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In a letter to the American Board of Plastic Surgery, Hamm says the patient denied having diabetes in a written questionnaire before the surgery. He says he was not in the office the day of her first visit, so he did not order the first blood test and didn't see it until after the surgery. Feanny says Hamm paid for the woman's hospital stay and "essentially saved her life."
The state health board prosecutor alleged Hamm "failed to meet the standard of care" by clearing M.A. for surgery without ordering further blood tests, despite her "dangerously elevated glucose level."
Feanny disagrees. "If she states that she's completely healthy, it would not be the standard of care to order a blood test," he says.
After a lengthy, expensive battle against the charges, in 2009, Hamm was punished by the Florida medical board. He's permanently barred from performing major liposuction procedures (removing 1,000 cubic centimeters of fat or more). His license was suspended for a year, although the punishment was enforced for only three months. He was also given one year of probation and a $10,000 fine.
"He couldn't afford to fight," Feanny says. "Did he do anything wrong? Absolutely not."
In June 2008, a third patient died after surgery at Strax. The unidentified woman had a face-lift, neck lift, and eyelid tuck at the Lauderhill office. Dr. Paul Goldberg, her surgeon, also administered her anesthesia during the operation. While the patient was in the recovery room, her oxygen level dropped far below normal. Goldberg ordered a nurse to give the patient a drug that would counteract some of the powerful opiates he administered during surgery. The patient was discharged that afternoon, had dinner with her family, and went to sleep. The next morning, she was dead.
The medical examiner said she was killed by a toxic combination of drugs, including a "lethal level"of Dilaudid, a narcotic that had been given to her during surgery, according to a complaint filed with the Florida health department. The complaint alleged that Goldberg "failed to meet the standard of care" either by overdosing the patient and/or "failing to diagnose that the patient was overdosed on narcotics and allowing her to be discharged before this condition was alleviated."
Woulfe, who also represents Goldberg, wrote a letter to the Florida health department investigator contesting the allegation. He said the amount of Dilaudid that Goldberg gave the patient during surgery was "appropriate" and that she must have taken more after she went home. There is "no other medical explanation" for her having a lethal dose in her system nearly 12 hours after the surgery, he wrote.
If the woman was able to go home, have dinner, and go to bed, she could not have been overdosed during surgery, Feanny adds. He says her family must have "overmedicated her."
Goldberg no longer works at Strax. Feanny says he left on good terms and that it had nothing to do with the death. According to the Florida Department of Health, Goldberg now works at several local offices, including A Pain Clinic of Boca Raton and A Pain Clinic of West Palm Beach.
Feanny adamantly dismisses all the criticism of Strax, saying other doctors resent Strax for lowering prices in the industry. He has sued people for spreading negative information about Strax on blogs.
"We're under more scrutiny than other people," he says.
This May, a fourth patient died after surgery at Strax. Rony Wendrow, 61, sister of Broward County Commissioner Ilene Lieberman, was undergoing neck and eyelid surgery when she developed breathing and heart problems. She was transferred to Florida Medical Center and died three days later. Official reports on what caused her death have not been made public. Feanny says Wendrow's family asked him not to discuss the case, and Wendrow's son didn't return a call seeking comment. But the death raised more concerns about the mortality rate at Strax.
A 2008 study published in the medical journal Plastic and Reconstructive Surgery found the mortality rate for surgeries performed in outpatient facilities was two deaths for every 100,000 procedures. Strax has had four deaths in roughly 90,000 procedures, so its mortality rate is twice as high as the national rate. Feanny argues that two of the deaths — the woman who died eight days after surgery and the woman who died of a drug overdose — should not be included in the count. "There's an intervening event there," he says. But deaths from similar, postoperative circumstances were counted in the journal study.
One outside observer — Dr. Walter Sullivan, a Las Vegas physician and attorney who is a former chairman of the ethics commission of the American Society of Plastic Surgeons — says the high volume of surgery performed at outpatient facilities like Strax should not automatically cause concern. "There's no way to infer that there's anything questionable about them," he says. Complications, while rare, do occur, he says, and two or three deaths at a center that employs more than a dozen surgeons is "not necessarily indicative of anything."
But he did say that one plastic surgeon having four patients die in seven years is "worrisome." Although he did not know details of the Strax cases and was reluctant to say anything negative about physicians he had never met, he added, "I would hope the state [medical] board would take a very close look at this situation," referring to Gordon.