James Williams was a self-made businessman with a bodybuilder’s physique and keen desire to look his best, so on June 18 he went in for cosmetic surgery to smooth out facial wrinkles and other signs of aging.
His sister argued that he looked just fine for a 62-year-old and should leave well enough alone. But Lynne Burghardt never expected her brother to die within hours of having a facelift at the Fountain of Youth Institute, a Palm Harbor plastic surgery center run by Dr. C. Randall Harrell.
Williams’ death is the fifth this year in Florida after what seemed to be routine cosmetic surgery, the South Florida Sun-Sentinel has confirmed. State health officials have been reviewing these deaths in recent weeks with an eye toward tightening oversight of nearly 500 doctors who work out of office surgical suites.
They had not examined Williams’ death, however, because they did not know about it. Harrell never reported it to the state under a surveillance system set up to help track injuries and complications that arise from cosmetic surgery.
“That’s incredible,” said Dr. Zachariah P. Zachariah, chairman of the Board of Medicine, when told of Williams’ death. “We certainly have to look at whether this patient was properly monitored.”
Harrell, a board-certified plastic surgeon, was not available to comment over the past two days. A center employee confirmed that messages seeking comment had been delivered.
Williams collapsed about two hours after he returned home from surgery. An ambulance took him to Northbay Hospital in New Port Richey, but he died later the same day, according to Pinellas County Medical Examiner’s Office records.
Williams, a landscape architect and nursery owner, had severe heart disease, according to Dr. Susan S. Ignacio, a Pinellas associate medical examiner, and that caused his death.
“He had a bad heart and his arteries were blocked,” said Ignacio. She said stress from having the surgery possibly contributed to the death.
Williams’ family and friends in the Tampa Bay area were shocked and angered. Edward Castagna, a lawyer who drove Williams home after the facelift and watched him collapse, said his friend often put in 12 hours at work, then jogged two miles or more on the beach.
“He spent his whole life trying to be healthy,” Castagna said. “He was a very vibrant individual, a hurricane of a man.”
Castagna said he cannot understand why doctors would not have detected Williams’ advanced illness before going ahead with an elective operation such as a facelift.
“My brother should still be alive,” said Burghardt, of Safety Harbor. “If he had heart disease, they shouldn’t have done the surgery.”
Medical Board chairman Zachariah, a Fort Lauderdale cardiologist, said state officials will have to fully review the medical records before they draw conclusions about Williams’ death.
But he said: “Before you put someone through elective surgery, it is the surgeon’s responsibility to make sure he is cleared for surgery.
“If the doctor went through the normal process of checking out the patient, then we can’t hold him responsible, ” Zachariah said. “We would make sure that the doctor did everything he was supposed to do.”
Even without a conclusion, however, Zachariah said Williams’ death should have been reported to the Department of Health. State law requires notification within 15 days of “adverse incidents” that stem from care in their offices. The intent is to alert the state’s Board of Medicine to the types and severity of complications occurring so that measures can be taken to improve patient safety.
But no clear guidelines exist as to precisely what must be reported, and there are no penalties for not reporting. Williams’ death is the second the Sun-Sentinel has confirmed in the past week that went unreported.
The other was Edward Ricke, a 72-year-old retired postal worker who died in April in a Hollywood nursing home from a blood clot that his primary care doctor said arose from liposuction and other cosmetic surgery. Ricke’s surgeon, Dr. Richard Edison of Hollywood, said he had no obligation to report the death because it did not occur in his office.
Medical examiner records show that Williams is the second patient to die after facial cosmetic surgery by Harrell.
Grace Boscarello, 63, died April 19, 1997, the morning after a facelift and brow lift there. Her husband picked her up about 7 a.m. to take her home from the center, where she had spent the night recuperating. She collapsed on the sidewalk outside her condo and was pronounced dead two hours later. In that case, the Pinellas medical examiner’s office could find “no anatomic cause of death.”
Health officials concede they are struggling to understand why a small number of people die after cosmetic surgery in Florida, one of the nation’s biggest markets for the operations. Accurate statistics are hard to come by, but industry groups estimate that as many as 77,000 cosmetic procedures are done annually in the state.
Florida’s Board of Medicine has already put in place some of the nation’s toughest office surgery standards, including a requirement for full physical examinations before surgery in some patients with chronic illnesses and a limit of eight hours on any office operations.
Several medical groups and some board members think the safety regulations are adequate to protect the public.
“Some offices have been doing surgery safely for years, and they should be allowed to continue,” said Dr. Kriston J. Kent, a Board of Medicine member who is also a facial plastic surgeon in Naples.
The Florida Society of Plastic Surgeons President Dr. Enrique J. Fernandez said the standards have made office surgery “significantly safer over the past two years.” His group, which represents 220 plastic surgeons, wants tougher discipline of doctors who violate existing rules, not new rules.
“We think that the rules are the best in the country, but they won’t stop adverse incidents if there are bad doctors out there who don’t follow the rules and who use extremely poor clinical judgment,” said Christopher Nuland, the plastic surgery society’s general counsel.
Earlier this week, the Department of Health issued an emergency order suspending the medical license of plastic surgeon Dr. Alton Ingram. He was cited for substandard care of three patients. One was Olga Myers, a Hollywood woman who slipped into a coma and died Aug. 7 after getting a facelift from Ingram.
Fred Schulte can be reached at or 954-356-4591.
