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Stamford Physician Called Into Question
Dr. Efraim Gomez-Zapata advertised himself as a pioneer in laser liposuction in the Hispanic community — at a discount rate, no less.
But state health officials say the Stamford doctor's cut-rate surgeries came at a steep price.
Twice in two years, patients had to be rushed to the hospital after suffering complications from procedures Gomez-Zapata may not have been qualified to perform, state health officials allege in disciplinary records reviewed by The Courant. In one case, Gomez-Zapata may have injected spinal anesthesia into the wrong part of a woman's back, leaving her in respiratory arrest.
And although Gomez-Zapata had a valid medical license, he didn't have the license necessary to operate a surgical facility. Nor did he have the appropriate staff, equipment, office setup and hospital privileges required in case something went wrong during surgery, state health officials allege.
The state Department of Public Health is pursuing disciplinary charges against Gomez-Zapata, accusing him of lacking the proper qualifications to administer anesthesia or perform procedures such as liposuction, scar revision and tummy tucks.
He's also accused of failing to obtain appropriate consent from patients, not keeping proper records and operating a surgical facility without the necessary state licensing or licensed staff.
The department has also ordered him to stop operating an outpatient surgical facility, which he agreed to do.
Through his attorney, Gomez-Zapata, of Stamford, has denied the allegations. His lawyer, John J. Evans, wrote to regulators that many of the specific qualifications they say he lacks are not required by law, and that Gomez-Zapata received training in managing anesthesia and in plastic surgery, including a five-day seminar in Colombia with "the inventor of liposuction."
Evans wrote that the complications patients experienced were not the result of Gomez-Zapata's work, which he described as detailed and impeccable.
The state Medical Examining Board is scheduled to hold a hearing on Gomez- Zapata's case on Friday.
The following week, a civil trial is slated to begin in a separate malpractice complaint against Gomez-Zapata, filed by a woman who says he botched a scar-revision procedure that left her with even larger scars that cannot be corrected. Through his attorney, Gomez-Zapata has denied those allegations.
Medical MishapsState health officials began investigating Gomez-Zapata after receiving a report from Stamford Hospital about a 35-year-old woman who was taken by ambulance to the emergency room from Gomez-Zapata's office.
On July 30, 2007, the woman, identified in state records as "M.S.," went to Gomez-Zapata's Stamford medical office for surgery. Although Gomez-Zapata specializes in family medicine, M.S., a native of Colombia, went to him for an abdominal liposuction, one of the "aesthetic procedures" Gomez-Zapata advertises on his website.
Gomez-Zapata, who also uses the name "Efrain Gomez," attended medical school in Spain and has been licensed to practice medicine in Connecticut since 1987. In a deposition, he estimated that 70 percent of his patients speak Spanish or Portuguese, according to an attorney suing him for malpractice in a separate case.
In M.S.' case, trouble started before Gomez-Zapata could even begin the liposuction, state records show.
He gave M.S. the painkiller Nubain intravenously, the anxiety drug Alprazolam by mouth, and administered local anesthesia to her abdomen.
She began having a seizure.
Someone called 911. EMTs found M.S. lying on an air mattress on the exam table, with a person one described as a "terrified young girl" holding her down.
The first seizure lasted seven minutes. She had another seizure after that.
M.S. had to be carried out of the office by hand because space in the room was so tight, records say. One EMT told investigators that the office's size and configuration made him think it was a dentist's office, not an operating suite. A paramedic said there was no ventilator in the room.
M.S. was taken to Stamford Hospital, where she was admitted to the intensive care unit. She was sent home the next day.
To find out more, investigators requested run reports from Stamford EMS for other calls from Gomez-Zapata's office.
They learned that nearly two years earlier, a 47-year-old woman in Gomez-Zapata's office for liposuction complained of numbness, tingling and shortness of breath after she was given anesthesia. By the time paramedics got there, she was in respiratory arrest.
The EMS report indicated that Gomez-Zapata tried to intubate her, but had not succeeded. A paramedic who responded to the call said the office had no ventilator or advanced life support equipment.
Dr. Patrick Felice, a Bloomfield plastic surgeon who consulted on the case for the state, wrote that the complications suggest that Gomez-Zapata missed the proper part of her body when he administered the spinal anesthesia.
Regulators also cited a third case involving a 43-year-old woman who received liposuction. Though there were apparently no problems during the procedure, Felice took issue with the large amount of tissue that Gomez-Zapata removed and the amount of time it took.
Felice questioned why Gomez-Zapata's records said the procedure lasted 7.5 hours — including three hours in which the patient was apparently not monitored — with a three-hour recovery time. A board-certified plastic surgeon could do the procedure in one to 1.5 hours, Felice wrote, with only 45 to 60 minutes needed for recovery.
Qualifications QuestionedFrom those episodes, state regulators and Felice raised a basic question: Should Gomez-Zapata have been performing plastic surgery or administering anesthesia at all?
The standard of care for performing surgery on patients under sedation requires a licensed facility, an office accessible for emergency medical services and a doctor with privileges to admit a patient to a hospital, Felice wrote.
Gomez-Zapata did not meet any of those criteria, according to state records. The state also accused him of failing to employ licensed medical staff to manage patients recovering from anesthesia.
Felice wrote that he was particularly concerned about Gomez-Zapata's inability to respond to M.S.' seizure. Another consultant for the state, Dr. Adam Perrin, noted that Gomez-Zapata's inability to intubate patients "brings into question his training and ability in emergency procedure."
And the majority of Gomez-Zapata's surgical training came from foreign courses not recognized by American surgical societies, Perrin noted.
There's no law against physicians who are not plastic surgeons performing procedures like liposuction or Botox, though groups like the American Society of Plastic Surgeons recommend that patients seek out doctors with board certifi- cation and several years of training and experience in plastic surgery.
But the practice of doctors who are not plastic surgeons performing cosmetic surgery appears to be increasingly common, possibly as a way for doctors to make extra money on the side, a representative for the society said. Physicians can take short training programs, such as weekend courses, and obtain credentials in plastic surgery.
"It's completely legal," said Brian Hugins, senior public relations associate for the society. "Is the patient the safest? It's a question mark."
Similar issues were raised in a lawsuit against Gomez-Zapata filed in 2007 by Vania Rodrigues, a Bridgeport woman who went to him at the advice of her hairdresser to correct two scars on her thigh from being burned by an iron when she was a child in Brazil.
Instead of erasing the scars, the procedure gave Rodrigues two larger, darker and permanent scars that cause her pain, the lawsuit states.
The lawsuit accuses Gomez-Zapata of failing to document how the procedures were performed or whether he gave any post-operative instructions. He also did not tell Rodrigues the nature of the procedures, the risks they carried — including the risk of worse scarring — and any alternatives, the lawsuit alleges.
In fact, the lawsuit states, "Dr. Gomez and Ms. Rodrigues do not share a common language."
Charges DisputedGomez-Zapata's attorney has disputed those charges in written responses to the health department, and offered a different view: Gomez-Zapata's "competency and adequacy of his services are detailed and impeccable."
Evans wrote that Gomez-Zapata was not aware that he needed an outpatient surgical facility license, but that he was qualified to perform the procedures he did. And he wrote that Gomez-Zapata's office provided a crash cart with a defibrillator, and called the state's facts "simply erroneous."
To demonstrate Gomez-Zapata's training, Evans gave regulators copies of 15 certificates from training sessions and conferences in the Dominican Republic, Colombia, Venezuela and Michigan. The attorney, Evans, also submitted a certificate of membership from the American Academy of Aesthetic Medicine.
Many of the deficiencies state regulators identified — like not having board certification in particular specialties — are not requirements, Evans wrote in a letter to the health department official who sent him a letter outlining the allegations against Gomez-Zapata.
"The general tone of your letter implies that Dr. Gomez has failed to do many things that he is not required to do under the law," Evans wrote.
He also defended Gomez-Zapata's action in the specific cases regulators cited.
M.S., the woman who had a seizure on Gomez-Zapata's operating table, failed to tell him that she had had a seizure once before, Evans wrote.
"The resulting seizure experience by M.S. was therefore [caused] by her failure to fully appraise [Gomez-Zapata] of her medical history which [Gomez-Zapata] inquired about, and was in no way [caused] by [Gomez-Zapata]," Evans wrote.
Instead, Evans wrote, M.S. suffered a brain aneurysm, though Stamford Hospital records do not indicate that.
In the case of the woman who went into respiratory arrest, Gomez-Zapata wrote that the "respiratory difficulties" were caused by an allergy to Lidocaine that the woman did not disclose. Of the work Gomez-Zapata did do on her, Evans wrote, it was properly performed.
In Rodrigues' case, Evans wrote, there are no laws specifying what information must be included in a medical file, and no signed consent forms are required by law. And an attorney representing Gomez-Zapata in the malpractice case gave a preview of what he would testify to: that he performed a reasonable scar revision, documented the case with reasonable care, informed Rodrigues of the risks, and obtained informed consent.
Neither Gomez-Zapata nor Evans returned calls requesting comment.