Article by
Tim Bousquet
The Silent Death of Linda Nassie
Close-Knit Medical Community is
Closed-Lipped, Refuses to Criticize one of their own
The Hidden Risks
of Liposuction
On July 10 Linda Nassi,
who was 53 years old and by all accounts healthy and lively, went to
see Dr. Daniel Thomas, a plastic surgeon who specializes in
liposuction. Eleven days later she was dead.
Nassie’s death, and the subsequent refusal of the
local medical community to criticize one of their own, underscores the
hidden risks involved in liposuction and body modification. Moreover,
it suggests that plastic surgery and liposuction are woefully
under-regulated, and that what regulatory oversight that does exist
does not have the power to adequately address problems in the
profession. Ultimately, redress for improper behavior on the part of
surgeons is left to family members and burdensome civil litigation
that can take years.
In researching this story, the Examiner attempted
to talk to dozens of people. Not so surprisingly, Dr. Thomas did not
return phone calls from the Examiner. But neither did Ron Stewart, the
attorney retained by the Nassie family, and the family likewise
declined to discuss the case. But even those who are not potential
litigants did not want to discuss it; other doctors refused to talk,
as did government officials familiar with Nassie’s death. Those who
did speak did so on the condition of anonymity.
"There’s going to be problems from time to
time," explained one local physician, "and we can’t be
criticizing each other from the outside."
Still, the Examiner has been able to piece together
the train of events leading to Nassie’s death.
Nassie, the Comptroller at
Chico High School, was known as a quiet efficient worker who was
praised for her competence and for sailing through the periodic audits
of the school.
"She was a real class act," said Gerald
Circo, the Activities Director at Chico High. "She always looked
sharp, really nicely dressed and quiet mannered. But it would shock
the students when the nice lady behind the desk would get up at the
school dances and danced a jitterbug with high heels on."
Nassie was a lifelong dancer and universally
considered fun. "She had a zest for life," explained Circo
"She was part of the ‘Rowdy Girls,’ a group of women that
would hang out and have fun together."
Robin Bicocca, a Counselor at Chico High, is one of
the Rowdy Girls, and Nassie’s best friend. "We named ourselves
the Rowdy Girls when we rented a house at Tahoe together," she
explains. Nassie "was, very, very, very fun," Bicocca says
with fondness. "She loved to dance, you know."
But Nassie was also "a deep thinker, and very
bright. She was a Diehard Democrat and liked to get into long
political discussions."
She also "organized every single social event
at the school, but never took any of the glory or the credit. She was
such an integral part of this place, and now there’s a terrible
void.
"I miss her terribly," says her friend.
Circo too is obviously shaken by Nassie’s death.
"I just can’t believe it," he said.
Nassie was by no means overweight—Circo described
her as "slender, real slim"—but perhaps had a dancer’s
sensibility about her body. For whatever reason, she made an
appointment for what she no doubt thought would be a minor liposuction
procedure to remove a few pounds from her waist. She entered Thomas’s
office on the July 10 for the outpatient operation.
Nassie had had three children, and each pregnancy
resulted in a Caesarian section, which left scars in the muscle tissue
above her bowels. "The muscle is weakened after any surgeries but
after three it is usually pretty weak and can easily be
ruptured," explained an Examiner source, a health care
professional familiar with Nassie’s death. The liposuction removed
the fat tissue above the muscle, but also penetrated through the scar
tissue and pierced Nassie’s small intestine.
"Nassie complained of pain the next day and
went in to see Doctor Thomas about it, but nothing was done,"
explains our source. After complaining to Thomas, Nassie returned
home.
The following day, the 12th, Nassie "went to
the Emergency Room where they discovered the problem and rushed her to
surgery, but she never awoke." At Enloe Hospital Nassie was put
on a ventilator, and received renal dialysis and antibiotics in a bid
to "try to turn the sepsis around but it was too late,"
explained the source familiar with the case.
Circo, Nassie’s coworker, visited her at Enloe
hospital during this time. "I didn’t even recognize her,"
he said. Nassie died on July 21.
The death certificate for Linda Louise Nassie
confirms our source’s understanding of how events unfolded. The
certificate says that the immediate cause of Nassie’s death was a
"multisystem organ failure" that occurred on July 1th,
attributed to "Klebsiella Pneumoniae Sepsis that occurred on July
10th, which was in turn
caused by the "perforation of small intestine with
peritonitis." The death was ruled an "accident," which
occurred at 619 West East Avenue, which is Thomas’s office, although
the death certificate does not mention Thomas by name. "Small
intestine was perforated during liposuction procedure," reads a
hand-written note on the certificate.
Our source bluntly lays the blame for Nassie’s
death squarely on Thomas. "Sepsis is an infection that gets in
the blood and over whelms the body—it must be caught early to
stand a chance and 48 hours after surgery was not early. If Doctor
Thomas had listened with a stethoscope to [Nassie’s] abdomen for
sounds the bowel normally makes when it is functioning, and had he
seen that she was distended (swollen) in her abdomen, he would have
known something was wrong.
"If this had been caught in the first
twenty-four hours she would have still been very ill but have stood a
chance." As it is, said our source, "I’m not sure Thomas
even took her temperature" when Nassie came in complaining the
day after her surgery.
Other health care professionals who have seen the
Coroner’s report on Nassie’s death also blame Thomas. "I’m
telling people not to go to him," said one. "There’s going
to be lawsuits all over this, and there should be," said another.
Liposuction has become
increasingly popular with Americans, with increases of between 200 and
300% in the number of liposuction procedures between 1990 and 1997,
according to the American Academy of Cosmetic Surgery, a trade
journal. More than 172,000 people visit board-certified physicians
each year for liposuction, but since any doctor can perform the
surgery the actual number may be twice that.
"Many of these surgeries," noted Richard
C. Prielipp, M.D. and Robert C. Morell, M.D. in an article they wrote
for the Anesthesiology Patient Safety Foundation Newsletter, "are
done in private offices, hence there is no mandatory reporting of
deaths or adverse events. Therefore, comparatively little is known
about the morbidity or mortality related to this very commonly
performed operation."
In contrast, all deaths occurring in hospitals are
required to be reported.
Plastic surgeons have resisted full disclosure of
deaths in their offices, and researchers have had to resort to
cat-and-mouse games to find statistical information. When, for
example, the Journal of the American Society of Plastic and
Reconstructive Surgeons (JASPRS) attempted to measure the death rate
for liposuction operations, only 917 plastic surgeons voluntarily
reported deaths, and then only after being assured confidentiality.
Still, that study found 95 deaths, or one death for
every 5,000 procedures. Causes of death included blood clots,
anesthesia problems and internal injuries like the one that felled
Nassie. The death rate for outpatient operations performed by the
plastic surgeons in the JASPRS survey is some twenty to sixty times
higher than the death rate for all operations performed in hospitals,
which typically rate one death in every 100,000 to 300,000 operations.
The hospital death rate includes deaths in heart surgery and other
difficult procedures.
"The difference [in death rates] is
gigantic," Ellison Pierce, executive director of the
Anesthesiology Patient Safety Foundation, told Afsun Qureshi, a
journalist with Safety Zone, a medical consumer website. "That’s
a completely unacceptable mortality rate."
"There are no rules for office-based surgery
whatsoever," Pierce continued, noting that because of the lack of
regulation "surgery in doctors’ offices is rampant with
death."
As bad as the JASPRS study death rates are, the
absolute death rates for liposuction might be much higher, because the
study only looked at cooperating board-certified plastic surgeons.
Anyone with a medical degree can perform liposuction.
"Anybody can do liposuction. Even dentists
have been doing it," noted Rod Rohrich, a plastic surgeon and
co-editor of Plastic and Reconstructive Surgery, which reviewed the
JASPRS study. Rohrich told Qureshi that board-certified plastic
surgeons are "the cream of the crop," and the death rate for
people visiting non-certified doctors for liposuction procedures is
probably substantially higher.
A more thorough study attempting to track deaths
from liposuction procedures performed in all settings is in the works,
but will not be completed until next year.
The Examiner source
familiar with Nassie’s death also criticizes the offering of
liposuction as an out-patient service through doctors’ offices. Had
Nassie’s operation been performed "in the hospital with closer
watching, [the perforation of the intestine] would have been caught in
the first eight hours, as the bowel should not shut down after this
type of surgery, and it would have been investigated."
Thomas, Nassie’s doctor, is fully licensed by the
Medical Board of California. A 1987 graduate of the McGill University
Faculty of Medicine, Thomas has never had any enforcement action taken
against him and is not currently under investigation, say
representatives of the Medical Board. There have been no malpractice
judgements against Thomas.
Medical Board investigations, which can result in
disciplinary action and suspension or revocation of licenses, are
initiated only by complaint, and no complaint has been filed against
Thomas, as yet. The Board does not investigate deaths on its own
initiative, and does not even track deaths.
Likewise, the Butte County Coroner’s Office
merely investigates and discovers the cause of death. If the Coroner’s
investigation discovers criminal intent the District Attorney is
notified, but if the cause of death is a medical accident no action is
taken; the Coroner does not notify the Medical Board or any other
regulatory body. "We don’t do anything. The family will have to
initiate civil proceedings," said one representative of the
Coroner’s Office, who asked not to be identified.
Presumably, if the deceased has no family nothing
whatsoever will be done in the case of accidental deaths that are
caused by medical malpractice.
Linda Louise Nassie is survived by her daughter
Summer, a recent Chico High graduate, her son Paul, who is currently
enrolled at Pleasant Valley High, and her husband Marc.
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