Cosmetic surgery clinic had other woes

BY DANIEL de VISE

ddevise@herald.com

Ronald Jones went in for an eyelid job so his new
glasses would fit better. Jeanette Mordica thought a
tummy tuck would succeed where diets had failed. Olga
Myers, a 42-year-old real estate agent, sought a
younger face.

All three died after treatments at the Cosmetic
Surgery Center in Hollywood.

The Stirling Road clinic and its director, Dr. Richard
Edison, loom large in South Florida's
ultra-competitive plastic surgery community, where
practitioners vie for business in full-page newspaper
ads, late-night television pitches and in-your-face
Internet sites.

Now, Edison and his practice are at the center of a
different sort of media blitz -- over Myers, who
lapsed into a coma and died after a July 29 facelift
at the center.

Edison has publicly distanced himself from that death
and has parted ways with Dr. Alton Ingram, the surgeon
who operated on Myers.

But Edison and the clinic have had other problems. The
Florida Board of Medicine reprimanded the doctor in
1995 for leaving a sponge inside a woman's breast. And
a 2000 lawsuit accused him of conducting a major
surgical procedure without the aid of either an
anesthesiologist or a nurse with anesthetic training.

Clinics such as Edison's, which attempt complicated
surgical procedures inside office buildings or strip
malls, are the subject of debate within the health
care industry -- largely because of the dangers
surrounding anesthesia.

SURGERY RULES

State regulations require that ''qualified anesthesia
personnel'' be on hand during any surgery requiring
deep sedation.

But language in the regulations gives doctors
considerable leeway in obeying that rule.

A doctor's report released Friday by state regulators
indicates that no anesthesiologist or trained nurse
anesthetist was present during Myers' surgery.

That scenario echoes allegations made by relatives of
Jones, a former railroad worker who stopped breathing
midway through a 1997 procedure while under heavy
sedation.

''The other day was his birthday, and it's just too
much,'' said his mother, Rose LaVallee. ``He was my
only child, and I came down to Florida to be with him.
And now my husband and I are here by ourselves.''

Asked last week to comment, Edison replied in writing:
``We will be in contact with you next week.''

Three deaths at a single clinic in a five-year span is
''unusual'' in an industry that prides itself on a
fatality rate of about one patient in 50,000, said Dr.
Ed Luce, president of the American Society of Plastic
Surgeons and chief of plastic surgery at University
Hospital of Cleveland.

But blame is hard to assign. Each of the deaths at the
Stirling Road clinic involved a different doctor. In
one case, a jury concluded the doctor was not at
fault.

The clinic presents patient testimonials and
before-and-after photographs on its Web site, which
greets visitors with dancing words that dissolve into
an enormous pair of breasts.

TESTIMONIALS

Broward court records reveal a different list of
testimonials:

• Diane Grande collected $400,000 in 1992 after Edison
left a surgical sponge inside her breast.

''He actually insinuated that I put this sponge inside
of me,'' Grande said. ``He is an unbelievable human
being. He deserves to be crushed like a bug.''

The Florida Medical Board fined Edison $2,000 and
faulted the doctor for keeping count of surgical
sponges ``in his head.''

• Tina Marshall reaped a $297,500 malpractice
settlement in 1996 over complications caused,
according to her attorney, by breast implants too
large for her body.

''They really forced these implants into a space that
couldn't really accommodate them,'' attorney Maria
Luisa Rubio said. ``They were literally forcing her
body off the table, trying to squeeze these implants
in.''

Had the case gone to trial, Rubio said she would have
treated Edison ``much more as a businessman than as a
surgeon.''

''You see his Yellow Pages ads. He's on TV all the
time. When I see him, I can't help but smile. His
telephone number ends in F-A-C-E,'' Rubio said.

• Jeanette Mordica was ashamed to tell her husband she
was going for cosmetic surgery in March 1997, so she
said she was spending the night with some old sorority
pals. Mordica went into cardiac arrest the next
morning in a recovery room.

'I had just gone out to wash the car, and my daughter
rushed out to the garage and said, `You've got to get
to the hospital, something's happened to Mom,' '' said
Bernard Mordica, Jeanette's husband.

Mordica died of a blood clot in her lungs. A civil
jury found that Edison was not responsible for
Mordica's death, her husband said.

After a string of highly publicized deaths across
Florida in the late 1990s, state regulators ordered a
three-month moratorium on office surgery.

Lifting the ban in November 2000, the Florida Board of
Medicine enacted a new set of standards to govern
surgery performed in doctors' offices.

The new standards limit office surgeries to eight
hours, cap how much fat can be liposuctioned out in an
office setting and call for stricter monitoring of
anesthesia.

But state regulators have not policed plastic surgeons
effectively, experts say, and doctors have found ways
around the new regulations.

''If they were abiding by the rules, Myers would be
alive and the patient in Naples would be alive,'' said
one prominent South Florida doctor, who asked not to
be quoted by name.

``We've got a board that has this rule. They are not
enforcing it. Patients are continuing to die.''

The Naples patient, Maria Delaney, died July 2 after
anesthesia complications at the start of a facelift at
another facility.

RECENT DEATHS

Delaney's death was one of three recent fatalities at
separate Florida facilities that have reawakened
debate on the safety of cosmetic surgery.

New safety regulations divide surgical procedures into
three ''levels'' according to the depth of anesthesia.

The rules are strictest at Level 3, the deepest
sedation.

However, experts say some doctors get around the
tougher standards by treating a surgical procedure as
Level 2 when it ought to be carried out as a Level 3
procedure.

The result is ''a perilous state'' for the patient,
said Dr. Brian Boyd, chairman of plastic surgery at
the Cleveland Clinic in Weston.

Many plastic surgeons who operate outside hospitals do
not employ anesthesiologists, choosing instead to rely
upon specially trained nurse anesthetists.

Some surgeons forgo the trained nurses and essentially
supervise the anesthesia process themselves.

''I wouldn't like to be treated under those
conditions,'' Boyd said.

A lawsuit filed against Edison and the Cosmetic
Surgery Center by the family of Ronald Jones in 2000
includes a sworn affidavit from Dr. Joseph Boolbol of
Miami, an expert witness.

Boolbol wrote in the affidavit: ''It appears from the
reports that this patient was not being monitored by
an anesthesiologist or a certified registered nurse
anesthetist'' during surgery.

Edison's response is not preserved in the court file,
and relatives say they are forbidden to discuss the
details because of a confidentiality agreement.

A newly released doctor's report on the August death
of Myers hints at possible similarities to the Jones
case.

In a three-page ''Adverse Incident Report'' to state
officials, Ingram lists two registered nurses on hand
for the surgery, neither one an anesthetist.

Ingram, contacted Thursday on his cellular phone,
stated: ``I'm not interested at all in speaking with
you, but thank you for the call.''

Plastic Surgery Nightmare
By Carolyn Clifford
Web produced by Jenny Clark
February 8, 2005

Plastic surgery shows are feeding the frenzy for
everything, from botox to facelifts. One woman who
appeared on a reality show, however, found her
experience a real nightmare.

It’s been a year and a half since Liz Skirving’s claim
to fame as a reality show contestant, but Liz turned
out to be one of the more complicated cases. She had
chin and cheek implants, eyelid surgery, nose
reshaping, liposuction, fat injections in her lips,
LASIK eye surgery, and veneers on her teeth, all in
just 12 weeks.

She expected some pain and swelling, but not the many
infections that followed. After a second round of
corrective surgery, things were still not right.

She consulted with plastic surgeon Dr. Fred Aguilar,
and he performed Liz’s third and final surgery.

"She had pain, but no one knew why," Dr. Aguilar
remembers. "When I saw her, I realized that the cheek
implant had actually migrated into her lower eyelid.
It was halfway up her lower eyelid, and the chin
implant had migrated about 40 degrees from its correct
position as well."

The work done by the cosmetic dentist caused many of
the problems.

"He was having to pull to get into my mouth, which
shifted the implant up towards the eye," Liz says.
"When he drilled the veneers, he had to put his hand
under my chin to drill and it buckled the implant."

Dr. Rod Rohrich is the immediate past president of the
American Society of Plastic Surgeons. He says when it
comes to plastic surgery, patients are not doing their
homework.

"Cosmetic surgery has really become a buyer beware
specialty, because you really need to know before you
go," he explains.

Every year people have to undergo "redo" procedures
after poorly performed surgeries. Doctors say they are
twice as hard to do, and you rarely get the results
you hoped for.

Still, Liz has no regrets.

"For me what it did was give me the confidence to move
a bit forward, and I thought if I could survive that I
could survive anything," she says.

Here’s a basic checklist to go over before you go
under the knife:

CORONA DEL MAR, Calif., Aug. 7 /PRNewswire/ -- Olivia Goldsmith, author of The First Wives' Club, died having cosmetic surgery.
(Photo: http://www.newscom.com/cgi-bin/prnh/20070803/FRIEDBERG)

With a 446% increase in cosmetic procedures since 1997, the book written by Dr. Barry L. Friedberg, specialist in anesthesia for cosmetic surgery, Anesthesia in Cosmetic Surgery from Cambridge University Press, is a timely arrival. "Minimally invasive anesthesia (MIA) dramatically increases patient safety for cosmetic surgery. Much like the days before fathers were permitted to observe the birth of their children, the public needs to be empowered to ask for safer anesthesia!" says Dr. Friedberg

"All cosmetic surgery takes place on the superficial layers ('the wrapper') of the body. As such, all cosmetic surgery (even a 'tummy tuck') must be considered minimally invasive. Minimally invasive anesthesia (MIA) is only logical for minimally invasive surgery. Growing numbers of anesthesiologists are beginning to share this view but public safety demands that more need to be asked to provide MIA for cosmetic surgery," says Dr. Friedberg.

According to Friedberg, the use of a level of consciousness monitor like the bispectral index (BIS) is fundamental to the administration of MIA. Prior to BIS monitoring, anesthesiologists were obliged to guess at the correct dosage and, for fear of under-medicating, routinely overmedicated by a factor of at least 20-30%.

Anesthesia was the art of the "controlled
over-dose." The advent of BIS monitoring has now made that style of anesthesia practice unnecessary and potentially dangerous according to recent research by Monk and Sebel.

BIS provides a number between 0-100 derived from information obtained from the sensor on the patient's forehead. The lower the number, the deeper the level of consciousness, sleep or "hypnosis," as it is known in the anesthesia profession.

General anesthesia sleep levels occur between 45-60. The patient doesn't hear, feel, or remember their surgery with general anesthesia. The same experience can be had with intravenous propofol at BIS between 60-75, a level Friedberg has incorporated as an integral part of MIA.

For greater patient safety, Dr. Friedberg deems BIS monitoring a standard of care, especially for cosmetic surgery.

Disclaimer: Dr. Friedberg is not employed by Aspect Medical Systems, makers of the BIS monitor. He is not a stockholder or a paid consultant. The opinions expressed herein are his professional opinion based on 10 years experience with BIS monitoring for cosmetic surgery.