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

Published on
September 10, 2010

Maria Garcia smoked.

That was her one big vice, according to her brother and her estranged husband.

This otherwise healthy 39-year-old visited the doctors at Hills Surgical Center in Anaheim because she didn't like the way she looked. To remedy that, the surgeons scheduled a series of procedures, all to happen in one day.

On March 13, 2008, Garcia died on the operating room table after a vaginal rejuvenation surgery and liposuction, another victim of the bad decisions made by the doctors at 145 S. Chaparral Court.

What is vaginal rejuvenation surgery?

During the procedure, surgeons cut away tissue both inside and outside ostensibly to make the patient look and feel younger. It's a fringe surgery done by so few doctors nationwide that The American Society for Aesthetic Plastic Surgery does not even recognize it as a standard cosmetic procedure. But Hills Surgical Center is a fringe cosmetic surgery operation, the kind of place that has a MySpace page where it posts Girls Gone Wild style videos of parties it has sponsored.

With any invasive procedure, elective or not, it is important for a surgeon to meet with a patient, chart a course of action and make sure the patient is adequately prepared both physically and mentally well in advance. The American Society of Plastic Surgeons (ASPS) in 2003 wrote a clear set of guidelines for these sorts of office visits. According to the ASPS website:

"Two of the most important steps doctors can take to ensure appropriate patient selection in office-based surgery are to give the patient a complete preoperative physical exam and evaluate the patient's medical history," said Ronald Iverson, MD, chair of the ASPS Task Force on Patient Safety in Office-based Surgery Facilities and co-author of the advisory. "Doing so helps the doctor determine the most appropriate time and facility setting for the patient and gives the medical staff helpful information to better interpret findings while monitoring the patient during and after surgery."

Dr. Lawrence Hansen did not meet Garcia in advance of the surgery. He did not perform a pre-operative exam on Garcia and did not even arrive at the medical office until about one half hour before the surgery was scheduled, according to the Medical Board of California.

Under Hansen's direction, Garcia was put under general anesthesia. This fact would not be worth a comment if Hansen and his surgical team had been paying attention to the rules.

First, Hansen should not have been operating on anyone in an unlicensed facility. At the time of the surgeries, the facility had no accreditation as an outpatient surgery center from the California Department of Public Health or the Joint Commission, the main accrediting body for health facilities.

Second, Garcia was given such a massive dose of anesthesia that, according to the Medical Board of California, she was put in jeopardy. In July 1996, California law prohibited doctors from using doses of anesthesia in outpatient settings that would "have the probability of placing a patient at risk for loss of the patient's life-preserving protective reflexes".

During the surgery, Garcia lost a lot of blood, about 250 milliliters. All surgeries result in some blood loss, but most surgeries also go according to plan.

During this surgery, Garcia's vaginal wall was punctured and she started to bleed. The coroner's office later reported that she had 2,000 cubic centimeters of bloody fluid in her abdomen, enough to fill a 2-liter soda container.

When one surgeon is going to take over from another surgeon, the two will usually meet and make sure that they both understand where the patient is physically, how she is handling the anesthesia and the prognosis for her complete recovery.

Hansen did not have this conversation with the surgeon scheduled to handle the liposuction.

Instead, while Garcia was still under anesthesia and bleeding through the hole he had left in her, Hansen left the room. Shortly thereafter, he left 145 S. Chaparral Court.

Garcia was crashing.

Next: How Garcia's death went unnoticed by nearly everyone in a position to take action

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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 10: Coroner rules mistakes that killed patient a "therapeutic misadventure"