BY SUSAN M. WITT, WITT LAW GROUP, LLCIt was a February evening when I got a call from a man about his fiancé who had undergone an outpatient plastic surgery procedure and was now lying in ICU fighting for her life. The family was led to believe that something had gone terribly wrong during the surgery, but the facts weren’t lining up.
I met briefly with the family before meeting Icilma Cornelius in ICU. Her breathing was supported by a ventilator, she was swollen to almost an unrecognizable state, her tongue was lacerated due to seizure activity and she had a circumferential incision around her waist that was held together by large staples. It looked as though someone had attempted to saw her in half. I knew immediately I wanted to help this family get some answers.
Icilma was 54 years old and a registered nurse. She was a single mother who had raised her son, age 24, while working admin-istrative jobs and putting herself through nursing school. While short in stature, her personality and heart towered above others. Icilma met the love of her life at her 50th birthday celebration. A few years later they were planning their beach wedding. Now that her son was grown, it was her time to enjoy life.
With her wedding just 8 weeks away, Icilma went to Dr. Windell Boutte at Premiere Essence Med Spa. Icilma’s plan was to get Botox and facial filler so she would look her best. On the morning of her appointment, Icilma went to the MedSpa and received Botox. As soon as she mentioned her wedding, she was advised to meet with a “cosmetic consultant.” The consultant told her she should have “SmartLipo” to her abdomen and back to enhance her wedding figure. Icilma expressed concern that she would not be recovered in time, but those concerns quickly dissolved by the assurances of the consultant. The finances would not be an issue because she could apply for credit on the spot. It was imperative to book and pay for her surgery that day or the opportunity would be lost. Then, Dr. Boutte swooped into the room and expressed concern that she might not be fully satisfied with the results of “SmartLipo,” and what she really needed was a tummy tuck. Icilma expressed serious concern about having that procedure so close to her wedding, to which. Dr. Boutte said she would do a less invasive stomach procedure and be recovered for her wed-ding. Icilma then paid the non-refundable $15,000.00 in full.
Icilma’s fiancé brought her to the surgery center on February 18, 2016. She was taken back by “Nurse Lee” and her fiancé was told to come back later. He called mid-afternoon and was told Icilma was doing fine. Hours went by without any word. Frustrated and worried, he went to the surgery center. It was getting dark and all the lights were out. With a rising sense of panic, he banged on the front doors until a staff member came and assured him Icilma was fine and in recovery. She suggested he leave and get Icilma some food.
While waiting for the food at a local restaurant, he heard the screaming sirens of emergency vehicles racing in the direction of the surgery center. Dropping the food, he ran out the door and raced back to the surgery center where his worst fears were realized. First responders were already inside the building and nobody would let him in or provide any answers. The staff present in the parking lot were visibly shaken and upset. Eventually he saw the paramedics carrying Icilma on a stretcher slowly and carefully down the stairs. At first sight Icilma was unrecognizable. She was being bagged and her head was the size of a basketball. She was covered in a blanket, but blood was seeping through. The paramedics told him she had suffered cardiac arrest, was in bad shape and needed to get to the nearest hospital. Icilma’s fiancé followed the ambulance to Eastside Medical Center distraught and confused.
At the hospital, Dr. Boutte showed up and assured Icilma’s family that she was going to be fine. Dr. Boutte explained that Icilma had experienced an allergic reaction during surgery and was in anaphylactic shock. Without further explanation Dr. Boutte left and Icilma was admitted into ICU on life support.
Icilma remained hospitalized on a trach with a ventilator and diminished brain activity. Her abdomen had to be stapled shut as it was still open upon arrival. Tissue had become necrotic and there was concern about infection. Discussions took place about whether or not the ventilator should be removed because there was significant question as to her quality of life if she survived. Icilma did not have a living will and had never executed a durable power of attorney for healthcare. Her fiancé had no legal authority to make any decisions on her behalf. The burden of the medical decisions fell on the shoulders of her young 24-year old son, Ojay.
Icilma remained in ICU for a month. She was transferred to DeKalb LTAC until her insurance benefits were exhausted two months later. Icilma was ultimately admitted to in-patient hospice where she spent another month. As a result of excellent care and Icilma’s grit and determination, she worked her way to being able to sit on the side of the bed with support, take sips of thickened liquid and eventually was able to sit in a wheelchair. Four months after Icilma’s near fatal procedure she graduated from hospice and was admitted to Southern Crescent Traumatic Brain Injury Center. Icilma learned how to eat and drink with support and received a great deal of therapy. She never gained the ability to walk, but she became stronger and learned how to make her needs known. She remained there for 10 months until her insurance was depleted. Ojay then made the brave decision to bring his mother home. She requires extensive assistance with all of her activities of daily living and is bed bound.
Icilma never got to walk down the aisle at her wedding, although her fiancé stays in touch. Her medical bills are in the millions and her life care plan is over ten million. What I learned during the course of discovery, not just about Icilma’s case, but about the state of medicine in Georgia, was deeply disturbing and alarming.
WHAT THE DISCOVERY PROCESS REVEALED
In discovery we learned Dr. Boutte’s “surgery center” operates under the Office Based Anesthesia and Surgery Guidelines adopted by the Georgia Composite Medical Board in 2011. The guidelines require no special license or permit and there is no regulatory body, inspection or survey required. There are no limitations as to the type of surgical procedures that can be per-formed under these Guidelines. This is not just applicable to plastic surgery cases, but any type of surgery. No accreditation is needed, and no credentialing of the physician or staff is required. There is no inspection to ensure the proper surgical equipment is present or that sterile procedure is followed. A physician need not disclose any of this to patients. The onus is 100% on the patient consumer to research the physician, staff and facility where they elect to have surgery.
So how do patients wind up in situations like Icilma? She was an educated and professional woman. It is actually quite easy to fall prey to doctors such as Dr. Boutte. Her building is shiny, bright, has nice artwork and décor, and has granite countertops and marble floors throughout. It looks like a legitimate medical office, at least on the surface, but the “surgical suites” were really just glorified exam rooms with an adjustable table. Once the patients were heavily sedated and in the surgical suites, they would not have known what was going on or who was performing what procedure on them.
Enter Dr. Boutte’s “staff.” Luis Remy is her surgical assistant. He was a doctor in Peru, but could not pass his boards in the U.S. He was trained by Dr. Boutte to perform liposuction. She trained him on making incisions, infiltration, disruption and fat retrieval, all of which are outside the scope of his permissible practice. He performs many of these procedures on his own, outside of Dr. Boutte’s presence. He also testified he does not perform “Smart Lipo.” He performs conventional lipo. Therefore, Icilma received a different procedure than what was on her consent forms. She also received an extensive abdominoplasty, not a less invasive procedure. There is no way she would have healed in time for her wedding.
Dr. Boutte is a board-certified dermatologist, but she advertises and holds herself out as a “board-certified surgeon” and “board-certified cosmetic surgeon.” There is no board certification for cosmetic surgery under the American Board of Medical Specialties (“ABMS”), but recent change in Georgia law permit physicians to call themselves “board certified” by other commercial organizations that do not require any verification of training or expertise. The ABMS is the only true “board,” and membership requirements are stringent.
Dr. Boutte provided extensive testimony about her “training” in liposuction and other cosmetic procedures she performs, yet her training was obtained from a few weekend preceptorships and watching videos of surgeries. Dr. Boutte further testified about how much she relies on “Nurse Lee” as her “right hand.” Nurse Lee is in fact not a nurse at all, despite how she is held out to patients in the office and in advertising. Her school transcripts indicate she took some prerequisites that could have led to nursing school, but she barely even passed those classes. All of her training as a “nurse” came from Dr. Boutte. She was also trained to perform liposuction and dispenses narcotics, catheterizes patients, marks the patients for surgery, and makes incisions.
On certain surgeries, and if the patient is willing to pay the fee, an independent anesthesia provider will be present. In Icilma’s case it was a CRNA (certified registered nurse anesthesist). In Georgia, CRNAs are allowed to practice outside the direct supervision of an anesthesiologist. On the day of surgery it was known by both the CRNA and Dr. Boutte that the capnometer (a medical instrument which measures the amount of carbon dioxide in the expired breath of patients) was not working, yet the surgery proceeded anyway.
Icilma was on the operating table for over 9 hours under oral and IV sedation. Her airway was not protected and for much of the procedure she was in a facing downward position. The intraoperative text messages between Dr. Boutte and Luis Remy evidence that Dr. Boutte was only present for portions of the surgery. Luis Remy was dismissed at 5pm to go to his evening job and the CRNA was dismissed around 7pm, before the surgery was complete. Dr. Boutte and “Nurse Brown” were left with Icilma while she was still under sedation. Nobody was dedicated to monitoring Icilma. If the CRNA had not forgotten her purse, returned to the surgery room and glanced at the muted monitor, nobody would have noticed that Icilma was in a deteriorating condition. The CRNA initiated CPR and a staff member called 911.
The first responders testified that upon arriving at the scene the “operating room” was a disaster. The room was so small it was difficult for the paramedics to move around. The TV was on and Dr. Boutte had been watching “Family Feud” while performing surgery. The back door of the room was open and cold winter air was blowing in. Instruments were lying around haphazardly, and it did not appear that infection protocol was being followed. Although Icilma required immediate transport to the hospital, Dr. Boutte had to spend another 30-40 minutes attempting to close Icilma’s abdomen before she could be transported. The paramedics had to carry the gurney down the stairs because the elevator was not large enough. As Dr. Boutte did not have admitting privileges at any hospital, EMS took Icilma to the closest hospital.
It is estimated that Icilma went without oxygen for 7 to 11 minutes. More likely than not her CO2 levels had been steadily rising, but there wasn’t sufficient monitoring equipment in place to sound the alarm. Because Dr. Boutte’s surgery center required no initial inspection, permit, accreditation or regulation of any kind, there was no way to verify she had proper, functioning equipment and appropriate procedures to ensure patient safety.
THE GEORGIA COMPOSITE MEDICAL BOARD’S RESPONSE TO ICILMA’S CASE
The plastic surgeon who consulted with Icilma when initially hospitalized was so outraged by Icilma’s condition, and the condition of another patient of Dr. Boutte who was under his care, that he filed a complaint with the Georgia Composite Medical Board. He was concerned about the aggressive plastic surgery procedures Dr. Boutte was performing and the safety of her patients. He was troubled to find Dr. Boutte rounding on Icilma while she was in ICU, as she did not have any privileges at Eastside Medical Center.
Most reporters and viewers were shocked to learn that in Georgia there are no limitations to a physician’s scope of practice. If you have a license to practice medicine, you can hang a shingle and perform any type of surgery.
In April 2016, I received a phone call from an investigator with the Georgia Composite Medical Board who was conducting an investigation regarding Dr. Boutte. I agreed to cooperate with their investigation. At the request of the Composite Board, over the next two years I forwarded every deposition, affidavit and document concerning Dr. Boutte. I worked closely with attorney Chloe Dallaire, who was also representing a patient severely injured by an infection she acquired during surgery with Dr. Boutte. Together we supplied the Board with mountains of documents upon request. Meanwhile, we learned that Dr. Boutte had ramped up her practice and was performing up to six procedures a day up to six days a week.
In late 2016 and early 2017, the infamous YouTube videos of Dr. Boutte’s OR were being filmed by Dr. Boutte and pushed on social media. The videos depict actual surgeries of actual patients while Dr. Boutte and her staff simultaneously sing, dance and perform to hip hop music. In one video a large piece of flesh removed from a patient is being held and flapped around the room while the staff member is dancing and singing. The videos clearly demonstrate the cavalier attitude of Dr. Boutte and her staff. These videos were preserved during the discovery process and were provided to the Georgia Composite Medical Board.
We became increasingly frustrated with the Board’s delay in taking any action whatsoever on Dr. Boutte’s license. It is unbelievable that there was nothing preventing Dr. Boutte from this type of practice in Georgia. It seemed unjust to physicians that invested the time and money to receive the proper education and training to perform the very procedures that Dr. Boutte was merely learning over a weekend or two. Many Georgia physicians spend huge amounts of money building accredited ambulatory surgical centers and navigating the complex requirements mandated by Georgia for this license. Yet Dr. Boutte was performing the exact same procedures in her office without any license, oversight or regulation. It became abundantly clear that the Board was more concerned about protecting the livelihood of physicians, than the safety of Georgia citizens.
THE MEDIA STORM
Jim Strickland, a local investigative reporter, learned of Icilma’s story and other women who had been harmed. Strickland ran the story and the YouTube videos became part of the storyline to demonstrate Dr. Boutte’s outrageous conduct. Hopeful the videos might attract some attention, Chloe and I were in no way prepared for the response our story received.
We received calls and requests for interviews by every major news outlet in the country. They wanted to meet our clients and hear their stories. Ojay became the voice for his mother. Icilma’s story was being aired numerous times on CNN, NBC, CBS, Good Morning America, Headline News, Inside Edition, The View and even TMZ. News outlets such as the AJC, New York Times, Washington Post and the BBC all came calling.
Most reporters and viewers were shocked to learn that in Georgia there are no limitations to a physician’s scope of practice. If you have a license to practice medicine, you can hang a shingle and perform any type of surgery. While these types of physicians would never make it through the credentialing process of a hospital or ambulatory surgical center, it does not matter because they can simply practice out of their office.
Dr. Boutte and the YouTube videos grabbed the attention of the public, but she is just a gross example of a chronic problem the Board refuses to address. We have seen cases where emergency room physicians, OBGYNs, internists and family medicine physicians perform extensive plastic surgery, in office-based settings, with little to no training. The results have been catastrophic. Yet no changes have been made by the Board and no bills have been proposed to enact legislation to protect patients.
Twenty-six months after being initially reported, and after immense public outrage, the Board ultimately suspended Dr. Boutte’s license indefinitely, with the provision that she could apply for reinstatement in two and a half years. Absent the public pressure the Board received, she would still be practicing. Yet, if her license had been timely suspended, hundreds of women could have been spared.
Dr. Boutte continues to advertise on social media that she “is taking a little break from surgery,” but that nobody “can stop what God has in store for [her].” Dr. Boutte has renamed her practice and hired other doctors.
THE SOLUTION IS LEGISLATIVE CHANGE
Dr. Boutte’s suspension was a victory, but many unqualified physicians continue to hold themselves out as “board certified” and perform dangerous procedures in unsafe environments. Georgia is one of 18 states that does not have some form of regulation over office-based surgery. It is time to implement legislation over office-based surgery. Until then, it is patients beware in Georgia.●
ABOUT THE AUTHOR
Susan Witt is the managing partner of The Witt Law Group in Atlanta. She has a broad level of experience in pursuing a variety of personal injury matters including, but not limited to, auto accidents, premises liability and products liability. She has vast experience with medical malpractice, nursing malpractice, nursing home, assisted living and elder care abuse matters.
1 See, Georgia Composite Medical Board Office-Based Anesthesia and Surgery Guidelines
2 See, http://www.lawatlas.org
PHOTO CREDIT: JULIEN TROMEUR/SHUTTERSTOCK.COM