Struck Twice

It had been the most difficult of months at Manhattan Eye, Ear and Throat Hospital. The death of novelist Olivia Goldsmith, who had gone there for elective facial surgery on January 7 and entered an irreversible coma within hours, became national news. Figuring out which of the well-known surgeons who work there had operated on her became a dark guessing game from Tribeca to Scarsdale. And Goldsmith herself would have been embarrassed to write an ending so baldly and tragically ironic: checking in to look more youthful—and never checking out.

Just as it seemed the storm was about to subside, the situation got worse. On February 16, a second woman, Susan Malitz, the 54-year-old wife of Connecticut urologist Alan J. Malitz and daughter-in-law of psychiatrist Sidney Malitz, died during a face-lift. And unlike in the Goldsmith case, where the surgeon turned out to be Norman Pastorek, a highly respected but relatively low-key otolaryngologist, Malitz’s doctor was Sherrell Aston, the hospital’s plastic-surgery chairman, widely considered to be one of the two or three most skilled facial sculptors in New York (who worked in tandem with veteran anesthesiologist Gary Mellen, a favorite with the hospital’s doctors). Aston has worked on some of the most famous faces in the world—Catherine Deneuve, Anna Wintour, Pamela Harriman, and Tipper Gore are reportedly four of his patients. In addition to being a fixture on Manhattan’s A-list social circuit with a much-photographed socialite wife of his own, Muffie Potter Aston, he is considered one of the field’s top academicians. Aston is one of the only practicing aesthetic surgeons to be a full professor of surgery—at NYU—and he runs the industry’s annual New York–based symposium. According to one doctor, “There’s nothing more humbling than surgery. You can be at the top of your game and performing the simplest operation, and some freak accident or reaction can occur that has nothing to do with you.”

The hospital Aston heads is a cliquish place where most of the city’s top cosmetic doctors work—including Daniel Baker, Alan Matarasso, Gerald Pitman, and Nicolas Tabbal—popping into each other’s operating rooms on a regular basis. But after Malitz’s death, Aston’s operating room was taped over like a crime scene. State investigators—called in by the hospital—were inside, local news crews were stationed outside, and doctors from a peer group called the American Medical Foundation were conducting their own explorations. Crisis-communications firm GCI Group, which has worked on crises like Firestone’s tire recall and the British Tourist Authority’s troubles with a foot-and-mouth disease scare, kicked into gear. “It’s a great hospital and a damn good brand. They are very sad about this,” says GCI’s point man in the case, Ray Kerins. This was not meeth’s first crisis. Two years ago, the hospital was shut down for a week during the anthrax scare when an exposed employee died there. Cynics then predicted the institution’s demise. But within weeks, the schedule was full.

“I’ve had three patients cancel today,” sighs one surgeon. “We’re losing business. If you are sitting around with your family this week, and your mother says, ‘I’m going to Manhattan Eye and Ear to have my eyes done,’ you’re going to want to lock her in the house.”

“It’s scary,” says another doctor. “Everyone is very concerned about what happened. Absolutely everything you can imagine is being looked into.”

“I’ve had three patients canceltoday,” says one surgeon. “We’relosing business.”

“We can’t even play our radios,” reports a third. “They want to make sure nothing is interfering with the electrical equipment.”

Olivia Goldsmith was allegedly taking mood stabilizers as well as homeopathic products, either of which could potentially be problematic during an operation, and there is the possibility that the local anesthetic could in and of itself have caused complications. The crucial question is not only why or if she had an adverse reaction to anesthesia but why, with all the medical resources at the hospital’s disposal, couldn’t she be saved? “It’s one thing when you arrest on a tennis court or in a store,” says one doctor. “But when your breathing stops on an operating table, you can often be resuscitated.” One theory of what happened in Goldsmith’s operating room currently making the rounds at the hospital is that Pastorek noticed that the color of Goldsmith’s blood wasn’t bright crimson, and asked the nurse anesthetist about it. She checked, and the readings looked fine. But in fact, it was a situation known as electromechanical dissociation, or PEA (pulseless electrical activity): Even though her heart had stopped contracting, it was still conducting electrical impulses. They were able to give her CPR, but her brain had been deprived of oxygen for too long, and she lapsed into a coma.

Susan Malitz had myasthenia gravis, a neurological disease, which some doctors say may have created problems. “It’s quite complicated in terms of anesthesia; certain drugs that are used can have peculiar or prolonged effects. If somebody is given sedation with myasthenia and the airway is not closely monitored, breathing can be severely compromised,” explains Mark Sivak, a doctor at Mount Sinai and one of the country’s foremost experts in the disease. “But generally when this happens, the patient is intubated immediately and breathing is regulated.”

But Malitz was well aware of her condition and had been cleared by her doctors for this operation. “She was from a family of top doctors. They never would have allowed her to do this if they didn’t feel she was completely safe,” says a family friend.

Over the past five years, there have been more than 13,500 cosmetic procedures performed at the hospital, but meeth spokesmen will not confirm the number of fatalities, and doctors have cited the medical privacy laws passed last April as a reason to withhold details about the cases and the doctors involved. Overall, a patient’s chances of dying during surgery are a relatively reassuring 1 in 90,000, according to the National Safety Council. By comparison, a person’s chances of dying in a car accident in any given year are about 1 in 18,000. It’s hard to overstate Manhattan Eye, Ear and Throat’s reputation among both cosmetic-surgery doctors and patients. “I’ve worked at Manhattan Eye and Ear for over 25 years, and it’s probably the best plastic-surgery hospital and the best group of surgeons in the world,” says Daniel Baker, who is widely perceived to be one of the city’s top two or three cosmetic doctors. “Other surgeons come to that hospital from all over the world to watch the doctors work.”

In recent years, however, an increasing number of the institutions’ surgeons have been following the national trend and choosing to operate out of the accredited rooms in their own offices. “Some people prefer the privacy of an office where they know the staff and it doesn’t feel as foreign,” says Baker.

Plastic surgeon David Hidalgo agrees. “I used to do all my operations there,” he says. “Now I go there two or three times a month. In my own office, I feel I have better control of the variables.”

Twenty-five-year Manhattan Eye, Ear and Throat veteran Gerald Pitman has his own accredited operating room but prefers the hospital atmosphere. “I actually like operating there, because if anything happens you have more back-up. Patients forget that surgery has risks, but meeth actually has a better track record than any other hospital I know of.” Manhattan Eye and Ear had no reported deaths in the years 1999 to 2001, and there are no cited violations or judgments against the institution over the last ten years listed on the Board of Health’s Website.

“My commitment is to make sure the tradition of Manhattan Eye and Ear continues,” says the hospital’s executive director, Philip P. Rosenthal. “These two deaths appear to be just an unfortunate coincidence, but we are taking the matter very, very seriously.”

“There is no plastic surgeon in the U.S. who is not thinking of this as we speak,” says Dr. Robert W. Bernard, president of the American Society for Aesthetic Plastic Surgery, the field’s most prestigious organization. “We all think, there but for the grace of God … ”

Struck Twice