Deaths from cosmetic surgery in Florida

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Cosmetic surgery claims three more lives in FloridaBy Fred Schulte Staff Writer Posted August 20 2002

Three people who turned to cosmetic surgery in the hopes it would restore fading youth have died since early July in Florida -- despite tough new office surgery safety standards state officials imposed to protect patients.The most recent case was that of Ralph DiGiovanni, 70, of Boynton Beach, a prominent Palm Beach County developer who died on Aug. 7, two days after surgery on his neck and stomach area, according to state records and interviews.

The operations were performed by Dr. Mark D. Schreiber, a Boynton Beach plastic surgeon who the state disciplined in 1998 after a patient of his died following lengthy office-based cosmetic surgery.The two other recent Florida deaths: Olga Myers, a Hollywood Realtor who was left in a coma after a facelift on July 29 and died less than a week later, and Delaney, 67. She died in Naples on July 2, at the start of a facelift, according to medical examiner records."We need to look at these cases and find out what went wrong," said Board of Medicine Chairman Dr. Zach Zachariah. "That is the only rational thing to do, to try and fix it."The cosmetic surgery death toll in Florida has spiked in a pattern chillingly similar to one that occurred two years ago, when four such patients died in less than six months.That cluster of deaths prompted the Florida Board of Medicine to order a three-month moratorium on office surgery statewide. When they lifted the ban in November 2000, the board unveiled tough new safety standards -- said to be among the nation's most stringent -- that board members predicted would prevent further loss of life.But the standards have not done so. Myers, who was 42 and had two children, suffered severe brain damage and a coma after the facelift and cosmetic eye surgery performed by Dr. Alton Ingram on July 29 at the Cosmetic Surgery Center at 3109 Stirling Road in Hollywood.While the Broward County Medical Examiner's Office has yet to determine the cause of her death, it has set up a panel of experts in anesthesia to determine what went wrong. Ingram, a board certified plastic surgeon, declined to comment.Explanations differDelaney died after anesthesiology problems at the start of a facelift by Dr. Jon F. Strohmeyer, an ear, nose and throat specialist and facial plastic surgeon."They were inducing anesthesia, and she had a problem breathing. They rushed her to the hospital, but they couldn't save her," said Britt, the Collier County Medical Examiner's Office chief investigator.Britt said Strohmeyer performed an emergency tracheostomy, which involves making an incision in a patient's airway, to help her breathe. That cut was cited as a cause of Delaney's death, according to the autopsy report.Perforation of the stomach area, an injury apparently caused by health workers in the emergency room at Naples Community Hospital as they tried to insert a breathing tube, contributed to her death, the autopsy found.Strohmeyer disputes the medical examiner's ruling. He said in an interview that the tracheostomy he did saved the patient's life and that the woman had "normal vital signs" when rescue workers took her to the hospital.Delaney's death, he said, was a rare and "catastrophic" reaction to the anesthesia used to put her asleep."This is the ultimate nightmare for a surgeon. It could have happened in any type of institution with any type of anesthesia," Strohmeyer said, adding his facility is licensed by the state, accredited as an ambulatory surgical care center and has much the same equipment available in a hospital."The fact is that patient safety is our number one priority," he said.Cleared for surgerySchreiber said DiGiovanni, the Palm Beach County developer, collapsed in the parking garage near his home about 10 a.m. on Aug. 7, two days after having the five-hour neck lift, hernia repair and some other stomach surgery. The patient, who was accompanied by a nurse from Schreiber's office, was on his way to see Schreiber for a follow-up appointment when he was stricken, the surgeon said.The nurse said DiGiovanni immediately turned dark blue and began vomiting after falling. Paramedics arrived within five minutes, according to a report of the incident filed with the state Department of Health. He was dead upon arrival at Bethesda Memorial Hospital, according to the report.Schreiber said DiGiovanni, who developed the Westchester Golf & Country Club in Boynton Beach, was in excellent physical condition for his age and had been cleared for the surgery by a cardiologist. "He didn't show any signs of being sick," Schreiber said. "He was getting into the car to come to the office when he fell down. It was a very sudden event."Schreiber said he had not seen a report of an autopsy performed at the hospital but had been told that pneumonia was listed as the cause of his death. Schreiber expressed doubts about the finding. So did Barbara Dame, an expert in office surgery and risk management consultant retained by Schreiber."That doesn't sound right to me," she said. "There would have been signs and symptoms [of pneumonia]," such as coughing and trouble breathing, she said.DiGiovanni's son, Domenic M. DiGiovanni, said his father had just retired in January. While he wanted to look younger, he never would have consented to the procedures had he fully understood the possible risks, Domenic DiGiovanni said."If they had told him he could be dead from this, I'm sure he wouldn't have done it," he said.Safety in questionState regulators have debated the safety of office surgery since 1998, when the South Florida Sun-Sentinel first linked scores of deaths and disfiguring injuries to beauty-enhancing procedures. In all, the newspaper has documented 48 deaths across Florida since the mid-1980s, most of them in medical offices, after seemingly routine operations.Twenty-eight of those deaths have occurred since January 1997. All but seven had surgery in a medical office, such as liposuction, tummy tucks, in which loose fat is cut around the stomach area, and facelifts. Six were operated on in hospitals and one had a facelift performed in an outpatient surgical care center.The newspaper's investigation also revealed that state health officials were imposing almost no controls over what doctors did in their offices, unlike hospitals in which deaths and other poor outcomes can be the subject of peer review. Some cosmetic surgeons, for instance, routinely performed lengthy, sometimes 10-hour total body makeovers in their offices, even though medical authorities warned of the safety hazards they posed.The January 1998 death of Parish at Schreiber's Plastic Surgery Art Center in Boynton Beach fit the pattern.Parish, who was 51 and lived in Lantana, wanted to get rid of facial wrinkles, jowls and other signs of age on his face as well as suction out "love handles" around his waist and increase the size of his penis.After more than eight hours of surgery, Parish was supposed to spend the night recuperating in Schreiber's office. Shortly after 8 p.m. a nurse on duty at the office noticed that Schreiber was not breathing. Rescue workers took him to Bethesda Memorial Hospital, where he was pronounced death less than two hours later. An autopsy found that Parish died from an overdose of Fentanyl, a drug used in surgery as an anesthetic.Schreiber paid a $5,000 fine and accepted a one-year probation of his medical license in October 1998 to settle a Board of Medicine complaint alleging he provided substandard care to Parish. A lawsuit brought by the man's family was settled for more than $1 million in 1999. Florida Department of Insurance records list eight other malpractice judgments against Schreiber since 1993 for more than $1.4 million.Office surgery rulesThe Parish case and several other deaths documented by the newspaper helped persuade the board to tighten oversight of office surgery, including anesthesia services, which medical experts said could be a critical factor in the safety and outcome of surgery.After lifting the moratorium, the medical board limited the duration of office surgery to eight hours, limited multiple procedures involving liposuction and required patients who are at high risk of complications to have their surgery in a hospital.Some critics argue that the board didn't go far enough."Office surgery has a lot of room to become safer," said Dr. Jacque, a professor of anesthesiology at the University of Miami and president of the Florida Society of Anesthesiologists."At some point, the Board of Medicine has to step up to the plate and look at what's going on. They need to spot-check what is going on in these offices," he said.Fred Schulte can be reached at fschulte@... or 954-356-4591.

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