O.C. Doctors Lose Licenses in Liposuction Case

The Medical Board of California revoked the licenses Wednesday of a plastic surgeon and anesthesiologist whose liposuction patient died of blood loss after 10 1/2 hours of outpatient surgery in Irvine.

Dr. W. Earle Matory Jr., 47, a board-certified plastic surgeon, and Dr. Robert K. Hoo, an anesthesiologist one year out of residency, committed gross negligence and incompetence in the case of Judy Fernandez, who died March 17, according to the administrative law judge who heard the case.

Fernandez died at Irvine Medical Center, where she was rushed 1 1/2 hours after the conclusion of liposuction to her legs, hips, thighs, buttocks, knees and arms, a mini-face lift, a brow lift and laser resurfacing of her face.

The judge’s 66-page recommendation to immediately revoke the physicians’ licenses was adopted by the six-member Division of Medical Quality of the state medical board in Sacramento.

Administrative Law Judge Vincent Nafarrete, who presided over a 26-day trial, concluded that Matory and Hoo failed to recognize signs that Fernandez’s condition was unstable at midday. Instead, they went on to perform four more hours of surgery without discussing the possibility of reducing the surgery plan, while infusing Fernandez with an excessive amount of tumescent fluid for liposuction and intravenous fluid for anesthesia, the judge said.

Further, Nafarrete wrote in his proposed decision to the board, the physicians failed to promptly transfer Fernandez to a hospital after the surgery, despite her declining state.

“This is not a case about liposuction or about the efficacy of performing large volume liposuction for body contouring in an outpatient, non-hospital surgery center,” Nafarrete wrote regarding the actions of Matory, a physician with more than 20 years of experience.

“This case concerns the performance of large volume liposuction in a safe and cautious manner.”

Fernandez’s family cheered the decision.

“This is really a Thanksgiving gift to our family and to the rest of society,” said Ruben Fernandez of La Habra, the patient’s widower. “It’s good news because it shows that all of what [the physicians and defense attorneys] were saying were lies, and the truth has prevailed.”

Mary Blum, Judy Fernandez’s mother, said the medical board’s decision was an answer to her prayers.

“We are elated, absolutely elated,” she said.

But Matory’s attorney, Lloyd Charton, said he and the plastic surgeon “are shocked and deeply saddened” and will “vigorously pursue an appeal.”

In an interview, he predicted: “Dr. Matory is going to practice again someday.”

Under California law, the physicians can apply to have their licenses restored in three years, at which time the California medical board can elect to review the case, said Richard Hendlin, the deputy attorney general who prosecuted Matory.

The judge made many rulings in Matory’s favor, such as finding that the surgeon was not dishonest, did not mislead Judy Fernandez and did not violate any provisions of the Medical Practice Act.

But while fluid management and monitoring vital signs is the anesthesiologist’s job, Nafarrete wrote that the surgeon shared responsibility.

“Dr. Matory feels that it was impossible to overcome the extreme bias caused by the negative media coverage that occurred in this case,” Charton said in a statement. “It also appears that Dr. Matory was tainted by the blame assigned to Dr. Hoo by Judge Nafarrete. However, Dr. Matory does not feel that Dr. Hoo deserves to lose his license.”

Arthur Chenen, Hoo’s attorney, said the anesthesiologist was disappointed by the revocation.

“He has been very discouraged all along that he was going to get a fair outcome,” Chenen said. The attorney said he needs to analyze the decision further before deciding whether to appeal.

In his proposed decision to the medical board, Nafarrete noted that Matory removed 8.7 liters of fat from Fernandez, far exceeding the preoperative plan to remove 4.6 liters and surpassing the amount the surgeon had ever taken from a patient before.

Large-volume liposuction is a new enough procedure that there are no set guidelines, he said.

“Due to the lack of scientific data and safety guidelines, a surgeon must take a cautious and prudent approach with respect to monitoring a patient,” Nafarrete wrote.

“Dr. Matory indicates [in testimony] he would now take a cautious approach and perform smaller liposuction operations. But it is incomprehensible why he did not take such a cautious approach from the outset or even after exceeding preoperative estimates of aspirate removal,” he wrote.

Judy Fernandez represented Matory’s largest-ever liposuction case. Yet, “. . . at every step of the operation, he treated the case as if it were entirely routine when the evidence demonstrated he should have been very cautious,” Nafarrete wrote.

Matory “exhibited such lack of caution over the entire course of this single surgery that public interest and welfare require that his certificate be revoked,” he concluded.

Regarding Hoo’s performance as anesthesiologist, Nafarrete was equally severe.

Hoo, who completed his residency in anesthesiology in July 1996, “would perhaps naturally have deferred to Matory’s clinical judgment and depended on his colleague’s experience and surgical protocol for guidance,” Nafarrete wrote.

But as the attending anesthesiologist, Hoo was required to abide by standards of care. Monitoring fluids was his primary responsibility, yet he did not adequately keep track of the 14 liters of tumescent fluid Matory administered, in addition to the 18 liters of IV fluid he himself administered, Nafarrete said.

“In this context, respondent Hoo’s violations of the standards of care were especially egregious.”

Likewise, the judge said, Hoo was “duty bound” to communicate “declining or problematic vital signs to the surgeon, discuss any therapeutic or diagnostic measures and to insist on termination of surgery and hospital admission where necessary.

“Third, Dr. Hoo failed to call for a hospital transfer even when the patient was in obvious distress” after surgery.

Nafarrete rejected the theory by Matory’s lawyer that Fernandez died of a “fatty embolism shower,” a clogging of blood vessels by clumps of fat, brought on by a condition caused by Fernandez’s previous use of now-banned diet drugs.

But he found that neither Matory nor Hoo caused Fernandez to suffer from lidocaine toxicity, which a coroner’s official had listed as a secondary cause of death.

Prosecutor Hendlin said Matory is licensed to practice medicine in Massachusetts and Florida. It was unclear whether Hoo holds medical licenses elsewhere.

While the California decision is not binding in other states, the information will be on file in the National Practitioner Data Bank, to which all state medical boards have access, authorities said.

Nonetheless, Ruben Fernandez is preparing to send by certified mail notices to the medical boards in all 49 other states.

“I’m going to make sure it is known everywhere,” Fernandez said. “I’m going to make sure every medical board knows about the facts of the case so that if they apply or have licenses in other states, [authorities] will know. They should not be able to go to another state and hurt people there. They killed my wife.”

He suggested that Matory and Hoo find new careers. “My wife cannot do that.”

Fernandez said he hopes the Orange County district attorney’s office will now file criminal charges against the doctors. Deputy Dist. Atty. Christopher Evans, who repeatedly attended Nafarrete’s proceedings, could not be reached for comment Wednesday.

Fernandez said the family also plans to file a civil lawsuit against the doctors.