The name of the patient in this story was changed in order to protect her privacy.
FOLSOM, CA - Susan Thomas is a Folsom woman with a happy marriage and a house in the suburbs. Her family complete, pregnancies behind her, she was ready to get her bustline back. Lured by the promise of a quick and easy, in-office procedure, Thomas chose Dr. Efrain Gonzalez who has a cosmetic surgery practice in Rocklin and Sacramento.
Besides, she said, he offered her a discount on silicone implants and gave her a complimentary Botox shot at her consultation. With her husband along, she and the doctor made plans for her to get high-profile implants -- implants that sit high on the chest as opposed to being further apart.
The procedure seemed to take a long time and she grew concerned. "The surgery was taking a lot longer," Thomas said. "He said he had to remove some scar tissue.
I found it very odd about his office that he doesn't put you under. I was talking to him during the surgery. I woke up at one point with all this tugging, cramming, a heavy weight on my chest," Thomas said.
Thomas suspects all that tugging and cramming had something to do with Gonzalez inserting the wrong size implant because he had run out of her size.
"He knew, his staff knew, they didn't have the correct one that I wanted. They did not have high profile, so she (the assistant) just grabbed what they had. She admitted it to us," Thomas recalls.
"He told us he was removing tissue to take out scar tissue, but that was the only way he could make them fit. I basically looked like one big blob. The implants were touching, bulging to the point there was no cleavage. They were way too wide. And because he took out tissue, they were floating in air, uneven, very uneven and just bulging."
Later that night she and her husband took the bandages off.
"It was horrific. Completely deformed. Almost like one big mound on my chest but it was flat. My nipples were bleeding. They were oozing," she said.
Gonzalez felt she didn't follow his post-surgical instructions "I told her she had to wear a compress because I explained to her that the new capsule forms in four to six weeks. The next day she was complaining that her implants were too saggy," Gonzalez said.
"I told her, If you are not happy with the procedure, I will give you your money back," he said. "There are patients who are never going to be happy with what you do for them. This is a patient that I was trying to do pro bono. I tried to do it for under $5,000. Instead of being happy, she was angry. She didn't think I performed the procedure to her expectations," Gonzalez continued. "Any surgeon is going to have patients who are unhappy. You can't hit a home run every time you go to bat," said Gonzalez.
Thomas sought the advice of board-certified plastic surgeon, Terry Zimmerman, who was the first to tell her Gonzalez was not a plastic surgeon, but a gynecologist who left Puerto Rico after the medical board revoked his license in 2006 for practicing illegal medicine when he performed plastic surgeries without a board certification in the specialty. Court documents state he may have been responsible for the death of one of his patients.
"He put in an enormous implant, too large for her chest wall. Unfortunately it deformed the shape of her breasts and it required another surgery," said Zimmerman.
Following Puerto Rico's medical board decision, Gonzalez moved to California where he established a cosmetic surgery practice in Rocklin and Sacramento. There are no laws to prevent surgeons who are not certified in plastic surgery performing cosmetic procedures in their office, said Zimmerman.
Gonzalez sued the Medical Board of Puerto Rico on grounds their license suspension decision violated his constitutional rights. He lost the suit and then appealed on the same grounds. On Sept. 16, 2011 the U.S. Federal Court of Appeals for the First Circuit denied his appeal, upholding Puerto Rico's decision to grant authority to the medical board in matters pertaining to revoking or suspending doctor's licenses.
News10 contacted Dr. Melvin A. Shiffman, a medical doctor, prominent cosmetic surgeon and a lawyer to ask him about Dr. Gonzalez' case.
Shiffman received his M.D. from Northwestern University School of Medicine in 1957 and his J.D. from Western State University College of Law in 1976.
Shiffman has been practicing in the field of general surgery, oncologic surgery, reconstructive and cosmetic surgery over the past 40 years. He has been a medical legal consultant in medical malpractice, personal injury, and medical board problems since 1976. He has written more than 320 papers on cancer, cosmetic surgery, and medical legal problems and has been author or editor of at least eight books. He has been editor of several cosmetic surgery journals over the past 10 years.
When asked about Gonzalez he responded, "I am not interested in talking about anything in cosmetic surgery. Thank you."
On behalf Thomas, on Sept. 9, 2011, the Medical Board of filed an accusation calling for the board to revoke or suspend Gonzalez' license citing gross negligence, incompetence, dishonest or corrupt acts, failure to maintain adequate records, and unprofessional conduct. The complaint also seeks to revoke Gonzalez authority to supervise physician assistants.
"To me that was shocking. There has to be some sort of regulation. You are doing a surgery. You are cutting them open. You have to be qualified -- there has to be some sort of regulation," Thomas said.
"We are his guinea pigs. Basically he's using people to learn how to do the surgeries. There's no way if I knew he was not qualified, not trained, that I would let him perform surgery. No way," said Thomas.
Zimmerman and a host of board-certified plastic surgeons in the greater Sacramento area want to see regulations that would prohibit doctors without plastic-surgery-board certification from performing procedures outside their specialty.
Dr. Richard Clark pointed out that hospitals in California do not grant privileges to doctors to perform surgeries outside their scope and training. And he's calling on legislators to impose this standard on doctors for in-office procedures.
"In the privacy of their own office, doctors can perform any surgery they want without regulations. The sky is the limit as long as they don't use general anesthesia. No one sees their mistakes," said Johnson.
The "anything goes" mentality is creating a frenzy in the booming world of cosmetic surgery, said Clark. "It's like the wild west here -- a frontier. Nobody is in charge. It's similar to when there's a hurricane or a natural disaster and looting occurs. The lights are off. The sheriff's not in town. Let the looting begin," said Clark.
"A lot of people say it's a turf battle - that we are just trying to protect our turf. Indeed we are. If you can set up in your office and put up a billboard and do a procedure, you are basically learning by doing. So there's a learning curve involved and you are doing it on paying patients. It's not fair and safe to have the patient be the guinea pig in your practice. Our concern is if the family doctor or internist or gynecologist is doing your procedure, do they know how to take care of you?" said Johnson.
Johnson said although it makes sense to regulate plastic surgery, the group of doctors not certified who want a piece of the pie and are not board certified is much larger than the estimated 750 board-certified plastic surgeons in California. She fears lobbying efforts by these doctors would prevent such legislation because they stand to gain by performing cosmetic procedures in their offices.
"Sadly the only thing that might change this I if somebody dies. Deaths motivate people to change," said Zimmerman.
By Duffy Kelly, firstname.lastname@example.org