Deaths at Strax raise questions about the safety of cheap plastic surgery
UPDATE: Strax Rejuvenation responded on its website after publication of this story and insisted discount prices do not translate to a lower standard of care. In March 2012 a 50-year-old grandmother named Idell Frazer became the fifth Strax patient to die in eight years. The doctor in that operation was John Nees, whose medical license had been suspended repeatedly. In April 2012 New Times Broward-Palm Beach reported that Strax CEO Jeffry Davis had a criminal record for financial crimes related to his former company.
For nearly 11 years, Osvaldo Vargas started his mornings by watching the woman he loved slip out of bed, drink Cuban coffee, and rummage through the closet for her favorite shoes. He felt her absence as soon as her skin was no longer next to his, when he could no longer glimpse the outline of her smile.
Vargas and his wife, Lidvian Zelaya, 35, had a life of simple routines. Zelaya was short, with soft curves and long tangles of dark hair. Originally from Nicaragua, she made a living selling watches at a store in Miami Beach. Vargas, 43, was gentle, with smooth, tan skin and a slight frame. He worked in construction, renovating hospitals and schools.
They met in 2000 through a friend, and Vargas was hooked immediately. Saturday nights, they went out to clubs, dancing salsa and merengue. Zelaya's hips moved deftly to the music; Vargas's hand was confident on the curve of her back. Sundays she asked him to cook for her — bistec and shrimp ceviche, a side of cocktails.
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On a Monday morning — December 27, 2010 — Zelaya wasn't quite herself. She woke up early, took a shower, and drank her coffee but wasn't hungry for breakfast. "She was nervous," Vargas remembers. "I told her to take it easy."
Zelaya's most coveted Christmas gift had been a plastic surgery procedure known as a "Brazilian butt lift," a transfer of fat from her stomach, back, and sides to her rear end. She and Vargas had saved $4,600 for her surgery, to be performed at Strax Rejuvenation and Aesthetics Institute in Lauderhill.
The couple, who did not have children, drove their decade-old Ford Expedition north through the quiet, predawn highways for the 7 a.m. appointment. Vargas tried to help his wife stay calm. Vargas, who is from Guatemala and struggles with English, didn't know why his five-foot-three, 130-pound wife was so eager for the surgery.
"She was beautiful. Maybe she want to feel beautiful?" he says. "I agree with her whatever she want to do."
It was a question that would haunt him. Zelaya never came home from Strax. Her death brought unwanted media scrutiny to the plastic-surgery office that claims to be one of the busiest in the nation. Strax officials say they have helped revolutionize the industry by lowering prices and providing affordable access to surgical makeovers for legions of working-class people. But lately they have come under fire for the high volume of surgeries they perform — and because patients have died during or after treatment there.
Several Strax doctors have been disciplined by the state, and the surgeon who worked on Zelaya, Dr. Roger Gordon, had four patients in seven years who died after operations. The Sun-Sentinel reported that Strax had more recent deaths than any other doctor's office in Florida. Yet a closer look at each case shows that surgery can be fatal for many varied reasons. A death might not be the doctor's fault. Strax officials say their mortality rate is in line with the national average, and they have an explanation for every incident that occurs in their operating rooms.
"Strax Rejuvenation says thank you to South Florida for making them the largest cosmetic surgery facility in the entire U.S., with a phenomenal get-ready-for-summer special!" says a husky-voiced announcer on WRMF-FM (97.9). "Not only will Strax beat the lowest price by any board-certified surgeons, in addition, for the next two weeks, you can receive either an area of liposuction absolutely free or 50 percent off a second procedure when combined with any surgical procedures. Smart Lipo starts at $1,999. Breast augs under $3,000..."
Every day, these and other Strax ads flood the radio waves, on English- and Spanish-language stations. They broadcast a message of easily attainable beauty.
Keith Sims, a former Miami Dolphins offensive lineman, appears in a video on Strax's website extolling the virtues of lap band surgery. A silicone band was inserted around the top of his stomach to help him lose weight.
A muscular, solid, fit-looking Sims stands in what appears to be a doctor's office with framed degrees on the wall.
"I went to Strax Rejuvenation for a consultation," he says. "Two weeks later, I had the procedure. It was simple. I was home in a few hours... One week after that, I had lost 30 pounds. I had more energy than I've ever had, and I'm never hungry. Strax Lap Band has changed my life. Call them today; they will change yours."
Plastic surgery was once available only to the rich but has become more common as costs have dropped, procedures have become less invasive, and outpatient facilities such as Strax have made them affordable to the masses. For some, loans make the procedures even more affordable. Strax's website says, "patients may be pre-approved for financing with a low-interest monthly payment plan." Last year, 13.1 million cosmetic procedures were performed in this country, a 77 percent increase since 2000, according to the American Society for Plastic Surgeons.
Strax has a rotating roster of roughly 14 board-certified doctors, who are not on staff but rather work as independent contractors at the company's offices in Lauderhill and Boca Raton. The company's doctors have performed a combined 30,000 surgeries in the past seven years, according to one of the five co-owners.
In 1980, Dr. Philip Strax founded the Strax Breast Cancer Detection Institute in Fort Lauderdale as a nonprofit mammography center. Strax was a radiologist who pioneered the use of mammograms for early, life-saving detection of breast cancer. After he died in 1999, the institute became a for-profit business and switched ownership. In 2004, the current owners bought it. Though they hoped to maintain the facility's patient base and name recognition, they closed the mammography institute, renamed it Strax Rejuvenation, and began focusing on plastic surgery.
As Vargas and Zelaya drove to Strax that morning in December, Vargas tried to calm his wife by reminding her that a friend's mother had recently survived risky open-heart surgery. By contrast, he said, "I think that liposuction is not dangerous."
Eventually, the couple arrived in the Strax waiting room, located on the second floor of a white office building on University Drive in Lauderhill. It has a flat-screen TV set and a wall of plaques featuring each doctor's picture and highlights of his resumé. At the front desk, women in scrubs sit behind a placard advertising the "G-Shot " — a procedure that "augments the G-Spot, resulting in enhanced sexual arousal and sexual gratification for 87% of normal sexually functioning women."
A nurse called Zelaya's name. She went into another room. "That's the last time I saw her alive," Vargas says.
Zelaya's doctor was Roger Gordon, one of the most popular surgeons at Strax. He routinely performed three to four surgeries a day. On Strax's website was a picture of Gordon smiling widely, his smooth skin tight and youthful, his auburn hair receding.
Gordon had performed breast augmentation surgery on Zelaya at Strax in 2009. The procedure had gone well, and she trusted him.
In the exam room, Zelaya removed her clothes. She stood while Gordon took a black marker and outlined her breasts and butt, laying out a map for his work.
She was wheeled into an operating room. The procedure would take about two hours.
Zelaya lay in a fog of anesthesia-induced sleep. Gordon carved what he called five half-inch "stab wounds" around her lower abdomen, according to his operating notes and the autopsy report. Two more smaller slices went between her ribs, aimed at her "bra rolls." He connected a vacuum to a thin tube and inserted it under her skin, suctioning more than 4,000 cubic centimeters of fat. The resulting globs were purified and measured.
The staffers in the room turned Zelaya's body over so Gordon could make two more stab wounds above her tailbone. He injected 1,000 cc's of fat into each butt cheek — making them look round and high.
But something went wrong. A glob of fat entered Zelaya's bloodstream and clogged her arteries. Gordon was sewing the patches of her skin back together when the anesthesiologist told him there was a problem. Zelaya's heart stopped beating.
The doctors tried to resuscitate her. They called 911. A nurse emerged to tell Vargas: "Your wife, something happened, and she is going to the hospital."
Vargas followed the ambulance in the Expedition, flooring the gas pedal as they neared Florida Medical Center. "She's fine, she's good, she's alive?" he pestered a paramedic but was told he had to wait.
Gordon did not accompany Zelaya to the hospital; he had lost his privileges at Florida Medical Center.
Finally, a stranger, a doctor Vargas had never met, emerged to deliver the news: "She passed away. We can't do anything for her."
"That was the most terrible moment of my life," Vargas remembers.
By the time Vargas came to Gordon for her Christmas surgery, three of his patients had died.
Gordon graduated from medical school at the University of Maryland in 1972, completed his plastic-surgery residency training in New Jersey, and worked in Maryland for the next three decades.
By 2002, he had begun seeing patients at the Florida Center for Cosmetic Surgery, a high-volume outpatient facility in Fort Lauderdale that predated Strax.
In December 2002, a patient named Melda Smith made an appointment with Gordon to discuss breast reduction surgery. Smith, 58, was married, raising two kids, living in Hollywood, and working as a nurse.
She was not in the best of health. At five-foot-six, she weighed nearly 200 pounds and was considered medically obese. She had tried diets and exercise but kept gaining weight, and her large breasts were causing her pain. She had seen her longtime internal medicine doctor, who diagnosed her with high blood pressure, high cholesterol, and an underactive thyroid, according to court documents in a lawsuit her husband later filed.
When Smith visited Gordon at the Florida Center for Cosmetic Surgery to discuss her options, center staffers sold her a package deal for breast reduction, liposuction, and a tummy tuck. Over the next month, Smith returned to her internal medicine doctor four times to have her health and high blood pressure evaluated. In mid-January, the doctor finally cleared her for surgery, although he noted she had an abnormal EKG — a test that searches for heart problems.
Gordon performed the three surgeries at the Florida Center in about three hours on January 24, 2003. Smith appeared to tolerate the procedures, and Gordon didn't note any complaints at her follow-up visit the next morning, according to documents filed with the state Department of Health. Later on the day after the surgery, Smith was recovering at home, taking pain medicine prescribed by Gordon. When Smith appeared "lethargic," her family called 911, her husband's lawsuit claimed. Paramedics came to her house and offered to take her to the hospital, but she refused, the Florida Center for Cosmetic Surgery alleged in the lawsuit. Three hours later, Smith's family called 911 again, because now she was unconscious. She was pronounced dead at Memorial Hospital in Pembroke Pines.
An autopsy report said Smith died from an overdose of hydrocodone, one of the pain meds Gordon had prescribed. In 2004, an attorney with the Florida Department of Health filed a complaint alleging that Gordon "failed to include on [Smith's] prescription the maximum allowed dosage" for the painkiller and did not document whether he had discussed the risks of the surgery with Smith or told her the surgery could be performed in stages. In response, the state temporarily barred Gordon from performing more than one surgical procedure at a time and from prescribing high doses of painkillers.
Smith's husband filed a lawsuit in Broward Circuit Court in 2004 alleging Gordon was negligent for "failing to appreciate that the amount of surgery that was being performed was too much surgery for an outpatient environment given Melda Smith's known medical conditions" and "should have been performed in a hospital or in stages" and for "negligently prescribing pain medication at twice the manufacturer's recommended dosage." In 2009, Smith won a $25,000 settlement from Gordon's insurance company. All of the state's charges against Gordon were dismissed.
In December 2003, nearly a year after Smith's death, Gordon had a second patient die after surgery. Jacquelyn Roberts went to the Florida Center seeking a tummy tuck and breast reduction. Roberts worked designing ads for the Sun-Sentinel. At 45, she had two sons and a granddaughter. She struggled with her weight, carrying 186 pounds on a four-foot-nine frame; had high blood pressure and diabetes; and smoked. Still, both her primary-care doctor and a rheumatologist cleared her for surgery — although they noted she had an abnormal EKG. Two anesthesiologists also approved her for surgery, although they knew she had bronchitis.
Gordon performed both procedures during a three-hour surgery for Roberts in January 2004, and signs of trouble emerged immediately. As she woke up from the anesthesia, her blood pressure dropped. "I feel like I'm going to pass out," she said, according to a complaint later filed with the health department. She was given smelling salts, and her anesthesiologist said she could be sent home. That night, she stayed with her parents. They alleged in a later lawsuit that she was "in severe distress and pain, unable to sleep." The next day, her family took her back to the Florida Center, where she saw another doctor, Jeffrey Hamm. He wrote in his notes that she "looks great" and sent her home, according to the health department complaint.
Roberts was still in pain the next day and was having trouble breathing. Her family called 911. She was admitted to the Florida Medical Center's emergency room in septic shock and had "several cardiac arrests" in the hospital, the health department complaint says. She died the next morning. An autopsy concluded that her cause of death was pneumonia and diabetes and that she caught the pneumonia before the surgery.
The Florida Health Department, which routinely investigates surgical deaths, filed a complaint alleging that Roberts had been a "poor candidate" for surgery and that Gordon had violated the law by failing to obtain an "adequate" pre-op exam and "adequate post-operative and follow-up care."
Gordon neither admitted nor denied the allegations against him. The Florida Board of Medicine fined him $10,000 and ordered him to perform 100 hours of community service. Also, Maryland's state medical board placed him on probation, in what it called "reciprocal action" for Florida's reprimand.
Roberts's family filed a wrongful death suit. This time, Gordon denied the allegations but settled for $250,000. The Florida Center for Cosmetic Surgery also paid the family $85,000.
In February 2004, two months after Roberts's death, Lynn Kirouac accused Gordon of leaving her breasts permanently scarred after breast-lift-and-augmentation surgery. At trial, Gordon said the scarring was not related to his surgical technique. A jury awarded Kirouac $109,000.
After these and 20 other lawsuits filed by patients prompted a lengthy exposé in the Sun-Sentinel, the Center for Cosmetic Surgery filed for bankruptcy in 2004. But Gordon and Hamm both found a new place to work: Strax Rejuvenation.
"Plastic surgery's about money," Philip Feanny says bluntly. The attorney is a part-owner of Strax Rejuvenation and head of the company's business and legal affairs. "We've essentially changed the nature of plastic surgery in Florida," he says. "It was a business venture. We saw a need and a desire, and we sought to fill it."
Though defensive and quick to argue when first reached by phone, Feanny eventually agrees to meet in person. Unwilling to give a tour of Strax until he has vetted New Times' questions, he drives his BMW to an interview at his lawyer's office in Davie. At 45, he's short, tanned, and confident in a blue shirt and gray slacks.
Zelaya's death had prompted threats of a malpractice suit from Vargas and several unflattering newspaper and television reports about Strax. "Be very careful about what you write, because I will respond in the courts," he warns New Times.
He explains Strax can afford to offer low-cost plastic surgery by buying supplies such as breast implants and sutures in bulk, at a lower cost than doctors who have their own, one-man businesses. Those savings are then passed on to customers. A breast augmentation can cost $3,500 at Strax and twice as much at a competing surgeon's office.
But he insists his doctors do not cut corners or perform sloppy surgery. "We do the same procedures in the same [operating rooms] by board-certified surgeons," he says. It's no different from the surgery "rich people could afford before."
Strax doctors are independent contractors, not full-time employees, and they are paid for the surgeries they perform at the facility. If anything, Feanny contends, this arrangement frees up doctors to concentrate on their patients. The surgeons don't have to worry about paying for rent, nurses, anesthesiologists, advertising, or other costs they would have to cover if they had their own offices. Strax takes care of those business concerns.
"The doctors do what they're trained to do and only what they're trained to do: practice medicine," Feanny says.
Feanny knew about Gordon's disciplinary record when he hired him. He says he had examined the two cases in which patients died but was not troubled by them. He notes that four outside doctors had cleared Roberts for surgery and that Smith died because her family "overdosed" her. (Gordon's attorney, Rick Woulfe, who also represents Hamm, did not respond to repeated requests for comment.)
In 2006, Gordon signed up to begin performing surgeries at Strax as an independent contractor. But he ran into another professional glitch in 2008, when he applied to renew his staff privileges at the Florida Medical Center hospital in Fort Lauderdale. He answered "no" to written questions about whether he had previously been disciplined by the state. A health department prosecutor filed a complaint, saying Gordon broke the law by making "deceptive, untrue, or fraudulent representations" related to his profession. He was fined $5,000. The Florida Medical Center terminated his staff privileges, and as of this spring, he no longer had privileges at any hospital in Florida. (If surgeons are operating in an outpatient facility and something goes wrong, privileges allow them to follow the patient to the hospital and fix the problem rather than having a new doctor pick up where they left off.)
In February 2009, a third patient of Gordon's died. Gordon performed a tummy tuck and liposuction on an unidentified woman at Strax. That night, the patient went to the ER at Palmetto General Hospital complaining of "bleeding," according to an incident report Gordon later submitted to the state health department. Staffers there couldn't find anything wrong and discharged her.
The next day, the patient "insisted" on returning to Strax for a post-op evaluation with Gordon, and once again, he didn't see a problem. He asked her to come back the next day, but she didn't keep the appointment. Six days later, Strax staffers reached her by phone and scheduled another appointment. "At that time, no information was ever relayed that the patient was in any kind of medical distress," Gordon wrote.
The next night, Palmetto hospital called Gordon. The patient had been admitted to the emergency room in shock. She died the next morning. The state health department found no probable cause to pursue the case. It's unclear if the patient's family has filed a lawsuit.
Among doctors at Strax, Gordon is not the only one with a questionable past. Mario Diaz, the anesthesiologist who assisted with Zelaya's surgery, was criminally prosecuted in Iowa for issuing Internet prescriptions in 2004. His license was suspended in Florida in 2007, but he's now able to work while on probation. John Nees, another Strax surgeon, had his Florida medical license suspended from 2004 to 2010.
Feanny has explanations for these blots: Diaz "got caught up in the early days of online prescriptions. He's a guy who made a mistake." And Nees's suspension stemmed from a romance with a patient in Washington state and "doesn't have anything to do with his surgical acumen."
Then there's Hamm, Gordon's colleague from the Florida Center for Cosmetic Surgery. In the past 15 years, Hamm has paid $1 million to settle malpractice cases filed against him involving patients who suffered infections and scarring. In a letter to Memorial Regional Healthcare Center, Hamm's attorney, Woulfe, argued those payments were not an indicator of fault; many settlements were arranged because Hamm's insurance company was ending its business in Florida and wanted to get the cases off its books.
In June 2005, a 32-year-old patient identified only as M.A. arrived at Strax asking for liposuction on her stomach, butt, and thighs. A pre-op blood test — which Hamm later contended he did not order or see before the surgery — revealed M.A. had diabetes, according to a complaint filed by a Florida Health Department attorney.
Hamm proceeded with her surgery. The patient developed a life-threatening chemical imbalance and was transferred to Broward General Hospital, where she spent a month recovering.
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.
Dr. Alberto Gallerani, a plastic surgeon in Aventura, has harsher words: "Doctors end up working in places like Strax because they can't work on their own."
Strax is "really set up as a factory," Gallerani adds.
Gallerani claims he performs corrective surgery for people unhappy with work they received at Strax. Gallerani gets some of his patients from Coral Gables attorney Spencer Aronfeld, who has been handling plastic-surgery cases for 20 years. Aronfeld says he's now reviewing 30 or 40 cases from patients wanting to sue Strax. Those clients include Vargas, who intends to file a lawsuit against Strax for Zelaya's death.
The Broward Circuit Court docket shows that six other malpractice and negligence cases have been filed against Strax since 2006. Five of the cases are still pending; the other was dismissed and sent to arbitration.
Although Feanny maintains that Gordon did nothing wrong in Zelaya's case and that a fat embolism is a rare but possible complication of liposuction, Aronfeld says his medical expert's theory is that Gordon injected too much fat deeply into Zelaya's body, raising the risk of complication. "There's no way to ascertain with exact specifics how far or how deep the fat was done," Aronfeld says. But "the most likely cause was it being too much, too deep."
For Vargas, after his wife died, weeks passed in a blur of grief. Gordon sent Vargas a condolence card. "I'm so sorry," he wrote.
Strax asked Gordon to temporarily stop seeing patients after Zelaya's death, but because of Gordon's "personal feelings," his absence might be permanent, Feanny says.
Vargas can't talk about his wife without weeping. "It's very, very difficult for me," he says through tears during a meeting at Aronfeld's office. Every day, he visits Zelaya at the cemetery. For a while, he contemplated joining her. "Sometimes I prefer I am dead too."
No longer able to afford the home he shared with Zelaya, Vargas moved in with her mother and sister. He lost his health insurance, which his wife's job had covered. He's now working two jobs and paying out of pocket when he needs to see a doctor about his depression.
After the meeting with Aronfeld, Vargas walks to his car. If he turns on the radio, a reminder of his wife will be nearly impossible to avoid.
"At Strax, 16 board-certified surgeons have performed over 29,000 successful surgeries," the radio DJ chirps. "Now it can be your turn!"
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