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?

Charlotte found her plastic surgeon the way many women do: by word of mouth. It seems there were plenty of women around who were unwilling to accept the will of their creator and had chosen to improve upon nature's handiwork. Some did so by having pieces of themselves surgically excised, others by inviting foreign objects into their bodies -- all in the pursuit of some illusory, and temporary, perfection.

But plastic surgery is also sought by those in pursuit of healing. Often, they are women such as Charlotte, for whom a better body was less an immediate concern than the neck and back pain caused by the one she had. Charlotte didn't necessarily want or need better-looking breasts, just smaller ones. She wanted relief from years of discomfort, and in an affirmation of that modest desire, her insurance company agreed to pick up the tab.

Charlotte's friends told her the surgeon to see was Dr. Gerald W. Johnson. A prominent weaver of aesthetic dreams, Johnson once owned a house with a breast-shaped swimming pool. To ensure the proper lift and form, he staked out the pool's dimensions himself. The result was a shimmering, aqua-blue monument to society's ideal of the perfect breast.

A crude gesture, or so some in his profession judged it. But the custom-made pool was typical of Johnson, who was one of the first, and most tireless, self-promoters in the plastic surgery business. Back then, in the early 1980s, other surgeons were critical of Johnson for chasing patients to undergo surgeries that were largely elective. Nowadays, advertisements touting the regenerative powers of cosmetic surgery are commonplace, and Johnson has been among those reaping the rewards the longest. In circles largely occupied by those with the goods to prove it, it is believed he does the best breast augmentations in Houston. Certainly, few surgeons have done more of them, or profited as much from a woman's desire to gerrymander her figure.

Johnson's best-known achievement is the bosom of the famous-for-being-famous model Anna Nicole Smith, who can thank the surgeon's two operations for a measure of her notoriety. Truth is, though, there's no telling how many of the fabricated female forms out there today can be attributed to Gerald Johnson.

Shortly after opening his practice in the northwest FM 1960 area, he was anointed by a colleague as the man who "made sooper-doopers out of super-droopers," a description Johnson had printed on the back of business cards. Later, he became sort of a Mattress Mac of boob jobs, offering bring-a-friend-and-get-one-free specials. He also began what were called "Grand Teton Days," when he performed as many breast augmentations as he could in one day.

Some who know his work say Johnson, 56, is a daring surgeon, though they are careful not to attach too much praise to that particular quality. Excessive innovation can be troublesome, as Johnson found out in 1991, when the Texas Board of Medical Examiners ruled that the surgeon had committed four counts of "professional failure to practice medicine in an acceptable manner consistent with public health and welfare."

The reprimand grew out of four complaints the board received from patients who had been hospitalized after undergoing liposuction in Johnson's surgery center. The board ruled that Johnson had removed too much fat from each of the women as an ill-advised way to reduce their weight, leading to excessive blood loss and trauma. The surgeon had also kept the women under sedation too long, the board said; one woman was in surgery for eight hours and subsequently developed secondary pneumonia and a stress ulcer. Another woman suffered respiratory distress and had to be admitted to the intensive care unit at Houston Northwest Medical Center.

The restriction placed on Johnson's medical license limited the amount of fat he could liposuction from patients and required him to have transportation to a hospital available before undertaking any surgery. He also was taken to task for an advertisement he ran in the August 17, 1987 edition of the Arkansas Gazette. The ad announced that Johnson was to speak at an upcoming workshop by the American Society of Liposuction Surgery and described him as an "internationally known plastic surgeon and leader in fat transplantation for augmentation of the breasts." That was news to the state board. In a fifth count of their ruling, the examiners said Johnson had claimed "professional superiority or the performance of professional service in a superior manner which was not readily subject to verification."

The restrictions on Johnson's license were lifted in August 1993, seven months after Charlotte first consulted him. During their initial meeting, the surgeon showed her a video of a standard reduction procedure in which fat and tissue are removed through an anchor-shaped incision in the lower half of the breast.

For whatever reason -- time, money, fear -- Charlotte didn't contact Johnson again until June 1994. This time, Johnson offered her the choice of another operation -- a bilateral endoscopic reduction mammoplasty. The procedure called for an incision along the side of the breast, in a fold near the armpit. Because the breast proper wouldn't be touched, there would be far less scarring than the standard procedure Johnson had initially proposed.

Excited by that promise, Charlotte scheduled her surgery for the early morning of July 12, 1994. As the day drew near, Charlotte felt good about things, and she expected that optimism to grow once Johnson had shaped her breasts into more manageable proportions. She wasn't getting a nose job or breast implants or having the fat sucked off her thighs. All the same, Charlotte understood the magnetic lure of those purely cosmetic procedures. In them lay the power to change the way a woman feels about herself, to allow her to be something she had never been, something more. Charlotte couldn't help but feel a surge of life-changing energy. As a 37-year-old single mother of two who drove a school bus for a living, it was not an unwelcome sensation.

There have been moments in the nearly two years since the operation when she's wished differently, but Charlotte survived her bilateral endoscopic reduction mammoplasty. She lost quite a bit of blood, and large pieces of skin died and had to be removed following the surgery. Her breasts are, in fact, smaller. But any relief brought by the reduction is trumped by a searing pain that starts deep in her chest and burns a path through her breasts to the surface, which is a morass of grotesque scars. Her right breast is noticeably smaller than the left one; both nipples have been cruelly repositioned.

As for the power of cosmetic surgery, the reconstructive procedure that would somehow transform Charlotte's torso into something to be admired does not yet exist. Then again, before Gerald Johnson prepared to work on her, it appears that few people besides Johnson had ever heard of a bilateral endoscopic reduction mammoplasty.

According to those who know him, it's unlikely Gerald Johnson thought twice before performing a radical procedure of his own creation on a paying customer. And he would have never expected it to fail. But now, as a result of Charlotte's surgery, Johnson faces a career-threatening malpractice suit in Harris County's 55th District Court.

For more than 20 years, Gerald Wayne Johnson has fought for respectability in a field of surgery where it's not often granted. Most cosmetic surgery is incidental to the health and well-being of a patient. Only in its purest form -- as a means to remedy a disfigurement or severe physical trauma -- is it considered a justifiable medical undertaking by those professionals who deal in life and death. Early in his career, Johnson was a trauma surgeon working in an emergency unit under Michael DeBakey. The before-and-after photographs of his patients -- among them, a young girl who had the lower half of her face almost completely torn off by a dog -- are almost awe-inspiring. Indeed, nurses who've worked for Johnson use words such as "brilliant" to describe his technique. As a cosmetic surgeon, Johnson most recently pioneered an umbilical breast augmentation procedure that is gaining credibility in the industry.

For all of his wealth and skill, however, Johnson's life has been a torturous affair. On June 4, 1979, ten-year-old Jill Newsome went into cardiac arrest while the surgeon was removing a birthmark from her right knee. Jill was resuscitated, but not before she lapsed into a coma and suffered severe brain damage. She died in 1984, two years after a jury slapped Johnson -- who had no malpractice insurance at the time -- with an $11.3 million judgment.

Johnson never appealed the judgment, one of the largest ever levied against a Texas physician. But he's never accepted it, either. Indeed, the surgeon has made no secret of his disgust with the verdict, as well as his intent to do whatever it takes to avoid paying the consequences. Since 1982, Johnson has worn a path between his operating theater and the courtroom, self-righteously fighting the justice administered on behalf of Jill's parents, Earl and Gail Newsome. The couple and their attorney, Bobbie Bayless, have reminded Johnson at every turn that Jill's death is his cross to bear, and a good-faith effort to make restitution is the only way to ease the burden.

According to Bayless, Johnson has paid between $1 million and $2 million of the judgment, which, with accrued interest, has grown to more than $30 million. To avoid turning over more of his assets, the doctor has taken most every twist and turn in the book, and the Newsomes have never been far behind him. But the couple's 14-year pursuit has mostly brought them more grief, while pulling them into the strange orbit of a man who makes more than $1 million a year yet has exhibited a fanatical unwillingness to part with it. Perhaps it's bad karma, but Johnson's financial gyrations and frequently bizarre behavior have created more trouble for him than the tragic accident would have ever caused on its own.

The wild ride began three months after the Newsome trial, when Johnson filed for personal bankruptcy in an attempt to have the judgment discharged. A federal judge dismissed the claim in November 1985, ruling that Johnson had stashed millions of dollars in assets "with the intent to hinder, delay or defraud creditors," specifically the Newsomes. A few months before the bankruptcy was dismissed, Johnson managed to enlist the unwitting assistance of a fellow physician by asking Dr. Michael Kelly, who trained as a resident with Johnson, to join his practice -- the first time Johnson ever had, or had wanted, a partner.

Kelly, like every other plastic surgeon in Houston, had heard of the $11.3 million judgment from the Newsome suit. But Johnson was able to convince Kelly that he had been unjustly persecuted.

"He blamed all this on, first, the nurse anesthetist, then the ambulance drivers, then the hospital," Kelly testified in one of several lawsuits spawned by the botched operation on Jill Newsome. "It was always somebody else's fault, but it wasn't his fault."

Kelly said he had no reason to doubt Johnson, so when a court-appointed receiver was assigned to monitor the surgeon's assets, he agreed to assume the appearance of having "hired" Johnson and his staff as employees. That done, Kelly opened a bank account in his name for Johnson, who clandestinely funneled what Kelly called "tremendous amounts of money" through it.

By the time Kelly realized he'd been, as he described it, "set up" by Johnson, he owed thousands of dollars in unpaid taxes on his partner's deposits. Kelly ended up bankrupt, and in 1989, he sued MediCash Co. Inc., an accounts-receivable service set up by Johnson in the name of his stepdaughter, Rae Lynn Martin. MediCash filed insurance claims and arranged patient payment plans for physicians. Since Martin was only 18 at the time, just out of high school and bound for the University of Texas in Austin, the company was staffed by employees who also managed Johnson's practice.

Kelly testified that MediCash was "an alter ego" of Johnson that paid the surgeon up-front for his operations. Kelly said that if a patient's insurance carrier covered less than the cost of a procedure, or if the patient defaulted on the installment plan, Johnson did not reimburse the company. Kelly claimed in his lawsuit (he was awarded a judgment but settled out of court when the company folded) that MediCash balanced its books with receivables the company collected and owed its other physician clients.

"I don't think [Johnson] refunded any of that to MediCash, and that's how we got to figuring, 'How in the world is he getting paid? Where did the overpayments come out of?' " he testified. "Me and the other doctors, that's where it came from."

By the time the Newsomes found out where Johnson's money was going, most of it was in an account under his wife's name. The rest had been channeled through a couple of Cayman Island shells that floated "loans" to Johnson's family members, who, in turn, helped Johnson liquidate his real property.

Johnson sued MediCash, too, not long after he filed for divorce from Rae Lynn's mother. His split from June Johnson, his wife of 18 years, occurred after Johnson had taken up with Lana Lea Ryan, a 45-year-old truck driver's daughter from the Rio Grande Valley who met the charismatic surgeon when she brought her teenage daughter in for a rhinoplasty.

The divorce of Gerald and June Johnson was an ugly, year-and-a-half-long affair. A settlement was reached last July, but June Johnson has received little of her share of the community property. She lost her high-powered attorney, Marian Rosen, because Johnson ignored a court order to pay his wife's legal bills. Johnson also refused to support his wife over the course of the proceedings, and was even cited for contempt of court at one point. June eventually filed for bankruptcy.

Though they've been together for four years now, there is no record of Johnson's having married the twice-divorced Lana in Harris County. She did, however, legally change her name to Lana Lea Johnson in July 1994, a week after Johnson's divorce from June was final. Lana is also listed as the owner of the $260,000 house in Bunker Hill Woods she now shares with Johnson.

Meanwhile, the surgeon is approaching his professional life from a new vantage point as well. After 20 years in northwest Houston, Johnson recently moved his practice to an office in the Texas Commerce Bank building in River Oaks. The change of locale puts him in the heart of a gold mine of opportunity, where he can satisfy the aging well-to-do's appetite for cosmetic rejuvenation in their own back yard. If all goes well, Johnson might someday choose to pay the eye-popping $106,000 annual malpractice premiums required of him. Until then, he is again performing surgery with no insurance.

At least when he operated on Charlotte, Johnson had insurance. She could receive up to $200,000 if she wins her malpractice claim, but perhaps more important, she'll have been spared the experience that has stolen the Newsomes' lives. But as Earl and Gail did 17 years ago, Charlotte and her attorneys think Gerald Johnson has done enough damage in his career. They'd like to see him lose his license.

"I feel like he used me for his own good, or so he thought, and it backfired in his face," says Charlotte, who, with her children, has moved to another state. "You don't use a human being as a guinea pig."

Johnson's credentials are respectable, if unspectacular: medical school at the University of Arkansas, class of 1966; an internship in Little Rock; two years in the Air Force, including a year as a flight surgeon in Vietnam; two years of general residency at Baylor Affiliated Hospitals; and a third year at the University of Texas-Hermann Hospital, followed by a two-year residency in plastic surgery.

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.

June's daughter, Elaine Martin, is perhaps a less embittered source. Though she naturally supports her mother, Martin was Johnson's scrub nurse for many years and still speaks in near-reverential tones about his skills. Martin was also the supposed beneficiary of a few of Johnson's asset-reduction moves, which, if true, doesn't really add up. Elaine was earning about $1,200 a month working for Johnson, yet she allegedly managed to pay her stepfather $220,000 for some real estate and pension-fund interests.

But that was a long time ago, and while she still describes Johnson as "brilliant," Martin says he wasn't always medicated as prescribed.

"You could always tell when Gerald wasn't taking his lithium," says Martin. "But even on his worst day, he was always a very good surgeon, technique-wise. Always pushing the envelope. It's half art and half science, and he was really very good."

In a phone interview, June Johnson said her ex-husband was "devastated" when Jill Newsome didn't recover. A registered nurse who worked for her husband, June wasn't on duty the day of Jill's surgery, but she had set up the routine protocol used in the surgery center's operating rooms. Johnson was running late the morning he was scheduled to remove the birthmark from the ten-year-old's knee. Fifteen minutes before the surgeon arrived, his nurse anesthetist, Guy Abbey, began to prepare Jill by administering a combination of sodium pentothal and phenegran, plus brevital to control nausea.

She was taken into the operating room at 9:10 a.m., just after Johnson arrived and scrubbed. The drugs Abbey had given Jill were to keep her calmly asleep long enough for Johnson to inject the area around the birthmark with Marcaine, a local anesthetic. But as Johnson pushed the needle in, the child flinched. Abbey administered more brevital and sodium pentothal.

Johnson was closing the wound, when, after two sutures, he heard a loud whoosh from the flush valve of Abbey's anesthesia machine, a signal that oxygen was rapidly being pumped into Jill's lungs. Johnson looked up and noticed Jill was cyanotic -- she had turned blue. Johnson then glanced over his anesthetist's shoulder at the EEG monitor and saw two blips, then a flat line.

Following the emergency protocol, Johnson ordered a nurse to fetch one of three internists who officed one floor above the operating room. Johnson was still administering cardiac massage when Dr. David O'Neill arrived from upstairs and took control. He picked up the heart massage and ordered a dose of Isuprel. Within a few minutes, Jill's heart was pumping and her blood pressure had stabilized.

But she was comatose, and her brain had gone without oxygen for eight minutes. Johnson accompanied Jill to nearby Houston Northwest Medical Center, where she remained in intensive care for almost a week.

Though he couldn't say what had gone wrong, Johnson continued to assure Earl and Gail Newsome in the days following the operation that Jill would recover. The Newsomes didn't learn otherwise until their daughter was transferred to Texas Children's Hospital. After Jill was admitted, an intern approached the couple, and as Earl put it, "read us the riot act."

"I mean, up one side of my wife and I and down the other about, 'How could you bring this child down here?' " Earl Newsome recalls. "He said, 'Can't you see she's already brain-dead? There is no hope for this child.'

"I have never been as sick in my life as I was that day, because up until that point we had been going along under the hope or the belief that, 'Well, maybe she did have an adverse reaction to the drug; maybe there is a sign.' "

Jill was released from the hospital on June 22, 1979, when the Newsomes learned what had been true since the life-and-death drama in Johnson's operating room. The discharge statement diagnosed her as anoxic encephalopathic, with slow and grossly abnormal brain waves, upper-gaze paralysis, no reflex action and rigidity. In other words, Jill had suffered permanent brain damage.

One thing June and Gerald Johnson agree on today is that the surgeon should not have been held responsible for Jill Newsome's injury. They both insist the problem that morning was the nurse anesthetist, Guy Abbey, who they believe failed to properly monitor the girl's sedation.

"He didn't pick it up fast enough, obviously," June says. "I'd been a trauma nurse for a long time. I've seen things happen when people didn't pay attention."

The Newsomes sued Johnson, Guy Abbey and David O'Neill, as well as Houston Northwest Medical Center and Johnson's outpatient clinic. The case against McNeill, who revived Jill, was dismissed quickly. The attorney for Abbey, who was not a licensed physician, argued that Johnson was "captain of the ship" and deserved the blame for the tragedy. The jury bought it, and declined to rule against Abbey. Johnson was found negligent in his care of Jill, as well as in his efforts to resuscitate her. In February 1982, the jury returned its $11.3 million judgment.

A few months after the judgment, Johnson took the first of a series of what might be considered retaliatory actions by suing People magazine and its owner, Time Inc., over a July 1982 article headlined "Licensed to Kill?" The story lumped Johnson in with other physicians who had been found negligent in the death or injury of patients, and raised the question of whether they should be allowed to continue practicing medicine. With a jury verdict against him, Johnson could never make much of a case for libel. The suit was dismissed in 1988.

Johnson also sued his malpractice attorney, David Davis, as well as Guy Abbey, whom he accused of altering medical reports on the ill-fated procedure. Those cases, like a subsequent malicious prosecution action against the Newsomes, were eventually dropped or dismissed.

Three months after the judgment, Johnson filed for bankruptcy. Actually, by then his practice had begun making him money hand over fist. Unlike June, who spent less and less time at the surgery center after the Newsome accident, Johnson took to working ridiculously long hours with little sleep. According to his own testimony, Johnson averaged a gross monthly income of between $80,000 and $120,000 from 1982 to 1992.

But apparently, Johnson remained troubled over the Newsome accident, and along with his anger over the jury verdict, it was crowding him toward the edge. According to his ex-wife, Johnson found a means of escape in nitrous oxide, the sweet, colorless laughing gas that fueled the twisted mirth of Dennis Hopper's character in the David Lynch movie Blue Velvet.

"I spent every night for several years running back and forth to the surgery center because I knew what he was doing," June says. "He'd be sitting in the operating room with the tanks and a mask on. I'd have to turn the nitrous off, turn the oxygen off and get him home. I tried different things to get him off it, but he had tanks hidden in the woods near our home."

June says the nitrous oxide kick lasted "two or three years," until she went to a support group for doctors' wives and learned of a Smyrna, Georgia clinic that specialized in treating physicians and their addictions. She went home and told her husband to pack his bags because they were leaving the next day. Johnson became angry and resisted, but finally let her make the arrangements. June says that when they arrived, the clinic's personnel wanted to admit Johnson. "They thought he was on other drugs," she recalls. "He was not well at all."

But Johnson had enough sense left to see his future amid the human wreckage lolling around the clinic. He refused the invitation to be admitted, but as far as June knows, he has not taken another whiff of nitrous oxide since.

"Fear," she notes, "is a great deterrent."

In 1976, due to what he called "underwriting considerations," Johnson lost his malpractice insurance. Though he testified that he considered obtaining it elsewhere, it was 1982 before he applied again. During those six years of, as they say in the medical profession, "going bare," Johnson employed what a federal bankruptcy judge called a medical malpractice defense plan, "a program designed to make [Johnson] judgment proof."

In the fall of 1978, Johnson sought some particular advice from his attorney, Ben Turner. The lawyer responded on October 16, 1978, with a letter that read in part: "It would appear that a transfer of assets to a foreign corporation would protect the assets from any judgment creditor of yours. However, if you own stock in the foreign corporation ... the judgment creditor could get at the assets .... I believe we discussed the difficulties of the judgment creditor being able to ascertain this information, without your volunteering it."

While attending a medical convention in Palm Beach in the mid-1970s, Johnson had noticed an abundance of advertising touting the tax advantages of doing business in the Cayman Islands. On a subsequent visit, Johnson learned that the banking secrecy laws in the West Indies tourist spot could enable one to avoid taxes and creditors. Indeed, the practice is so popular that there are 1,000 banks and 50,000 corporations headquartered in the Caymans, which have a population of roughly 20,000.

In June 1979, a short time after the botched operation on Jill Newsome, Johnson christened a scheme that seemed complicated on the surface, but, in fact, was a simple method by which he could funnel his income into a Cayman corporation, which would spit it back out to Johnson's relatives to use to "buy" his assets.

It started when Johnson chartered Houston International Plastic Surgery Associates on Grand Cayman. Ostensibly, the new corporation was to be a practice to cater to stateside patients who wanted vacations with their tummy tucks. Johnson testified that he had gotten approval to practice in the Caymans, but quit the venture because "the doctor who was controlling the deal had too much of a stranglehold on the operation."

The man who helped Johnson with the Cayman charter was Joe Bond, an attorney he met at a marriage counseling session the men and their wives attended. Bond was U.S. counsel for Bruce Campbell & Co., the Caymans' largest law firm. In the fall of 1981, around the time the Newsomes petitioned the court for a trial setting, Johnson talked to Bond about arranging the transfer of some real estate.

In November, Johnson sent $125,000 to something called International Medical Consultants. A week later, Bond received a letter from Campbell & Co., advising him to set up a corporation for Johnson "so that some loan agreement can be made." Just before Christmas 1981, Bond incorporated the Caribbean Investment Co., naming himself as president and sole director. Nine days later, on December 30, 1981, Caribbean Investment loaned $100,000 to Irene Martin, Johnson's live-in mother-in-law. The loan was for the purchase of two lots that Johnson owned adjacent to his homestead. As part of the same transaction, $20,000 was put in an escrow account in the name of Joe Bond.

A few months later, Bond arranged a $10,000 deposit from Caribbean Investment to a bank in Vicksburg, Mississippi. The certificate of deposit was used to collateralize a loan in that amount to Johnson's brother-in-law, Rex Eley, to buy Johnson's motor home, which was worth $30,000. It was pointed out to Bond during his testimony in Johnson's bankruptcy proceedings that Caribbean Investment's only transactions involved the purchase of the surgeon's assets by his relatives.

"I don't know if that's coincidental," Bond replied. "It may have been that the funding source from this was from a contact with, or somebody that knew, Dr. Johnson."

Bond testified that, as far as he knew, Irene Martin had never made any of the $15,000 annual installments on the loan, and he couldn't recall whether he received the maturity on the certificate of deposit when Eley repaid his loan. Bond also acknowledged that he didn't attempt to recoup the $10,000 that Caribbean Investment put into E. J. International, an Amway distributorship shared by Eley and Johnson. The venture eventually failed, and Johnson later testified that he lost $150,000 on the deal.

There was nothing illegal about the Caribbean Investment transactions, but their dissection in court exposed Johnson's reported insolvency as a lie. With his credibility a shambles, Johnson decided to go for broke and spin a tale that his own lawyer described as "almost too bizarre to be reasonable."

According to the surgeon's testimony, it was late 1980 or early '81 when he met Harry Bradmore in the bar of the Holiday Inn on Grand Cayman. As it often does in the Caymans, the conversation turned to business, and Bradmore told his new friend that there was a wonderful opportunity in Venezuelan oil. An investment could return as much as five times the original amount in a few years. Bradmore gave Johnson a business card with his Houston address, Two Shell Plaza downtown.

Johnson testified that by June 1981 he managed to save $210,000 in a briefcase in his closet. Without calling or visiting Bradmore's Houston office, he took the briefcase to the bar at the Holiday Inn and gave the money, in bundles of $100 bills, to Bradmore. A month later, Johnson returned to Grand Cayman with another $30,000. According to Johnson, it was another eight months, in March 1982 -- a month after the Newsome judgment put him $11 million in debt -- when he returned with another $180,000, which he again parted with at the Holiday Inn bar.

"First of all," Johnson would later testify, "let me say, a lot of the way I do business is the same as I did with Harry Bradmore. [I] meet somebody I like and I think I like and go on their advice."

Johnson said that all $430,000 in cash changed hands at a secluded place at the edge of the bar "where there was some bushes and a tree." Bradmore would bring along his own briefcase, and they'd step just out of view of the rest of the room. After the transfer was made, they would adjourn to the Holiday Inn's business office, where they borrowed a typewriter to make a receipt.

"Well," asked Bobbie Bayless, the Newsomes' attorney, at Johnson's bankruptcy trial, "if you were able to use the office to type up this receipt, why did you transfer the money behind a tree and bush?"

"Because," Johnson answered, "we transferred the money before we typed the receipt."

"Well if you knew that you could go into the office, why didn't you say, 'Let's go into the office up here to do it?' "

"That's just the way we did it," Johnson replied.
According to Bayless, by the time Johnson described his meager attempt to find Bradmore, whom he claimed had "defrauded" him, the testimony had turned laughable. Johnson said that in pursuit of his $430,000 investment, he wrote two letters to Bradmore in care of the Holiday Inn on Grand Cayman. He also paid one visit to his Houston office -- which, he discovered, was the parking garage at Two Shell Plaza.

On November 13, 1985, U.S. Bankruptcy Judge Edward J. Ryan ruled that Johnson had "failed to satisfactorily explain the loss and sudden diminution of his assets" and threw out his discharge attempt. Ryan found that the Cayman Island transactions, as well as the sale of several pension fund and real estate interests to Elaine Martin and brother-in-law Rex Eley, were "the clumsy effort of a desperate man seeking to avoid in any way the payment of his just debts ....

"The badges of fraud were shown to be present here coupled with perjury and forgery."

In his defense, Johnson insisted that the assets he set loose were his wife's, as the result of several divisions of assets the couple executed between 1977 and 1981. But Ryan blew that explanation apart by ruling that since the partition documents, for some unexplained reason, weren't legally recorded until a week after the Newsome lawsuit went to trial, they obviously had been backdated.

In a memorandum accompanying his verdict, Ryan was most eloquent in writing about what he called Johnson's "fanciful account of his imaginary friend ... Harry Bradmore, phantom agent for the non-existent Venezuelan International Oil Corporation." Ryan concluded that Johnson's story of "investing well over $400,000 by passing cash to this barroom acquaintance on several occasions is utterly incredible. It would bring a blush to the cheek of Baron Munchausen and qualify for high rank in the Ananias Club. It smacks of Lewis Carroll."

But the learned judge failed to note the salient irony in Johnson's bankruptcy filing. If he hadn't made the bogus transfers, Johnson certainly could have had his debt to the Newsomes discharged. Of course, he also would have lost everything. Apparently, that was a deal he couldn't accept.

Michael Kelly once agreed with a courtroom description of Gerald Johnson as having "a way of convincing people that something that's going to be beneficial to him is also going to be beneficial to them."mmmmm Johnson may have accomplished such a mutual agreement with Charter Bank Colonial, the depository for his personal and professional assets. Following the $11 million judgment, a state district court judge ordered that Johnson's bank account at Charter be frozen. But by then, the bank reported that the account had less than $50 in it. A few weeks later, Johnson filed for bankruptcy.

In 1987, the Newsomes discovered that Michael Kelly had taken over Johnson's practice in the spring of 1986, "hired" the surgeon and opened a special bank account in Johnson's name, which the surgeon used freely as his own. The court ordered Charter to temporarily freeze Johnson's account again. The freeze was lifted when the surgeon and the Newsomes reached a settlement agreement in June 1986, with Johnson promising to turn over some real estate to the couple and pay them $20,000 a month.

Johnson complied with the agreement for a while, but eventually quit making the payments. In 1990, Charter Bank was brought in as a defendant in the still-unpaid malpractice suit. The Newsomes alleged that from May 1982 until 1984, while the bankruptcy case was pending, more than $10 million of Johnson's money had moved through the bank. They later amended their suit to allege that Johnson had deposited and withdrawn more than $5 million on an account in his wife's name from 1986 until 1992.

Oddly enough, Johnson's testimony seemed to strengthen the Newsomes' case against him, since he admitted to having access to accounts in Kelly's and his wife's names. Johnson testified that Charter Bank president Bill Terry, who was also a patient of the surgeon's, knew about the arrangement, but did nothing to keep him from banking at will on other people's accounts. Johnson was even making his loan payments, in cash, on several notes he had with Charter.

Yet the Newsomes lost the case against the bank. According to their attorney, "the jury thought he'd conned the bank like he'd conned us."

While it seemingly would have been tough for anyone close to the situation to remain ignorant of what was happening, June Johnson has testified that she seldom had much to do with "the business part of things." She professed to know nothing about Johnson's Cayman dealings or how he was managing his business finances. June had access to what surely were her own accounts. But other bank accounts in her name, as well as the accounts-receivable service, MediCash and other business ventures begun by Johnson in someone else's name, were handled by the surgeon and his business manager, Jeanne Palmer.

June's contention rings true if one considers how Johnson was able to wrest such total control of the so-called community assets while their marriage was falling apart. For that matter, June didn't contact a divorce lawyer until she discovered that Lana Lea Ryan had become Johnson's business manager and had been given financial control of his practice. June had long ago learned how to deal with women who chased her husband, the surgeon, but Davis gave her a "bad vibe" immediately, she says.

"Even our therapist said she was only there to seduce him," June says. "Everyone tried to tell him, but he wouldn't believe it. She made things a lot worse by not being the kind to be considerate to an ex-wife. Lana would like to have everything I have."

Apparently, Johnson did his best to oblige her. In April 1993, a few months after Johnson filed for divorce, he was held in contempt for failing to meet the court-ordered terms to support June during the proceedings. According to a motion for a protective order filed by June, Johnson broke into their northwest Houston home in August 1993 and took thousands of dollars in jewelry, furs and rugs.

Her attorneys suspected it first, but June didn't realize Johnson had been tapping her phones and recording conversations until he was arrested on the evening of September 17, 1993, in her back yard. Johnson was found by a deputy constable who followed a single wire from the back of the house to a fence. Just on the other side was Johnson, standing in the dark, holding a plastic bag containing a tape recorder, a pair of gloves, wire cutters and a switch box. A search of the surgeon's car turned up a pistol.

In December 1993, Johnson was indicted on a felony count of unlawful intercept of wire communication. That charge, which could have cost Johnson his medical license, was later reduced to a misdemeanor. Four months ago, Johnson pleaded no contest and received deferred adjudication. He was placed on two years' probation and agreed to undergo a psychiatric evaluation and to remain on any prescribed medications. He was also ordered to submit to twice-monthly drug screenings for six months.

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.

Fredricks, however, contends that it was the combination of the components, as well as how Johnson performed them, that made the procedure experimental and dangerous. "He neglected specifically to let [Charlotte] know," he testified at deposition, "that he intended for her to be an experimental animal in the procedure that he performed."

Charlotte's malpractice action only serves to further complicate Johnson's life, which, it seems, is still haunted by the June morning that Jill Newsome lapsed into a coma. In 1994, the IRS hit the surgeon with nearly $2 million in liens for unpaid taxes as far back as 1976. The surgeon was recently ordered into mediation in his 1993 lawsuit against MediCash, the company he helped set up 14 years ago for his stepdaughter, Rae Lynn. The case had been dismissed for lack of prosecution, but Johnson refiled it in March.

His amended complaint suggests that Johnson bears a few scars from his divorce. He has added June's name to the list of those he's suing in the MediCash lawsuit, as well as those of June's son, Michael Graham; her daughter, Elaine Martin; June's first husband, Ray Graham; and a man June was dating after Johnson moved out. Johnson is alleging that the "relationships between the defendants ... enabled them to steal, conceal, remove and dispose of" property owned by Johnson. The surgeon also has listed "Jane Doe 1-10 and John Doe 1-10," as defendants, in case more alleged co-conspirators are identified.

Meanwhile, Johnson has abandoned or lost any privileges he once had with local hospitals, and is performing surgery in his office's operating suite. In his deposition, Johnson testified that he has in fact continued to perform the endoscopic reduction mammoplasty in his office, even though he has no nurse anesthetist and is only using local anesthesia on his patients.

Last September, Johnson authored a chapter of a book on endoscopic techniques, based on his experiences with 130 or so bilateral endoscopic reduction mammoplasties. The surgeon has testified that before Charlotte's operation, he had performed the procedure seven to ten times. That means that, in the year after the bungled operation, Johnson performed more than 120 of the unusual mammoplasties. Of course, if he's performing them today, it's without medical malpractice insurance.

No one -- least of all Earl and Gail Newsome -- thinks that the lack of insurance will hurt Johnson's business. Nor will it keep him up nights.

"The man is devoid of morals or any type of humanity," says Earl Newsome. "If the man is making a million bucks a year, which is supposedly what he's doing, if that's what having that kind of money a year does to you, boy, I wouldn't trade it.

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