Florida legislators failed to act as the high-volume businesses left 13 dead, a dozen injured, according to a USA TODAY investigation.
One man pleaded guilty to bank fraud. One was convicted of grand theft in a real estate scam. Two others admitted to elaborate Medicare schemes that siphoned millions from taxpayers.
In Florida, one of the nation’s top destinations for plastic surgery, a felony conviction can bar someone from operating a massage parlor or a pawn shop.
But not from running a cosmetic surgery clinic.
Nearly a dozen miles from the iconic beaches of South Florida, the four convicted felons ran facilities that became assembly lines for patients from across the country seeking the latest body sculpting procedures at discount prices.
And at those businesses, at least 13 women have died after surgeries. Nearly a dozen others were hospitalized with critical injuries, including punctured internal organs.
The state health department was alerted to the casualties. Government inspectors cited the clinics for serious violations, including dirty operating rooms and sales agents with no medical licenses determining the appropriate surgeries for patients.
Plastic surgery experts warned lawmakers to take control of the centers by screening owners and boosting regulation.
Four times, legislators tried. Four times they failed to muster enough support to change the law, even as the toll at the four businesses continued to rise: two dead in 2013, no action; another dead in 2015, no action; three dead in 2017, still no action.
“It’s absolutely incredible,” said Dr. Grant Stevens, a clinical professor of surgery and president of the American Society for Aesthetic Plastic Surgery. “Government is supposed to protect the health and welfare of its citizens.”
Discount surgery centers founded by felons leave two women scarred
Porche Campbell and Nicola Mason discuss the aftermath of visiting Spectrum Aesthetics, a clinic in the Miami area founded by two partners who had been convicted in a Medicare fraud case.
At Seduction by Jardon, a 31-year-old woman went into kidney failure and nearly bled to death as she languished in a back room for six hours before her mother found her, hospital records and a state complaint show.
At New Life Plastic Surgery and Strax Rejuvenation, women died after their doctors injected fat into their muscles in a popular procedure known as the Brazilian butt lift. Medical experts who reviewed autopsies for USA TODAY said the fat was injected too deep and collected in their lungs, killing them.
One woman, who left Spectrum Aesthetics with a stray surgical sponge sewn into her abdomen, said she would have canceled her tummy tuck if she had known the operators had been convicted of defrauding Medicare of $1 million.
A manager of the clinic, Evelyn Parrado, was granted permission to run the cosmetic surgery center during the day while spending her nights under house arrest on the felony charge.
“Why is that allowed to be legal?” said Porche Campbell, the 40-year-old mother who needed emergency surgery to take out the sponge and, later, reconstructive surgery to get rid of the scar. “How can I trust them to keep me safe?”
Most of the women who died – 10 in all – were African-American or Hispanic, ethnic groups frequently targeted in the clinics’ advertising campaigns.
Representatives of three of the clinics – Spectrum, Strax and New Life – told USA TODAY that criminal histories have no bearing on the way the centers are run and that their facilities meet all state safety requirements to carry out procedures.
Jeffry Davis, a co-founder of Strax Rejuvenation, pointed out that his convictions on federal bank fraud and tax evasion were nearly a quarter-century ago, in 1995.
“I personally don’t see how that would affect anybody’s feeling of my integrity today,” he said.
The president of Seduction declined to answer written questions about the business or the involvement of her husband, who was convicted in a mortgage fraud case.
The role of clinic operators varies greatly but can include hiring doctors, ordering drugs, scheduling surgeries, and overseeing risk management to cut down on deaths and injuries.
Health care experts say a criminal history – especially a conviction for financial crimes – is among the most important factors in deciding who should be allowed to run a center.
Clinic operators are expected to follow a litany of health regulations that require them to put safety over profit, said Michael Gonzalez, an Ohio lawyer who advises medical institutions on hiring practices. With felons, he said, “you have people with a propensity” to break the law.
Florida legislators in Tallahassee are back this year with another proposal that would give the state the power for the first time to shut down clinics and impose other punishments.
The bill was introduced by Sen. Anitere Flores in February, days after a USA TODAY and Naples Daily News investigation revealed dangerous practices in a Miami-area plastic surgery business where eight women died after operations and nearly a dozen were hospitalized.
“People are coming here from all over the country for what should have been simple procedures, and they’re dying,” said Flores, a Republican whose district includes the state’s cosmetic surgery hub in the suburbs of Miami. “We don’t want to be known as a place where people come to die.”
The proposal has gone further than previous bills, clearing three Senate committees and two House panels – all unanimously. Yet critics continue to question whether a legislature historically opposed to regulation will support the crackdown.
They point out that even as lawmakers turned down past attempts at stricter oversight, they approved millions of dollars to promote Florida as a destination for medical tourism, with plastic surgery as one of its big draws. In 2014, the state allocated the first $5 million to that marketing campaign.
Nicola Mason, a Maryland woman with deep, jagged scars along her lower stomach that she blames on an operation at Spectrum in 2015, wonders why it has taken so long for the state to act.
“It’s outrageous,” she said. “They should have thought about this six or seven deaths ago.”
At New Life Plastic Surgery, seen here, and Strax Rejuvenation, women died after their doctors injected fat into their muscles in a popular procedure known as the Brazilian butt lift, autopsy records and interviews show.
Packed waiting rooms, busy surgical suites
At Strax Rejuvenation near Fort Lauderdale, surgeries turned deadly nearly every year.
A 64-year-old woman was given lethal doses of opioids by her doctor during a face lift in 2008, a state malpractice probe found. Another woman died three years later after a neck lift during which her doctor gave her a dangerous mix of sedatives and then failed to monitor her, state investigators reported.
Eight deaths in eight years, according to autopsy and state records. None of them made a difference.
Florida legislators passed laws decades ago that allowed the state to discipline doctors who owned clinics and practiced there. They never envisioned that private investors would jump into the industry, too.
That loophole means people without medical degrees can own clinics that break state laws with little chance of being shut down, even if they leave patients dead.
“There is a gap,” said Christopher Nuland, a health care lawyer who helped write the first legislation in 2000. “No one anticipated that non-physicians would take over clinics and be largely immune to these good laws.”
In the end, the operators who benefited most from the discount clinics faced no repercussions.
One of those clinics was Strax, which opened in 2004 and became the first of the large, high-volume clinics that can create unique risks for patients.
By paying doctors strictly on commission and offering cut-rate prices, the clinics often operate with packed waiting rooms and busy surgical suites, and at times leave patients to fend for themselves after procedures.
State inspectors have cited Strax’s two clinics more than 45 times in the past six years for violations that included dirty operating areas, cracked and worn equipment, and no records to show doctors examined patients to clear them for surgeries.
Davis, Strax’s manager, defends the model. He says the physicians control how many surgeries they do each day and the facility’s medical director makes sure patients are safe for their procedures.
“The Department of Health, if there was something (wrong), would be sending correspondence,” Davis said.
But records show about half the doctors who have worked at Strax – 11 total – have been disciplined by medical boards during their careers for charges that included unethical conduct and malpractice in death and injury cases.
After facing 18 negligence and malpractice claims by patients – with awards and settlements in eight cases totaling $1.5 million – Strax’s parent company filed for bankruptcy in 2013.
Through all of it, the clinic never shut its doors.
Instead, the clinic provided a prepared statement, saying it has been “delivering the highest standards of care to thousands of patients” for many years and the doctors connected to the injuries are no longer working for the facility.
Omulepu told USA TODAY the two women who suffered perforated organs were the “only serious complications of my career.”
However, two years later, while working at a competing clinic, Seduction Cosmetic Center, a patient died after surgery by Omulepu. The cause of her death: fat embolism.
Medical experts say the only way such an embolism occurs is when a doctor injects the fat into areas they are warned to avoid: the deep gluteal muscles. Omulepu says the surgery brings high risks and he regrets what happened in the operating room that day.
“Is it tragic? Absolutely,” he said. “Do I wish it didn’t happen? Absolutely.”
As to Mason’s claim that he performed the wrong surgery, Omulepu flatly denied the allegation, saying he would never do a procedure without the patient’s consent. “That’s assault and battery,” he said.
He said Mason initially signed up for a butt lift, but when he examined her, he determined she was not a good candidate, and they agreed she would get a tummy tuck instead, his surgery records show.
At the urging of the Florida Society of Plastic Surgeons, Sobel stepped forward with yet another bill in 2016, asking lawmakers to require background checks on owners. This time the bill was especially harsh on felony offenders: They would be automatically banned.
That proposal not only failed to draw a House sponsor, but it died in Sobel’s own health committee.
“Over-regulation, they tell people,” she said. “They use that as an excuse even when people die.”
Ultimately, the medical board revoked Omulepu’s license in 2017 over the cases of the punctured organs. He fought the charges in a state appeals court and temporarily won back the right to practice.
He returned to work and five weeks later performed the surgery at Seduction that led to the patients death by fat embolism. He lost his license again and is no longer practicing.
Source: USA TODAY