March 28, 2010

Larry D. Helvey, MD, JD
2735 1st Ave. SE, Suite 101
Cedar Rapids, Iowa 52402

Dear Dr. Helvey:
As per your request, I have reviewed the medical records of Donna Oeltjenbruns.

Mrs. Oeltjenbruns was a 4 7 year-old female with chronic back problems who
underwent an elective back procedure by Cyril A. Raben, MD, on September 11,
2009, at Fairmont Medical Center in Fairmont, MN. The operation involved a twolevel lower back fusion with instrumentation including interbody fusion cages for
stabilization. In the course of the operation during the posterior spinal dissection,
brisk bleeding was encountered, blood pressure became unstable in the range of 4060 mmHg systolic, and both the somatosensory evoked potentials and pulses were
lost in the left lower extremity. The cell saver records during the operation
indicated whole blood loss of 2375 cc during the operation and the patient was
given 3 units of banked blood and 2 units of cells from the cell saver during surgery.
Dr. Raben consulted Dr. Hodges during the operation and they decided to close the
patient's incision and observe her in the recovery room without further operative
exploration. A helicopter was requested for transfer to the Mayo Clinic but the
patient went on to cardiac arrest within an hour of arriving in the PACU and could
not be resuscitated. An autopsy revealed 2.5 liters of blood in the peritoneal cavity
and almost complete transection of the left common iliac artery due to
intraoperative injury.
It is my opinion to a reasonable degree of medical certainty that Cyril A. Raben, MD,
fell below the standard of care for a spinal surgeon in his management of Mrs.
Oeltjenbruns while in the operating room on September 11, 2009. He failed to
recognize the seriousness of the bleeding he encountered and the obvious
hemodynamic instability, and Mrs. Oeltjenbruns died as a result. It is my opinion
with a reasonable degree of medical certainty that immediate exploration of the
abdomen with control of the lacerated iliac artery would have likely resulted in
survival for Mrs. Oeltjenbruns.

James M. Levett, MD, FACS
Chief Medical Officer
Physicians' Clinic oflowa
Cedar Rapids, Iowa

'

/