The Shadow Practice, Part 13: Court records are both gold mine and minefield for documenting clinic’s troubles

Published on
October 13, 2010

Maria Garcia's death after a cosmetic surgery procedure at Anaheim Hills Surgery Center has so far failed to roust the Joint Commission or the Orange County district attorney. The Medical Board of California is attempting to discipline one of the doctors involved.

Meanwhile, evidence is piling up in a lawsuit filed by Garcia's family against the clinic, also known as Hills Surgical Institute, and its doctors.

As experienced investigative reporters know, court files can be a gold mine of documents. Reporters who attribute their stories directly to the documents give themselves an extra layer of protection against a libel suit.

At the same time, though, libel attorneys recommend that reporters using court files take care to acknowledge when facts are in dispute or how a case ultimately turned out. For example, if I write an entire story about all the horrible things that happened to a patient at the hands of a surgeon based on the patient's lawsuit but fail to mention that the surgeon won the case, I am making it harder for myself if the story ends up being challenged in court. That's why open cases can be minefields. You find some great facts, but it is difficult to stay on top of all the filings and make sure you are developing a comprehensive picture of what happened.

At the bottom of this post, I am posting links to a few documents from the Garcia lawsuit, filed in Orange County Superior Court, for any reporters interested in pursuing the story. Here are five (of many) interesting items to be found:

1. As a starting point, any reporter who wanted to dig into this story could begin by backgrounding all the people and entities named. The suit names the two doctors who operated on Garcia: Dr. Harrell Robinson and Dr. Lawrence Hansen. It also names Hills Surgical Institute, Physicians & Surgeons of Orange County Inc., Royalty Perfections Global Medical Surgery Center, Global Medical Surgery Center, and Royalty Perfections Cosmetic Institute. Those last four names were new to me. The only one I could find that had been licensed to do business at 145 S. Chaparral Court was Global Medical Surgery Center, which is owned by Robinson and AlinkaTymkowicz, according to the city of Anaheim.

2. One of the current owners of Anaheim Hills Surgery Center is named in the suit: Gustavo Gutierrez. He also oversaw the anesthesia while Garcia was undergoing two operations.The lawsuit documents spend considerable time with Gutierrez, and he has filed to have the case dismissed, a common occurrence in civil cases. The case also includes depositions from Gutierrez. In there you can find that Gutierrez, despite being one of the clinic's owners, did not interview Hansen before granting him privileges to perform procedures there. Nor did he know whether Hansen had ever performed a vaginoplasty before performing one on Garcia.

3. Hansen provided the answer to that question in his deposition. He said he had been looking for a little extra income to supplement his retirement when his friend, Dr. Gary Rheinschild, told Hansen to check out Hills Surgical Institute. (Antidote will write more about Rheinschild in a future post.) By the time Hansen saw Garcia in March 2008, he was 83 years old and had not performed a vaginoplasty since 2003, he said.

4. Hansen's lack of practice in vaginoplasties is one of many issues in the case in which different parties in the suit are at odds with each other. Reporters should never assume that there is one "good" side and one "bad" side in any legal case. Sometimes over the course of a case the facts can stack up in unexpected ways. One might expect, for example, that because both Robinson and Hansen worked together at the clinic and now have been blamed in a lawsuit that they would want to bolster each other's defenses. Not so. Robinson said in his deposition that he did not know that Hansen had not performed a vaginoplasty in five years and that, had he known, he would not have allowed Hansen to perform the procedure. "Are you kidding," he said. "I would not have allowed my patient to undergo a surgery, no matter how simple, if a guy hadn't done it in five years. I mean that's tantamount to a resident not having any experience in it."

5. Finally, in case there are any reasons to doubt what killed Maria Garcia, the deposition of Dr. Aruna Singhana, the physician who performed the autopsy on Garcia, pointed to what he saw as clear and convincing physical evidence. In the deposition, Singhana reviewed the possible contributors to Garcia's death from multiple angles, including whether she may have been killed by fat loosened during the liposuction and lodging in her brain or lungs. Then the attorney for Garcia's family asks him, "But in terms of what you believe to be the cause of death, you ascribe that to the blood loss that you found in the abdomen of 2,000 cc which you felt was caused by the puncture wound through the posterior cul de sac" of the vagina. He answers, "That's the physical evidence. I have it based on the physical evidence."

Now here are some links:

Read the lawsuit.

Read some of Gutierrez's objections.

Review the first set of exhibits.

Review a second set of exhibits, but also be warned that these exhibits include disturbing photographs from the autopsy.

Check out the Shadow Practice Google map.

To inquire or quibble, write askantidote [at] gmail [dot] com

Related Posts:

The Shadow Practice Part 1: Disciplined doctor found an exile community in immigrant health care

The Shadow Practice Part 2: New owners can't exorcise ghosts of clinic's past

The Shadow Practice Part 3: Immigrant clinic had deep roots in deception

The Shadow Practice Part 4: Doc begs patients for loans

The Shadow Practice Part 5: Drug pushers running this clinic were far from saints

The Shadow Practice Part 6: Doctors sell their souls, and their licenses, on the cheap

The Shadow Practice Part 7: Punishment for drug-dealing doctors more severe in Arizona

The Shadow Practice Part 8: How one California clinic became a magnet for bad medicine

The Shadow Practice, Part 9: Woman dies during cosmetic surgeries at unlicensed clinic

The Shadow Practice, Part 10: Coroner rules mistakes that killed patient a "therapeutic misadventure"

The Shadow Practice, Part 11: Joint Commission overlooks risky practices that led to patient death

The Shadow Practice, Part 12: Patient safety net still in tatters three years after court ruling