Surgeon Imprisoned for 1978 Death of Woman

Dr. Ralph J. W. Small, a Northridge physician, on Friday was ordered to prison for two years for the 1978 death of woman at his former cosmetic surgery clinic in Orange County.

Santa Monica Superior Court Judge Raymond Choate resentenced Small on a 1979 plea of no contest to involuntary manslaughter after ruling that Small had violated terms of his probation.

The case involved the death of Kim Plock, 33, of Santa Ana, a mother of three who went into a coma during surgery at Small’s office and died five days later of respiratory and cardiac arrest.

The probation terms called for Small, 37, to practice medicine only under the supervision of another doctor, but testimony at the six-day hearing brought out that he opened offices in Northridge and Newhall without supervising physicians.

Fainted, Hit Head

As a sheriff’s deputy prepared to usher Small from the courtroom to jail following the sentencing, the tall, broad-shouldered physician fainted and hit his head on the wooden defense table. He lay unconscious for two to three minutes while his family and friends screamed for help.

An unlicensed doctor from Brazil, who was in the hall, came to his assistance. When he regained consciousness, Small apparently could not remember his name or where he was. Paramedics took him to Santa Monica Hospital where he was treated and released.

When he gets out of jail, Small will not be able to practice medicine in California. Last month, the state Board of Medical Quality Assurance voted to revoke Small’s medical license effective Aug. 26.

The board concluded that Small failed to honor the probation conditions it set for him after it found the ear, nose and throat specialist guilty of gross negligence and incompetence in his treatment of Plock and numerous other patients.

Flourishing Practice

In Orange County, Small enjoyed a flourishing cosmetic surgery practice at a walk-in clinic in Santa Ana. Plock’s death following breast-enlargement surgery touched off an investigation of his practice that culminated in the Orange County district attorney charging him with 41 criminal counts, including murder, assault, unlawful practice of medicine, grand theft and false advertising.

In a controversial plea bargaining agreement, Small pleaded no contest to involuntary manslaughter, the other charges were dropped and he was placed on probation for five years.

The court adopted the medical board’s limits on Small’s practice. While on probation, he not only was to work under a supervising physician, but also was restricted to practicing ear, nose and throat medicine.

Latest Day in Court

After agreeing to the rules, Small in 1981 left Orange County and began practicing at the Lake View Medical Center in Lake View Terrace.

Small’s latest day in court was prompted by the medical board’s discovery last year that he also had been operating an office in Newhall without its knowledge since 1982. Small also opened an office in a Northridge bungalow in 1984.

In addition, he advertised in the Yellow Pages for medical specialties--plastic and reconstructive surgery, pediatrics and dermatology--which he had been forbidden to practice, the board said.

During the just-completed Superior Court hearing and the previous medical board hearing, prosecutors portrayed Small as a brilliant, ambitious physician who refused to obey the probationary terms. They said the limits on Small’s practice were necessary to prevent other tragedies in his office.

Probation Violation Case

Brent Romney, one of the Orange County prosecutors in the involuntary manslaughter case, was deputized as a Los Angeles deputy district attorney to handle the probation violation case. Commenting after the judge resentenced Small to jail on the involuntary manslaughter plea, Romney said: “That should have been the sentence seven years ago.

“When you look back at the offense and see how through his gross negligence he caused the death of the mother of three children, it seems completely proportional.”

Small’s attorney, Richard Guluzza, asked the judge for leniency for Small, who graduated first in his class at MIT and who was one of the youngest students ever accepted into Johns Hopkins University School of Medicine.

‘A Man of This Caliber’

“State prison is no place for a man of this caliber,” Guluzza said.

Small has maintained that he has been a victim of the medical board’s incompetence. Small testified that he tried to observe the terms of his probation but that board officials in Los Angeles provided him with conflicting and confusing advice on how to do that.

Small said he believed physicians at Lake View Medical Center could supervise his work at his private offices by telephone. Board officials, however, said they required Small to have a supervising physician in his office.

Small also testified that he told board officials about his Newhall office, but that they must have forgotten.