FATAL LIPO AT MALL: LAX RULES TO BLAME? SURGEONS OUTRAGED

BY: SONJA ISGER, Palm Beach Post Staff Writer
DATE: October 18, 2009
PUBLICATION: Palm Beach Post, The (FL)
EDITION: FINAL

WEST PALM BEACH — A 37-year-old nurse and mother of three walks into a Broward County strip mall Sept. 25 to have liposuction and walk out a little trimmer that afternoon. Instead, she is wheeled out in a coma by paramedics and dies two weeks later.

The routine surgical procedure took place in a storefront that once housed a tanning salon and is not equipped for surgery -- and it was conducted by a doctor who studied treatments for workplace injuries.

Dr. Omar Brito took up liposuction three or four years ago "following a trend in modern-day medicine," his attorney said.

And local experts in the field say the scariest thing is that nothing about these circumstances is illegal.

"The Board of Medicine needs to crack down on this -- now," said Dr. Alan Pillersdorf, president of the Palm Beach County Society of Plastic Surgeons and chairman of JFK Medical Center's department of surgery.

It appears some members of Florida's Board of Medicine agree.

This month, the board's surgical care committee moved to ask colleagues to compile records of patients who come to them needing fixes for problems created in so-called "medical spas." It also is drafting rules that, in the end, could move even the most minimal liposuction out of malls and back into surgical facilities.

No one knows how many liposuctions are being performed in shopping malls.

And those who get burned, sometimes literally, seem to be reluctant to complain, members report.

"We have only anecdotal data about complaints against medical spas," Eulinda Smith, spokeswoman for the Florida Department of Health, said recently. "But we are hearing this is a problem -- not just physicians practicing outside of their scope; it's the facility, too."

Woman's fateful day
It is too late for Rohie Kah-Orukotan.

She went into Weston MedSpa a vibrant woman at noon on Sept. 25. At 4:30 p.m., someone at the medical spa called 911.

She was taken to the Cleveland Clinic hospital in Weston, where doctors found she was in a coma and brain dead, says Chuck Malkus, a family spokesman. The Broward County Medical Examiner's Office confirmed Tuesday that Kah-Orukotan died at the hospital Oct. 9.

Broward County sheriff's investigators continue to look into the matter.

But on the face of it, the state's rules and regulations seem to back up the assertion by Brito's attorney, Brian Bieber: "This unfortunate or unforeseen incident could be a catalyst for a change in the law, even though Dr. Brito did nothing wrong and followed the law."

The medical world considers liposuction a surgery. Brito is not a surgeon.

Instead, he has spent most of his career in occupational medicine.

But state rules say Brito's credentials as a doctor are all he needed to perform a liposuction that sucked minimal amounts of fat out of someone under local anesthesia.

They call it a "Level 1" office surgery.

Level 1 surgeries, as defined by the state, include skin biopsies, mole removals, abscess draining and liposuction that removes no more than 4 liters of fat.

And Level 1 surgery can be done by any trained physician. It also can happen in an office, according to the state.

Weston MedSpa is listed as Brito's office. It is not a hospital, an ambulatory surgical center or a medical facility licensed for surgery by the state. And it doesn't have to be, under state rules defining office surgery.

Those requirements change only if the doctor intends to remove more than 4 liters of fat from the client or if that client is going to be sedated using general anesthesia, said West Palm Beach plastic surgeon Fred Barr.

That kind of liposuction rises to Level 2 or 3 under state rules and requires the facilities to be licensed by the state. It also requires the surgeons to have staff privileges and patient transfer agreements with local hospitals.

Surgeries of that level also usually require more medical personnel to be attending the procedure and more equipment on site.

Attorney: Doctor diligent
But even Level 1 liposuction can go wrong, surgeons agree.

Removing that fat may seem innocuous, but it is surgery. The body reacts as if it has been burned, sending fluids to the target site. Doctors introduce serious medicines such as lidocaine, a local anesthetic, into the body.

Bieber, Brito's attorney, says his client was diligent, consulting with Kah-Orukotan a week in advance. He reviewed her blood work. Bieber says it was only toward the end of the procedure that she went into distress.

When that happened, the doctor made every effort to revive her, giving her oxygen and performing CPR before calling 911, Bieber said.

The facility did not have a defibrillator or an emergency crash cart, Bieber said.

That's one reason neither Barr nor Pillersdorf is happy to see this procedure done in strip malls they say are not equipped to handle disaster.

"In the best hands, there can be problems," Barr said. "These things are not meant to be done at bargain-basement whatever."

Brito had performed about 25 liposuctions in the past three or four years, his attorney said.

By comparison, Pillersdorf said he has done between 50 and 75 a year for the past 15 years.

Brito is on record as having privileges at Palmetto General Hospital in Miami -- where Kah-Orukotan worked as a nurse.

Barr has privileges at Good Samaritan and St. Mary's medical centers and Columbia Hospital in West Palm Beach, and Jackson Memorial Hospital in Miami.

Hospital privileges, Pillersdorf and Barr say, are a good guide when patients look for someone to perform any surgery. While any doctor can perform an office surgery, hospitals have a system to grade and approve a doctor's work before granting privileges.

Copyright (c) 2009 Palm Beach Newspapers, Inc