Irma Saenz told family members she was going to Tijuana for the day. But she didn't tell them what for: The 51-year-old Downey resident had scheduled a liposuction procedure at a cosmetic surgery clinic.
Four days later, Saenz was in a coma when an ambulance brought her across the border, her relatives said. She died on Nov. 11, nearly two weeks later, at Sharp Chula Vista Medical Center, after her family made the decision to take her off life support.
"We want to know what really happened," said her niece, Nora Saenz, who said distraught relatives were misled about what was happening as her aunt lay in a coma in an intensive care bed at a Tijuana hospital. "We don't want another family going through what we went through."
The incident has drawn scrutiny to the clinic where the surgery took place, Embellecete Aesthetic Surgery Group, and the clinic's director, Dr. Guillermo Diaz Vergara, who reportedly performed the procedure. Diaz Vergara does not appear to have training as a plastic surgeon, and leaders of Tijuana's medical community are questioning his qualifications.
"The only ones who can perform liposuction are plastic surgeons who have obtained a diploma in the specialty," said Dr. Javier García, the head of Baja California state's association of plastic surgeons. Díaz Vergara is not a member.
Díaz Vergara did not respond to telephone calls to his clinic's offices in Tijuana and Ensenada.
Saenz's death comes as Baja California authorities have been striving to showcase their state as a high-quality medical tourism destination that features top-notch facilities and highly trained doctors at lower costs on a wide range of procedures.
"The problem is that many times patients don't want to pay for a plastic surgeon, and they go to a cosmetologist, who often does a very poor job," said Dr. Enrique Schulz, president of the Medical College of Tijuana, the main medical association in the city. "These cosmetologists survive because there is a market for them."
Figures from Baja California's Tourism Secretariat show some 2.4 million patient crossings in 2016 generating revenues of close to $800 million, with Tijuana the state's most important destination.
Saenz was the primary caregiver for her 99-year-old mother, who is in the early stages of dementia, said Nora, her niece. She loved her family and had a soft spot for stray animals, the niece said. And she wanted to lose weight.
"My aunt was the one who was always worried about dieting," Nora Saenz said. "In my opinion, she didn't need the procedure she went to get."
Liposuction is a common cosmetic surgery that involves suctioning off fat deposits from different parts of the body. Like any surgery, it has risks, and complications can in rare cases result in death.
Statistics on overall mortality in plastic surgery procedures are difficult to obtain on both sides of the border. In the United States, there is no single national source that shows all medical complications that occur during plastic surgeries, said Dr. Robert Singer, a well known La Jolla plastic surgeon. Only 27 of the 50 states require plastic surgery centers to be accredited, which includes inspection and the obligation to report all complications to a central database.
Singer is co-author of a 2013 study analyzing 5.5 million plastic surgery procedures performed on 3.9 million patients in the United States from 2001 to 2012. It showed 94 deaths. That placed the risk of at one in 41,726, but Singer points out that the report looked only at those cases reported by clinics certified by the American Assn. for Accreditation of Ambulatory Surgery.
Saenz opted for Tijuana "because she didn't have the financial means to get that procedure done here," said her niece. Family members believe Saenz learned of the clinic through Facebook groups. They say she contacted an intermediary who collected Saenz's deposit, set up an appointment with Embellecete, and arranged for an Uber to pick her up in Downey and drive her to Tijuana on Oct. 27.
Saenz gave the driver an ex-boyfriend's phone number in case something happened to her. When the driver went to pick her up later that day, he was told she was in a coma, so he called the number, family members said.
Saenz's relatives rushed down the next day, Oct. 28. By that time, Saenz had been transferred to Hospital Arcangeles, an 18-bed clinic with an intensive care area. A cousin who was briefly allowed into the room said Saenz's face was swollen and almost beyond recognition.
"I asked one of the nurses and she said, 'it's very tragic, it's very severe," said her nephew David Reynoso. He said the physician offered reassurances that Saenz would come out of the coma.
The hospital's director, Dr. Joaquín Merlos, said he argued against moving Saenz, but family members insisted, and on Oct. 30, she was moved across the border. "It was a bad decision, the patient was improving," Merlos said in an interview.
But Saenz's relatives said they received a different story from doctors at Sharp Chula Vista. "They told us the damage my aunt suffered was irreversible," said Nora Saenz. "As of Saturday, my aunt had already suffered brain damage."
It was not possible to verify the family's version with Sharp Chula Vista by Friday. Results of an autopsy by the San Diego Medical Examiner's Office were pending.
Diaz Vergara is neither a member of the Medical College of Tijuana nor of the plastic surgeons group, both voluntary organizations that require that members are properly certified.
García, head of the plastic surgeons' group, said state law in Baja California since 2014 has stipulated that only certified plastic surgeons can perform liposuction and a range of other cosmetic procedures.
It appears that Diaz Vergara is not a plastic surgeon. His academic training includes a medical degree obtained in 2006 from the Autonomous University of Sinaloa, according to Mexico's National Register of Professions. In 2012, he obtained a master's degree in "esthetic surgery."
Baja California health authorities are aware of Saenz's death, according to a statement issued this week.
Inspectors are visiting "the medical facilities involved in this case," ensuring that they are up to legal standards, the statement said. The authorities are also "inquiring as to whether the doctor who performed the procedure" was in compliance with health laws.
Dibble writes for the San Diego Union-Tribune.
Union-Tribune staff writer Paul Sisson and researcher Merrie Monteagudo contributed to this report.