by Ann Rule
8
In the year after his father’s death, Anthony seemed to be back in control. As far as Debbie knew, he was no longer seeing Moira, whom she now knew was an exotic dancer. That had baffled her. If he’d gone off with a snobbish society woman, she might have expected that. But a woman who danced in a sleazy club? That didn’t seem like Anthony, who always insisted on the very best of everything.
Debbie took some satisfaction in remembering the way she had frightened Moira with her threats. She never knew she had that much guts or that such strong language would come out of her mouth. Now she knew she was tougher than she had thought. Their marriage was different from how it had been before. Anthony didn’t pick on her quite so much. He wasn’t as nice to her as he had been after his first affair came to light, but he was better than usual. Once in a while, he even cooked supper.
“Steak and lobster,” Debbie said. “Nothing but the best.”
Anthony was pleased with his basement surgery suite. It was convenient, and it was economically advantageous. He was frugal about spending extra money on staff that he felt were unnecessary. He employed a secretary and a licensed practical nurse from a local trade school, and he used Debbie when he needed a trained medical assistant. Although she had worked for many years in a pharmacy, and had also been employed in doctors’ offices while helping to put Anthony through his five years of residencies, Debbie wasn’t a trained nurse or even an L.P.N. Anthony told her that didn’t matter—that his skill, and his ability to train her for the specific kind of surgery he practiced, were far more important than any nursing school curriculum.
Whatever trust Debbie might have lost in Anthony as a person, she still believed he was a good doctor, even if he wasn’t a good husband. But Debbie was aware of only a fraction of the disasters that had happened in Anthony’s surgeries. He hadn’t told her about most of them.
The worst thing Debbie remembered was the time he left her alone to do a chemical peel on a patient without enough instruction. The woman suffered burns and sued both her and Anthony.
But now, Anthony seemed to know everything there was to know about plastic surgery. And he had refined his practice so that breast and hair surgeries made up 70 percent of his scheduled operations. All he needed Debbie for was to monitor body functions.
Anthony certainly didn’t believe he needed to have an anesthesiologist present during operations in his office. Their fees were outrageous, he thought, and there wasn’t anything they did that he and Debbie couldn’t do. He had worked out his own combination of pills to relax his patients before surgery. Later he combined the pills with intravenous drugs to lull the patients into forgetful sleep while he practiced what he considered his art.
Anthony felt it was important for students at Nichols School who wanted to go to medical school to have some practical experience. He often hired teenaged boys at minimum wage to do various chores in his clinic.
He was still traveling to continuing medical education courses and other seminars, learning more about plastic surgery—or at least he told Debbie that’s where he was going on weekends. One day soon, he would unveil his subcutaneous bra. He believed that would make more headlines than bolts for toupees.
In the first part of July 1997, Connie Vinetti* went to Anthony’s office in West Seneca for a consultation. She wanted to ask him whether liposuction on her abdomen would be effective in making her stomach flatter. She also wanted to be sure that Dr. Pignataro was board-certified. Having done some research, she knew that was important. The sight of a framed certificate on the wall of his office reassured her. It said “American Board of Cosmetic Surgeons,” and his name was there, all right, in flowing script.
After she asked him the questions she had written down, Pignataro checked her stomach and told her flatly, “Your abdominal muscles are shot.”
Connie was embarrassed; she hadn’t realized that she was in such poor condition. The doctor recommended that she consider a procedure called an abdominoplasty. It would take only about an hour to an hour and a half and would leave a discreet 4-inch scar. He assured her that she would be back to work in a week with taut muscles.
“I would throw all those pieces of fat in the garbage,” Dr. Pignataro said crudely, “and you will have a V-like waistline.”
The surgery would be a bit more expensive than liposuction, which cost between $1,500 and $3,000. Abdominoplasty would be $4,000, but he told her that she would be much happier with the result. Pignataro urged Connie to reconsider, stressing that she was “the ideal candidate” for the operation he suggested.
She could expect to pay $2,000 up front and another $2,000 on the day of the surgery.
But Connie Vinetti had another concern. She was going to have a hysterectomy (the removal of her womb and ovaries) at Buffalo General Hospital in two weeks. She asked if he could coordinate the abdominoplasty with that surgery and said she would rather have it all done at once than undergoing two surgeries.
“I’ll try to do that,” he said, “but you will have to talk to my office manager about it.”
Connie came back to see Pignataro on July 13, but when she asked again about doing the abdominoplasty at the same time as her hysterectomy at Buffalo General Hospital, he told her that he couldn’t do that because his “schedule was full.”
What he didn’t tell her was that he didn’t have privileges at Buffalo General. He had no privileges at any hospital.
Connie Vinetti asked if her insurance would cover the plastic surgery on her abdominal muscles, and Dr. Pignataro told her he’d found that 90 percent of the time a hernia was involved when stomach muscles were as badly out of shape as hers were. The presence of an actual medical reason for an abdominoplasty would then fit within insurance guidelines. Pignataro smiled as he said that he could really “stretch it” on the forms for her insurance company.
By now, Connie was convinced that she needed to have the abdominoplasty. They agreed that she would come to Dr. Pignataro’s office at 8:30 A.M. on August 5.
Connie arrived with her husband at the appointed time, but was told the doctor was still waiting for the results of some of her blood tests. An hour later, he was ready to operate and suggested that her husband leave and come back for her about 1 P.M.
The next several hours would be blurred for Connie Vinetti. She remembered being taken to an examination room, where she changed into a gown. At that point, Pignataro had given her seven or eight pills. She would remember that one was red and the others were white. She noticed that the doctor was watching her closely to be sure she swallowed them all.
Then a nurse whose name was Betty led Connie through the waiting room, and she was embarrassed that she had to walk past other patients in bare feet, wearing only a gown.
In the operating room, Connie was washed down with betadine to fight infection. Another woman was there, wearing scrubs, who said her name was Jean.
Connie recalled hazily that Jean had trouble getting a needle into her vein and that Dr. Pignataro had to do it. She was left alone for a while and then taken to the “surgical center” downstairs, where she was asked to lie facedown on the operating table.
She was feeling a little woozy, but she remembered seeing a young boy in the room who looked to be in his teens. He wore scrubs, too. So did a young female nurse.
She felt another needle in her vein, and then only a soft blackness. Connie remembered nothing more until she finally woke up at 4:30 in the afternoon.
Her husband was waiting to drive her home, and he helped her to their car. But on the way Connie realized that she was bleeding so heavily that the blood was oozing scarlet splotches through her clothes. She couldn’t walk, so her husband carried her into the house. She couldn’t even sit upright on a chair.
Connie Vinetti kept hemorrhaging, so much so that the carpet beneath her turned bright red. Her husband was very worried, and he called Dr. Pignataro before six that evening.
The doctor didn’t seem at all concerned. He explained tha
t he got “these calls all the time. I know it looks like blood, but it’s really just drainage,” he said soothingly. “Connie has a lot of fluid in her.”
What, the worried husband asked, were they supposed to do to stop the bleeding? Pignataro suggested that he purchase some sanitary napkins to absorb the leakage from the incision. They would be more absorbent than a regular bandage.
They tried that, and Connie pressed the super-size sanitary pad against the gash in her abdomen. It wasn’t a sterile bandage, but she didn’t think of that. The bleeding continued, leaking through the layers of the pad. Soon, she was in excruciating pain as whatever Dr. Pignataro had given her wore off.
“I tried to tough it out over the next two days,” Connie recalled.
By Thursday, August 7, she could no longer bear the pain. She went back to see Dr. Pignataro early in the morning and waited for twenty minutes until he hurried in, not apologizing for being late. By that time, the upper part of her belly was severely swollen.
Pignataro examined Connie and told her he had found the problem; the girdle he’d placed around the incision after surgery should have been located higher. “That’s why you have this swelling,” he said easily. But as he pushed against the swollen spot, she began to bleed again.
He suggested that she come back early Saturday morning. He was going out of town later in the day, but he would see her at 6:30 A.M.
And then Connie Vinetti watched in shock as Pignataro summoned Sue, his young nurse. “Sue will take care of you next week,” he said.
“Sue, do you know how to suture using staples?” he asked.
“No,” she said, shaking her head nervously.
He brought out what appeared to be a surgical stapler and touched it to Connie’s bloody incision. She wondered if it was sterile. She thought probably it wasn’t when he put it back on the shelf without even wiping it with alcohol.
How was Sue going to take care of her when she obviously didn’t know anything about patching a wound back together?
“Your drainage tubes are pointing up,” Dr. Pignataro muttered.
“What…?”
“They’re supposed to be pointing in the other direction,” he said, as if someone other than himself had put them in.
At that point, Connie Vinetti lost all confidence in this doctor, who had seemed so professional when she first visited him. She was in terrible pain, she probably had some kind of infection, and he was simply going to go out of town and leave her in the care of a girl who clearly had next to no experience.
Connie got up from the examining table and said she’d be back, but she left, determined never to see him again.
Connie got even sicker as Thursday wore on, and her husband called the ER at Buffalo Mercy Hospital. He said his wife was very sick and in pain, and was told to bring her in.
Dr. K., the physician who examined Connie in the ER, saw that her abdomen was grossly distended and her temperature was soaring. Removing the elastic bandage commonly used after liposuction, he saw that her incision was badly infected with bacteria. Pockets of pus had formed. Some of the flesh around the incision was necrotic (dead). The swelling was so profound that he suspected she might have an ileus, a temporary paralysis of the bowel that sometimes follows surgery in which the walls of the abdomen have been perforated.
The ER doctor admitted Connie Vinetti at once to Buffalo Mercy Hospital. He went a step further and took Polaroid pictures of the incision. The wound had been stapled so clumsily that it looked like a crazy quilt, with all the edges of the incision mismatched.
One of the nurses on duty recalled Connie’s condition with a shudder. “It was terrible,” she said. “It looked as if someone had opened her abdomen with one of those old-fashioned can openers; it was all jagged and infected. I’ll never forget it.”
On Friday, August 8, Dr. Anthony Pignataro visited Connie in the hospital. He appeared to be his usual blithely confident self. But he looked at her with surprise and asked, “What happened?” as if he couldn’t understand why she’d gone to the hospital.
Before she could protest, he examined the incision.
“There’s nothing medically wrong with you,” he said firmly. He picked up her chart and wrote that she should be discharged.
Nurses watched him and summoned doctors who did have privileges at Buffalo Mercy. They asked Pignataro to leave.
But he was back again on Saturday morning at 6:30, asking Connie, “What are you still doing here?”
She stared back at him as if he were crazy. You didn’t have to be a doctor to see she was sick. He picked up her chart again and studied it, telling her that she had no fever and her blood work was perfectly O.K.
Once more, Anthony Pignataro was asked to leave the hospital. His visit had not been sought by the patient, and he had no authorization whatsoever to be in her room, to be reading her chart, or even to be in the hospital.
* * *
Later, Dr. K., the physician who was treating Connie Vinetti, placed a phone call to Dr. Anthony Pignataro. Eventually, the call was returned.
“I hear you’re seeing one of my patients,” Pignataro began smoothly. “What seems to be the problem?”
Dr. K. explained the problems he had noted in the acutely ill patient.
“That’s nothing,” Pignataro scoffed. “There’s nothing wrong with her. I’ve seen worse.”
Dr. K. was stunned. “This is bad, Doctor,” he said. “You shouldn’t be doing these procedures in your office.”
“It isn’t an office. It’s a surgery center,” Pignataro countered huffily.
Dr. K. tried once more to convey how very ill Connie Vinetti was and to describe the extent of her infection. He suggested that Pignataro was hurting people with his heedless approach. He was blunt.
“Well,” Anthony Pignataro said, “I’m sorry you feel that way. Maybe we could have lunch and talk this over, before things get out of hand.”
It was akin to a conversation out of Alice in Wonderland. How could any medical doctor be so oblivious to the dangers of septic infection in a terrible stomach wound? Dr. K. hung up, shaking his head.
Connie Vinetti spent another five or six days in the hospital, taking strong antibiotics to fight her raging infection. She survived, but she would never again want to wear a bikini.
Anthony Pignataro had another black mark against him, but it really didn’t matter to him. He still believed that he was a superior surgeon and that other people had simply overreacted to the occasional medical mishaps that could happen to any doctor.
He was in denial. Some might say he was having a breakdown, that he was overwhelmed with grief at the loss of his father nine months earlier. Those less charitable would lay it squarely upon his narcissism, a personality disorder, enhanced by drug use and alcohol.
There were four people in the world, however, who genuinely cared about the future of Anthony Pignataro, despite the times he had disappointed and betrayed them: his mother, Lena; his children, Ralph and Lauren; and his wife, Debbie. They all loved him.
But that wasn’t enough. Anthony plunged into more office surgeries. He had learned nothing from the disastrous operation on Connie Vinetti.
To reassure himself, perhaps, Anthony’s writing alias, “Debbie,” added more validation of his skills to his manuscript:
“For better or for worse, how many of us have spoken these vows with the sincere belief that it will, for the most part, always be for the better?” “Debbie” wrote. “For me, there was no reason to believe that it would be anything but glorious. As a third-generation Italian American, of humble but virtuous means, all I ever desired was to marry a decent man who loved me and provided me with the emotional support I needed. If good fortune were to bestow on me any more than middle-class fare, this would not matter.
“Anthony S. Pignataro, M.D., my husband, found genuine success and fulfillment in his career as a Cosmetic Surgeon. It was his sixth year in private practice and we had just begun to see the light at the en
d of the long and arduous academic tunnel…We began to talk about a real house for our children. The winds of fate, however, would not blow in that direction…
“The practice had grown steadily over six years. Anthony enjoyed his work. Hair transplants, liposuctions, and breast implants were a mainstay of the practice. Having been published in the medical literature several times, the doctor frequently gave conferences and was active in the cosmetic academy as well as many other medical societies. Always eager to learn the latest new technique, he would travel to continuing medical education conferences. Ironically, it would be one of these new techniques that Anthony would use the day our world fell apart.”
But it wasn’t Anthony’s or even Debbie’s world that truly fell apart. It was the world of a young wife and mother named Sarah Smith.
Part Four
Sarah
9
Connie Vinetti recovered, and Anthony moved on, unconcerned that the New York State health authorities were still watching him. He was intrigued by a revolutionary new procedure in breast augmentation that he had learned about at one of the conferences for cosmetic surgeons. He had never been pleased by the scars that often remained under the patient’s arms or beneath her breasts after breast implants were inserted. This new technique was known as TUBA (transumbilical breast augmentation), and it involved “tunneling” from the navel (belly button) to the axillary (armpit) area next to the breast.
An endoscope formed a tubular space through the fatty tissue just beneath the skin, an “expander” widened the area, and then a tightly folded sac was pushed through the groove into place, where it could be filled with saline solution. Any scars would be around the navel, but those would virtually disappear.
If gallbladders could be removed through the navel, why not use that route to insert breast implants? Board-certified plastic surgeons were having success with the navel approach. Anthony visited one physician in the Southwest and observed a few of the navel-to-breast procedures. He returned to Buffalo, convinced that he was fully prepared to add this new technique to his practice.