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Some 9 million Americans had some part of their body lifted, plumped, reshaped, tucked or peeled last year. In sunny Florida, where cosmetic surgery is wildly popular, most folks don't even go to a hospital to get it done. But what's missing from some walk-in clinics there is a danger sign.
Watch Lynn Sherr's full report tonight on 20/20.
Since 1997, 36 people have died after cosmetic surgery in Florida - most of them not in hospitals, but in private offices. In the last year alone, there have been five such Florida deaths ... at least one of which, according to an eyewitness, might well have been prevented.
Julie Rubenzer, who grew up outside Milwaukee, was a healthy, beautiful woman: 5-foot-6, 120 pounds, a cheerleader and a runner. Her parents, Maureen and Don Ayer, thought she was perfect. But Rubenzer - who had moved to Florida and was divorced and dating again - decided, at 38, to get her breasts enlarged at a private clinic in Sarasota. Her surgeon, Dr. Kurt Dangl, a dentist and oral surgeon by training, advertised his services on a Web site, complete with testimonials and the magic phrase "board-certified."
But Dangl was not certified by any board recognized by the state. And he did not have admitting privileges at any hospital. Even more worrisome: "He cut corners by not having an anesthesiologist or a nurse anesthetist in the room."
That was the observation of a surgical technician - call him "Matt" - who says he assisted Dangl a dozen times in the operating room. He said Dangl often administered too much anesthesia, and "at the beginning of the procedures, many times, I witnessed patients that would stop breathing."
Dangl himself could not be immediately reached for comment.
Hospitalized With E. coli and Staph Infection
Another patient, 64-year-old Clara Scott, went to Dangl for surgery, but when her operation lasted almost nine hours instead of the projected five, her daughter Stacy was concerned.
Stacy Scott was horrified when Dangl sent her mother home just half an hour after the surgery was completed. "Her head was as big around as a basketball. And her limbs were just jerking around. And she was trying to get up. And I passed out. And when I woke up he was shoving my mom in the passenger side of the car," Stacy said.
Clara, herself, was in agony and she was terrified. "Nothing was getting any better. And it was just getting totally worse," she said.
Clara Scott had a huge black spot on her face and said her "ears hurt so bad. They were so infected that they were just coming loose from my face."
When Stacy Scott asked Dangl to put her mother in the hospital, she says he told her he couldn't - because he didn't have admitting privileges anywhere. So Stacy found a hospital on her own, where Clara was quarantined with E.coli on her face and a staph infection on her belly. The treatment saved her life. But it took six more painful months for her wounds to heal, and Clara says it cost $25,000 ... that's on top of the $10,000 Dangl charged, and which he demanded before the operation.
So Clara Scott took her case to state officials, and in April 2003, the Florida Department of Health issued a complaint, charging Dangl with misleading advertising, failing to document his procedures and failing to practice medicine with an acceptable standard of care.
'She Just Crashed on the Table'
But the state took no action. It did not stop Dangl from performing surgery. Five months later, in September 2003, when Julie Rubenzer showed up for her breast augmentation, she likely had no idea about these critical allegations, and she didn't know that, contrary to the written consent form from Dangl's office, no one trained in administering anesthesia was dedicated to that task alone in his operating room as she went under.
The surgery went well for about two hours. Then, while still under what an expert later called "a dazzling array of anesthetic agents," Rubenzer was propped up so the breast implants could be adjusted. According to Matt, "As soon as we laid her down, she just crashed on the table" and went into cardiac arrest. Dangl, he says, "threw a tantrum. He just stood there and he said, 'I don't need this today.' "
Matt says Dangl forced air into her lungs with an Ambu Bag, a disposable artificial ventilation bag. But when he stopped, Rubenzer's heart wasn't beating.
"I said to him, 'Doctor, she is flat-lined. She needs chest compressions.' He said no, don't give chest compressions. He was afraid it would mess up her surgery."
Matt says Dangl only allowed CPR when he was told that Rubenzer's fingers were turning blue. Her heart started again, but because it had been stopped for so long, her brain was starved of oxygen. By the time paramedics got her to the hospital, she was in a coma.
Rubenzer never woke up. Her parents, Don and Maureen Ayer, took her home to Wisconsin, where she died, her body curled in a fetal position, the day after Christmas. They still had no idea what had happened in the operating room. But through a series of circumstances, including some alert reporting by WFTS in Tampa, Matt came forward, and the incredible events in the operating room began to become clear.
To Matt, the most painful recollection was that he had not been allowed to start chest compressions when Rubenzer stopped breathing. "If we were allowed to give those chest compressions, she would be walking around today."
Dr. Rod Rohrich, president of the American Society of Plastic Surgeons, doesn't know the specifics of Rubenzer's case, but he offered these tips for anyone who is planning to have plastic surgery:
1. Interview several doctors, and pick one certified by a board recognized by the American Board of Medical Specialties. 2. If you're not going to a hospital, be sure someone trained in anesthesiology is present, that the surgeon has privileges at a nearby hospital and that the operating room meets state regulations, with emergency equipment in case of a crisis.
"In America, it's amazing," he said. "Most women spend more time finding a pair of shoes than they do finding a cosmetic surgeon. You can take the shoes back, you can't take your face back or your life back."
For Rubenzer's parents, that cold reality has led to one very bitter question: Why was Dangl allowed to operate with formal charges about his competence hanging over him?
The Florida Department of Health declined to be interviewed for this story, but just days ago, issued an Emergency Restriction against Dangl. He can no longer perform the kind of surgery that cost Rubenzer her life without a licensed anesthesiologist. But while his own license is being investigated, he's still free to do cosmetic surgery - despite being charged with "committing gross malpractice" by "failing to practice medicine" with acceptable "care, skill and treatment."
But those words come too late for Julie Rubenzer and her parents, who think the state has not done its job, and that the lack of vigilance means their daughter's death may not be the last. "There's somebody right now, walking around the beaches of Florida," said Don Ayer. "Probably a gal with the name 'next' on her. She won't necessarily walk into this clinic. But she's gonna walk into a clinic down there and get nailed." <img src="http://a.abcnews.com/images/aquadot.gif" width h
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