Dr. Jeffrey Monash: Facts of the Case & Response to Misleading Claims

What’s Going On?

A lawyer desperate to collect a factually and legally shaky medical malpractice verdict before it’s overturned on appeal fed anything but the whole truth to a TV personality who, when she finally interviewed the doctor being “investigated,” admitted that nothing he said was going to change her narrative.

With constant claims about the legal system and media being “rigged,” the last thing we need are people who prove this to be true: people who will say anything and threaten anyone in the name of sensationalism.

This story began when Jeremy Marine, a 500 lb. 45-year-old man, went to Dr. Monash in September 2018 for bariatric surgery. Mr. Marine, who had undergone a weight loss surgery in the past, started the long process of preparing for another surgery, this time with Dr. Monash.

Mr. Marine met with Dr. Monash 4 times pre-operatively (on two visits, his wife was also in attendance) and met with Dr. Monash’s staff another 6 times over the course of 15 months before being deemed ready for surgery.

On January 13, 2020, Dr. Monash converted Mr. Marine’s previous surgery to a gastric bypass. There were no complications during the surgery. Although Mr. Marine complained of severe abdominal pain post-operatively, his low pain tolerance stemmed from his taking 270 double-strength Percocet’s per month, a prescription written prior to surgery by his primary care physician to treat his chronic back pain. On September 13, 2018, Mr. Marine, who was a Board-Certified Mental Health Nurse Practitioner, told Dr. Monash that the “only time I can eat is when I take Vicodin.”

On October 30, 2018, Mr. Marine told Dr. Monash that he had been dependent on Vicodin for 10 years. He was still taking it as of his last two pre-op visits with Dr. Monash (October 3, 2019, and January 9, 2020). After the operation, Mr. Marine’s pain eventually improved, and his care team, including Dr. Monash, determined he was stable for discharge on January 18, 2020.

A week later, on January 25, 2020, Mr. Marine returned to Tucson Medical Center with abdominal pain. He was kept overnight, monitored, given IV fluids, and when all tests came back normal, he was discharged on January 26, 2020.

According to Mr. Marine’s wife, on the evening of January 27, 2020, she and her husband were sitting in the family room watching TV when he decided to get up, go to the bedroom, and take some Percocet. He then collapsed on his bed and became unconscious with his legs hanging off the bed. He was taken by ambulance back to TMC but could not be resuscitated. He was pronounced dead at 10:50 PM.

The Marine family filed suit. Their lawyer’s theory was that Mr. Marine should not have been discharged from TMC on January 26, 2020, because the surgical site was leaking into the abdominal cavity, which caused a systemic infection—sepsis, septic shock, and death.

The Problem With That Theory

The three most definitive tests found zero evidence of a leak at the surgical site:

1. A CT scan on January 25, 2020, did not show any leakage of air or bowel contents into the abdominal cavity. Studies have shown that CT scans are 99.7% accurate when ruling out a leak.
2. On January 26, 2020, an Upper GI series revealed “no evidence of an enteric [GI tract] leak.” No allegations were made that either of the radiologists who read these studies missed a leak or otherwise malpracticed.
3. The forensic pathologist hired by the family to perform a private autopsy on January 29, 2020, did not find a leak.

What About the Sepsis Theory?

Sepsis requires evidence of infection in the blood. A January 25, 2020, blood culture resulted in no bacterial growth.

If Mr. Marine had been in septic shock, he would not have been able to sit and watch TV with his wife and then walk unassisted across the house to the bedroom. Septic shock typically causes a person’s blood pressure to drop to the point that they’re so weak it’s almost impossible to stand, let alone walk.

So, What Caused Mr. Marine’s Collapse?

The first thing Mrs. Marine said to paramedics when they arrived was, “Give him Narcan.”

Mr. Marine’s demise fits an opioid-induced respiratory arrest that causes a fatal arrhythmia and sudden death.

The day after his January 13, 2020, surgery, a pharmacist warned Mr. Marine that his opioid tolerance was high for pain relief but that he did not have tolerance for the respiratory depressive effects of the drugs. The pharmacist noted that Mr. Marine’s opioid usage in the previous 12 hours was six times his baseline consumption.

On January 15, 2020, the pharmacist noted that Mr. Marine had significant risk factors for opioid-induced respiratory arrest, including:

• Underlying respiratory issues due to excessive weight
• Sleep apnea
• CPAP use while awake

It is known that Mr. Marine took Percocet the night he died. However, the forensic pathologist hired by the family destroyed the fluids and tissues that could have been tested for opiates to confirm Mr. Marine’s cause of death—opioid-induced respiratory arrest.

Where is Due Process for Doctors?

Unable to prove that Dr. Monash failed to diagnose a leak or sepsis, and with the family’s forensic pathologist destroying critical evidence, the family’s lawyer had no case—yet continued to pursue it.

The lawyer also used allegations from Dr. Monash’s ex-wife from their divorce years earlier, taking 23 depositions in an attempt to find a single healthcare professional who would testify that Dr. Monash was impaired—and found nothing.

Under Arizona law, all doctors and hospitals are required to report any suspicion of impairment, and no such report was ever filed against Dr. Monash.

The Case is Under Appeal

Despite the overwhelming medical and legal evidence, the trial was flooded with irrelevant claims, and 80% of the evidence had nothing to do with the patient’s care. Post-trial juror interviews revealed that those who voted against Dr. Monash relied not on medical evidence, but on unrelated accusations.

This legally flawed verdict is expected to be overturned on appeal.

Christopher J. Smith, Esq.
Attorney for Dr. Jeffrey Monash