Cut & Run

He made millions sculpting the figures of Houston women while dodging one of the largest malpractice judgments in Texas history. But after botching another surgery, can Dr. Gerald Johnson continue to operate?

Johnson was trained in plastic surgery by Simon Fredricks, a huge figure among reconstructive surgeons and a teacher of unparalleled credentials. Johnson's connection to Fredricks is useful as a means to compare how two talented surgeons have approached their careers.

Fredricks is the former chief of plastic surgery at St. Luke's, just one of about a dozen high-ranking positions he's held. He chaired the commission that first evaluated liposuction in the United States and helped author reviews of the procedure for the Food and Drug Administration. Fredricks was also present at the first gel-implant breast augmentation in Houston. His 41-page curriculum vitae is stuffed with the benchmark moments and voluminous writings of a true pioneer.

Not that things haven't gone wrong for Fredricks before: some years back, a patient died on his operating table from an anesthetic reaction. He's been sued a few times, as well -- once by a young woman who, Fredricks says, didn't know breast reduction meant her bosom would be made smaller.

Johnson finished his residency requirement under Fredricks, then entered private practice. He applied to become certified by the American Board of Plastic Surgery, the industry's only AMA-approved professional association. But it was years before he actually got around to taking the tests.

"I just never felt I had the amount of time to study and to take off and go take exams," Johnson once said in a deposition. He finally took the written portion of the test in 1990, but failed. The board of plastic surgery -- citing the 15 years that had passed since his residency -- denied Johnson's application to try again.

While his earning power has never suffered, the lack of certification no doubt contributes to Johnson's reputation as a renegade. Indeed, he admits to being self-taught in liposuction, arguably the most important advance in the history of cosmetic surgery. As Johnson describes it, years ago he attended a speech by the inventor of liposuction, a Frenchman by the name of Illouz. The procedure was so new at the time that Johnson had to have a machinist make his cannulas, the missile-shaped instruments used to loosen and suction the fat.

Compared to Fredricks, whose career is a continuing rebuttal to the oft-scorned status of cosmetic surgeons, Johnson sometimes sounds like a tinkerer in a workshop rather than a doctor of medicine.

"I mean, if anybody has got half a brain and an ability to use their hands," Johnson said in a recent deposition, "you can do the liposuction."

Though they've shared no professional affiliation since Johnson's residency training, the two men have come full circle, now that Fredricks has been secured as an expert witness against Johnson in Charlotte's malpractice suit. Fredricks declined to be interviewed about the case or his former student. But in a deposition he gave three months ago, he displayed a clear lack of respect for Johnson's professional judgment.

Fredricks characterized Johnson's endoscopic reduction mammoplasty as a crude invention, experimental in nature and a violation of acceptable practice. He also criticized the post-surgery care given Charlotte, as well as the decision by the Texas Outpatient Surgery Center, or TOPS, to sanction an operation for which the center had not granted Johnson privileges.

"They can't just credential a man one time to do plastic surgery, and then whatever he wants do after that is okay," Fredricks said of TOPS, which was founded in 1980 by Johnson. "And I think this hospital was intimidated by Dr. Johnson to allow him to do whatever [he] wanted to do because he was a high-income producer for the institution .... You know, basically they allowed Gerald to do whatever Gerald wanted to do, and this is another example. Except here, someone was badly injured."

Johnson forfeited his privileges at TOPS on February 1, a development he has attributed to his lack of malpractice coverage. The center's medical director, Dr. Carl J. Battaglia, says Charlotte's malpractice suit had nothing to do with Johnson's departure. In his 16 years at TOPS, Johnson was never censured by the center's board of directors, Battaglia says, and he left as "a member of the staff in good standing."

An anesthesiologist and a longtime colleague of Johnson's, Battaglia says the surgeon is a "creative thinker" and shouldn't be vilified for trying to advance the field. Battaglia can hardly be expected to criticize Johnson too much; after all, he's responsible for allowing Charlotte's operation to proceed. Still, he genuinely sounds as if he's maintained some admiration for Johnson.

"There's a lot of professional jealousy on the part of other cosmetic surgeons about things he's done," Battaglia told the Press. "He does not shy away from controversy. But he did do some things that didn't work out."

But Charlotte's lawyers suspect that the reason that Johnson's endoscopic reduction mammoplasty didn't work out in July 1994 has to do with the surgeon's health and mental condition at the time. They are alleging Johnson was somehow impaired when he performed the operation or when he conceived it, and have asked the court to allow them access to his medical records.

Apparently, the motion is not without merit. Few things, outside of making money at his practice, have gone easily for Johnson in the 17 years since Jill Newsome went into a coma. Though she's admittedly something of an adversary these days, Johnson's former wife says her ex-husband has been wrestling with his own demons since his upbringing in Crossett, Arkansas. Like many of the men in his family, Johnson takes, or should be taking, lithium to control extreme mood swings, June Johnson says.

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