Angelina Hernandez
Angelina Hernandez stood less than 5 feet tall, weighed more than 300 pounds and was dependent on insulin shots to treat her diabetes.
She hoped liposuction surgery would offer a quick means to improve her appearance and help restore her health.
But the 56-year-old Hialeah woman died in June, about nine hours after surgery in the Miami office of Dr. Constantino G. Mendieta, according to Miami-Dade Medical Examiner’s Office records.
Mendieta had no comment for this article.
The cause of Hernandez’s death was respiratory arrest associated with anesthesia given her during the four-hour operation, medical examiner records state. Her obesity contributed to her death, the autopsy found.
An internist who examined Hernandez the day before the surgery and cleared her for the procedure said the operation should be done in a hospital to reduce the risk. Another doctor consulted by the Medical Examiner’s Office agreed.
“I believe that this patient’s interests would have been better served if the procedure had been carried out in a hospital setting as the internist had originally noted,” wrote Dr. James J. Jacque, assistant professor of clinical anesthesiology at the University of Miami School of Medicine.
Jacque also criticized the performance of the nurse anesthetist, who was not named in the state’s records.
In reviewing the medical records, Jacque said it was likely Hernandez did not get enough oxygen throughout the surgery, or afterward.
Jacque also noted that monitoring the anesthesia is critically important, especially when a patient is obese.
Hernandez entered the office operating room just after 9:45 a.m., according to Jacque’s evaluation. The operation took about four hours, and Mendieta removed fat and some skin from her stomach, and repaired a hernia.
Hernandez awoke from the surgery and removed a breathing tube stuck down her throat. She complained of shortness of breath and was given an oxygen mask at 2:35 p.m., according to medical records, apparently because the woman’s obesity made it difficult to re-insert the breathing tube.
Patients awakening from anesthesia often dislodge the breathing tube because it is uncomfortable, said Dr. Reinhard Motte, a Miami-Dade associate medical examiner who conducted the autopsy.
“You’re supposed to put [the tube] back in. They didn’t,” Motte said. The mask delivers less oxygen than the tube, he said.
By 3:40 p.m., Hernandez was growing increasingly more restless and was given a tranquilizer to help calm her.
Exactly what happened next is unclear, according to Jacque, the medical examiner’s consultant.
In his written evaluation of the case, Jacque said that despite Hernandez’s worsening medical condition, staff at the doctor’s office didn’t keep trying to re-insert the breathing tube and waited more than an hour to call paramedics.
Rescue workers took Hernandez to Mercy Hospital, where she suffered cardiac arrest about 6 p.m. and again at 10:35 p.m. She died at 11:42 p.m.
Motte, the associate medical examiner, said surgeons who choose to operate in their offices “are supposed to know how to handle any emergency that arises and respond appropriately.”
Jerry Osuch
Jerry Osuch loved Disney World so much that he left Arizona to take a job as a senior systems analyst at the Kennedy Space Center to be close to the amusement park.
Every day, he wore one of his almost 300 Mickey Mouse ties to work. Osuch was passionate about his health, too. He watched what he ate, walked on the beach every night for exercise and mulled over books on how to reduce stress and live to be 100.
But he made it only to age 49, felled by a heart attack.
Osuch rejected conventional cardiac treatment. Instead, he chose chelation therapy, intravenous drips of a chemical called EDTA. Advocates argue chelation can cure heart disease and extend life, by ridding the body of harmful calcium deposits that cause plaque to form and clog the coronary arteries.
Osuch, a father of two adult children, started feeling poorly in late 1994. His doctor suggested he see a cardiologist, but Osuch opted to start chelation therapy, according to his daughter.
“My father had a fear of surgery. The idea of it petrified him. When he heard of chelation, he thought he would try it. He hoped it would cure him,” said Michele Melanson, a respiratory therapist who lives in a Chicago suburb.
Osuch picked Dr. Neil Ahner, a former chiropractor who returned to medical school and received a license to practice medicine in Florida in 1982. Ahner now operates four chelation centers, from Jupiter to Vero Beach.
Melanson said Ahner told her father that after 10 chelation drips, he would be re-evaluated. But Osuch felt worse.
On the day after his final chelation treatment in March 1995, she said, he took a nap during work and was a “terrible gray color” when he got home.
The following day, an ambulance took Osuch to Cape Canaveral Hospital, where he died after a heart attack.
A lawsuit filed by Osuch’s widow, Janine, claimed Ahner failed to realize Osuch required immediate medical attention and a specialist in cardiac care.
Instead, Ahner started him on a series of chelation treatments. The suit also claimed that chelation was “not an accepted practice” in treating Osuch’s condition and that Ahner failed to properly review his patient’s medical tests and history.
Ahner said in an interview that he did everything properly and that Osuch did not have “unstable angina” and did not need a bypass when he came for chelation therapy.
“I didn’t do anything wrong,” Ahner said. “[The family] said he should have had a bypass. I said fine. I don’t have anything to do with that.”
The suit was settled in May 1998. Terms are confidential.
Ahner said he wanted to fight the suit in court but his insurer chose, in a business decision, to settle. He said the insurance company paid a “couple of hundred thousand dollars” to end the case.
Melanson said she is still upset her father didn’t get the traditional medical treatment that might have kept him alive.
“I was furious that they kept giving him chelation. But he had faith in the doctor. If you went into a room wearing a lab coat, he’d think whatever you said was Scripture,” she said. “It was a horrible experience all the way around for our family.”
Louis Labbe
In his last days of life, Louis Labbe, 69, an accountant from Wilton Manors, endured chest pains so severe he couldn’t sleep through the night. He drove to see Dr. Daniel Roehm in Pompano Beach on Feb. 25, 1992.
Roehm, who has since died, was a maverick cardiologist with a radio talk show and an abiding faith in vitamin therapy and chelation as the closest thing to a cure for heart disease.
An electrocardiogram showed Labbe had suffered a heart attack before he arrived at the office. The doctor gave Labbe a course of chelation and sent him home with nitroglycerine, which seemed to ease his chest pains, according to Broward County medical examiner records.
The next day, Labbe returned to Roehm’s office for a second dose of chelation. He again complained of chest pains that kept him awake at night. Roehm conducted a second EKG, which showed worsening heart damage from another heart attack.
But Roehm stuck with chelation, state records show.
Almost two hours into the chelation drip, Labbe turned cold, weak and clammy. Orange juice and sugar didn’t help. About 20 minutes later, his blood pressure plunged and he started vomiting, according to medical records.
Roehm called an ambulance to take Labbe to North Broward Medical Center. He suffered a massive heart attack and died in the emergency room, according to state records.
“It was a real surprise,” said Rona Dupont, Labbe’s cousin, who lives in Massachusetts. “It was a shock. He always had a bad cholesterol problem, but it was so sudden.”
Labbe’s case outraged Dr. Stephen Nelson, then a Broward associate medical examiner. Nelson complained to the state’s medical licensing board that, given the gravity of Labbe’s illness, Roehm should have hospitalized him on his first visit.
The Florida Board of Medicine agreed. In June 1992, a three-member panel found probable cause to believe Roehm’s care of Labbe fell below accepted standards.
Roehm’s medical records “failed to demonstrate that the doctor even understood how serious and how sick this patient was and how important it was to get some intensive care and some aggressive therapy,” argued Larry McPherson, a state health care agency attorney.
The state went on to accuse Roehm of gross malpractice in treating Labbe. Roehm relinquished his medical license in July 1993 to avoid further board action against him. He died in 1996.
Elena Busto
Elena Busto, 66, a grandmother of six from Titusville, went to Dr. Robert M. Knight’s office in Winter Park after seeing an ad in a local newspaper. She wanted relief from thick varicose veins, which were painful, particularly when she stood for long periods.
At first, the injections went fine. But during a November 1993 visit, the physician’s assistant may have mistakenly hit an artery instead of a vein, according to a lawsuit Busto filed. The artery then spewed the chemical into the surrounding tissue, leaving Busto with a severe burn and a gaping hole in her calf.
“I felt a very bad pain. I was on my stomach. It hurt so much. I felt like I still had the needle inside,” Busto said.
She said Knight told her it would take a few weeks for her leg to heal. Instead, she said, it took almost six months. She was forced to use a walker and a wheelchair to get around.
Busto argued that Knight did not properly train or supervise the assistant’s work, but Knight disagreed. In a deposition, he noted that Busto had signed a consent form and watched an educational video that made clear the risks and complications of sclerotherapy.
Knight’s insurance company settled the suit for $37,500 in January 1998, according to Department of Insurance records.
Busto, formerly a $6.25-an-hour paste-up artist for a publishing company, said she hasn’t worked since the injury.
“The nerve is damaged. The pain is there all the time,” Busto said. “If something just touches my leg, I feel like electricity going there. It’s never going to go away.”
Knight said his complication rate was lower than that of most surgeons.
Knight still does vein treatments. He works in a chiropractic office in a shopping center on Taft Street in Hollywood. He calls his practice Metabolism, Longevity & VeinCare, and hopes to focus his efforts in the future on human growth hormone to retard the aging process.
Sharon Fogan
Sharon Fogan, 30, a mother of two, was “a beach person all her life and was very self-conscious of her legs,” a family member told state investigators.
Worried about varicose veins, Fogan visited the office of Dr. Robert M. Knight in April 1990 for a course of sclerotherapy, a series of injections that cause the unsightly veins to recede.
Knight wasn’t there at the time, but when a physician’s assistant made the first vein injection, Fogan immediately felt severe pain, and her right calf turned black. Once Knight arrived, he gave her a shot of narcotic to ease the pain and sent her home, according to state medical records.
Fogan later had a series of operations at Holy Cross Hospital in which doctors cut away dead tissue in her leg in an effort to restore its appearance.
Despite the subsequent operations, Fogan was left scarred, in severe pain and depressed by her appearance.
In September 1991, she killed herself with an overdose of tranquilizers. Family members said she was despondent partly over the complications from the vein treatment.
Knight denied any negligence. But two state medical experts criticized Knight for Fogan’s care. Dr. Gary Rosenberg, a Delray Beach plastic surgeon, said doctors had “no business” performing this sort of procedure if they could not recognize and aggressively treat a complication.
The other expert, Dr. Joseph L. Akerman, of Apopka, determined that Knight had not supervised his assistant adequately.
But the state’s inquiry of Knight’s conduct dragged on for more than five years. By that time, both Fogan and her mother, who had accompanied her to the office and was considered a key witness, had died. The physician’s assistant who did the injections had moved to Texas.
“All pertinent factual witnesses either passed away or left the state,” wrote Kevin W. Crews, attorney for the Agency for Health Care Administration, in a May 1996 letter explaining why the case against Knight was being closed.
Fogan’s case was one of at least seven against Knight investigated by the Florida Board of Medicine. The board ended up taking no disciplinary action against him.
Twelve former patients of Knight’s collected settlements totaling $1.67 million since 1985 — among the highest number of claims for any Florida doctor who works exclusively at a private medical office, state insurance records show.
Knight said he ran a large-volume practice with several vein-care centers around the state.
“If you do enough injections, you will have some scars,” he said. “Everything I did in my practice was defensible.”
Silvana Lopez
Silvana Lopez, 25, checked into Palm Springs General Hospital in Hialeah on the morning of Dec. 11, 1998, for what was supposed to be simple surgery.
The dental assistant and mother of two from Sweetwater was there for a tummy tuck to get rid of some excess weight. At the same time, she was to have a tubal ligation and removal of an IUD, a birth-control device.
The operation started at 1:40 p.m. By 2:55 p.m., Lopez was sent to a recovery room. Soon after, she was moved to a regular patient room, according to medical records.
Lopez began complaining of pain and was given medications ordered by the doctor. She remained under the effects of anesthesia.
Hours passed. About 11:05 p.m., a nurse noted that Lopez was alert but drowsy and had no complaints. At midnight, Lopez vomited large amounts of bile-like substance, according to medical records. She was washed and her bed was raised.
A nurse later told authorities that she and an aide checked on Lopez every half-hour. At 2:30 a.m., Lopez was found again to be vomiting, according to medical records. A nurse contacted the doctor, who prescribed a medicine to treat nausea.
At 3:45 a.m., Lopez was observed to be breathing heavily, with a tremor in her arms. She was warm and clammy. A nurse shook her and placed her on her side. At 4:20 a.m., Lopez was unresponsive. Medical staff called a “code blue” and tried to revive her, according to a police report. Lopez died at 5:35 a.m.
The Miami-Dade County Medical Examiner’s Office ruled the case a natural, sudden death associated with the narrowing of an artery.
“This is an unusual case,” said Dr. Michael Bell, associate medical examiner.
The physician who performed the surgery, Francisco Monteavaro, a general surgeon from Hialeah, said that “tragically,” Lopez’s death was caused by her heart condition.
“Surgically, nothing went wrong,” Monteavaro wrote in a letter to the Sun-Sentinel.
Hospital officials did not respond to requests for comments.
Family and friends of Lopez were stunned that she could have died following such seemingly routine procedures.
“It’s been rough. It’s been devastating,” said her fiance, Eduardo Montano. “We figured this would be a pretty simple routine procedure. It never crossed my mind that anything like this could happen.”
Miami attorney Alfonzo Perez, who is representing Lopez’s children and Montano, called the case “really, really sad.”
“She was a good, hard-working person who worked at a dental office in Hialeah,” Perez said. “She was a very nice lady.”
Steve Crebbin
Steve Crebbin, 32, a landscape architect soon to be married, was excited about traveling from Tavernier to Ybor City to meet some buddies for a bachelor party.
His best man couldn’t make it, but Crebbin and two other pals figured they would go anyway; they already had plane tickets to Tampa and could stay at a friend’s apartment.
That night last February, Crebbin and a friend drank several beers and watched a hockey game on television at the apartment. Another friend arrived, carrying a red liquid in an unmarked plastic jug that had been purchased by a fourth party at a health food store in Central Florida.
Police later learned that the red liquid contained a growth hormone, popular with bodybuilders and those hoping to slow the aging process. Though the brand name never was verified, dozens of such hormonal preparations are on the market, available in health stores or over the Internet.
But authorities said this red liquid, after Crebbin swallowed it, metabolized into GHB, an illegal compound that has depressant effects.
GHB gained popularity in the early 1990s for its alleged ability to provide an alcohol-like kick without the hangover, and gained notoriety for its implication in “date rape” cases.
Over-the-counter sales of GHB, which acts as a central nervous system depressant, were first questioned by the U.S. Food and Drug Administration in 1990, when the agency declared the drug unsafe. The FDA banned sales of the drug in 1997.
Since then, the FDA has warned the public that the substance, which is mixed in illicit laboratories, can cause injuries, even death, especially when ingested with alcohol.
But the FDA has not banned a number of growth hormones, like that found in the red liquid Crebbin drank, that have properties similar to GHB.
Many of these hormone products are marketed as dietary supplements, as alternatives to steroids for weight lifters hoping to bulk up, and as curatives for aging and sleeplessness.
Crebbin and his friends drank a shot of the red liquid, then poured some into a metal flask, which they took with them to a dance club in Ybor City.
Crebbin had more beers, at least one shot of a liqueur and downed more of the red stuff in the men’s bathroom, a police report states.
As he left the club about 1 a.m., Crebbin appeared to be falling-down drunk. He got dizzy and vomited on the sidewalk. His friends took him to their truck, where he passed out in the back seat. When they got to the apartment, they couldn’t wake him up, so they called 911.
An ambulance took Crebbin to St. Petersburg General Hospital, where he was dead on arrival at 2:32 a.m., according to a police report.
The Pinellas County medical examiner ruled that Crebbin had died accidentally from the combined effects of alcohol and GHB.
“You could talk for hours about how tragic it is. Our business was on top of the world. It was peaking. He was going to get married [the next month],” said Richard Brown, Crebbin’s friend and business partner who was with him when he died.
“We didn’t even know what this stuff was or the implications of drinking it,” Brown said. “It’s just terrible that there’s no second chance on something like that. There are people who abuse their bodies, do terrible things and live through it. For Steve to die from something like this is so upsetting.”
Crebbin’s father, Bob, said his son never would have gone near the hormone liquid had he known of its dangers.
“When the drugs would come out if they were at a party, he and his fiancee would excuse themselves and go home,” said Bob Crebbin, a retired fire-rescue worker from Homestead.
The elder Crebbin said he was deeply troubled that GHB, or substances like it, still can be purchased on the Internet, and in the case of the red liquid, from health food stores.
“Our son’s death was a tragedy,” he said. “You can buy this material on the Internet by the case. That’s absolutely disturbing to me.
“I think it’s a sales pitch that they use that draws people in. The way they advertise it, it’s not harmful to you and it does you good.”
