48 year old Carlos Orlando Chacon M.D., was initially charged in late 2021 with involuntary manslaughter and other charges, along with Heather Vass, one of his nurses, in the death of Megan Espinoza, a 36-year-old mother of two who died more than a month after undergoing a breast augmentation operation at Divino Plastic Surgery in Bonita, California on Dec. 19, 2018.

San Diego County Prosecutors said Espinoza was provided anesthesia by Vass, a nurse who was not trained to do so. The patient went into cardiac arrest during the operation and Chacon allegedly delayed contacting emergency services for about three hours.

Chacon was previously released on his own recognizance under a number of conditions, but was arrested and jailed last week. Years after he was charged with involuntary manslaughter in the death of the 36-year-old mother of two, California authorities have now charged Dr. Chacon with second-degree murder for Megan’s death.

Deputy District Attorney Gina Darvas said Monday that further investigation into the case yielded additional information that led to the filing of the murder charge, including allegations that Chacon ordered his staff not to call 911 when Espinoza’s condition declined and that he instructed staff to lie to Espinoza’s husband regarding her condition.

The April 6, 2023 probable cause warrant outlines the results of the investigation the Medical Board of California provided the San Diego County District Attorney’s Office, and what further investigation disclosed about the death. A complaint was filed with the Medical Board by one of the paramedics who transporter Espinoza because of concerns that Dr. Chacon had waited almost 3 hours to call 911 to request emergency medical assistance, which is standard protocol when CPR is performed, as defined by the American Heart Association.

Court documents claim that Chacon did not contact 911 to request emergency assistance until approximately 3 hours after Espinoza’s cardiac arrest. Paramedics arrived and Espinoza was transported to Scripps Hospital, in Chula Vista.

Upon her arrival at the hospital, doctors intubated Espinoza to establish a secure airway and placed her on a ventilator. Doctors discovered she had a pressure induced pneumothorax as a result of prolonged and aggressive bagging. Espinoza had also sustained undue stress to her heart as a result of the prolonged bagging.

Espinoza was admitted to the Intensive Care Unit of Scripps Hospital. A chest tube was inserted and over the next five days Espinoza’s pulmonary function improved. However, her neurological function remained critical.

Espinoza was transferred to UCSD Medical Center’s Neurological Intensive Care Unit, where her condition continued to deteriorate. Physicians notified Espinoza’s husband and mother that she was not expected to regain neurological function. The family chose to place Espinoza on palliative/compassionate care.

Espinoza never regained consciousness, or the ability to breath on her own. Espinoza passed away on 01/28/19. An autopsy was performed. The autopsy determined the cause of death to be, “lschemic Encephalopathy due to resuscitated cardiac arrest following anesthesia for elective surgery.” lschemic Encephalopathy is defined as a brain dysfunction caused by a lack of blood flow and oxygen to the brain.

Two medical experts were consulted by the Medical Board. Both provided the opinion that Dr. Chacon’s handling of Espinoza’s surgical procedure was an extreme departure or deviation of the standard of care.

The District Attorney’s Office investigation continued after the original charges were brought. This lead prosecutors to claim that “Chacon began a pattern of conscious disregard for human life prior to beginning Megan Espinoza’s surgery.” and that as a result “probable cause exists to believe Chacon is allegedly guilty of PC 187(a) Second Degree Murder with Malice Aforethought.”

Mr. Espinoza stated in sworn testimony, in the related civil case, that he had been present when Mrs. Espinoza discussed anesthesia with Chacon. Chacon told Mrs. Espinoza that an anesthesiologist who had privileges with two different Sharp Hospital locations would be coming to Divino to provide the anesthesia, which was not what happened.

The transcript of Chacon’s sworn testimony during the civil deposition revealed that Chacon admitted Heather Vass administered the anesthesia, and that he did not specifically direct Nurse Vass what medications and dosages she should administer to Espinoza during the surgery. Instead, Chacon provided Vass with a two-page chart that listed drugs and dosage amounts that Vass could use during every surgery in which she provided anesthesia services for Chacon.

Vass confirmed in her deposition that Chacon did not give her any verbal or written instructions regarding any of the medication and dosages she charted on the Nursing Note. She independently made those decisions.

Dr. Michael Dinh and Dr. Jesus Lozano, were two anesthesiologists whom Chacon contacted by phone for advice after Espinoza’s cardiac arrest. When prosecutors interviewed Dr. Dinh, they were told that a registered nurse is not allowed to pick and choose the drugs and dosages and administer them to a patient. They can only act upon a physician’s orders that are tailored to the specific patient’s needs.

Investigators noted that videos taken by Chacon during Espinoza’s surgery showed that Chacon used a sterile drape, which blocked Chacon’s view of what Heather Vass was doing during the surgery. And witness Zenia De Los Santos, who was in the surgical room during Espinoza’s procedure, stated Chacon was playing loud music during the procedure that made it difficult for anyone in the room to hear what the others were saying, or to hear any auditory warnings from the surgical monitor.

Prosecutors say Chacon did not call 911 until 3 hours after Espinoza’s heart stopped. During that time, Vass was using the Ambu bag to assist Espinoza with her breathing. She never regained consciousness.

Coworker, Zenia De Los Santos, described ineffective efforts at resuscitation, and about feeling overwhelmed and abandoned by Chacon who left the operating room for prolonged periods of time during the three hour resuscitation effort. She claims she and her coworkers were told by Chacon not to call 911 until instructed to do so. De Los Santos also told investigators that finally at 5:00 the office was ready to close, and about 30 minutes later, after everyone was gone, the ambulance arrived. By then, it was much too late to save her.

Chacon allegedly saw at least four other patients in the hours after Espinoza’s cardiac arrest but before he called 911 at 5:24 p.m. and was described as acting “robotic” during that time-frame – “as if he wasn’t concerned,” as the warrant put it. Nor did he tell Megan Espinoza’s husband about her condition until 5:41 p.m., documents alleged.

The warrant concluded that Chacon had displayed the kind of deliberate inaction with conscious disregard for human life required for a charge of second-degree murder committed with implied malice.

His criminal defense attorney Marc Carlos told a local news station that the charges against Chacon are unsupportable.

In December 2022, KGTV reported that Megan’s family had reached a settlement in a lawsuit against Chacon.