Posted on 04/24/2005 4:14:15 PM PDT by aculeus
WHEN Liam Cregan got a call from the Irish Consulate in New York on March 15, telling him that his wife, Kathleen Kelly Cregan, was in critical condition at St. Luke's-Roosevelt Hospital, he thought it had to be a mistake, that someone had stolen her passport.
Mrs. Cregan had left her home in rural Ireland two days before, telling her husband, a farmer and part-time plumber, that she would be attending a business course in Dublin.
In fact she had flown to the United States to have a face-lift performed by Dr. Michael E. Sachs in his offices on Central Park South. Hours after surgery she went into cardiac arrest and was rushed to the hospital.
There, on March 17, with her husband and two sisters at her side, Mrs. Cregan, 42 and the mother of two young sons, was taken off life support and died. Her death is under investigation by the New York State Health Department. An autopsy was inconclusive, and the New York City medical examiner is awaiting toxicology reports that might explain what went wrong.
But from the time of her death her family had a simpler question: How did a farmer's wife from outside Limerick meet her end in such an improbable place?
Examining Mrs. Cregan's knapsack after her death, her family found a folded copy of an article from The Sunday Independent of Ireland. It was a glowing account of a face-lift performed by Dr. Sachs, "a leading cosmetic and facial reconstruction surgeon" in the United States, the article said, with a "highly confidential client list."
"There's a lot of money and interest here when it comes to plastic surgery," the article continued, "but there is also confusion and ignorance."
There were certainly things Mrs. Cregan was confused by and ignorant about. She had no idea, said her sister, Agnes Kelly, a nurse who lives outside Boston, that Dr. Sachs is among the most sued doctors in New York State, having settled 33 malpractice suits since 1995. She did not know that last year the State Health Department took the extraordinary step of banning Dr. Sachs - an ear, nose and throat specialist - from performing complex nasal surgeries without the supervision of another surgeon; that the operating room in his office is not accredited, as many of the best ones are; or that while he states on his Web site that he has been affiliated with the New York Eye and Ear Infirmary "for the last 23 years," he is not affiliated with that hospital or any other.
What Mrs. Cregan knew about Dr. Sachs came from publicity he helped generate through newspapers, magazines and television shows in Ireland, just as earlier he had paid publicists in the United States to help make him a celebrity doctor and attract patients. Her journey from Ireland to a private operating room in Manhattan offers a cautionary tale about the ability of doctors with tarnished records to promote themselves to trusting patients and the news media's role in abetting these efforts.
Dr. Sachs maintains that he has been unfairly singled out by New York State, by patients with unrealistic expectations of plastic surgery and by the media. He said he had settled the large number of lawsuits at the urging of insurance companies that favored payouts over the cost of litigation. And Dr. Sachs said he was confident that the state investigation into Mrs. Cregan's death would show he did nothing wrong.
"I'm a good surgeon and a caring doctor and a good doctor," he said. "We certainly had absolutely nothing to do with this."
THE son of a wealthy Manhattan real estate family, Dr. Sachs ignored his father's wishes by choosing medicine over the family business. From early on, colleagues say, he distinguished himself not just with his surgical skills - he once directed the residency program at New York Eye and Ear - but with his flair for self-promotion. Nancy Behrman, a publicist who worked for Dr. Sachs in 2003, said that while many surgeons come across as reserved or even taciturn, he was a favorite of magazine editors and television producers because he was outgoing and personable. McCall's and Harpers Bazaar featured him in makeover stories in the 1980's and early 90's. In 1991 and again in 1993 he appeared on the Oprah Winfrey show.
But because of the exposure he ran afoul of some in the medical establishment. On "Oprah," Dr. Sachs boasted he spent much of his time fixing the botched work of lesser surgeons, comments that angered the American Academy of Facial Plastic and Reconstructive Surgery, a medical society Dr. Sachs had joined 10 years before. The group demanded that Dr. Sachs appear before its ethics committee to explain his remarks. Instead he quit.
"I said, 'You know what, I'd rather not be in an inquisition like that, and I'm just going to resign,'" Dr. Sachs said in an interview last week. "And I did."
Not long after his second appearance on "Oprah," the lawsuits began. He settled 4 in 1995, 1 in 1996, 2 in 1997 and 11 in 1999. One woman sued Dr. Sachs after cotton packing was inadvertently left in her sinuses after surgery, infecting the cartilage and bones in her face and requiring multiple surgeries to correct. Another patient charged that Dr. Sachs improperly removed cartilage from her sinuses, causing her breathing passages to collapse. In all, Dr. Sachs said, his insurers have paid around $3 million in settlements.
Jay R. Butterman, a lawyer for Dr. Sachs, said the number of suits stemmed from Dr. Sachs's specialty, revisional rhinoplasty - fixing botched nose jobs - which, Mr. Butterman said, carries higher risks than first-time nose jobs. "We're talking surgery a literal handful of physicians in this country are willing to do," Mr. Butterman said.
But Dr. Peter B. Fodor, the president of the American Society for Aesthetic Plastic Surgery, said revisional rhinoplasty was quite common and not a viable explanation for the large number of suits. "That's a very lame excuse," he said. "A lot of us do it."
How was a much-sued doctor able to get malpractice insurance? It would be difficult in many states, experts said. But in New York all doctors are guaranteed coverage through the state's malpractice risk pool, which was set up to ensure that even those with small, high-risk practices can buy insurance, said Bruce R. Swicker, the president of Earhart Leigh Associates, which sells malpractice insurance. "It guarantees that even doctors like Dr. Sachs can keep practicing," Mr. Swicker said. "The private market in other states probably would have priced him out by now."
Despite the wave of suits Dr. Sachs did not lack for patients. Dr. John J. Grillo, who worked with him as an anesthesiologist for six years, beginning in 1996, said Dr. Sachs often crammed as many as 10 surgeries into a single day. Dr. Grillo said he became concerned about Dr. Sachs's furious pace and what he perceived as a lax attitude towards patient follow-up. In 2001 he quit, fearful, he said, that the number of lawsuits might portend something far worse.
"I wasn't comfortable working in an environment with so many lawsuits," Dr. Grillo said. "In my opinion he lost his compassion. I didn't think he cared."
In response, Dr. Sachs said: "I'm shocked he would say that. That's absolutely untrue. I really care about my patients."
Many patients were happy with Dr. Sachs's work. Michael Longo, a hair stylist at the Stephen Knoll Salon in Manhattan, who has had his eyes and nose done by Dr. Sachs, said he had sent more than 100 patients to him since the mid-1980's.
"He's done my mother, my friends, my clients," Mr. Longo said. "My reputation is at stake when I refer people to him." Mr. Longo said that Dr. Sachs showed his appreciation for the referrals by giving surgery to Mr. Longo's friends and relatives free.
In 2000 The Daily News in New York included Dr. Sachs on a list of the "most sued doctors in New York." State health authorities soon began investigating a case in which Dr. Sachs had performed 16 surgeries on the same patient. The next year, as a routine review of his credientials was approaching at New York Eye and Ear Infirmary, Dr. Sachs said he decided to end his affiliation because of what he called negativity from his peers there. From then on, Dr. Sachs would operate exclusively at his office without the oversight of other physicians.
At the conclusion of the state investigation in 2004, the Health Department allowed Dr. Sachs to keep his license but prohibited him from doing any nose procedures that required more than two surgeries unless he was supervised by another surgeon. Despite the finding, Dr. Sachs said he was relieved.
"I said, 'If it's a very complicated congenital case, fine, we'll do a team approach.' I welcomed them coming in and observing, and it got twisted in the press that I was somehow being punished."
Dr. Sachs continued to appear in magazines with no questioning of his qualifications. He also appeared in an article in The Wall Street Journal about Botox parties, in The New York Observer commenting on the appearance of Senator John Kerry and in an article in The New York Times about holiday tipping habits in Manhattan. (Dr. Sachs had given his masseuse and nanny cosmetic surgery for their tips.)
In 2002 Dr. Sachs expanded his practice to Ireland, a country with a booming economy that was just getting past the view of plastic surgery as taboo. In interviews there he displayed his familiar confidence. He told The Irish Examiner that most Irish plastic surgeons "wouldn't be allowed to practice for five minutes in New York." Appearing in 2003 on a broadcast of "Ireland AM," the country's most popular morning television show, he stated he had done 42,000 rhinoplasties.
"Forty-two thousand rhinoplasties?" asked the host. "Lot of noses."
"That's right," Dr. Sachs said. "Lot of noses." Indeed it was: an average of more than four every day since he graduated from medical school at Loyola University in Chicago.
In 2004 an Irish grandmother named Helen Donaghy agreed to allow a reporter from The Sunday Independent to chronicle a face-lift that Dr. Sachs would perform free. Most medical societies prohibit members from bartering surgery for public relations purposes. "We'd frown on that," said Kelly Miller, a spokeswoman for the American Academy of Cosmetic Surgery, of which Dr. Sachs is a member. "It's a conflict of interest."
Dr. Sachs said he was unaware of the policy.
The result of his agreement with Mrs. Donaghy was a cover article in the Independent's Sunday magazine. "People have been stopping me on the street to tell me how good I look," Mrs. Donaghy was quoted as saying. "I'm having the time of my life." The article gave contact information and a Web site for Dr. Sachs but omitted any mention of the problems he faced.
"If this guy is fit to practice medicine in the United States, who are we to say he's not fit to practice?" said Brendan O'Connor, the editor of The Sunday Independent magazine. But Mr. O'Connor said last week he was unaware of the 33 lawsuits or the restrictions placed on Dr. Sachs by New York State health authorities.
The article made an impression on Mrs. Cregan, a town clerk in Limerick, who was quietly despairing over her appearance. "I am 42 years old but look 56 to 58," she confided in an e-mail message to Dr. Sachs. "I have become very self-conscious when meeting people."
Mrs. Cregan had visited the doctor's Web site, www.MichaelEvanSachs.com, her sister said, where Dr. Sachs identifies himself as surgical director of the Sachs Institute for Facial Plastic and Reconstructive Surgery. In fact, he acknowledged, he is the institute's only surgeon, and the institute is merely his office.
The Web site also identifies Dr. Sachs as a founding member of the American Society of Revisional Surgery and a clinical professor at New York Eye and Ear Infirmary and implies he has "courtesy privileges" at the prestigious Manhattan Eye, Ear and Throat Hospital.
IN reality Dr. Sachs had had no affiliation with Manhattan Eye, Ear and Throat since 1991, the hospital said, and he ended his affiliation with New York Eye and Ear in 2001. The American Society of Revisional Surgeons was an organization Dr. Sachs said he had once tried to start, but that "never really got off the ground."
Dr. Scott L. Spear, the president of the American Society of Plastic Surgeons, commenting on Dr. Sachs's curriculum vitae and biography, said: "This thing is full of puffery, self-aggrandizement and not professional. This is not a surgeon of high professional standing."
Dr. Sachs acknowledged that the credentials on the two-year-old Web site were "confusing" and out of date, adding that he would soon correct them.
Although Mrs. Cregan may not have had the expertise to decode Dr. Sachs's résumé, an Internet search might have revealed his inclusion in The Daily News's list of most sued doctors. A New York State-run Web site, www.NYDoctorProfile.com, lists medical malpractice judgments and disciplinary actions against doctors.
Agnes Kelly said her sister would not have thought to doubt what she read about Dr. Sachs in the newspaper or on his Web site.
By e-mail Mrs. Cregan told Dr. Sachs she wanted a full face-lift. He said he could do it for 25,000 euros, or $32,600. But there was a twist. Dr. Sachs was planning to be in Ireland in February for a charity event, and if Mrs. Cregan would meet him at his hotel, a lavish golf resort in Kildare, and pay in advance, Dr. Sachs's office manager in New York wrote, Dr. Sachs would reduce the fee to 15,000 euros.
Mrs. Cregan took out a loan, her sister said, met Dr. Sachs at the resort and one month later left her home at about 6 a.m. for a flight to Kennedy Airport. By 6 p.m. she was undergoing surgery in Dr. Sachs's office.
Around 9, the surgery was completed, and Mrs. Cregan walked to a recovery room, where a nurse checked on her every hour. At 6:30 the next morning, a nurse's log shows, Mrs. Cregan complained of dizziness. She went into cardiac arrest shortly after.
Mr. Cregan arrived in New York the following night, in time for a tense family meeting with Dr. Sachs.
"He was full of praise for himself," Mrs. Kelly said of Dr. Sachs. "He said, 'I operate on presidents' wives' and talked about where he is in life, how popular he is."
That evening Mrs. Cregan was declared brain-dead. The family had her respirator disconnected the next morning, and she died almost immediately.
"Without a doubt it's a tragedy," Dr. Sachs said last week. "We did everything we could to treat her with as much care, respect and love as we could." He said he has resumed his normal surgery schedule and has the support of friends and former patients.
"They're patting me on the back, and saying, 'Listen, Dr. Sachs, you're a really fine surgeon, and I trust you to do my surgery.' My patients were consoling me. It made me feel great."
Mrs. Kelly said the family was awaiting a final report from the medical examiner and looking into a lawsuit against Dr. Sachs. Whatever the outcome of the report, she said, she is certain her sister was unaware of Dr. Sachs's track record.
"If she had known in advance, she would never have gone to Dr. Sachs," Ms. Kelly said.
Copyright 2005 The New York Times Company
Details of a outrage which, I'm sure, is well known to you.
Reads like part of a script from Law and Order...
I dunno. The most sued doctor in NY with 33 malpractice suits, a full time lawyer spouting endless BS, and a massively faked resume on his website? This guy is a walking public health hazard.
Looks like this guy's got a future in liposuction and abortion where his future stints in Women's Healthcare are concerned.
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