After an exceedingly rare and shocking medical error, state officials have taken away the medical license of a Sarasota ob-gyn who aborted the wrong fetus in a woman carrying twins, mistaking a seemingly healthy girl for a boy with congenital defects.
Dr. Matthew J. Kachinas performed abortions but never before had attempted this procedure, known as selective termination, in which a chemical injection terminates one fetus in a multiple pregnancy.
But in January 2006, he agreed to treat a woman identified in state records as K.M. She was roughly 16 weeks' pregnant with twins conceived through in vitro fertilization, a procedure used to help couples who have difficulty reproducing.
Doctors had counseled her that selective termination was an option after learning the male fetus had multiple problems, including a possible heart defect and Down syndrome. The female twin appeared normal.
"It seemed like something that was within my purview, that I would be able to do safely and appropriately," Kachinas said Monday in a telephone interview after his license was revoked at a meeting Friday of the Florida Board of Medicine in Tampa.
"I have never, ever in my entire career ever said 'no' to a patient," he added. "And that was my downfall."
The 50-year-old physician said K.M. and her husband were informed of his lack of experience with this procedure, but asked him to do it anyway.
Kachinas said he took his time examining the twins. He thought that he had correctly identified the fetus with the abnormalities before terminating it.
A week and a half later, K.M. returned to the doctors at Florida Perinatal Associates monitoring her high-risk pregnancy. An ultrasound revealed that the fetus still alive was the one with congenital issues and Down syndrome. She returned to Kachinas several days later to terminate the second twin.
Dr. Mark Evans, a New York ob-gyn and geneticist who pioneered the procedure, said in a phone interview Monday he has not in 25 years heard of another case in which the wrong twin or fetus was terminated.
While records are not kept on how often the procedure is performed nationally, Evans said it requires significant expertise that few physicians possess.
"In my hands, it's not complicated because I do it every day of the week," said Evans, noting that half of his patients, including some from Florida, travel by plane to his Manhattan office, Comprehensive Genetics.
The procedure is done for different reasons, he said. In pregnancies involving multiples, selective termination may be performed when one of the fetuses is diagnosed with an abnormality, often in the second trimester.
Selective reduction, by contrast, is conducted when the concern is that the woman is carrying so many fetuses — frequently the result of fertility treatments — she may not be able to carry them safely. It can occur during the first trimester.
Both are distinct from abortion, when a pregnancy is ended and the uterine cavity emptied.
"Selective termination and reduction are done in multiple pregnancies with the specific aim of preserving the pregnancy," Evans noted.
In such cases, the fetus is terminated with a chemical injection that stops its heart. It shrivels up and disappears, Evans said, while the other is left to develop.
Kachinas blamed his mistake on ultrasound equipment that did not allow him to view the fetuses with the high resolution possible with newer, more expensive machines. Experts called by the state, however, disagreed with his assessment in a November administrative hearing.
Kachinas represented himself during the state proceedings. He said he plans to appeal the license revocation, a disciplinary action issued to just seven other doctors last year in Florida. However, he did express remorse, saying in his November testimony, "I am haunted every day by the outcome on this case."
Kachinas said in the interview Monday that there was a financial settlement with K.M. State records show a $250,000 liability settlement for an incident on the day of her selective termination.
After his state hearing Friday, where he was also charged with two less serious complaints stemming from separate incidents in 2002 and 2004, Kachinas told a reporter he was going to kill himself. Police were summoned, and he was involuntarily taken to St. Joseph's Hospital for psychiatric evaluation.
Kachinas said Monday he was making a flip remark. Calling the incident a "great misunderstanding," he said he was released after talking to a psychiatrist.
Times researcher Will Gorham contributed to this report. Letitia Stein can be reached at firstname.lastname@example.org or (813) 226-3322. For more health news, visit www.tampabay.com/health.