by Ann Rule
When they compared what they learned to the sedatives and painkillers that had been given to Sarah Smith, they were stunned.
“We knew he wasn’t meeting standards in the proper care of a patient,” Craven said. “So now we had something to hang our hat on.”
They moved ahead, gathering evidence to present the case of Sarah Smith’s death to a grand jury. At the same time, the New York State Board of Health continued its meticulous investigation to see whether Anthony’s medical license in that state should be suspended permanently.
For the moment, Anthony had continued seeing patients. His opinion was that Sarah Smith had been taking some over-the-counter herbal additives she hadn’t told him about. In Anthony’s opinion, that was the only way his anesthesia could possibly have harmed her. As always, Anthony Pignataro believed that he never made mistakes. Any problem had to be the patient’s fault.
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Frank A. Sedita III, now head of the Homicide Investigation Unit of the Erie County D.A.’s office, would be designated as the assistant district attorney working on the case of Sarah Grafton Smith. Like most of those involved in this medical tragedy, Sedita’s family went back many generations in Buffalo. His grandfather, Frank A. Sedita, had been the sixty-third mayor of Buffalo, and he had been an awesome hero to his son and his grandsons.
The first Frank Albert Sedita was born in New Orleans in 1907, one of eight children of Italian immigrant parents. When the Seditas moved to Buffalo, Frank was 4, and by the age of 10, he was selling newspapers on downtown street corners to help support his family. As his son and grandson would do later, he attended Canisius College, but he had to work his way through as a busboy and a salesman.
It was 1931 and the height of the Great Depression when Frank Sedita earned his law degree; the next year he was admitted to the bar. He had many jobs over the next several decades: deputy sheriff, secretary of the Division of Water, city clerk, and city court judge. As a judge, he saw the plight of the homeless and the alcoholic, and he worked to help them. As the city’s mayor for three terms, he quelled incipient race riots in Buffalo and appointed blacks for the first time to high city positions. The African-American population had come to Buffalo in large numbers in the 1860s as they escaped from the South through the Underground Railway. With Canada just across the water, Buffalo was a prime passageway, but many running from slavery chose to stay. Mayor Sedita gave them respect, just as he fought for urban renewal.
He was a man ahead of his time, dealing with issues that most of America would ignore until much later. “FAS,” the first, was a staunch Democrat and the first mayor of a large city to endorse John F. Kennedy in 1960.
Ill health forced Mayor Frank Sedita to resign in 1973, and he died at 68 on May 2, 1975. His mammoth desk now sits in the foyer of Frank Sedita III’s home in the city’s historical section, North Buffalo. It is the young prosecutor’s proudest possession.
Frank A. Sedita, Jr., is a New York Supreme Court judge, and Frank III’s cousin Joe is an attorney. “He’s the smartest of all of us,” Sedita comments. Perhaps. The fact is that they are all smart.
As in so many other East Coast cities, Buffalo’s 305,000 residents belie its small-town atmosphere. Families who settle there don’t leave, and connections are forged through decades. Buffalo has seen its struggles, first with the history-changing excavation of the Erie Canal and then with both the wealthy and the criminal elements, who flocked to the crowded harbor to make their fortunes.
But by the 1990s, Buffalo was designated an All-American City. Today, it is a city rich in tradition and culture. The legal community is tight, and friendly��at least outside the courtroom.
In the 1930s and 1940s, all the Italian Buffalonians lived on the west side. Three generations ago, the first Frank Sedita and Anthony Pignataro’s grandfather—for whom Anthony was named—were contemporaries. Anthony’s grandfather owned a restaurant/bar, Scottie’s, where the menu featured clams and pasta. It was a very popular hangout for the “guys,” where they could smoke and drink undisturbed, and the first Frank A. Sedita and the first Anthony Pignataro knew each other well. A similar establishment, across the street, was where organized crime gang members met, and neither the mayor nor Anthony’s grandfather patronized that spot.
Of course, Anthony’s father, Dr. Ralph, had a fine reputation in the community and was welcome at any hospital. The Pignataros were well thought of. Though perhaps not quite as solid as the Seditas, they were an integral part of Buffalo history.
At first, Anthony thought that the old-time family connections were a good omen for him and that the prosecutor Frank Sedita would look upon him more kindly because of that. It was a flawed assumption.
“I never met him,” Sedita recalled. “I had a vague memory of reading his ads in the Buffalo Sunday newspaper. I kind of chuckled at the hair implant and breast implant ads.”
Although he looks as Italian as his name, with dark hair and eyes, the “third FAS” explains that he is half Italian and half Scots—which he is. His dog is a West Highland Terrier, and his son is named Mac. His thick brush of a moustache and his suspenders sometimes give him the appearance of a Buffalonian of a much earlier generation.
Frank Sedita met his wife, Leslie, at a party, where they explored their mutual Scottish roots. His ability as a chef, however, comes from a cousin on his Italian side with whom Sedita lived while he was going to law school. Sedita’s biggest triumph in the kitchen is probably his chicken marsala. Frank Sedita knows the words and the orchestration of every song Frank Sinatra ever sang; they are both “Frank Albert” (although Sinatra’s given name is Francis). Sedita has a deadpan sense of humor that can be off-putting until you get to know him and realize that he’s teasing.
In the courtroom, Frank Sedita, III, is a tenacious opponent. Leslie Sedita attributes that to his intense preparation and the fact that he approaches his cases backward.
“He starts where he knows he wants to end up, and then works back to what he wants in a jury.” Like most attorneys involved in major trials, Sedita is consumed with preparations for the weeks in court and during the time the case is being heard. So, at home, there’s the “trial Frank” and the “regular Frank,” according to his wife.
Leslie’s career may not be as high profile as her husband’s, but it is just as vital to the citizens of Buffalo; she runs the Buffalo Sewer authority’s Industrial Waste section.
Together, the Seditas are restoring their century-old house, bringing it back to the way it was in its glory days. Some of the original wood is magnificent, even though it was referred to as “scrap wood” left over from the Pan-American Exposition of 1901.
All up and down their block and the blocks around them, homeowners are doing the same. These were the streets where Frank Lloyd Wright chose to build the Martin House Complex when he was only thirty-six years old, a very avant-garde weaving of brick and beam structures with square clean angles commissioned by Darwin and Isabelle Martin. Most people connect the country’s most famous architect with the Southwest, but the young Wright chose Buffalo to build this outstanding example of his Prairie House era in the early years of the twentieth century.
By 2003 standards, the North End streets are narrow, but they are ablaze with Christmas lights in December, and they bloom with flowers when the frigid Buffalo winters finally give way to spring and summer.
Almost everything about Anthony Pignataro’s bizarre saga is interwoven with the Seditas. The threads of lives are braided together so that the characters almost seem to change sides as a new “game” begins. Initially, Debbie Pignataro would view Frank Sedita as her enemy and a threat to the family she had struggled for two decades to keep intact. She could never imagine that a time might come when she would welcome Frank Sedita into her home.
As for Anthony, as the nineties moved toward the millennium, Frank Sedita III, became the most dogged enemy he had ever faced. He despised Sedita just as he hated anyone who criticized his superiority.
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“The first time I ever really thought about Pignataro,” Sedita recalled, “was when the D.A. called me in and said, ‘This is a very unusual case. I want you to think about it.’ I was on my way to a death penalty conference, and we agreed we’d talk about it when I came back.”
It would turn out to be not one case, but three—and they were the most memorable of Sedita’s career to date.
Pat Finnerty and Chuck Craven had located everyone who was in the basement operating room when Sarah Smith stopped breathing except for Tom Watkins, the high school junior from Nichols School. The private school attended by the scions of Buffalo’s richest families was very protective of Tom and reluctant to let detectives talk to one of their students. It was November 1997 when Finnerty and Craven finally met with Tom, his attorney, Terry Cotters, and Frank Sedita.
Sedita explained to Tom that they weren’t trying to incriminate him in any way. He said, “Listen, I don’t know what the attorneys have told you, but we’re not interested in prosecuting you. We just want to find out what happened that day.”
As soon as Tom and his mother understood that they simply wanted to know the teenager’s recall of the operation, “The dam opened up,” Sedita said.
The investigators quickly understood that Tom had been in the operating room as a gofer. Sedita asked if Tom had ever assisted with the intravenous sedatives.
Tom shook his head, obviously relieved. He was clearly very intelligent and quite willing to talk to them. He said that Dr. Pignataro had come to Nichols in late spring looking for someone who would be an “intern” at his office over the summer vacation. Tom was interested and visited Pignataro’s office, where he observed him doing a hair transplant. Where most people might be nauseated, Tom was fascinated. He wanted to be a doctor himself one day. He began his “internship” in late June, 1997, and earned $5 an hour for working three to six hours a day for four or five days a week. He said Dr. Pignataro paid him periodically by check.
Tom said that some of his duties were to sterilize the surgical gowns and instruments and help the nurses set up the surgical trays. He was allowed to watch many operations, including breast augmentations. He agreed with the other witnesses that the breast patients were usually given pills and water upstairs, and then walked to the operating room in the basement. The doctor, Tom said, kept all medications in a safe, sending him or one of the nurses to get them. On occasion, he—or a nurse—had mixed them, but always with precise instructions from Dr. Pignataro.
As for machines to monitor the patients’ condition, the only machines Tom ever saw the doctor use during the operations were the pulse oximeter and the blood pressure cuff.
He recalled that during July Dr. Pignataro had gone to California to learn the new technique of inserting breast implants through the navel, and Tom said the doctor was very excited about it. He had bought some new equipment to tunnel under the skin. Pignataro never measured or marked the skin of a patient before he started cutting.
Sedita asked Tom about the pulse-ox machine. Tom said that he had been present two or three times when a patient’s oxygen level had dipped below a 70 percent reading during surgery. When that occurred, the doctor had rapped the patient on the head or on the sternum and then had the patient given oxygen by a mask. But they always came back. He said the doctor was never worried if the reading was in the 80s. The men questioning him knew now that readings below 85 percent were dangerous.
For Sarah Smith’s surgery, Tom recalled that it was Mrs. Pignataro who had become concerned about the patient’s lack of oxygen, but that the doctor kept right on with his operation, not even glancing up. Debbie Pignataro had quickly put an oxygen mask over the patient and had tried to get her husband to check on Sarah. She sent Tom to get nail polish remover so they could see the color in Sarah Smith’s nail beds more accurately. He brought it to her and then they could see that the patient’s nail beds weren’t pink, and her oxygen reading didn’t go up.
Finally, the doctor had “broken scrub,” gone to the patient’s ear, and shouted at her to breathe. Mrs. Pignataro had frantically tapped her on the chest, but there was no response.
Tom felt that it had taken about ten to fifteen minutes while he was sent to look for things, and then the doctor had sent him up to find the Ambu-Bag. He had mistakenly grabbed one that was too small and was sent back for an adult size. By this time, he thought that either the doctor or Mrs. Pignataro was doing closed chest massage and the doctor was telling Janie to get the “shockers” ready.
But even with a bigger Ambu-Bag, Tom said the patient’s lips were pale blue. She wasn’t getting any oxygen. Tom said he tried to follow the doctor’s directions to hold her jaw while the surgeon used a piece of metal that broke, and finally a coat hanger, to open an airway. And all this time, Janie was saying she didn’t know how to use the “shockers.”
“Did you see the heart monitor?” Sedita asked.
The boy shook his head. He had never seen any sign that either the EKG machine or the “shocking machine” were turned on.
Dr. Pignataro had shouted at his wife to call 911, but when she stood frozen, Tom said he took the initiative and made the call. When the paramedics arrived, they had taken over and put the patient in the ambulance.
The boy said that the doctor had located him later that day and warned him about what to say. Tom was to stress that he was only observing the operation. Anthony wanted him to say that he was employed by the clinic to answer phones. A few days later, Dr. Pignataro had called Tom and asked him, “Isn’t the media coverage wild?”
Tom had no idea what to say to that.
Only a teenager, Tom Watkins had given them the most comprehensive report of anyone who had been there in that chaotic scene in the operating room.
This was definitely a different version than Anthony himself had written in his report, which was only three quarters of a page long. Whatever he lacked in technique in surgery, he made up for in his very professional-sounding report. He had always been good at making excuses and explaining away mistakes. In his report, his actions sounded entirely proper.
But as brilliant as the report sounded, it was very difficult to explain away a dead patient. Perhaps only a man who viewed the world as Anthony Pignataro did would have chosen to blame the patient. He covered it in his “biography.”
“What could have gone wrong? What information that, if available preoperatively, could have prevented this tragedy? Sure, an overdose of herbals taken in an attempt to ‘purge’ one’s system, leading to an extremely low potassium [count] could explain the events, yet one got the distinct sense that there was an unknown—an unknown that the husband may have well known.”
Anthony even pondered that lawyers for Dan Smith were keeping everyone who knew the secret from talking.
“Several days later,” Anthony wrote, still in Debbie’s voice, “it was revealed that illicit drugs may have played a role in the patient’s response to the sedation used during the surgery. The office manager reported an anonymous phone caller who stated that he/she felt that it was not fair the way the media was crucifying the doctor and that he [the doctor] should know that the patient had been partying with her boyfriend and doing cocaine the night before the surgery to celebrate her new breasts…I do not want to believe this. A brilliant mind and career [Anthony’s] may have been sacrificed for this error in judgment. Yet, too many subsequent coincidences occurred to call it paranoia.”
The Debbie voice in the unpublished memoir was vehement that Anthony had brought Sarah Smith back and started her heart beating again. He actually blamed the hospital and Dan Smith for pulling the plug on her respirator, and laid out a plot whereby a conspiracy connected to the Erie County D.A.’s office had begun a spurious investigation into his actions, whereas he, the surgeon, had tried so heroically to save Sarah.
“What had taken thirty-nine years to build,” Anthony wrote, still using his wife’s voice, “was destroyed in one week. Anthony was so bereaved that he coul
d scarcely get out of bed in the morning.”
Anthony quoted everyone from Kenneth Starr to the Bible to make his argument. He insisted that Sarah Smith had come to him with a defective heart and liver dysfunction, and that her own actions and those of her husband, the hospital where she died, and the District Attorney had brought him to the end of his career.
Reading Pignataro’s manuscript isn’t easy, because he continually changes narrators, usually writing as his wife but occasionally forgetting and slipping into his own voice. Anyone who talked with Debbie Pignataro could see that it was obvious, however, that Anthony had written every word. She didn’t have his vocabulary, his knowledge of medical terms, or his hubris.
Anthony added yet another conspirator. His attorney had sent an unsolicited package of information on the case to the famed Dr. Michael Baden, former Chief Medical Examiner of New York City, an expert in forensic science, enclosing a check. The attorney didn’t know that Baden was out of the country for an extended period. When Dr. Baden returned, he read only as far as Anthony’s attorney’s cover letter and knew this was not a case that he could confer on. Baden worked directly with the New York State Police, and any consultation on Pignataro’s case would be a conflict of interest.
Baden returned the material unopened and sent a for check the full amount to Pignataro’s attorney. (Baden’s secretary had deposited all checks that came in to his bank account while he was out of the country.)
Nevertheless, Anthony created several scenes in his book in which Debbie had conversations with Baden. Debbie—using perfect medical terminology that never was and never would be part of her vocabulary—“wrote” of her many conferences with Michael Baden.