A few hours before dawn on April 1, 1998, police found a disoriented woman lying on the sidewalk outside a Fort Lauderdale medical office. Bandaged, bleeding and still attached to a catheter and heart monitor, she was suffering from seizures brought on by an overdose of anesthetic given during liposuction. The woman had stayed overnight in a doctor's office to recover from surgery. She awoke in the middle of the night gasping for breath and panicked when nobody answered her screams for help.
Thinking she would die if she didn't get help, she crawled out to the street and collapsed. She spent five days in a hospital intensive care unit recovering. I got a tip about the woman's ordeal from a source who said many poorly trained doctors did lengthy cosmetic operations — sometimes eight hours or more — in their offices and then let patients stay overnight to recuperate. This wasn't the first disaster, the source said.
Identifying Victims The source was right. Courthouse records showed the surgeon whose patient had ended up on the sidewalk had nearly a dozen malpractice suits filed against him in just two years of practice in Fort Lauderdale. There were women who alleged they had been scarred horribly by botched breast-implant surgery and several people who couldn't close an eye or move their faces fully after a face lift.
I decided to sample other plastic surgeons who advertised in our newspaper or in the Yellow Pages; many of them also had high numbers of malpractice suits. (Florida health officials consider three or more claims in a five-year period to be a red flag.) Next stop: Florida's Board of Medicine, which disciplines doctors and can be searched online. Some of the doctors in my sample also had been disciplined, in a few cases more than once, by the state medical board.
But it was the early interviews with several plastic surgeons that persuaded me to pursue this as a major project. I had never heard so many doctors so critical of their colleagues. They spoke openly about the need for tighter state regulation of office surgery and criticized the state medical board for being too lenient in punishing incompetent surgeons. A couple of surgeons even said they knew of patients dying during what should have been routine cosmetic surgery.
Unfortunately, none of these doctors could, or would, provide any details such as patient names or dates of death. Local medical examiners weren't much help either; they said they had no way to check with the name and date of death. Senior writer Jenni Bergal and I began visiting morgues in South Florida and rummaging through thousands of cases by hand. One by one, we found deaths and began contacting families.
We also tried to track down police reports on patients who had died in their homes a day or two after surgery. Some of these provided additional details about the operations. By the time we published 'Cosmetic Surgery: The Hidden Dangers' in November 1998, we had confirmed 34 deaths in roughly the last 12 years. Thirteen of them occurred in 1997 and 1998. We have since documented five more deaths since 1997, bringing the total to 18.
Fatal Pattern The number of deaths stunned state regulators, medical examiners and even the gossip-prone plastic surgeons of South Florida. A troubling pattern emerged in fatal cases. Many patients had more than one cosmetic procedure that took eight or 10 hours to perform in a medical office — longer than a liver transplant takes in a hospital. The victims tended to be in late middle age, were overweight or had chronic medical conditions that made them questionable candidates for such operations.
About half of those who had died since 1997 were men older than 50 even though women account for the vast majority of cosmetic operations in the state. Finding Fault Still, we needed to keep the deaths in perspective. Nobody knew exactly how many cosmetic operations were performed in Florida every year, though it seemed from industry statistics to be at least 77,000. Lacking any means to compute a death rate, we searched for data to bolster the case that some cosmetic surgeons were the problem.
We found the data in the Florida Department of Insurance closed-claims database, which listed all malpractice settlements paid by insurance companies. These claims include cases settled by insurance companies before any lawsuit is filed. The state insurance department charged us $150 for about 10 floppy disks, which we loaded into Access with the help of John Maines, our research center's database specialist.
The data included the doctor's name, location, specialty, training, severity of the injury and the money paid to the patient. Sorting by 'plastic surgeons' gave us more than 1,100 cosmetic-surgery claims settled since 1990, including some deaths. Unfortunately, the database didn't explain the type of injury or how it occurred. We had to pay 15 cents per page for paper copies of a detailed narrative that had this information.
None of the documents included the patient names, which are confidential under state law. Still, we documented scores of injuries, ranging from permanent facial scars to grossly disfigured breasts after botched implant surgery. Many doctors with multiple claims against them (several had a dozen or more) we already knew from our search of Department of Medicine disciplinary files. I also used the insurance-claims data to create graphics.
For example, we published charts showing the severity of injuries, the average size of claims and the board-certification status of doctors with large numbers of malpractice claims. Board certification became important because plastic surgeons held that uncertified surgeons were injuring patients. In fact, the data showed that 80 percent of the injuries came at the hands of board-certified plastic surgeons.
Since our series, state officials have tightened oversight of office surgery. Florida's Board of Medicine banned overnight stays in medical offices and limited office surgery to six hours. The Florida Legislature also passed a bill that requires office-based surgeons to report deaths and serious injuries to the state.