations of state regulations.

Matthias Gafni and Cynthia Dizikes are San Francisco Chronicle staff writers. Email: matthias.gafni@sfchronicle.com, cdizikes@sfchronicle.com Twitter: @mgafni, @cdizikes