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?

Attorneys for Charlotte will likely argue for the right to submit as evidence information on Johnson's arrest and sentence, as well as on a heart attack he suffered in March 1994. The surgeon's physician blamed the cardiac arrest on stress related to Johnson's lengthy and bitter divorce from June, which wasn't final until July 19, 1994 -- two weeks and a day after he performed the endoscopic reduction mammoplasty on Charlotte.

Charlotte's first suspicion that something might have gone wrong came a moment after she awoke from anesthesia. She opened her eyes to see the clock, which read sometime after 2 p.m. -- almost seven hours after she'd been sedated.mmmm In a recent interview, Charlotte said that Johnson admitted to her after she awoke that there had been some "complications." She stayed at Johnson's surgery center for several days, during which she received four units of blood. But other than explaining that she'd lost 2,000 cubic centimeters of blood during the procedure, Johnson was vague about the ultimate result.

After a month, Charlotte was still in pain and frustrated by the slow healing process. Though she'd been released from the center, she was making frequent visits to Johnson's office to have blood drained from her wounded breasts, to have the bandages replaced and to receive prescriptions for pain medication. On August 4, Johnson used local anesthesia to perform a revision of the eschar -- the removal of dead skin -- from Charlotte's right breast. The procedure was so painful that Charlotte refused to let Johnson perform it on her left breast unless he admitted her and used general anesthesia. Johnson obliged her a week later.

A short time later, Charlotte received a phone call from a woman who identified herself as one of Johnson's nurses and advised her to contact an attorney.

"She said the people at the hospital were concerned, and that she had even lost sleep over it," Charlotte says. "She said she had seen many breast reduction surgeries, but had never seen one botched like that."

A video of the operation -- Johnson often taped his procedures, for posterity or in case he hit upon something unique -- was shown to Simon Fredricks before his March deposition. As it turned out, Fredricks had the opportunity to share the video with Oscar Ramirez, a Latin-American surgeon of some renown who also happened to be the expert witness Johnson planned to use. Fredricks said that Ramirez, upon viewing the tape, noticed the problem immediately. "Where's the blood supply?" he asked.

According to Fredricks, Johnson had severed the blood supply from the skin of Charlotte's breasts, which caused the skin to die, turn black and slough off. Fredricks noted that it was the "type of procedure that one might carry out ... to remove the breast totally."

Johnson also performed a procedure that had been condemned by the American Society of Plastic and Reconstructive Surgery, a prestigious and influential body composed of board-certified plastic surgeons. Referred to as subdermal liposuction -- or SDL -- the procedure has been known to cause excessive loss of skin. Fredricks said he considered SDL "an extremely hazardous thing to do" and personally knew no plastic surgeon willing to perform it.

But perhaps the most troubling aspect of Johnson's operation, for Fredricks anyway, was the use of an endoscope, a flexible tube with tiny cameras at its end. The instrument is typically employed when a surgeon cannot make a large enough incision to see what he's doing behind bone or tissue. According to Fredricks, Charlotte's breasts were too large to reduce by simply suctioning the tissue out. Johnson had to remove a good deal of it through other means, which entailed making an incision large enough that, in essence, ruled out the need for an endoscope.

Nonetheless, Johnson used an endoscope while lifting the breast from the chest wall. At one point, after Johnson abandoned the endoscope, he was able to reach in through the incision and separate the parenchyma -- the essential tissue closest to the blood supply -- from the chest wall with his hands.

"So, he could have done that from the beginning," Fredricks testified. "The whole purpose of the endoscope, I have no idea why he used it."

When pressed for an explanation by Johnson's attorney, Fredricks offered that Johnson had attempted "to create a great discovery, which he could then herald [himself] as the great inventor of a procedure ....

"And it was inconceivable to me that this procedure was done within the present state of knowledge and thought by any surgeon that it would succeed."

Johnson testified in his deposition that he had performed the operation a handful of times before he carried it out on Charlotte. His post-surgical notes indicated that he thought Charlotte's scarring was less extensive than if she'd undergone the standard procedure, and that she still might end up with a "good result."

Charlotte's attorneys are alleging that Johnson did not give Charlotte an accurate picture of the operation he would perform, and that neither the patient nor Johnson's staff knew anything about what he planned to do. Indeed, Margie Neimeyer, Johnson's operating room nurse, gave a deposition in which she testified that she brought Johnson's plans to perform the unfamiliar procedure to the attention of TOPS medical director Carl Battaglia a few days before the surgery date. Battaglia testified that he asked Neimeyer to check Johnson's credentials folder, and when he learned that Johnson was sufficiently experienced in "all of the separate components" of the operation, he issued his approval.

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