LAST DANCE, LAST CHANCE - and Other True Cases

by Ann Rule

  And he continued to work on his permanent subcutaneous underwire to lift sagging breasts.

  5

  Dr. Ralph Pignataro could see no wrong in his doctor son, nor could his wife. Anthony considered his father his greatest mentor. He had always spent hours on the phone with his father, discussing the cases he saw in medical school and residency. Anthony said he idolized his father, and that was probably true.

  Both Dr. Ralph and Dr. Anthony were bald. There was a strong balding gene in the Pignataro family, and Anthony had started to lose his hair when he was only 23. He continued to be vain about how he looked. He tried comb-overs held in place by hairspray, and then toupees held down with glues, clips, and tie-downs. He even resorted to intricate weaves that combined human hair from someone else with the rapidly retreating rim of hair that still remained.

  He concluded that women wanted large, perky breasts and men wanted hair. Anthony figured—correctly—that there would be an unlimited market for an expensive real hairpiece that would never blow off or even slip sideways. As an intern, he had once seen a technique called implantology in which surgeons used snaps to anchor artificial eyes, noses, and even ears. Further, Anthony recalled that dental surgeons had successfully implanted teeth in a procedure known as osseointegration, in which the replacement tooth was threaded into the softer bone tissue of the jaw. After about four months’ healing time, the teeth had literally grown into the bone.

  What if a man—or a woman, for that matter—could have snaps implanted into their skulls? Anthony thought it could be possible to have the receptacle part of the snap sewn into a hairpiece. Actually, the more he thought about it, the more it seemed to him that putting snaps into a skull would pose less danger of infection than putting a tooth into a bacteria-laden mouth.

  “I recall that at the time, it seemed like a crazy idea,” Anthony said. “I initially exercised caution with whom I would discuss the details of the project.”

  Other doctors, including his own father, found his research bizarre, but Anthony kept on. He knew that bolts were routinely inserted into human skulls to give patients with unstable spines traction until they healed. Why not move up the side of the head and somehow insert the male part of a snap into the bone?

  He felt he was on to something big. But who would test it? There had to be a guinea pig willing to be a modern-day Frankenstein with semipermanent metal “bolts” protruding from his head. Men were not likely to stand in line for that operation, even if the metal would never show beneath the attached hairpiece.

  Anthony thought of Sy Sperling, president of the Hair Club for Men, a successful entrepreneur whose familiar television commercial featured him saying, “I’m not only the president; I’m a client!”

  It dawned on Anthony that he should be his own first patient. If he truly believed that his invention was sound, he should be willing to undergo the necessary surgery. “Would it not be a tremendous advertising advantage to proclaim that I’m not only the doctor, I’m the patient?” he mused. “Who would perform the first surgery? Who did I trust? Who had the skill and confidentiality to be trusted with my technique…which, if successful, I hoped could be patented. The answer was patently obvious: my own father. He certainly had the necessary skills and could be trusted.”

  It took some convincing for Anthony to persuade his father to operate on him. Finally, Dr. Ralph Pignataro agreed, and Anthony noted that a distinguished dentist, experienced in prosthetic surgery, assisted.

  Afterward, Anthony proclaimed the procedure no more painful than having a cavity filled. His father had drilled four holes in his bald head. After three and a half months of healing, an implant was integrated into the surrounding bone, and then the center screw was removed and a protruding bolt with a socket remained just above the skin. “The female or ball portion of the attachment was fastened to a custom skullcap cover with synthetic hair—which was then easily snapped into the socket of the bolt.”

  Anthony was elated. His invention worked, and he would be the main model. His “hair” stayed on beautifully. It was, he believed, the first of many triumphs—but this one meant the most to him because he saw new respect in his father’s eyes. He began to research how he could best sell his new process and get the most publicity out of it.

  Debbie was happy for Anthony and enthusiastic because he was so overjoyed about having hair again—but then, she had always thought her husband was handsome. Their family life was going well—as well as it could when she lived with a man of such energy and mercurial temperament. They did things as a family, going for ice cream or to the wonderful Buffalo Zoo. Ralph still went fishing with his father and grandfather, and Anthony promised him he could go hunting with them as soon as he was old enough.

  Hunting was important to Anthony, although it seemed a little strange that a doctor enjoyed killing things. He shot a cheetah on a safari and proudly had it stuffed and mounted, and then placed it in the great room of their duplex. It gave Debbie a start whenever she looked at it, but Ralph thought it was sensational. He was a little boy who thought his father was perfect.

  Sometimes Anthony and Debbie took vacations in Florida, where Anthony’s brothers lived. Steve and Ralph Jr. were in the ice cream business there. His sister Antoinette was a physician. Vacations there were fun, with trips on family boats, although Debbie sometimes felt a stinging sadness that she was so removed from the celebrations on her side of the family. She talked to her mother on the phone, but that didn’t seem enough. She wanted her to be more a part of her life. Even during the years when Frank and Caroline Rago were struggling to meet their budget, they had wonderful parties with their extended families. Now, it seemed to Debbie that there were so many things to do for Anthony that there never seemed to be time to be with her family.

  Anthony considered himself to be from a higher class than the Ragos. After all, his father was a distinguished surgeon much beloved by the community, and their home was definitely upscale. Country clubs and private schools had never been part of the Ragos’ world.

  Anthony continued to be critical of Debbie. It was almost as if he deliberately set out to tear down her self-confidence. She could never be thin enough for his tastes, and he reminded her of that repeatedly while still wanting her to cook whatever he fancied. Anthony worked out at Gold’s Gym almost compulsively, and with his new fail-proof toupee he looked better than ever.

  He wasn’t home a lot. He had the long commute to Warsaw to take over his elderly benefactor’s patients, and at the same time he was struggling to get his own clinic going.

  And his Wednesdays were sacrosanct. Nothing interfered with his research.

  6

  By 1994, Dr. Anthony Pignataro was moving rapidly toward the specialty he aspired to—that of a plastic surgeon. But for every success he had, there were red flags and censure raised. He chose to ignore them for the most part. He always had a smoothly crafted explanation for any negative event in his life.

  In 1994, he was sued by a patient for an allegedly negligent face-lift and blepharoplasty (eyelid lift) that caused the seventy-one-year-old patient to seek further surgery to correct Anthony’s mistakes. Anthony blamed the problem on the patient, insisting that she had failed to follow his postoperative instructions. He also said she had gotten a second opinion from a competitor who spitefully encouraged her to sue. The lawsuit was eventually settled by a $75,000 payment from his malpractice insurance to the patient.

  Also in 1994, Anthony was investigated for the first time by the New York State Department of Health/Office of Professional Medical Conduct. He advertised for clients enthusiastically, something physicians rarely did then. Not only that, despite the fact that it was not true, his ads said he was “Board-Certified in Otolaryngology.”

  He claimed that he was affiliated with “Cosmetic Plastic Surgeons International.” Debbie said later that Anthony had formed some sort of alliance with a plastic surgeon in Canada and then had used that man’s name to become “international.” An
thony referred eye-lift and skin care patients to the Canadian doctor, whose face-lift patients were referred back to Anthony.

  His operating room in the basement of his office was finished to his satisfaction, and Anthony advertised that his facility provided “state-of-the-art care in outpatient surgery.” He sent coupons to hair salons in his area, offering them $100 for every patient they sent to him for a hair transplant. He was not yet using his snap-on-snap-off technique; instead, he was taking hair grafts from the back of the patient’s head and transplanting them to the balding area.

  “This was a long and laborious technique,” he recalled. “The state of the art had advanced. Minigrafts and micrografts had become the standard. Minigrafts are four to eight hair grafts, and micrografts are one-to three-haired grafts.”

  It took about a thousand of these per session, and Anthony and his transplant team, mostly office help and licensed practical nurses, would take five or six hours to manage this. Now, he invented what he called the Micrograft Implanter. He was pleased with it because it worked “even in untrained hands,” and it cut down on the time needed, allowing him to operate on even more patients.

  He felt so relaxed doing hair transplants that he sometimes sent out for pizza to eat during the surgery. One patient, as easygoing as Anthony, joined him in eating the slices of pizza.

  But Anthony’s advertising brought an investigator from the State of New York, a physician who questioned him about the plastic surgery he was performing in his office. He was cagey when he answered her questions, saying he didn’t really do plastic surgery in his office. He did admit that he was doing occasional tummy tucks, but everyone knew those were “easy.”

  Asked about what he used as anesthesia, Anthony shook his head and said he used only “sedation” and never considered general anesthesia. He used narcotics for the sedation. When the visiting doctor pressed him to specify which narcotic, he answered, “Versed.” Versed is a powerful drug given intravenously.

  It was apparent to the investigating physician that Anthony Pignataro did not have the training to become legitimately board-certified by the American Board of Medical Specialities in Plastic Surgery. The investigator wasn’t reassured at all by his glib responses and his unctuous, confident manner. She stared Anthony Pignataro in the eye and said, “You had better stop these [plastic surgery] procedures in the office before you kill somebody.”

  He stared back at her, neither angry nor insulted. He was hardly impressed. In his own mind, he was confident that he was far more skilled than any board-certified, hospital-approved physician. Far beyond the mundane doctor, he had imagination and the ability to see beyond the staid old methods. It was only that other doctors were envious of his skill.

  Later, Anthony would write about that interview, and it was as if the doctor’s warning was a hollow shout into the wind. Anthony’s own version of the meeting demonstrated his talent for twisting the truth to suit himself: “With the surgical suite fully operational, the cosmetic practice improved as more patients were able to afford the procedures,” he wrote confidently. “In this state, physicians are overseen by the Department of Health…The Department of Health has always maintained a justifiable vigil on physicians doing more and more procedures in the office. Nonetheless, this was the trend in the 1990s. A cadre of health department officials had already reviewed the practice and done an on-site review of the facility. Having not a single violation was a comforting, positive sign.”

  He had forgotten the investigator’s warning that he might kill someone with his office surgery; he saw only a “comforting, positive sign…”

  In 1995, Anthony Pignataro became partially “certified” by the American Board of Cosmetic Surgery and Facial Cosmetic Surgery. But to do this, he had had to prove he was board-certified in otolaryngology, which, of course, he was not. Instead, he faxed the Facial Cosmetic board a forged diploma dated October 31, 1991, guaranteeing his good standing in otolaryngology.

  He took only the first part of the test, deciding to get more “practice” in the coming year before he took the part that encompassed cosmetic surgery on the entire body. “Having passed the standard written portion, I would only have had to face the eight hours of grueling oral examiners again—a bone-chilling prospect at best.”

  He hated probing questions, but now Anthony was very optimistic. “In April, 1995, I took and passed the written as well as the oral exam for facial cosmetic surgery. Recognizing the sacrifices my family and office staff had made so that I could steal away for hours of study, I treated the entire family and staff to a five-star meal at a nearby restaurant…This was the true validation of my long-enduring academic history. I had definitely paid my dues. The day the notice came in the mail, I opened the envelope at about 11:00 A.M. No one of the staff was aware…It was 4:00 P.M. before anyone was made aware of my success. I needed those five hours to savor the moment just for myself…”

  It apparently didn’t matter at all to him that he had used a forged diploma to qualify to take this exam. If Anthony Pignataro was anything, he was expedient. Whatever it took to accomplish his goals, he did without a backward thought. He had so much to offer the world that he couldn’t allow “small thinkers” to impede him.

  Anthony continued to claim that he had current hospital privileges. One lie begat another, and Anthony’s lies continued to pile up. In 1995, he was terminated by the Individual Practice Association of Western New York, Inc. In November, he applied to an HMO to be part of its staff. But once again, he lied, claiming that he had never been the target of malpractice claims or illegal actions and had not been denied hospital privileges in the previous ten years. He lied and said there were no proceedings currently against him, that judgments had never been brought against him, and that he had never been the object of peer-review proceedings. Indeed, he had been beleaguered by every one of these questions. Everywhere he turned, it seemed that someone was investigating him or suing him.

  Debbie Pignataro had no idea how many lies Anthony was telling. As far as she could see, his practice was going well. He was very popular with his patients, and she believed him when he said he knew everything there was to know about ear, nose, and throat ailments. She no longer spent much time in his office; he was doing so well, he assured her, that he had hired a full staff so that she could spend most of her time with their children.

  Anthony seemed happy and fulfilled at last. He was working hard to hone his skills in plastic surgery, traveling often to attend teaching conferences in this medical art. He wanted to be able to offer his patients a full range of cosmetic surgery, including breast reduction or augmentation.

  It also never occurred to Debbie that Anthony might be unfaithful to her again. That early affair had happened so long ago, and they had worked through it and stayed together. Anthony had been so sweet for the whole year after she found the tapes and cards in the back seat of their car. He had literally begged her to forgive him, and he had promised that he would never cheat on her again if only she would take him back. Her father had warned her not only to forgive but to forget, and to give her marriage another try. They had survived the death of their baby and all of the disappointments Anthony had in his residency programs. They had been together all the way. Debbie felt that any couple who had been through so much had forged a bond that could never be broken.

  Debbie loved her home, her husband, and her children. Their duplex in West Seneca was very nice, with a big kitchen, dining room, and living room. Upstairs, there was a master bedroom, and Ralph and Lauren each had their own room. They had a rec room in the basement, where the windows were now protected by bars to ward off any other vandals who might try to get in.

  But that was less of a danger now; building was going on around them, and families were moving in all up and down the street. She had friends and neighbors close by.

  Debbie told herself there were no perfect marriages, and she accepted hers for what it was—the good and the bad. Anthony was still critical of he
r, and he seldom helped around the house or suggested that she take some time for herself. He was drinking more than he should, and that worried her. But the good times offset the bad, and although Anthony could make her cry when he complained about her appearance, Debbie never thought about leaving him now. They were both close to forty, and they were settled down. At least, Debbie was settled down. She never looked at another man; she hadn’t since the moment she first saw Anthony.

  Despite what Anthony had told the investigator, he was doing a lot more than tummy tucks. He needed to make as much money as he could from plastic surgery to offset jobs he had lost. The part-time practice in Warsaw ended when the elderly doctor returned to his office after his recovery from open heart surgery. Anthony felt he had been dropped because the doctor was East Indian and that he was jealous of how popular Anthony was with his patients.

  “I had done an outstanding job of keeping the practice going for him,” Anthony said. “So I was shocked and disappointed that his first order of business was to remove me from his office. He didn’t like the rural populous [sic] of the area preferring a white American doctor without a heavy foreign accent.”

  So once again, Anthony felt that jealousy had made another doctor turn against him. He said he was just as happy to be able to devote full time to his own practice.

  And he was about to become a national celebrity. The Associated Press carried the syndicated story of the doctor who had the answer to the prayers of bald men all over the country.

  “Anthony Pignataro reached under his hair,” reporter Stephen Sobek wrote, “and—pop! pop! pop! pop!—in a matter of seconds, held most of his thick brown locks in the palm of his hand…”