State Probe of Doctor in Liposuction Death Assailed
A Lynwood obstetrician whom the state calls a danger to patients has been allowed to continue practicing for nearly a year after one woman bled to death and two others endured life-threatening injuries after cosmetic liposuction procedures, records and interviews show.
Last June, Dr. Patrick Chavis allegedly left one groggy liposuction patient with a nurse in his office to check on another one--bedridden, blood-soaked and unattended--at his Compton home, according to an emergency petition by the California Medical Board to suspend the doctor’s license. The patient in the office ultimately died from massive blood loss.
The case has patient advocates lashing out at the state for what they consider an unacceptably slow response to such serious allegations. And it has jolted many in the medical community who fear that too many doctors without specialized training are flocking to the field of cosmetic surgery, and to liposuction in particular, in search of hefty, upfront cash payments. Insurers generally do not cover liposuction, so patients often pay in cash.
“I think the problem is increasing because we are seeing and hearing of more and more [surgical] complications,” said Dr. Ronald E. Iverson, president of the American Society of Plastic and Reconstructive Surgeons, who was not commenting specifically on the Chavis case. “Partly a result of managed care cutting back on reimbursements, people are looking at plastic surgery as a way to get cash and income.”
Nonspecialists, of course, are not the only ones who run into trouble in cosmetic surgery. The state’s suspension petition in the Chavis case comes about a month after a plastic surgeon in Orange County, Dr. W. Earle Matory Jr., was accused by the state of gross negligence in the death of a patient subjected to nearly 11 hours of liposuction surgery. In that case, the medical board won a suspension of the doctor’s license within two months of the March death.
Consumer advocates and the malpractice attorney involved in the Chavis case are troubled at the slower pace of the Los Angeles County investigation. Why, they ask, would the board take longer to act against a non-plastic surgeon with multiple alleged victims than against a trained specialist with one?
“These [Chavis cases] are so egregious you’d think the board would have jumped on them,” said attorney Colleen M. Newkirk of Los Angeles, who is representing the dead woman’s family and a patient allegedly injured during a procedure in May 1996. “I don’t understand what accounts for the delays.”
Chavis did not return calls this week to his Lynwood business, New Attitude Body Sculpting. But attorney Michael D. Gonzalez, who is defending Chavis in malpractice lawsuits arising from the alleged incidents, said “they are inflammatory [accusations]. . . . I look forward to defending the doctor.”
Newkirk said the state’s pace is especially alarming given a psychiatrist’s sworn declaration last month that the doctor’s behavior suggests a “[mental] impairment which poses a danger to his patients.”
Dr. Howard Dolinsky said in a statement filed with the state’s petition that Chavis demonstrated poor impulse control and insensitivity to patients’ pain. He cited a tape recording of “horrific screaming” by patients in Chavis’ office that indicated the doctor responded by telling the patients, “Don’t talk to the doctor while he is working” and “Liar, liar, pants on fire.”
A medical board investigator said in a sworn statement that she had a brief interview with Chavis that was “one of the strangest I have ever witnessed” because the doctor insisted on knowing whether the interviewers were Catholic and thus biased against him.
Chavis’ personal life may have been complicated by financial pressures, Newkirk said. Chavis filed for Chapter 7 bankruptcy in March, court records show. He also fell behind in child support payments this year, and, as a result, his physician’s license was suspended for almost three weeks in April, according to the state Department of Consumer Affairs.
Asked why, under the circumstances, the Chavis case has taken so long to prepare, medical board spokeswoman Candis Cohen said that complicated cases with more than one victim are more time-consuming.
Deputy Atty. Gen. Richard Avila added that the Chavis case had some uncommon “wrinkles,” including the fact that it took the state until January to find an expert witness qualified to review medical records pertaining to the form of liposuction Chavis used.
Also, records show that the state did not receive documentation of a hospital investigation of Chavis’ cases until January, although the hospital, St. Francis Medical Center, notified the state in August of its suspension of Chavis for “deficient professional performance and judgment.”
Newkirk complained about the state allowing Chavis to practice in the two weeks before his suspension hearing, but Avila, the deputy attorney general, said he wanted to give the judge time to review the complex and voluminous records involved.
The circumstances of the Chavis case are indeed elaborate.
According to the medical board petition and exhibits, Chavis’ troubles began in May 1996, when he performed a simple liposuction surgery on Yolanda Mukhalian at the Westwood Surgery Center. After the surgery, the woman was vomiting and had blood running down her pants legs, and Chavis took her to his home to recover for a few days in a spare bed, the petition states.
After nearly a month of complications, she was admitted for emergency hospital treatment, having lost 70% of her blood volume and having developed a severe abdominal infection that did not heal until September, the petition states.
On June 21, the state alleges, Chavis did the same surgery--which involves injecting fluid into fatty areas to allow extraction of the fat through suction--on another patient. Just hours after going home, the woman, bleeding through gauze wrappings onto her bed and floor, fainted. Her sister took her to a hospital emergency room.
Chavis later discharged the patient and took her, along with her IV and catheter, to his own home, the petition contends. Hours afterward, he allegedly left her in the care of his 19-year-old niece in order to return to his office and operate on a third patient.
Tammaria Cotton, 43, a Los Angeles deputy court clerk and avid walker, wanted to trim the fat from her stomach, hips and thighs, her husband, Jimmy Cotton, said. She came to Chavis on the recommendation of her hairdresser. By the morning of her June 22 surgery, she was nervous, Jimmy Cotton said, asking Chavis’ nurse only half-jokingly if the doctor would be upset if she changed her mind.
After the surgery, the petition states, the patient complained of difficulty breathing, gagged on water, moaned and appeared groggy; “reddish fluid” leaked from her bed.
Late that afternoon, several hours after the surgery was finished, Chavis left Cotton in the care of his nurse and went home to check on the patient at his house, who had been left alone by his niece, the petition states.
By 6:15 that evening, Tammaria Cotton was in full cardiac arrest, the records state. She died later at a hospital.
Jimmy Cotton, a school police officer who breaks down when he recalls that night, said he went from frantic to stunned. He said he couldn’t help muttering to himself and everyone else, “But it was just liposuction.”
Liposuction, experts caution, is still surgery, and, though generally safe, carries risks. Patients should check doctors’ credentials and training, even call hospitals where they work to make sure they are authorized to do liposuction at such facilities, where they are subject to peer scrutiny.
Although many doctors seek specialized training, it may be no more than weekend seminars, and there is nothing in the law that requires additional training. Chavis is not board-certified in plastic surgery, but he did a four-day hands-on training course at the Liposuction Institute of Beverly Hills, an institute spokesman said. Chavis did not complete the second half of the program.
“Ob-gyns should not be performing liposuction or other procedures for which they are not adequately trained or qualified,” said Jamie Court, director of Consumers for Quality Care, a Los Angeles watchdog group.
Yet many doctors, including some expert cosmetic surgeons, see state regulation as unwarranted interference in the practice of medicine. Blurred boundaries among specialties, they say, can work to patients’ advantage.
The burden of checking out doctors, now and in the future, will fall mostly to the patient.
“Patients themselves need to help out . . . by discouraging fly-by-night operations,” said Dr. William Shaw, a plastic surgery professor at UCLA. “Some regulation may be fine. But no matter how you do it, some people can always get around it.”
