Kay Kelly Cregan of County Cork, Ireland, came to Manhattan for an ordinary face lift. After reading a positive article in her local newspaper about the celebrity clients of Dr. Michael Sachs, she entrusted her life to his care and looked no further.
She most likely would have selected another physician if she had better researched his record. In less than ten years, Sachs had settled thirty lawsuits for botched operations—more than any other doctor in the state of New York. Hours after her procedure, Cregan went into cardiac arrest. She died two days later on St. Patrick’s Day, 2004.
That same year, Olivia Goldsmith, author of The First Wives Club, visited the Manhattan Eye, Ear and Throat Hospital for a chin tuck. She, too, experienced cardiac arrest, slipped into a coma and died. The state health department fined the hospital $20,000 for a serious breakdown in patient care.
The year these two women died, there were more than 1.9 million cosmetic surgical procedures performed in the United States. Most of them were done to the patients’ satisfaction and without serious detrimental effects to their health. To the families of Kay and Olivia, however, the success stories of others pale in comparison to the loss that darkens every day of their lives.
The most important thing to remember when seeking one of these treatments is that elective surgery is never an emergency. Take the time to research your physician. Finding the right doctor can be a byzantine effort and accessing a doctor’s record is often a convoluted process.
In some states, a system has evolved to provide easy access to needed information on line. In others, it is necessary to grapple with a bureaucracy that obstructs or delays full public disclosure. No matter how complex the task, don’t proceed with any elective surgery without knowing your doctor’s record.
You also need to be certain your doctor really has the credentials he claims. Watch for red flags—anything that indicates an abnormal medical process. If you visit a person claiming to be a dermatologist or plastic surgeon and you are whisked through with minimal paperwork, be concerned. An ethical physician will be certain to obtain extensive medical history, provide you with information on exactly what will be done, let you know what to expect afterwards and give you a clear understanding of any risks you may face. When asked to sign an informed consent document, don’t do so until you have a genuine awareness of what lies ahead. Every invasive procedure—every anesthetic—carries a risk. If your questions are not receiving thorough and satisfactory answers, head for the door.
The practitioners who claim to be licensed physicians and are not create yet another trap for the unwary. Dean Faiello did so verbally, but others take it even further. They plaster “M.D.” after their names, steal school records and medical credentials from real doctors and advertise board certifications they do not possess.
The most notorious fake, Gerald Barnes, pretended to be a doctor for more than twenty years after attaining the documentation of a real doctor with the same name. His ruse was so perfectly executed, he contracted with the federal government to provide physicals for FBI agents in Los Angeles without being caught in his scam. Barnes was arrested and served sentences in jail more than once. After every release from prison, he resumed his medical practice. Now, at the age of 73, he is serving time for his fifth conviction for practicing medicine without a license.
He is only one of many people impersonating doctors in hospitals, clinics and private practice. David Tremoglie saw more than 500 patients and wrote thousands of prescriptions as a psychiatrist at a mental health clinic in Pennsylvania. He served 3 years in jail. In the same state, Douglas Lenhart went to prison in 2004 for attempting the castration of a transgendered woman in her dining room. Dennis Roark treated more than a thousand patients in Michigan and assisted in hundreds of surgeries—including heart bypass operations—before he was caught and sentenced to 6 to 14 years behind bars.
According to Ronda Lustman of the attorney general’s office in New York, “There is a lot of illegal practice in New York with the highest concentration in Chinatown. Much of what we see involves fraudulent diplomas from the Dominican Republic and forged credentials from medical school.” In fact, investigators in New York found 580 cases of phony doctors practicing medicine in a four-year period. In Florida, the Department of Health created an unlicensed activity office in 1998. In fiscal year 2003, they investigated 765 complaints and scored 101 convictions for the unlicensed practice of medicine.
Contact state officials to confirm that your doctor is licensed to practice medicine. Do it every time you need the services of a new physician. Just because they are in business doesn’t mean they have a right to be.
Many of the perpetrators are caught not by something they’ve done in their practice, but by how they reacted in a situation where the unexpected occurred and a crisis developed. Dean Faiello panicked instead of getting the appropriate treatment for Maria. He then took the situation to an extreme, burying her body and concealing her death.
In the cosmetics industry, the problem goes beyond practitioners falsely representing themselves as doctors. There’s also an issue with technicians who, without claiming any false credentials, perform procedures for which they are not qualified. The problem often lies in the way legal definitions are written.
“Technology,” Lustman said, “has outstripped the law.” In most states, the statutes governing the use of lasers are vague and confusing—to physicians, technicians and the public alike. In New York, laser hair removal clearly does not require a medical license and oblative—or invasive—laser procedures demand it. In between, there is a gray area of undefined services. Also open to interpretation is the meaning of a doctor’s supervision when mandated by law. New York is not the only state where no black-and-white standards are spelled out in existing regulations.
Many licensed dermatologists and plastic surgeons in New York want the use of lasers in treatment to be the sole prerogative of licensed physicians, as it is in some states. They claim that laser technology has become increasingly complex and advanced. These strides in technology make a laser in the hands of a non–medical operator a danger to the public. Roy Geronemus said that mishaps at dozens of spas in Manhattan have sent a steady stream of patients to his office. He’s treated models whose careers have been destroyed by burns from laser hair removal. One of his patients went to a spa for the removal of a mole. “She came into my office with a large scar on her lip. In addition to the scarring, there were serious medical concerns. No biopsy was performed, so there was no way to know whether cancer was present or not.”
Unfortunately, it is difficult from anecdotal evidence to assess how much real danger exists and how much is due to the conflict of interest physicians face. There are those who are motivated solely by concerns for the public welfare. Others, however, are more focused on financial interest when they express a desire to make the use of laser as restrictive as possible. “Doctors want to own the beauty industry,” cosmetic technician Muriel Farina said. “They want you to come to them for laser hair removal and facials so that they can upgrade you to something even costlier like Botox injections and surgery. It’s all about money.”
Technicians like Muriel point out that electrolysis is a far more invasive procedure than laser hair removal, and a medical degree has never been required for the practice of electrology. In fact, many states do not have proficiency testing or licensure of electrologists. Technicians insist that although a doctor is only necessary for oblative laser treatments when infection is a possibility—for example, the removal of spider angiomas, commonly known as spider veins—doctors are attempting to reserve the use of lasers exclusively for themselves with other less risky procedures. Procedures like facials, pimple punctures with sterile lances, microdermabrasion and electrology, they say, require training but not a medical education.
Where does the spin end and the truth begin? These technicians—like the doctors—are biased by their personal financial interests.
It is an issue that needs to b
e considered by an informed, disinterested third party. Only if legislators educate themselves on the technology, weigh the claims on both sides and ignore lobbyists can they draft laws that protect the public. With increasing numbers of Americans seeking these cosmetic services, the time for a thorough examination and clear, concise legislation is long past due.
Practitioners often skate the edges of legality because they do not understand existing laws. Then there are those who extend their services beyond what they know is legal—people like Dean Faiello, who look a prospective client in the eye and assure him of their medical qualifications; people who manage to pull it off because unethical physicians—like Andrew Reyner and Michael Jackowitz—aid them in their deception by providing prescription drugs and protective cover.
How, though, could a woman like Maria Cruz be deceived? Highly educated and incredibly smart and knowledgeable about Internet research techniques, she seemed an unlikely client for a man like Dean Faiello.
Why didn’t she check to see if he had a medical license? Why didn’t she ferret out his arrest in October 2002? And if she did, why did she ignore the warning signs? Why didn’t she run from him the moment he asked her to bring cash? If Maria knew the answers to these questions, she took them with her to her resting place.
And what motivated Dean Faiello? Greg Bach pointed to Dean’s insatiable hunger for drugs, but also said, “There is a part of him that really thinks he is Dr. Faiello. I think he can disassociate from himself and believe his own lies because it is too painful to be him.”
Criminal profiler Pat Brown has a harsher assessment. She said Dean Faiello was “a guy who always wants power and control—the usual hallmarks of psychopathy. He simply won’t take himself out of the driver’s seat. He practiced medicine illegally because he liked the powerful feeling he got from it. He got busted and continued to practice medicine because he liked the power.
“Everybody follows patterns. This guy has a history of not giving a damn what is right and wrong—both legally and ethically. He demonstrated little concern for anyone but himself in his past and in this crime.” Because of his psychopathology, she surmised, when Maria Cruz became dangerously ill, he still placed his needs over those of his patient, and acted in his self-interest without a thought for hers.
Wherever Dean fits in this continuum—from an emotionally damaged man seeking admiration and respect, to a narcissist or psychopath who has no real regard for other individuals—he deliberately created an image for himself that took advantage of others’ gullibility. He was part caring practitioner, part con artist. He is one of the handful of people in every profession whose corruption taints the whole system.
Barbara Nevins Taylor began an on-line essay about the nature of evil with these remarks:
Until a few years ago, I believed that we were all basically good. It seemed to me that most of us, given a little time to think about things, would make the right decisions and behave ethically. Foolish me.
Every day as I investigate one scheme or another, I meet people who are bad, maybe even evil. They are schemers who recognize that people with dreams will believe the most implausible stories simply because they hope that their dreams will come true.
She wrapped up the piece with a warning:
We’ve found that people who get ripped off in any scheme often step into the traps that are set for them with their eyes half closed. They don’t do research about a company, or a contractor, and they are often eager to do things quickly, cheaply and easily.
Unfortunately, they end up learning the hard way and costly way that the bad guys have no conscience when it comes to taking advantage of their vulnerability, making promises for things they will not deliver and taking their money.
From doctors to roofers, be sure you know in whom you’re entrusting your life, your health, your cash. Protect yourself from victimization by doing your homework and questioning everything.
In the oft-repeated words of Hill Street Blues’ Sergeant Phil Esterhaus at the end of every roll call: “And hey, let’s be careful out there.”
You can do it—for yourself, your loved ones, your friends. I know you can.
Under the Knife Page 21