As more information begins to arise surrounding the death of Kanye West's mother, Donda — an autopsy conducted Tuesday (November 13) was inconclusive pending the results of toxicology tests, according to CNN — a spokesman for the Los Angeles County Coroner's office said her death was likely the result of complications from surgery, and many sources have said the surgery was cosmetic.
What is also unclear is whether or not she ignored medical advice in seeking out the surgery.
According to multiple reports, Donda West first consulted with Beverly Hills, California, plastic surgeon Dr. Andre Aboolian to conduct an abdominoplasty (commonly referred to as a "tummy tuck") and breast-reduction operation.
"It's not like she was being vain," Dr. Aboolian told New York's Daily News. "It was heavy on her body."
CNN reports that Aboolian refused to perform the procedure on Dr. West after she consulted him in June. He said she contacted him again just two weeks ago, at which point Dr. West said she was ready to go forward with surgery, but he stipulated that he needed a medical clearance before he would perform it. "I always insist on a medical clearance for women over 40, and in this instance it was particularly important because of a condition she had that I felt could have led to a heart attack," Aboolian said in a statement through his publicist, according to CNN. Dr. Aboolian said he recommended that West see an internist for tests, but she did not make the appointment.
Another doctor, Dr. Renato Calabria, a board-certified plastic surgeon with over 10 years' experience, told MTV News that such a referral is standard practice for any patient over age 50 (and in some cases over age 40) who may be overweight.
West did not return to Dr. Aboolian's office, but a surgeon — Dr. Jan Adams reportedly told TMZ.com that he performed the procedure, had consulted with Dr. West over four months and did "nothing wrong" — reportedly performed the procedure.
According to The Associated Press, the Medical Board of California is investigating whether Adams' medical license should be revoked or suspended. The development came in light of revelations that Adams faced multiple malpractice lawsuits and is under investigation over two DUI-related incidents. "Access Hollywood" reports that Adams was one of two doctors recommended to Dr. West by Oprah Winfrey, who had featured both Adams and Dr. West (with Kanye) on her show in the past. But a representative for the talk-show host reportedly told MSNBC.com in a statement that Winfrey "did not personally introduce nor recommend Dr. Jan Adams to Donda West. ... Oprah Winfrey has not been in touch with either Dr. Adams or Donda West since their respective appearances."
And while the details remain unconfirmed, the procedure may have directly caused her death. An autopsy, originally scheduled for Wednesday, was completed Tuesday, according to UsMagazine.com, although the details will not be made available for another six to eight weeks, pending more tests.
L.A. County Coronor's Office Captain Ed Winter held a press conference later Tuesday, according to the site. "The findings of the autopsy have been deferred pending the receipt of additional tests that have been ordered by the deputy medical examiner," he reportedly said. "The final cause and manner of death has not yet been established." Winter also reportedly clarified that West's surgery lasted "under four hours, based on the information we've received from the doctor."
"There was nothing apparent that jumped out at us," he added. "That is why we are deferring this at this point. The doctor said everything appeared normal."
Dr. West, 58, died on Saturday night at Centinela Freeman Regional Medical Center in Marina del Rey after she stopped breathing at her home, Deborah Ettinger, a hospital vice president, told AP. West was taken to the hospital by paramedics who "tried to resuscitate her, but were unsuccessful," Ettinger said.
What could an internist have done to prevent or approve the procedure?
"[Certain patients] may have heart problems, and even if an EKG [electrocardiograph, used for measuring heart rhythms] is normal, an internist may recommend a stress test to make sure the patient's heart is in good condition," Dr. Calabria explained to MTV News. "Sometimes routine lab work is not enough. If a patient has their own internist, that's even better, because they would know more about the condition of their patient. They would emphasize that even if the patient has problems and the surgeon is too cavalier, it's important to educate the patient. [In any event, the patient] should bring up to the problem to the surgeon and internist."
In the case of West, Dr. Calabria said he would "absolutely not perform the surgery" if an internist raised concerns.
"A good plastic surgeon is one that knows how to say no," he stressed.
Dr. Calabria emphasized that plastic surgeons are licensed doctors with experience in multiple specialties, but they are not as skillful as a radiologist or internist in reading heart measurements. "It's important to know our limits," he said.
Specifically in regard to West's reported requests for a breast-reduction and abdominoplasty, Dr. Calabria suggested in the case of patient who may have a weak heart, the surgeries be divided into two separate procedures to lessen stress. And Dr. Calabria also suggested the patient be treated at an outpatient facility and not be allowed to travel home to recuperate. Dr. West was reportedly at home when she called 911, meaning she could have opted to bypass outpatient care.
"It's better that patients be around to call me for nothing than have it become something the next day," Dr. Calabria said. "There's been this glamorization of plastic surgery on TV and people think they can have a complete makeover and the next day they look like nothing has happened. That's not going to happen."
The West family released a statement Monday night thanking well-wishers for their support. In lieu of flowers the family is asking that donations be made the Kanye West Foundation in his mother's name.
No immediate funeral arrangements have been made as of press time, however, Oklahoma City TV affiliate KOCO is reporting West will be laid to rest in her home state of Oklahoma.
[This story was originally published on 11.13.2007 at 2:47 p.m. ET]