Tuesday, April 1, 2014

Dominican Republic: New Yorker, 28, Dies from Plastic Surgery

According to The Associated Press, New Yorker Beverly Brignoni, 28, was searching for an inexpensive solution to enhance her physical appearance through cosmetic surgery in the Dominican Republic.

Tragically, on February 20, 2014, Ms. Brignoni died from her surgery.

The Dominican physician who conducted the surgery told her family that the cause was a massive pulmonary embolism while getting a tummy tuck and liposuction at a clinic in the Dominican capital recommended by friends. Family members have serious questions about her death and want local authorities to investigate.

COMMENT: I nearly died in 2005 from a low-risk angioplasty procedure in a respected US hospital that resulted in my contracting antibiotic-resistant MRSA. At one juncture, my surgeon contemplated removing my right leg at the hip, although, fortunately, he was able to save it. I was in the Intensive Care Unit (ICU) for over three weeks.

The District Attorney's office for the capital of Santo Domingo says it had commenced an investigation because it has not received a formal complaint from Brignoni's family. Brignoni's family assured the DA would promptly receive a complaint.

Shortly after Brignoni's death, the Health Ministry inspected the Vista del Jardin Medical Center where she was treated and ordered the operating room temporarily closed, citing the presence of bacteria and violations of bio-sanitary regulations. The doctor who performed the procedure and the clinic have not responded to requests for comment.

Concerns about the booming cosmetic surgery business in the Dominican Republic are enough of an issue that the US State Department has posted a travel warning, noting that in several cases US citizens have suffered serious complications or actually died.

The US Centers for Disease Control issued an alert on March 7, 2014 after health authorities in the US reported that at least 19 women in five states had developed serious mycobacterial wound infections over the previous 12 months following cosmetic procedures in the DR such as liposuction, tummy tucks and breast implants.

There were no reported deaths in those cases, but treatment for these types of infections, which have been caused in the past by contaminated medical equipment, tend to involve long courses of antibiotics and can require new surgery to remove infected tissue and drain fluid, said Dr. Douglas Esposito, a CDC medical officer.

The Dominican Republic, like countries such as México, Costa Rica and Thailand, have promoted themselves as a destination for medical tourism, so-called because people will often tack on a few days at a resort after undergoing surgery. 

The main attraction at a number of the aforementioned destinations is patients being convinced that the same attention in preventing infection which is not necessarily the case.

In 2013, there were more than 1,000 cosmetic procedures performed in the Dominican Republic, 60% of them on foreigners, according to the country's Plastic Surgery Society.

The price of such surgeries is often one-third of the cost in the US.

Dr. Braun Graham, a plastic surgeon in Sarasota, FL, says he done corrective surgery on people for what he says were inferior procedures abroad. He warns that even if a foreign doctor is talented, nurses and support staff may lack adequate training.

"Clearly, the cost savings is certainly not worth the increased risk of a fatal complication," said Graham, past president for Florida Society of Plastic Surgeons.

Brignoni was referred to the Vista del Jardin Medical Center by several acquaintances in the New York borough of the Bronx where she lived, said Lamboy and Lenny Ulloa, the father of the 4-year-old daughter she left behind.

The doctor who performed Brignoni's procedure, Guillermo Lorenzo, is certified by the Plastic Surgery Society, but there are at least 300 surgeons performing cosmetic procedures who are not, said Dr. Severo Mercedes, the organization's director. 

The number of people pursuing treatment in the Dominican Republic doesn't seem to have been affected by negative reports, including a previous CDC warning about a cluster of twelve infections in 2003-04.

In one recent case, the Dominican government in February closed a widely advertised clinic known as "Efecto Brush," for operating without a license. Prosecutors opened a criminal case after at least six women accused the clinic of fraud and negligence. The director, Franklin Polanco, has freedom of movement while awaiting trial. He denies any wrongdoing.

There was also the case of Dr. Hector Cabral. New York prosecutors accused him of conducting examinations of women in health spas and beauty parlors without a license, then operating on them in the Dominican Republic, leaving some disfigured. Cabral pleaded guilty to one count of unauthorized practice of medicine in October 2011 and returned to the Dominican Republic, where he still practices.

In 2009, Dominican authorities charged Dr. Johan Tapia Bueno with illegally practicing plastic surgery at his apartment after several women, including a local television personality, accused him of malpractice that left them with infections.

Juan Linares, a lawyer hired by Brignoni's boyfriend, said he is still awaiting an autopsy report, some two weeks after her death.

Because she arrived in the country late at night on a delayed flight and was on the operating table early the next morning, a main concern is whether she received an adequate medical evaluation before the procedure. Graham, the Florida surgeon, said sitting on a plane for several hours can cause blood to stagnate in the legs and increase the risk of an embolism.

I strongly urge that anyone contemplating surgery abroad consider consulting with a board-certified physician in the specialty at home FIRST so as to select a medical facility abroad that can safely perform the surgery with minimal risk of infection and complications.

For those considering surgery in developing countries, I urge readers to consider going to the link below: