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    TODAY'S STORY......WHAT HAPPENED TO ASHER DEAN LUBOFSKY?

    ASHER DEAN LUBOFSKY

    Asher Dean S. Lubofsky, age 5, returned to Guam with his brother and father on October 27, 2018.

    • Asher Dean S. Lubofsky, a five year old, died suddenly, October 31, 2018, 2 days after seeing Dr. Shishin Miyagi at the Guam Seventh Day Adventist Clinic. Asher was previously already scheduled for a full wellness exam, but coincidentally was feeling sick the day before,  per his father, David Lubofsky. Mr. Lubofsky reports that Asher was throwing up, had on and off fever and a hoarse voice. Asher's appointment with Dr. Miyagi was set in advance for Monday, October 29th. Mr. Lubofsky reported that Asher had symptoms on Sunday and knew young Asher had an appointment with Dr. Miyagi for a physical so waited to then, the following day, to take Asher to The Guam Seventh Day Adventist Clinic. 
    •  Mr. Lubofsky stated that he and his two sons arrived on Guam early Saturday morning from the Philippines on October 27, 2018 and that Asher was full of his usual vivacious energy and having a great time. Videos on Mr. Lubofsky’s facebook attest to that. Asher had all of his immunizations and was a healthy child and showed no symptoms on arrival, per his father

    DR. SHISHIN MIYAGI

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    • Once at The Guam Seventh Day Adventist Clinic, October 29, 2018, the nurses took Asher's vitals and did the hearing and vision test. According to Mr. Lubofsky, Asher had a fever prior to heading to the clinic and he gave him childrens fever medicine. Dr. Shishin Miyagi, per Asher's father, when he met with them he discussed the immunizations, Asher's height and weight, the hearing and vision test results and Dr. Miyagi even left the room to ask his nurse to copy the immunization record. Mr. Lubofsky declares that he clearly told Dr. Miyagi that his son has been ill with fever, throwing up and hoarse voice that was evident when they met the doctor. Dr. Miyagi never examined Asher as a routine physical calls for and never ever even used a stethoscope, per David Lubofsky. According, to Mr. Lubofsky, he got flustered with the doctor and said to him, "Can you at least check him?" Dr. Miyagi then said Asher doesnt have a fever now, upon which Mr. Lubofsky repeated that he gave Asher fever medicine for children? Dr. Miyagi then looked in Asher's mouth and still never did the full annual exam as reported by Asher's dad. Dr. Shishin Miyagi gave young, sick Asher Dean all of 20 minutes of his time to do an annual physical and address the medical needs of Asher who died less than 2 days later. Mr. Lubofsky and his family are heart broken over the death of their 5 year old son and just dont understand how Dr. Miyagi could first not do the scheduled annual physical completely and second not address the clearly stated and evident medical needs of Asher.
    • To make matters worse, Mr. Lubofsky requested and received young Asher's medical records from the Guam Seventh Day Adventist Clinic and was upset to see that Dr. Miyagi reported that he did all the required usual checks in an annual physical. Mr. Lubofsky angrily expressed not only didnt he help or exam my son, but later lied that he did. If he did all that he claims and did what he described, how was it that he was only with us for 20 minutes, as documented, and how is it that he didnt hear my sons hoarse voice or how in less than 24 hours later my son is using secondary muscles to breathe and Miyagi didnt hear it, lamented Lubofsky.
    • It's because he didnt see Asher Dean as important enough to do his job and was in a hurry, said Asher's father.

    ETHAN S. SNIDER, PHYSICIAN ASSISTANT

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    • Day 2 at SDA.  
    • Mr Lubofsky reports that his son’s condition had worsened after the SDA appointment with Dr. Miyagi and he brought him to urgent care at Guam Seventh Day Adventist Clinic on October 30th in the morning.  In 24 hours from seeing Dr. Miyagi to urgent care, Asher’s condition had taken a downward spiral, he said, but then again, he wasn’t examined by Dr. Miyagi. Explain how that can be, nothing wrong with him per Dr. Miyagi to having to be rushed to the hospital and I lose my son 20 hours later, Lubofsky asks? While at urgent care, at the Seventh Day Adventist Clinic, a Physician Assistant, not a doctor, Ethan Snider, was told clearly by me, Lubofsky said, that Asher was there the day before and with his arms crossed, Snider said HE DIDN’T SEE ME. Lubofsky said he told him, but he was here. Ethan Snider refused to even check the records, was argumentative and did not bring a regular supervisory doctor to see his son even when asked by Mr. Lubofsky to see a doctor. The doctor is busy was Ethan Snider’s response and why no other doctor consulted, Lubofsky wants to know? "My boy is dying and they tell me the doctors are busy," Asher's dad emotionally related. Ethan Snider warned Mr. Lubofsky  to bring Asher to the hospital ER for further assessment, but wanted them to take an ambulance which can take 30 minutes to get to SDA or longer. The hospital is 3 minutes away. Ethan Snider refused to give Mr. Lubofsky anything in writing or a referral to take to the hospital, saying it’s not allowed and that he would call the ER.  Ethan Snider, per Mr. Lubofsky, threatened to call the police, which ASHER asked why they will call the police on us? At that time, in distress, Mr. Lubofsky was alone with his dying 5 year old son and also his 6 year old son. Imagine talking like that to a family in crises, stated emotionally, Im alone with my two young kids. Do you need a witness to that as my other son clearly heard it as well, said Lubofsky. My 5 year old Asher  had to hear that threat as some of the last words he would ever hear before his death outside of the hospital. When they got to the ER, at Guam Memorial Hospital, they had not heard yet from Ethan Snider, who refused to give a referral and said he would call. What a waste of time and lousy policy to not give a referral in our situation just to save SDA money on paper in a crises, Lubofsky stated.
    • Lubofsky pointed out that when he saw Asher's records from Ethan S. Snider, there were discrepancies, among which, the record stated in one place that Asher was discharged home and there was no mention of some things that were reported by Mr. Lubofsky.  
    • I asked Asher’s dad, why did you not wait for the ambulance to take Asher to the hospital? He said, “day one with Dr. Miyagi was a let down as that Guam Seventh Day Adventist doctor didn’t even examine my son leading to a worsening of symptoms and day two at SDA. Then the Physician Assistant, Ethan Snider in the Urgent care on day two refused to check what Dr. Miyagi did or did not do. Ethan Snider refused to bring his supervisory doctor in to help Asher or any other doctor. I was feeling his arrogance to control a situation that he did not have the medical background to work thru as he is not a doctor. When he told me my boy needed to go the hospital and I said, okay, we leave now he refused to give us a letter or any notes to take with us. By that time, I had no faith in the Seventh Day Adventist Clinic. Would you wait 30 minutes for an ambulance, or take your child in 3 minutes to get there? What parent would wait for their child to die in such an unprofessional atmosphere? “


    MEDICAL FACILITIES

    GUAM MEMORIAL HOSPITAL

    After the Seventh Day Adventist Urgent Care visit, Asher was transported to the Guam Memorial Hospit

    • After the Seventh Day Adventist Urgent Care visit, Asher was transported to the Guam Memorial Hospital by his father into the ER. According to Mr. Lubofsky, ER screening staff were slow to respond initially and had few people waiting. The ER staff told Mr. Lubofsky that they never received any call from Ethan S. Snider, Physician Assistant from the Guam Seventh Day Adventist Clinic. The ER, without any info. had to start their own assessment to figure out Asher’s condition, which was a waste of critical time after they were at the Seventh Day Adventist Clinic just minutes before. Why didn’t they just give us a referral in writing from the SDA clinic, Mr. Lubofsky again said in frustration to save time?  "Ethan Snider threatened to call the police, but didn't even make the promised call to the ER," Asher's dad said  
    • Asher was evaluated in the ER and eventually transferred to a room on the Pediatrics ward. What stands out is that no one told Asher’s dad what was wrong with Asher except that he had a viral lung infection, said Mr. Lubofsky. No culture of the virus was done there or at any time in the hospital. After they got Asher’s fever under control, things seemed better and still no one was indicating otherwise. Asher was conversing with his dad in the room and at around 7pm, Dr. Garrido, a Pediatrician came in and told Mr. Lubofsky that Asher may have pneumonia, but it wasn’t clear. No one ever said that Asher’s condition was dire or expressed concern until about 1 am or so, Mr. Lubofsky said, when nurses told him they were going to transfer Asher to ICU. No doctors ever came into the room; no one discussed why a transfer to ICU was necessary, except to say to keep a better eye on Asher. The transfer to ICU never happened. Asher was having problems with the respirator mask and was trying to remove the mask most of the night, with his dad holding it in place. Mr. Lubofsky is asking why no doctors ever came in to see Asher and why no one told him how serious Asher was. Asher passed away at around 7am, about 12 hours after the last and only doctor visit to Asher in the hospital. Mr. Lubofsky doesn’t understand why the virus was not cultured and why no doctors ever came into the room all night. Mr. Lubofsky regrets now trusting the opinion of those in charge of Asher’s care and sadly his eventual demise. Still to this day, no one can explain how Asher entered the hospital and 20 hours later died. It’s a mystery to the family and Mr. Lubofsky indicates it shows that Guam Memorial Hospital really does not care and continues to perpetuate its own negative reputation. Mr. Lubofsky said it was very difficult to get records from the hospital and that they, the supposed experts, were quoting a law incorrectly that said Asher’s records would not be released for 50 years. Eventually, that “dumb decision” Mr. Lubofsky said was reversed. “You would think if a 5 year old dies in 20 hours in the hospital after a 2 day sickness that they would want to know what caused it and if it’s a health hazard for the island of Guam. They did not care as if they did, a culture would have been done. “The question was asked again, by Asher’s dad, if Dr. Miyagi had really examined Asher two days before his death, with reported presenting symptoms, would the end results be the same?
    • When Mr. Lubofsky did review Asher’s records he found mention of Sepsis, but questions whether the hospital ever treated Asher for Sepsis at all. Again, no one ever mentioned that to him the whole time Asher was in the hospital. 


    GUAM SEVENTH DAY ADVENTIST CLINIC

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    • Mr. Lubofsky had two meeting at the Guam Seventh Day Adventist, one of which was soon after Asher had passed away, when he went in to the clinic to take issue as to how his son was treated by Dr. Miyagi and Ethan Snider and the Guam Seventh Day Adventist Clinic. He met with Dr. Arakawa, Medical Director and Ms. Anita, Nursing Supervisor. He explained what happened, as outlined in this report and was told they would investigate, but Lubofsky never ever heard back from anyone, he said. A few weeks later after not hearing back, Mr. Lubofsky sent an email to Dr. Arakawa, asking him why he never got back to him. Again, Mr. Lubofsky waited another two weeks before he got a response and eventually another meeting. In summary, Mr. Lubofsky said, Dr. Arakawa told him that the Dr. Miyagi and Ethan Snider had “different recollections” of what happened than he did. As irritating as this was, it was expected as they have to protect the doctors and the clinic first before young Asher or any innocent patient. They must fear they will be sued. Lubofsky asked Dr. Arakawa how an official medical record can show things that were claimed to be done, but never actually done. It’s a forged file. Lubofsky lamented whether changes were made after his first meeting with Dr. Arakawa to the file to cover the discrepancies and the shoddy medical care of his young son.
    • The medical records indicated, per the document that we saw, provided by Mr. Lubofsky,  that Dr. Miyagi claims to have taken a medical history, social history, a review of systems including head, cardiovascular, pulmonary, gastrointestinal, neurological, general appearance, checked Asher’s nose, pharynx, lungs, musculoskeletal and skin. The report also indicates that Dr. Miyagi claims to have done a routine physical and preschool history. Dr. Miyagi’s records stated he did anticipatory guidance for play and reading and discussed foods. “My gosh"' Lubofsky said, he did all of that and left the room to find the nurse, discussed my child’s weight and height and the immunizations along with the results of the eyes and ears in all of 20 minutes which is documented. Its impossible, especially when you add to that, I had to raise my voice to check my son for being sick. If he did all of those tests, why he did not hear anything wrong at all, not even the hoarse voice? He does not mention anything that I told him in the record, including getting upset to him for not checking my son. 
    • Mr. Lubofsky said he has 5 children who have been seen for similar exams at the Guam Seventh Day Adventist Clinic and all were near an hour. Mr. Lubofsky said he has been coming to this clinic for 30 years. 
    • Lubofsky pointed out interestingly, that the Guam Seventh Day Adventist Clinic has real issues as their priority is to save money, down to the last penny and they are reluctant to do anything they can get away without doing including lab tests and maybe even writing a referral to the hospital.  
    • The records at the Seventh Day Adventist Clinic, per Lubofsky, are templates. This means that if a doctor is rushed or lazy and does not read what is entered in the template or takes time to personalize the information; my child’s record will look like your child’s record, said Lubofsky. Dr. Miyagi in his records never noted any of the things that Mr. Lubofsky told him, just used the template to process another child. Lubofsky said template records can be very dangerous as they are not personalized to the patient. He further proved this by showing Asher’s record by Ethan Snider that raises questions. Snider in the record, states at one section, that young Asher was discharged home, and the family was advised to return if any problems, not to the ER. In another part Snider mentions the ER. Snider, obviously, never checked the template from the last patient and used part of it for Asher, without giving my son the benefit of a personalized record, Lubofsky said. What else did he miss? Lubofsky ventured to say that most of these templates records at the Guam Seventh Day Adventist Clinic have information that is either not correct, or copied from a past patient, or excludes reported information from parents etc. What they are doing is dangerous and not professional. 


    GUAM CHIEF MEDICAL EXAMINER

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    • According to Mr. Lubofsky, any patient that dies at the Guam Memorial Hospital within 24 hours of admission may have to undergo an autopsy, which was the case with Asher Lubofsky. The hospital never did a culture on Asher’s virus which complicated matters trying to get to the exact cause of Asher’s death, not to mention, according to Asher’s father raises question as to the quality of Asher’s medical care. “How can they treat him, if they do not know what he has? The virus culture should have been done on admission, not on death, “he said. The autopsy was finally finished about a week after Asher died with a cause of death being Generalized Viral Infection. My Lubofsky was stunned by that and the generality of the diagnosis that could kill a healthy child in just two days after he was seen by Dr. Miyagi, who still claims he examined Asher. Mr. Lubofsky asked to meet with the Guam Chief Medical Examiner, Dr. Aurelio Espinola and Dr. Espinola agreed. According to Mr. Lubofsky, Dr. Espinola told him that his son died from an aggressive virus that infected every part of young Asher’s body at the same time. Mr. Lubofsky said the Medical Examiner told him that in his 40 years at this kind of work that he has never seen such a virus. All the questions of how did Asher get it, was it contagious, can others on Guam get it, etc. will never be answered as the virus wasn’t cultured. Mr. Lubofsky said the Medical Examiner was also surprised the virus wasn’t cultured when he asked. As of this writing, the autopsy report has not yet been released. It has been over 2 months since the autopsy was finished. Mr. Lubofsky never got the answers he was seeking from the medical examiner and as of now, it seems that the mystery of what happened to Asher can’t be answered clearly by the Medical Examiner, outside of an unidentified virus caused his death. 

    ASHER DEAN LUBOSKY

    The mystery of Asher Dean S. Lubofsky remains, amidst the pain and suffering that the family has to endure thru their deep grief over losing their precious son. Nothing anyone can say or do will ever alleviate that. As Mr. Lubofsky said, life goes on for everyone else; I am stuck in today’s grief over the loss of my son and have no idea how to go on without him. 

    What is evident in this story is that the Guam Medical Community at many steps along the way failed young Asher. Those questions raised and the so called differences on how the family saw things at the Guam Seventh Day Adventist Clinic and the Guam Memorial Hospital have to be answered. Is the template medical record system, as an example, at the Seventh Day Adventist Clinic dangerous or even flawed as Mr. Lubofsky stated?  Did Dr. Miyagi ever examine young Asher and if so, how did he do all that he stated that he did in just 20 minutes? Why no call or assistance was done by Ethan Snider to help the family get to the hospital with what ever way they chose to get there, rather than threatening a dying child’s father who was alone with two young kids and trying to save his son? Why no doctors saw Asher at the Guam Seventh Day Adventist on the second day and day in which Asher was in dire medical needs? When Asher arrived in front of Ethan Snider, he only had 20 hours left of his young life and he was reportedly denied a doctor. Why no doctor at the Guam Memorial Hospital ever entered Asher’s room after 7pm at night until he died the next morning. As a parent, I know I would want to know these answers. It may be too late now to help Asher, but what about the next child, your child or mine?  Medical Care on Guam has been criticized for a long time and the loss of life of a 5 year old healthy child is another example of a failed system.

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