Physician Gets Prison for ’78 Surgery Death

Dr. Ralph J. W. Small, a Northridge physician, was ordered to prison for two years on Friday for the 1978 death of a woman at his former cosmetic-surgery clinic in Orange County. Kim Plock, a 33-year-old mother of three, died of respiratory and cardiac arrest during surgery.

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 a sentence of probation.

Small was supposed to practice medicine only under the supervision of another doctor, but testimony at a six-day hearing showed that he had opened offices in Northridge and Newhall without supervision.

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

Brazilian Doctor Helps

Finally, an unlicensed doctor from Brazil, who was in the hall, came to his assistance. When he awoke, Small could not remember his name or where he was. Paramedics took him to Santa Monica Hospital Medical Center where he was treated and released.

When he gets out of prison, the 37-year-old physician will be prohibited from practicing 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 other patients.

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

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

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

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.

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.

Board Cites Advertising

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

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 prison 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 Massachusetts Institute of Technology and who was one of the youngest students ever accepted into the Johns Hopkins University School of Medicine. “State prison is no place for a man of this caliber,” Guluzza said.

Calls Himself Victim

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.

“This is an example of the Board of Medical Quality Assurance’s complete bungling of a situation from the time this case left the Orange County office,” Guluzza said. “Dr. Small was led down the primrose path.”

Choate agreed that the board’s supervision of Small had not been ideal. But the judge said Small had broken the board’s rules when he “let his ambitions and lack of self-discipline take over.”