SAN LUIS OBISPO — Although neither the prosecution nor defense has shown its entire case, the preliminary hearing for transplant surgeon Hootan Roozrokh revealed details about what happened during Ruben Navarro's final hours and the hurdles both sides must overcome at trial.

San Luis Obispo County prosecutors jumped their final pretrial hurdle Wednesday, when Judge Martin Tangeman ruled a jury would decide whether Roozrokh committed dependent adult abuse Feb. 3 and 4, 2006, at Sierra Vista Regional Medical Center.

Originally, prosecutor Karen Gray charged Roozrokh, 34, with three felonies, alleging he prescribed excessive amounts of medication in an attempt to hasten Navarro's death in order to harvest his organs. Tangemen dismissed two charges for lack of evidence and failure to apply to this case.

Never before in the United States has a transplant surgeon been tried for dependent adult abuse in connection with harvesting organs.

Many people were hoping the case would be thrown out before trial, fearing a conviction could have a serious chilling effect on transplant surgeons and potential organ donors, said Brian Liang, a law professor at California Western Law School.

"The idea of extending elder or dependent adult abuse charges to medical care is a sensitive one," Liang said. "You don't want a chilling effect on physicians doing the right thing."

Now that the case is going to a criminal trial, Liang said, people will pay even closer attention. Typically, the civil courts or state licensing boards deal with charges of medical malpractice, he said.

Roozrokh is set to return to Superior Court for a formal arraignment April 2, but no trial date has been set.

Unprecedented case

The circumstances surrounding the attempted organ harvest are extraordinary, Roozrokh's attorney, M. Gerald Schwartzbach, said in court. "What happened on Feb. 3 and 4, 2006, has never happened in this world before that night."

Navarro was dying of a debilitating neurological condition he'd suffered from since childhood. He was taken to Sierra Vista in late January in a coma; doctors determined he'd suffered irreversible brain damage, though he was not legally braindead.

His mother, Rosa Navarro of Oxnard, agreed to donate his organs. The Oakland-based California Transplant Donor Network dispatched a transplant team to Sierra Vista, which included Roozrokh, surgeon Arturo Martinez and nurse Carla Albright.

Navarro qualified for a rare type of organ donation known as cardiac-death donation, in which organs are harvested within minutes after a patient's heart stops beating.

The hospital had no practiced protocol for the procedure. Roozrokh and Albright had seen one such donation, but no one else in the operating room that night had been trained in or participated in one.

Burden of proof

One area the defense is likely to pounce on at trial, and which Schwartzbach repeated during the preliminary hearing, is that there is no evidence any of the medication allegedly given to Navarro hurt him.

Navarro died about eight hours after being removed from life support and his organs were never used. A coroner's investigation concluded Navarro died of natural causes.

Schwartzbach argued at the preliminary hearing that Navarro was tolerant to pain medications, which is why he never died from the high doses alleged, and those doses saved him from pain and discomfort.

Gray, though, argued that circumstances clearly show Roozrokh's intentions were to get Navarro's organs before time ran out by giving him drugs to stop his breathing.

Nurse Diana Stevens testified she gave Navarro 130 milligrams of morphine and 60 milligrams of Ativan at Roozrokh's order in less than an hour. She said she gave an additional 50 milligrams of morphine and 20 milligrams of Ativan at Albright's direction.

Albright hasn't been charged with a crime, and prosecutors granted Stevens immunity in exchange for her testimony.

Gray argued that Roozrokh, as the surgeon in charge, was responsible. She must prove that he was criminally negligent and willfully caused Navarro to be in a situation that endangered his health.

"The jury might think she's stretching the concept of abuse," Liang said. "And that's going to be a significant hill for them to climb, because there is no clinical bad outcome."

Inconsistent testimony

Another difficulty for the prosecution is inconsistencies among statements from witnesses about who did what and said what to whom. For example, none of the preliminary hearing witnesses agreed on the amounts of medication given to Navarro.

In most instances where witnesses directly contradict each other, Stephen Crawford, the lead sheriff's investigator in the case, testified he had no way to determine who was telling the truth.

Also, witnesses said no one present that night tried to stop the medication administration. That includes Navarro's attending physician, Laura Lubarsky, who said she thought she was there as an "independent observer," and transplant surgeon Martinez, who has 17 years' experience and was the head of the San Francisco Kaiser Permanente kidney transplant program.

Roozrokh "is the one who ordered it," Gray said. "He's the one who's responsible for what he did."

Calling on expert opinions

Another area that likely will be explored in considerable depth at the trial is whether Navarro could feel pain and whether the prescribed medications allowed him to die peacefully. Each side will call expert witnesses to support their claims.

At the preliminary hearing, two experts testified that Navarro was in an irreversible coma and could not feel pain. Nurse Stevens also said Navarro showed no signs of suffering to indicate he needed medications.

But Schwartzbach pointed to several instances in Navarro's medical records during his final hospitalization that show he responded to painful stimuli.

Schwartzbach said his side was only "counter-punching" at the preliminary hearing, but at trial, will "throw punches of its own." That includes bringing its own medical experts.