Surgeon in Fatal Liposuction Case Defends Actions

Irvine plastic surgeon W. Earle Matory Jr. testified Monday that he will never again perform large-volume liposuction, after seeing his patient Judy Fernandez die following 10 1/2 hours of surgery.

“This was without question a big operation,” Matory testified at a hearing to determine whether he is to be stripped of his medical license by the California Medical Board. Such extensive operations have been well tolerated by many of his other patients, he said. “But it may have been too big for Judy.”

While he does not know “100%” what caused Fernandez’s death, he said he wonders every day “what I could have done so that Judy would be sitting here today.”

“I will not do this type of thing to another patient. . . . I would feel comfortable [performing] liposuction, but on a smaller scale.”

Matory also said he never would have performed such extensive procedures on Fernandez if he had known she had a history of heart and circulatory problems. Still, he testified, “Judy Fernandez was a patient in my care. I have to accept responsibility for her death.”

The Medical Board has accused Matory and anesthesiologist Robert Hoo of negligence in connection with Fernandez’s death. The two are banned from practicing medicine pending the outcome of the administrative law trial, which continues today with cross-examination by the state’s attorneys.

Fernandez, 44, died March 17 at Irvine Medical Center, where she was transported by paramedics after undergoing liposuction, a brow and mini-face lift and laser resurfacing of her skin. Ten liters of “aspirant” (fat and fluids) were extracted from Fernandez during the liposuction. The procedures were performed under general anesthesia, from which she never regained consciousness.

An Orange County coroner’s official has testified that Fernandez died of blood loss and dilution of her blood, with lidocaine toxicity as a secondary cause. Lidocaine is used in liposuction, and also was administered in the hospital emergency room.

But the defense has countered that Fernandez died when a shower of fat cells clogged circulation to vital organs. The condition was aggravated by pulmonary hypertension and heart problems, possibly brought on by Fernandez’s prior use of the now-banned diet drug cocktail known as fen-phen, defense witnesses have testified.

Matory, a Yale graduate who earned his medical degree at Howard University and trained at a Harvard University-affiliated hospital, said he has performed 2,800 liposuction procedures, 120 of them large-volume.

During Monday’s testimony, Matory gave a step-by-step description of liposuction procedures, at times showing Administrative Law Judge Vincent Nafarrete the machine, tubing, syringes and thin, foot-long metal tubes that are used to infuse the body with tumescent solution and then extract the fat and liquid. He described events in chronological order, explaining how he how performed the brow and mini-face lifts and the laser resurfacing after the liposuction was done. He began about 7:30 a.m. and finished shortly after 6 p.m., he said.

During the entire surgery, he said, Fernandez was stable. The aspirant did not appear excessively bloody, he testified.

When he left the operating room about 6:20 p.m., there was no indication that Fernandez was in distress, he said. He discussed post-operative care with Ruben Fernandez, the patient’s husband, and was taking care of other business when the anesthesiologist informed him that Fernandez was slow to wake up, he testified.

The two doctors talked about the possibility of admitting Fernandez to the hospital as a precaution, but there appeared to be no imminent danger, the plastic surgeon said.

About 7:10 p.m., Hoo called him again, to say that hospital admission looked necessary, Matory testified. Shortly afterward, the operating room nurse appeared in Matory’s office, saying she was concerned about Fernandez’s condition, Matory testified. Matory said he went to the operating room a minute or two later and was alarmed to see that Fernandez had been positioned with her head down and feet elevated, a position used when a patient is in distress and needs to have more circulation to the heart.

Hoo was having trouble getting a blood pressure reading on Fernandez and had given her a drug to clear liquid from the lungs, Matory said. Matory said it appeared that Fernandez was hypovolemic--she needed more fluid in her circulatory system--and he began administering intravenously a drug that expands plasma, to increase the fluid in her veins. He also told his office manager to call Irvine Medical Center to arrange for Fernandez’s transfer. No 911 call was made then because “no one felt we were losing her,” he said.

A few minutes later, Matory was called to the telephone to talk to the emergency room physician who was expecting Fernandez. Then he started another bag of the plasma expander, but Fernandez was not getting any better, and the ambulance had not arrived, he said.

Shortly after 8 p.m., he told his staff to call 911. When the paramedics arrived, he said, he rode with Fernandez to the hospital.

“I saw nothing up to that point to think I would lose Judy,” he said. “She was a viable patient until we hit the ER.” He joined in what he called the “mammoth effort” to revive her at the hospital.

Her death was “very distressful,” he said.

“I retrospect every single day; is there something different I could have done to save Judy Fernandez?” he said. “To lose any patient is a loss. But losing Judy was a special loss because she was a special patient.”

Fernandez’s mother, Mary M. Blum, wiped away tears upon hearing the story of her daughter’s death, but she and other family members said outside the hearing afterward that Matory did not tell the truth. For example, they said, a private nurse who had been hired for the post-operative care had been alerted as early as 4 p.m. that Fernandez might need to be admitted to a hospital.

Ruben Fernandez said he was not told how ill his wife was until the paramedics arrived. If Matory had told him when the problems were first detected, he said, “I would have been in that [operating] room and called 911 right then and there.”