Debbie and Anthony Pignataro - Part 1

0:00 Hi, I'm Rich and I'm Tina. If there's one thing we've learned in over twenty years of marriage, it. Said, some days you'll feel like killing your husband. And some days you'll feel like killing your wife. Welcome to love, Mary Kill. Hi, Tina, Hey Rich, How are you today? I'm great? How are you? I am doing good? Actually I'm lying. I'm really irritated because it's ninety degrees outside. I know we're. Recording this early because we're going on vacation. So it's October fourth, and I was told it was fall.

0:43 It should not be ninety degrees. I'm October fourth in Michigan. It's crazy. I guess I'm gonna sell all my sweaters. You might as well. Yeah, it's disappointing because it's Michigan game day and I don't have all of my Michigan gear is like sweatshirts because it's usually sweatshirt weather. Yeah, so I think that you have had to wear Well, you have a Michigan T shirt some. Waint I just couldn't find it. But I don't think you've worn a Michigan sweatshirt yet this season because it's been really warm. I haven't had the opportunity. Right, Well, we could have worse problems. I guess true. If we sound a little bit different, that's because we're trying out some new microphones today. Exciting day here in the light Bulb Lab Love Mary Kill Studios. Yeah, we've got some fancy new microphones. Yeah, let us know what you think. I don't know if we're going to keep them.

1:29 Why wouldn't we keep them? I can tell already that we sound more professional. I'm not sure if we want to sound more professional, but yeah. Oh, we don't want to sound more professional. I think I'm still gonna say idiotic. Thanks, I'm just going to sound a little better when I say them. Oh, I thought this meant you were no longer going to. Say we were laughing so hard when we were trying to do our intro because it did sound different to us. It sounded like we were being pretend podcasters. We still we've been doing this for three years. We still feel like we're not real professional podcast. I don't know what makes us feel that way. So mon Pa at the Homestead. Right before we go into today's case, I have three public apologies that I need to make public. Three three One I need to apologize to everyone for saying that Prue is no longer going to be on The Great British Faking Show next season. I said that in the last episode.

2:26 Well, I said it because you told me. I guess I should be apologized, isn't that? It's it's getting a little scary and we're only at the beginning of AI news. I got duped by fake news, and I feel bad that I said that because apparently Prue has no intention of leaving. Super happy to hear that, because I love her. I think she's marvelous. Yeah, me too. Second, I need to apologize to the Detroit Tigers. When we recorded a couple episodes ago, I was really irritable because they lost, and it turns out they actually won their series and I was completely wrong about them. By the time this is released, you probably blushed in the playoffs. So I'm not sure if that public apology is necessary.

3:07 I was pretty mean. But the third one is to you because the other night. Well, why does this need to be a public pology? I think this could just stay in our own house. I had. I had the opportunity to talk about it, and I chose not to because I didn't want to publicly shame you. Okay, never mind. No, the other night, we were sleeping and I was having a bad dream and I was flailing about, and apparently I. Hit you right well, I sweetly tried just to like, you know, like touch you, and hey, honey, you're okay, You're okay. Yeah, and you've punched me really pretty good in the eye, like you popped some pop some blood vessels.

3:48 And I'm so sorry. I felt terrible about it. Okay, it's fine. I felt really bad for you because you were clearly upset, and I didn't know what you were upset about it. I have no idea what I was dreaming. But it wasn't good. It wasn't good. One thing I forgot to say in the last episode that we did, which was Nancy and Rob Kissel, that min and Connie were the heroes of the story. They were there, the nanny and the housekeeper. I forgot to mention that I just really admired the way that they really were there for the kids. And so you're doing a public apology to men and Connie. Well, every episode, I don't know if this happens to you, but every time there's always a couple of things that I forget to mention that I don't put a notes and I'm like, oh, I'll remember to say.

4:31 That every time. Yeah, all right, well, would you like a snack? Sure? I'm very excited because we have a listener snack today. Our buddy Teresa sent us something. Teresa sent this from Louisiana. I believe this is from the Cane River Pecan Company, Cinnamon pecan straws. You just hit pecan, But. Yeah, these look really interesting. I don't I don't really know what they are cinnamon pecan. Straw Teresa is great and she also is a big baker, so a lot of times she sends me pictures of what she's baking. Okay, cool, would you like to try these? Absolutely?

5:16 What did you think of these cinnamon pecan straws. I thought they were really good. Yeah, they're really interesting. Yeah, it was surprising. They were very different from what I was expecting. Just hearing the name, it's almost like a churo. Yeah yeah, I was thinking like a short bread cookie, but yeah, churo too, think a. Short bread If a short bread cookie and a churo had a baby, that's what that would be. Yeah. Really nice flavor though, really. Good of Texter. Thank you so much, Teresa. I love thank you. Today's case is a recommendation from Christy. Thank you Christy for the recommendation. Really interesting case. Patreon Christy, Yes, Patreon, Christy. We love Patreon, Christy. We do. A quick note. A lot of my research for this case came from a book by Anne Rule, which was a great book, and Rule is amazing as always. But the one thing I want to note is Ann Rule does use pseudonyms for a lot of her characters, and for some of them I wasn't able to find out real names. So I'm going to use the names that Ann Rule used in her book, and I'll just note fair not that. Okay, today's case is about a married couple, so it is a love Mary Kill case. But it's also about a doctor who is a really bad doctor.

6:21 Okay. Every year in the United States, millions of people undergo cosmetic procedures. In fact, recent statistics show more than one point six million surgical cosmetic procedures are performed annually in the US, everything from liposuction and breast augmentation to facelifts and tummy tucks. On top of that, there are also millions of minimally invasive treatments like botox, fillers and chemical peels. For the vast majority of patients, the risks are very low. Complications such as infection, bleeding, or anesthesia issues can happen, but they're extremely rare compared to the enormous number of procedures performed safely. Cosmetic surgery has become so routine that many people think of it as little more than a tune up, a quick way to change something about their appearance with minimal risk, And that's why today's case is so shocking. We trust doctors with our lives, and we expect the system to protect us when something goes wrong, but sometimes that trust is misplaced.

7:19 Well, I know that Anne Rule wrote the book that you read, so this case must be at least twenty years old. It is. I would be curious to see how many plastic surgeries took place twenty years ago versus how many take place today. I think it's much much higher today. I did a quick Google. Guess how much they're up from the year two thousand to today. Fifty percent, one hundred and fifteen percent. Oh wow, restlifts are up by eighty nine percent. Bodox lifts are up two hundred and fifty two percent, lower body lifts three thousand, nine hundred seventy three percent, Wow, upper arm list four nine hundred and fifty nine percent. So those must have been procedures that essentially didn't exist.

7:59 I'm not even sure what those Well. Let me start by talking about the married couple at the heart of this case. It was May of nineteen ninety nine when forty one year old Debbie Pignataro first felt something was terribly wrong. What began as a sharp, excruciating abdominal pain sent her rushing to the er, with her husband, Anthony at her side. Doctors thought it was pancreatitis, a painful but treatable condition. When her pain eased, they sent her home, hoping it was nothing more. Debbie tried to convince herself the doctors were right. It could be that stress was a contributor, and she had plenty of that. The past few years had been brutal. A boding accident had left her with chronic pain and multiple neck injuries.

8:40 Her marriage to Anthony had been on shaky ground, with their problems only piling up, and she had stood loyally by him as he faced professional scandals and legal problems as a physician. But soon after leaving the hospital, Debbie's health took a terrifying turn. Instead of improving, she declined rapidly. Some days she couldn't lift her from the pillow, other days she could barely stand. Her arms and legs swung wildly between agonizing pain and total numbness. Her body was failing her piece by piece, and baffled doctors scrambled to find an answer before whatever was attacking Debbie Pignataro claimed her life. Deborah Rago was born in July of nineteen fifty seven in Erie County, New York. Her father, Frank, worked construction, while her mother, Caroline, picked up shifts at Krasner's women's clothing store. Debbie had an older brother, Carmine, and together they made up a close knit, blue collar family living in the Buffalo suburbs. Life shifted suddenly when Frank was just thirty eight years old. He suffered a massive heart attack that forced him to leave construction behind.

9:45 From then on, he stayed home to care for Debbie, while Caroline shouldered the family's income by working full time at the clothing store. By then, Carmine had already moved out, so it was just Debbie and her parents. Debbie pitched in as soon as she could. At sixteen, she started working, first at the mall and later as a pharmacy technician. Even after finishing high school, she stayed home, balancing work while helping her parents and saving toward the future. By the summer of nineteen seventy eight, Debbie was twenty one. One night, she and her friends headed out to the Lone Star, a popular local spot for disco dancing. Pulling into the parking lot, Debbie cut the wheel too hard and scraped the side of her car against a wall. Mortified, she got out to inspect the damage and found herself being watched. A tall young man stood nearby, laughing at the mishap with a grin, he teased, you must have missed the wall because you were too busy looking at me.

10:39 His name was Anthony Pignataro. Debbie was instantly struck. At six feet tall, with a head of dark hair and sharp, classic features, he looked like he could have stepped off a movie screen. She thought to herself that he was handsome enough to have caused the accident just by standing there, But there was a catch. Anthony was already dating Karen, an acquaintance of Debbie's, so for the moment he was off limits. Still, Debbie kept running into him on nights out with her friends, and when he finally asked her to dance, she couldn't resist. Boldly, she leaned in and said, I wish I'd met you before Karen did. Anthony smiled, and that night he broke up with Karen. Wow, was that their first meeting the night of the accident?

11:21 Yes, I believe it was. Soon after he broke up with Karen, he asked Debbie out. Their first date was to see the new hit movie Grease. From there they were inseparable, dancing, going on picnics, catching concerts, spending weekends at the beach. Debbie had found her movie star, and she was certain this was the start of her happily ever after. Greece would be a really good first date movie well you met, Yeah, I think it would put you in a really good mood and totally'd be dancing in your seat. Well, in the story like, they met during the summertime and he was going to be going back to college in another month or so, so it kind of ties into the whole summer loven Thing of Greece as well. Anthony Ignataro was born in May of nineteen fifty eight.

12:03 Unlike Debbie's modest, blue collar upbringing, Anthony grew up surrounded by wealth and privilege. His father, Ralph, was a well known surgeon in the Buffalo area, and his mother, Lena doated on him. Anthony and his siblings, older sister Antoinette and younger brothers Ralph Junior and Stephen, enjoyed the best of everything, including an exclusive private school education. When Anthony first met Debbie, he was home on summer break before starting his junior year at Lehigh University in Pennsylvania, where he was majoring in mathematics. By the end of that summer, the two were inseparable. Debbie worried that their romance might fade when Anthony returned to school, but it didn't. They talked on the phone several times a week, and Anthony often made the five and a half hour drive home on weekends. For the next two years, they kept the long distance relationship alive. In May nineteen eighty, Debbie proudly stood with Anthony's parents as he graduated from Lehigh. The couple was in love and knew they wanted to make but Anthony insisted on waiting until he landed on a career.

13:04 He was ambitious, even grandiose, convinced that he was destined for something big. For a while, he toyed with the idea of computer science, but ultimately he chose to follow in his father's footsteps and pursue medicine. Anthony idolized his dad, and he loved the idea of working side by side with him. One day, confident in his future, Anthony applied to some of the top medical schools in the country. In his mind, it wasn't a question of if he'd be accepted, but which elite program he'd choose. He barely studied for the MCAT, assuming his family name and natural intelligence would be enough. They weren't. One by one, the rejections rolled in Harvard Columbia Johns Hopkins none wanted him.

13:46 His scores simply weren't good enough. In the end, the only school that accepted him was the San Juan Bautista School of Medicine in Puerto Rico, a non accredited program with a far less rigorous reputation. For Anthony, who had always seen himself as destined for prestige. It was an embarrassing blow, but instead of taking it as a lesson in humility, it would only deepen his drive to look successful, no matter what the cost. Debbie understood that Anthony's decision to become a doctor meant their life together would be on hold for years, but she was committed. She believed in his big dreams, and she was willing to wait. While Anthony left for Puerto Rico to begin medical school, Debbie stayed in Buffalo, working and supporting herself, faithful to him across the distance. Anthony's program wasn't easy. The classes were all taught in Spanish, so he had to learn the language quickly. To his credit, he picked it up fast, and within a short time he was fluent. Their long distance relationship stretched on for nearly eight years before they finally married in June of nineteen eighty five. Debbie was twenty eight, Anthony twenty seven.

14:56 The wedding took place at Saint Bonaventure's Catholic Church with three hu ard fifty friends and family in attendance. The reception was held at the prestigious Wanaka Country Club, where the Pignaitaro family were members. That night, Anthony gave a glowing toast to his own father, then he turned his attention to Debbie's father, Frank. We don't know exactly what he said, but it was intended as humor and instead landed as demeaning. Debbi watched her father try to laugh it off his embarrassment plane, and her heart sank. It was a small moment, but revealing a glimpse of Anthony's lack of tact and of how easily he could wound others without even seeming to notice. The warning signs didn't end there. On their honeymoon, a two week cruise, Anthony again revealed an uglier side. While dining one evening with another couple who happened to be Jewish, he began making loud, cruel jokes about Jews. Offended, the couple asked to be moved to another table. Debbi was troubled, even disturbed, by his behavior, but she loved him, and, like so many newlyweds, determined to make their marriage work. She tried to convince herself to accept the bad along with the good. Anthony's father had strong connections in the medical community, and he used them to secure a residency for his son at Saint Agnes Hospital in Baltimore. It was a saddleite hospital within the prestigious Johns Hopkins Health System, a valuable opportunity Anthony might not have gotten on his own, So the

16:26 couple moved to Baltimore, where Anthony began his two year program in general surgery. Debbie found work as an administrative assistant in a plastic surgeon's office. Debbie was eager to start a family. In the spring of nineteen eighty six, she became pregnant, but heartbreak followed when she miscarried. Early on. Anthony was supportive, reassuring her that they would try again, and by late summer, she was pregnant once more. This time the pregnancies seemed healthy, but as her due date approached, she endured a terrifying ordeal. The neighborhood where the Pa Nataro's rented an apartment wasn't the safest. One night, while Anthony was at the hospital, Debbie woke to strange noises outside the sliding glass doors. The latch had never worked properly, and before she could react, the door slid open. A naked man stumbled into her living room babbling incoherently. Debbie's heart pounded. She remembered Anthony had bought a handgun. She retrieved it, steadied herself, and pointed it at the intruder while dialing nine poet one. Somehow she managed to hold the drug addled man at gunpoint until police arrived and arrested him.

17:34 It's a really terrifying scenario, isn't it? Like just so scary having a naked man just crazily babbling in your living room. He just randomly opened their door. He just found an open door somehow. Yeah, that's crazy. Just weeks later, in April nineteen eighty seven, Debbie gave birth to a healthy baby boy. They named him Rafael Frank Pignataro, honoring both of their fathers. Everyone would simply call him Ralph, No one called him Ralphie. As Anthony neared the end of his two year residency at Saint Agnes, he hoped to stay on for a third year, but he was blindsided when the hospital chose to not renew his contract. By then, it was too late to apply elsewhere, so the couple decided to move back to Buffalo and regroup. How many years is a residency? Does it depend on your area of study?

18:24 Yeah, I think it can vary. From what I've read, is between like three and seven years, just depending on what you're studying. Okay. In the weeks leading up to the move, Debbie began noticing odd phone calls to their apartment. Whenever she answered, the caller immediately hung up. At first, she brushed it off as a wrong number or prank, but on their very last night in Baltimore, the phone ring again. This time, when Debbi picked up, a woman's voice spoke. Her words were cold and direct. Go look in the back seat of your car. Debbie rushed outside. In her back seat, she found a cassette tape, a letter, and a Christmas card. She pressed play on the tape recorder and froze. It was Anthony's voice. He was speaking intimately with another woman.

19:08 The truth was undeniable. Furious, Debbie called Anthony at the hospital and demanded he come home immediately. When he walked through the door, her rage boiled over. She screamed, cried, even hid him, threatening to take their baby and leave. Anthony, panicked, phoned Debby's father. She wants to leave me, he pleaded. She wants to take the baby. Frank asked to speak to his daughter. Debbie, still in tears, told him the truth. Anthony had been unfaithful. Frank's advice was calm but firm. Debbie, listen to me. You forgive once, now hang up and go make your marriage work. Anthony seized on that lifeline. He was contrite, begging for another chance. He swore the affair meant nothing, just to fling with the crazy girl.

19:54 He promised it was over. He promised he loved Debbie and the baby. He promised there would no never be anyone else, and Debbie, clinging to hope, chose to forgive him once, just once. They had a new baby. They were heading home to Buffalo, and she wanted to believe their family still had a future. What do you think about that advice from Debbie's dad? Oh gosh, it's so hard it is. I mean, once it she had always a cheat, right. It's kind of odd too that the woman went to those lengths too to, you know, make a morning and put it in her car. I never learned anything more about this woman that he had an affair with, but it must have been something to do with him moving back to Buffalo. Maybe she was angry and decided to blow the whistle on him.

20:39 But yeah, that is a very odd way to find out your husband's having an affair. Well, it seems like maybe it was in an intense fair too, you know, it could be. Yeah, she went to those lengths, right, we'll be back. After a break. Back in Buffalo, Anthony took a job at an emergency walk in clinic to fill the year before he could land another residency program. Around this time, he also began writing. It wasn't exactly a journal or a memoir or even fiction, though it contained elements of all three. He titled it m D. Mass Destruction, which is a very strange name. Page after page celebrated his supposed brilliance and accomplishments in medicine.

21:24 In some passages, he even slipped into the third person, as if Debbie or someone else were writing glowing tributes to him. But make no mistake, every word came from Anthony Pignataro's own mind. Here's a quick excerpt to give you a glimpse into Anthony's mind. I honestly believe that Anthony is the Galileo of the twentieth century Galileo the sixteenth century Italian physician and scientist was banished for his forward thinking and teachings. Pope John Paul two pardoned Galileo in nineteen seventy nine, three hundred forty two years later. I do hope Anthony does not have to wait that long. Boy, How do you have this writing? It wasn't published or anything.

22:04 No, it was never published, but it was. We'll get into it later. It was found later. We'll share a couple more excerpts later. But suffice it to say, Anthony's fixation seemed less about reflection and more about self worship. For Debbie, that year back in Buffalo was brutal. Still reeling from Anthony's affair, she suffered a devastating personal loss when her father, Frank, died of congestive heart failure in November. He had always been her rock, and suddenly he was gone. Not long after, Debbie became pregnant again. The couple dared to hope for a new beginning, but when their baby girl was born in June nineteen eighty eight, doctors discovered the unthinkable and inoperable brain tumor.

22:44 Oh that's so sad. The baby couldn't survive without life support. Debbie and Anthony faced the most heart wrenching decision any parent could confront. Together, they said goodbye to their daughter. While Debbie was still recovering from her sea section and mourning the loss of her baby, Anthony was already moving forward. He had been accepted into a new residency program at Georgetown University Medical School in Washington, d C. In the summer of nineteen eighty eight, he left Buffalo to get settled, while Debbie stayed behind with one year old Ralph. She and the baby joined him later that July, but once reunited, Debbie began noticing new and troubling patterns. Anthony's criticism turned on her.

23:25 Anthony had always taken great pride in his appearance. He never missed a workout, always kept himself lean and muscular. Debbie, meanwhile, had endured three pregnancies in just a few years, two of them ending in loss. Her body was healing, still carrying the weight of grief. To Anthony, it wasn't good enough. He started picking at her, constantly belittling her looks. Have you looked at yourself in the mirror? He would sneer, Do you think I want to be with someone who looks like that. Debbie tried to brush it off, but the words cut deep. She began dieting, working hard to meet his impossible standards for his approval. But no matter what she did, nothing was enough. Anthony was slowly chipping away at her confidence and her sense of self. What do you think about Anthony Pignaitaro so far?

24:11 I don't think I like him very much. I really hate when men try to make women feel bad about their bodies. Yeah, you and I have been through some really hard things. I don't want to go into details here, and you were always so supportive of me when I was going through a hard time, And it just is really hard when you know men are so unsupportive. Yeah, you can't see that their wife is in a lot of pain. Yea, And that's just not okay. Correct. At Georgetown, Anthony chose to specialize in odo laeryngology, ear nose and throat medicine. He also rotated through plastic and cosmetic surgery and found himself intrigued by the possibilities there.

24:55 But if Anthony was gaining skills, he wasn't gaining many friends among his colleagues. He quickly developed a reputation for arrogance. He wasn't a team player. He seemed to care only about himself. That attitude boiled over On New Year's Eve nineteen eighty eight, Anthony was scheduled to be on call at the hospital, but instead he went out drinking. When word of his drunken night at a bar reached his supervisors, he was chastised severely. Dismissal from the program was on the table, but ultimately they let him stay for now. Wow. I mean that's got to be a big no no, right. Yeah, absolutely, I'm a little surprised he wasn't dismissed immediately for that. That seems like a really bad violation of policy.

25:37 In the meantime, life at home brought new anxieties and new hope. In early nineteen eighty nine, Debbie learned she was pregnant again. After everything she had endured, she was nervous, bracing herself for the worst, but that October her fears gave way to joy. She gave birth to a healthy baby girl. They named her Lauren. With Ralph and Lauren, Debbie felt the family was complete. A few years later, they would even add a dog, Polo to the mix. You get the joke. Polo Ralph and Lauren are their two kids spelled like Ralph Loren. I'm not sure if that was intentional, but I think when they named the dog. Polo, I'm surprised you got that, my friend. I think Annroll maybe pointed it out to me. But Anthony's frustrations didn't ease As his residency continued. He grew increasingly bitter. He complained constantly to Debbie, and he vented in his journal about not being treated with the respect that he deserved in his mind, no one around him recognized his talent or brilliance.

26:35 Oh wow, so he's a textbook narcissist. Yes, absolutely. If you look up narcissist in the dictionary, I think his pictures should be there. There's probably a lot of pictures there. Yeah, I'm sure there are. Maybe out of frustration, or maybe because he sensed he was on thin ice in DC, Anthony secured a new residency, this time it was in Philadelphia at Thomas Jefferson University Medical Center. In June nineteen ninety, the Pignataros packed up and moved to the Philly suburbs. But a change of scenery didn't change Anthony just like before, he rubbed his colleagues the wrong way. They saw the same arrogance, the same all about me attitude. Anthony dismissed it all as jealousy. In his mind. They resented him for entering the program at a senior level and for his obvious brilliance. He clashed constantly with coworkers, but oddly enough, patients liked him. Anthony had charisma, and he could turn on the bedside charm when it mattered. At home, that charm was becoming harder and harder to find. Debbie began to dread social outings with the other residents and their spouses.

27:39 Anthony could always be counted on to say something offensive or cruel, only to wave it off later as a joke, and he never let up on his criticism of Debbie. He called her fat, He accused her of holding him back. He expected perfection. He made time to stay in peak conditions, so why couldn't she. Meanwhile, Debbie found work again at a plastic surgeon's office. She hated leaving Ralph and Lauren in daycare, but the family needed the extra income. Residents were paid but modestly, the equivalent of about forty five to sixty thousand dollars a year. Debbie's job had a perk. Employees got a steep discount on procedures. Debbie had always disliked her nose, so she decided to have it fixed.

28:21 The results thrilled her, and surprisingly Anthony too. He even decided to undergo a nose job himself. But what concerned him more than his nose was something harder to fix, his rapidly thinning hair. So, because you said he was so devastatingly handsome, I did look up pictures of Anthony, and it was a little confusing to me because his hair in some pictures is like big and bushy, and in other it seems to have disappeared. Yeah, we'll talk a lot more about Anthony's hair. I have great empathy for any man that is losing his hair. Though, I have to say you were blessed. I was blessed. At the end of his first year in the Thomas Jefferson Residency program, Anthony received his evaluation and it was not good. In fact, it was damning.

29:11 His peers did not hold back. One wrote simply put, he is unreliable, poorly informed, dishonest, and dangerous. Do not rehire the responsibility is too great, the risks innumerable. I fear that lives truly are at stake. Another added, I find him to be dishonest, manipulative, and conniving. He has demonstrated a lack of fundamental medical knowledge. His dishonesty and lack of medical knowledge, combined with his arrogance, makes him dangerous. Residents in ODO Laryngology were rated on a scale of one to five. A score of four or higher was expected to continue in the program. Anthony's overall rating was two point four, nowhere near good enough. So the reviews that you had me read there said that he was dis dishonest. Yeah, do you know what he was dishonest about?

30:02 Is that like dishonest about patience or. Just I don't know specific examples, but yes, I think he was just dishonest, like if something went wrong in a procedure, he might lie about it or cover it up. Once again, Anthony would not be invited back for a second year of residency, and worse, he was now ineligible to set for the American Board of ODO Laryngology examinations. He was officially an MD, but without board certification, his career prospects were grim, hospitals would be reluctant, if not outright unwilling to grant him privileges. For a man who saw himself as destined for a prestige, it was an inauspicious start to doctor Anthony Pignataro's medical career. I feel like I have so much knowledge because we've been watching The Pit. Yes, Like I really feel like I get a feeling for all of this.

30:54 Well, yeah, when I read he wasn't a team player, one of the comments I think was he's not a team player. I was like, that was ray after we watch an episode of The Pit where doctor Robbie was lecturing someone about the importance of being a team player. As Yeah, the family returned to Buffalo. Anthony was finished with residency programs. He could legally practice medicine, but without board certification, his options were limited. It didn't stop him from stretching the truth on hospital applications. Anthony claimed he was eligible to set for ODO laryngology aboards, a lie that was easy to disprove. Hospitals weren't fold. You want me to say that word as much as possible, don't you? I do yes. Instead, Anthony found work with an elderly NT physician who was struggling with health issues and needed part time help.

31:40 Anthony picked up a couple of days a week, just enough to make some money while he worked on a bigger plan starting his own NT practice in West Seneca. He leased office space and took out a loan to remodel it. His vision went beyond exam rooms. Anthony wanted an operating room in the basement where he could perform soies himself. No hospitals, no oversight, no need to rely on privileges he couldn't get anyway. At the time, Debbie didn't think much of it, but in hindsight, the idea of major surgeries happening in a private office basement was more than a little unsettling. I mean, I'll say. Yeah, very unsettling. Debbie, ever supportive, handled the books and paperwork to get the practice off the ground. Meanwhile, the family moved in with Anthony's parents while the new three story duplex was built on a lot gifted by his father. Debbie knew about Anthony's career stumbles, but she still felt optimistic. They were home, back near family. Anthony was launching his own practice.

32:41 She believed in his skills as a doctor, and to her it felt like their life together was finally beginning. Anthony's dad was a surgeon. He was, and initially Anthony wanted to work with his father, so that never happened. Well, he had dreams of, you know, working at hospitals with his dad. I don't know if he wanted to work directly with his father, but he Yeah, he definitely had dreams of them being colleagues. I guess so his dad didn't know that he was kind of fumbling around and really didn't have his legs yet. I mean, he must have known that he got dismissed from multiple residency programs, But I think his family had kind of rose colored glasses when it came to Anthony, like he could do no wrong. Because Anthony was working under an older, well respected E and T doctor, he was able to secure conditional operating privileges at a couple of Buffalo area hospitals despite not being board certified. That's bananas to me. So I thought doctors needed literally thousands of hours in an operating room before they could perform a surgery on.

33:42 This This whole story is kind of shocking to me that there wasn't more oversight. I think it's gotten better since this story took place, and I'll talk a little bit about that later, but it is surprising that there aren't more controls in place to stop a bad surgeon from getting through slipping through the cracks. In August nineteen ninety four, he operated on a thirty year old man with a deviated septum. On paper, it was a fairly low risk procedure, but surgeons know there is a danger. Just a paper thin bone separates the nasal passages from the brain. If that bone is fractured, cerebral spinal fluid can leak, leading to brain abscesses, meningitis, even nerve damage. Precision and experience are crucial. During Anthony's operation, he perforated the bone, the patient's spinal fluid leaked into his nasal passages. Instead of addressing it, Anthony simply sent the man home By sheer luck. The patient healed without complications, but when a senior E and T reviewed the case, his report was critical and blunt. The very next day, Anthony's hospital privileges were revoked. At another hospital where he still had access, Anthony performed surgery on a seventy one year old man with a laryngeal tumor, another routine procedure, but this time the patient died. A hospital board investigated and first restricted Anthony's privileges, then allowed them to expire without renewal. Now Anthony had no hospitals where he could operate.

35:14 For most doctors, this might have been a moment of reckoning. For Anthony, it was an excuse to lash out. He blamed others. Convinced he was a victim of a vendetta, he sued Thomas Jefferson Hospital, claiming they had conspired to block him from board certification. A doctor was appointed as an arbiter in the case. She interviewed those who had worked with Anthony in situations like this. Physicians usually closed ranks to protect their own, but not this time. Her final report was scathing. She concluded Anthony was unqualified, not just in terms of medical skill, but in moral character. The lawsuit was dismissed. Whule passage is just so terrifying for a number of reasons. Yeah, first of all, thinking about sinus surgery and how I hadn't realized that fixing a dev a scept him had that kind of a risk to it. Yeah, but The fact that he just did this and didn't tell anyone is just shocking. It's again, we talked about it a little bit earlier, but it's hard to imagine how he didn't lose his medical license right then and there.

36:16 Well, it's a nightmare for any patient. You expect that your doctor has the appropriate training and the credentials, and you don't really. Know, right yeah, you just trust that they do. By this point, Anthony was ready to leave ODO laryngology behind. He had long set his sights on plastic surgery, and E and T work had always just been a stepping stone. The problem was Anthony had little formal training in plastic surgery, but that didn't stop him. He began attending plastic surgery conferences and setting aside every Wednesday for research. He worked on cadavers, experimenting with procedures that were more untested than proven. In his mind, brilliance meant living on the cutting edge, he believed was inevitable, and in a way he did become semi famous, not for a medical breakthrough, but for an invention born from his own vanity. Anthony had always obsessed over his appearance. He worked out daily, stayed lean, and carried himself with the confidence of a man who knew he was considered attractive. But one thing undermined that confidence his hairline. It began receding when he was just twenty three years old. This was before the days of rogaine or modern implants. He tried combovers, then two pays, glued, clipped, or tied down. When those failed, he had tempted elaborate weaves with other people's hair. Nothing worked, so Anthony dreamed of something better, A hair piece that wouldn't slip, shift,

37:46 or blow away, A permanent solution. He drew inspiration from surgical implants that he'd seen as an intern. Anchors set in bone to hold prosthetic teeth, noses, and even ears. Why not implant anchors and the skull to secure a two pay. Other doctors were skeptical, but Anthony pressed ahead, testing his idea on cadavers, convinced it would work. He needed a live subject, and he decided the best guinea pig was himself. The timing couldn't have been better. Commercials for Hairclub for Men were everywhere, with founder Cy Sperling's famous line, I'm not only the hair club President, but I'm also a client. If Anthony believed in his invention, what better pr than to be both doctor and patient.

38:35 Oh it sounds pretty scary, but still he had to find someone to perform the surgery on him. He turned to the one surgeon he trusted, his father. After much convincing, doctor Ralph agreed. Ralph drilled four holes into his son's skull and implanted bolts, just like a real life Frankenstein. Months later, Anthony had ball and socket joins protruding slightly above his scalp, to which a custom hairpiece could snap securely into place. It worked perfectly. Anthony was elated. Debbie, always supportive, was relieved to see him happy. But Anthony's renewed confidence only sharpened his cruelty. With his failed proof to pay in place and his ego soaring, he went right back to belittling Debbie, criticizing her weight, her looks, and reminding her she could never measure up to his idea of perfection. Wow, I have a lot of questions about this bolted on hair piece.

39:36 It sounds crazy, doesn't it. So what were you attaching to the bolts? So? Was it like a to pay essentially? Yeah, so you had a too Pay that had like four pieces that matched up with the bolts in your head. So the bolts in your head were like little sockets, like almost little like ball joint sockets like coals. And you would push the two pay into him and it would pop into place like it would. Snap in Holy cow. And what was the hair like? Though? The hair could be whatever you wanted. I mean, I think the bolts were. That was the key thing he invented, was the mechanism to attach it. But the actual hair piece itself, you know, could be whatever. Why not Belcrow, that seems like maybe a better idea.

40:17 Do you think on something? I think he might be. We'll be back after a break. By now, Anthony had fully pivoted to plastic surgery. His West Seneca office was open and his basement operating room was outfitted to his liking. At the time, most doctors still considered advertising beneath them, but Anthony styled himself as an innovator. He advertised aggressively in newspapers and on the radio, promoting discount rates for tummy tucks, nose jobs, and breast augmentations. He even partnered with a radio station to run a contest where the prize was a free breast enhancement. To drum up more business, he sent Cooper bonds to local hair salons, offering a one hundred dollars referral fee for every patient they sent his way for hair transplants. Of course, savvy patients knew to ask if their surgeon was board certified.

41:11 Anthony wasn't and couldn't be. He hadn't finished his residency, so he wasn't even eligible for the exams, but that didn't stop him. He faxed a forged diploma to the Facial Cosmetic Surgery Board, which allowed him to sit for the written exam, but when it came for the more difficult oral test, Anthony skipped it. He still wasn't board certified, but now he had just enough paperwork and just enough nerve to claim that he was, and with his charm and charisma, business began to grow. Patients liked him. Anthony relished the role of successful surgeon. To complete the image, he bought himself a red Ferrari, sometimes even picking up patients in it, the flashy car serving as proof that doctor Anthony Pignataro had made it.

41:55 He reminds me so much of Andrew Kissel the case that we just finished. Yes, Anthony's business got a major boost when the Associated Press picked up a story about his surgical hair piece innovation. The article was syndicated nationwide, and soon Anthony was fielding calls from media outlets across the country. Here's how the article began. Anthony Pignataro reaches under his hair and pop Pop Pop Pop. In a matter of seconds, holds most of his thick brown locks in the palm of his hand. All that remains atop his scalp are four gold snaps embedded deep in the bone of his skull. He appeared on Hard Copy with Mary Povich, the CBS Evening News with Tom Brokaw, and was even featured in Esquire magazine.

42:38 On television, he wowed audiences with a demonstration pressing his twope into the four metal snaps anchored in his skull, locking it neatly into place. Anthony boasted that the implants would last forever and require no maintenance, and the hair pieces themselves would last up to four years. At around four thousand dollars a procedure, it was lucrative by then. He claimed to have performed the surgery on about one hundred patients. Riding the wave of attention, he began working on another innovation, and Invisible bra, a surgical implant designed to hold breasts in place against gravity. He experimented with different materials on cadavers, but stopped short of trying it on live patients. Professionally, Anthony was basking in the spotlight. Personally, the cracks in his marriage were widening. His focus was entirely on himself, his career, his inventions, his workouts. Debbie and the kids rarely factored into his time or attention.

43:35 The only exception came when their son Ralph began showing promise in football. That at least drew a spark of pride from Anthony, but otherwise Debbie and the children were left on the sidelines while Anthony chased fame. I'm still fixated on these bolts stiffing out of people's heads and drilled into their skull. It is wild. Can't be a good idea. There had to have been some infections along the way. I mean, actually, implant surgery is pretty common. You know. I have I have a dental implant and it's drilled into my jaw, and other people have implants drilled into you know, if they're if they have like a fake nose or something, which some people do. So it's actually the implant part of the surgery is actually pretty accepted and happens all the time.

44:18 What is the bolt made out of? What material? I'm not sure. Titanium maybe it would be my guess, but I'm really not sure. And then the skin just grows around it and the bolt. Yeah, exactly, So it's anchored into your skull and it sticks up just above your skin, and the skin just kind of adapts and yeels around it. Well, I need to look at a lot of pictures of that. Yeah. Do you think that that hair looked good? I mean that I think the way the hair looked was really dependent on the two pay itself. I think it was securely attached. That was his goal, right, is to create something that wouldn't fall off, and that seemed to be the case. You have these four different pelts of hair on your skull. No, this is one piece had four.

45:00 That makes more sense because I'm thinking like it had to snap into but ye yeah, yeah, this one piece of hair out. It's wild though. In June nineteen ninety six, Anthony's volatility spilled into public view. Driving in Buffalo, he cut off a Pontiac Firebird carrying two people. At the next stoplight, the firebird's passenger got out and confronted him. Anthony's response he reached for the handgun he carried everywhere. The man quickly retreated to his car, but Anthony wasn't finished. He got out, aimed his weapon at the firebird, and pulled the trigger. A single shot rang out. By sheer luck, neither occupant was hit. Anthony was arrested for reckless endangerment and discharging a firearm. His pistol permit was revoked for a year. That same year, while the family vacationed in Florida, tragedy struck again. Debbie was holding Lauren in her arms while her brother in law, piloting a boat, swerved. Suddenly, unable to break her fall, Debbie slammed against the deck.

45:56 She broke several ribs and injured her neck. The ribs eventually healed, but her neck didn't. Chronic pain followed, and over the next four years she would endure five surgeries. For a woman already carrying the weight of being the primary parent, the injury was crushing Anthony barely seemed to notice. After one surgery, the steroids that Debbie was prescribed left her face swollen. Anthony looked at her and sneered, look at you, who would want you? Doctors prescribed painkillers for her recovery, but before long, Debbie realized the pills were disappearing. The only explanation was Anthony. He had always been a heavy drinker, ending most nights in front of the TV with a bottle of tequila, but now Debbie noticed something different.

46:42 His speech slurred, his behavior foggy. She began to wonder just how many of her pills he was taking. By the mid nineteen nineties, Anthony seemed to be living out a mid life crisis. And fast forward. He was still obsessive about his body, but now he added to the image a red ferrari, a nose job, his revolutionary hair piece. He even got cheek implants and corrective eye surgery. The only thing missing was the younger woman, and before long she appeared. She was an exotic dancer from Virginia who had come to Anthony for breast augmentation surgery. He was instantly infatuated. She wasn't impressed at first, but Anthony was relentless for nearly a year. He courted her, driving down to Virginia in his Ferrari, showering her with gifts and pressing his case until she finally gave in. While Anthony chased youth and vanity, his father's health collapsed. In the spring of nineteen ninety six. Ralph began acting strangely, confused, forgetful, fumbling for words. An MRI reveal the cause a massive tumor in the frontal lobe of his brain. He also had tumors in his lungs and liver. A lifetime of smoking had caught up with him. Doctors gave him six months to live. Anne Anthony it was devastating. His whole career had been about trying to make his father proud about one day working alongside him as equals. Now he realized that dream would never happen. Anthony took charge of

48:12 his father's care, urging him to seek treatment in Houston with one of the nation's top specialists, but Ralph refused. He knew the fight was over. He wanted to spend his remaining time at home with his family in Buffalo. In November nineteen ninety six, Ralph Pignataro died at just sixty two years old. Not long after Ralph's death, Anthony whisked his exotic dancer girl friend away on a trip to Puerto Rico. To Debbie, he explained it his business. He was scooping out locations for a hair clinic. While he was away, Debbie phoned the hotel. To her shock, a woman answer the call from Anthony's room. Who are you and what are you doing in my husband's room, Debbie demanded. The woman stammered, I'm I'm a model. Doctor Pignataro did my press like that would be okay. Maybe that excuse would have worked if Anthony were actually opening a breast clinic, but Debbie knew better. She snapped, well tell him his wife called Anne. I don't know who you are, but if you ever come near him or my family, I'll fucking kill you. Now, get out of my husband's room. The girlfriend was so shaken she packed her bags and fled the hotel. When Anthony heard what happened, he spent the entire day trying to reach Debbie. When she finally picked up, he begged her to fly to Puerto Rico to save their marriage. Furious but torn, Debbie relented.

49:35 Anthony greeted her with a lavish gift, a pair of diamond earrings. Despite her father's advice to forgive only once, Debbie forgave Anthony again. She still loved him after twenty years together, through every high and low, she couldn't bring herself to walk away. But the trust between them was gone that would never come back. For a time, Anthony seemed to change. He eased up on the criticism, spent more time with Debbie and the kids, and acted like a husband again. But it didn't last with Anthony. It never did. Before long, there was another woman, this time. Her name was Tammy Maxwell. This was not her real name, This is Anne Rule's name for her.

50:17 Tammy owned a cleaning business, went to the same gym as Anthony, and shared his passion for fitness. Even though Anthony's plastic surgery business was thriving, he remained notoriously brutal. He refused to spend money on staff or equipment he considered unnecessary. His office ran on a skeleton crew, a secretary, a twenty two year old licensed practical nurse fresh out of trade school, and occasionally Debbie. Debbie sometimes assisted during surgeries. She had once worked in a pharmacy, but had like a pharmacy is training to be a surgical. Assistant, you know something in the medical field. Still, Anthony insisted she was good enough. He even recruited a seventeen year old high school Tom Watkins, who wanted to be a doctor someday. Anthony let him observe operations and paid a minimum wage to run errands and fetch supplies.

51:10 More troubling than the skeleton crew was Anthony's approach to anesthesia. He never hired anesthesiologists. Their fees were outrageous, he said. He insisted he and his nurse could handle it. Oh my gosh, yes, this. Whole this whole situation is so alarming. Yeah, it really is. Anthony had devised his own anesthesia regimen. Before surgery, patients were handled a cocktail of eight to twelve pills to relax. Once they were prepped, the nurse inserted an ivy into it went sodium pentathol and versad, a narcotic similar to velium. During the procedure, Anthony would signal for more of the drugs whenever he thought it was needed. Anthony believed his method was good enough, safe enough, but good enough is not the standard for surge, and in Anthony Pignataro's basement operating room, every corner cut put patients at risk on a scale of one to ten. How illegal is this?

52:12 Like a thousand? Right? Like you can't just perform surgery in a basement somewhere and you can distribute your own anesthesia. I'm not sure if what he was doing was illegal or not. To be honest with you, I think you could. We'll talk at the end. I've got some information about like rules and regulations and things like that. But he had a medical license. He could theoretically perform surgeries, and I think especially cosmetic surgery back then was very unregulated. It was I've heard it described as kind of the wild West that people were just doing, you know whatever. This is so insane to me. I know, we have a lot of medical professionals that follow us, and I'm sure that they are a gas right now. For years, Anthony's corner cutting hadn't led to any public disasters, but that changed in the summer of nineteen ninety seven. In July, thirty nine year old Terry Lamarty visited Anthony's office. Her husband had given her a gift certificate for LiPo section.

53:09 That's just a great berth. He can't give you a birthday gift. She was thrilled to finally use. After four children, she couldn't shake the belly weight despite her best efforts at the gym. During the consultation, Anthony's confident manner and the framed certificate on his wall reading American Board of Cosmetic Surgeons, immediately put her at ease. He examined her abdomen and told her liposection wouldn't be enough. Her muscles were shot. He said what she needed was an abdominoplasty a tummy tuck. It would cost more, but he promised it would be worth it. Terry agreed. The surgery was scheduled for eight thirty a m. On Tuesday, August fifth.

53:49 That morning, Terry and her husband Ned arrived. Anthony handed her about ten pills to swallow. He told Ned to head home and call around one p m. To see if she was ready. The nurse led Terry downstairs to the basement operating room. The next thing she knew was four or thirty in the afternoon. The surgery was over and Ned was there to help her. Home, but on the way back, she realized something was terribly wrong. Blood was soaking through her clothes. By the time they reached the house, it was running down her legs. Her daughter had to mop up the floor. Terry, who had endured four childbirths, said it was the worst pain of her life. Ned called Anthony alarmed. Anthony brushed it off. I'ds just drainage, she said, perfectly normal. He suggested sanitary napkins. They tried, but the bleeding didn't stop, neither did the pain. For two days, Terry tufted out. Finally, she insisted on returning.

54:44 Anthony examined her swollen belly and adjusted a surgical girdle around her incision. He told her to come back in a couple of days. He'd be out of town, but as nurse could check on her. The nurse, young and visibly inexperienced, inspired no confidence. By then, Terry had lost all faith in Anthony. That afternoon, Ned drove her to the er. What doctors saw shocked them. Her stomach was grotesquely swollen, as if she were seven months pregnant. Twenty staples ran across her abdomen, but wide gaps between them were large enough to slide a finger through. Tests confirming Anthony had punctured her intestine, causing a severe infection. She was immediately started on ivy antibiotics. The next day, Terry got an unexpected visitor, Anthony. What happened, he asked, feigning confusion about why she was there. He glanced at her incision and declared, there's nothing medically wrong with you. Then he grabbed her chart and wrote that she should be discharged.

55:47 Nurses intervened and called for a doctor, who ordered Anthony to leave, but he came back the next day, angrier holding her chart. He shouted at her, I told you you don't belong in a hospital. You need to go home. A physician stepped in again and forced him out. Later, Terry's doctor called Anthony to explain her condition. Anthony dismissed it. That's nothing. There's nothing wrong with her. I've seen worse. The doctor was stunned. This is bad, doctor, He said, you shouldn't be doing these procedures in your office. Anthony shot back, it isn't an office, it's a surgery center. From then on, hospital security was stationed outside Terry's door to keep Anthony away. Thankfully, after nearly a week in the hospital, Terry recovered, but not every patient of doctor Anthony Pignataro would be so lucky.

56:38 The whole the image of Terry's abdomen and these staples and the gaps between these staples is just hearing. That just makes me spine chilling. It really is just it's so shocking to me and so scary. And I'm glad that she was okay, but it sounds kind of like a miracle. I'm so glad that they went to the er and didn't keep going back to Anthony's office. But yeah, what a full I mean, there's just not enough words. No, there really aren't. And he is just so arrogant that he can't see that he could possibly make any mistake or do anything wrong. It's just such a bad combination of lack of surgical skill and arrogance. It's just really bad. Always eager to be seen on the cutting edge, Anthony jumped at the chance to offer a new procedure, trans umbilical breast augmentation or TUBA, often called belly button breast augmentation. Traditional breast enhancements left scars either beneath the breasts or under the arms. TUBA promised something new, a tiny incision hidden in the patient's belly button. Through it, the surgeon would thread empty saline implants up under the skin to the breasts, then fill them to the desired size.

57:52 It was less invasive, and the only scar, if any, would be hidden at the navel. Patients loved the idea, but there was a reason few surgeons performed it. TUBA required specialized equipment, an endoscope, camera system, and custom surgical instruments. More importantly, it demanded expert skill, precision, dexterity, and advanced endoscopic training. One pioneer of the procedure even wrote that surgeons should take a full week long intensive course before attempting it. Anthony had no interest in a week of training. He didn't need it, he told himself. He had supreme confidence in his own abilities, and so without the training, without the specialized experience, Anthony began offering TUBA in his West Seneca office. Sarah Smith had the misfortune of being one of his very first patients. What should have been a routine cosmetic procedure would instead turn into a nightmare from which she would never truly wake. Sarah Smith born Sarah Grafton in May nineteen seventy one. Grew up in Springville, New York. When she was just six weeks old, her four year old brother David was diagnosed with muscular dystrophe.

59:01 He needed constant care, and as a child, Sarah sometimes resented the attention that David received, but as they grew resentment gave way to love. Sarah became his best friend, his confidante, and his fiercest protector. She never complained about helping him, no matter how much it disrupted her own life. Sarah thrived in school. She took violin lessons, played in the school orchestra, and had plenty of friends, but she always made time for David, who by then relied on a wheelchair. As a freshman, Sarah began dating Dan Smith, a junior. Dan's compassion showed early. He welcomed David into their plans without hesitation. To Sarah, that kindness revealed Dan's character and made her love him all the more. In February nineteen ninety, not long after Sarah graduated high school, her brother David passed away. Through grief. Sarah and Dan's relationship endured even after his family moved forty five minutes away, and Dan left for college. They stayed together. In June nineteen ninety they married and settled in an apartment in Lancaster, New York. Soon after, they welcomed their first child, Nathan.

1:00:08 Sarah worked as a courier for a law firm with hopes of one day becoming a paralegal, while Dan found steady work as a drafter. Three years later, their daughter, Amanda, was born. By August nineteen ninety five, they had saved enough for a starter home. Dan built a shed in the back yard, and Sarah discovered a love of gardening. Their marriage, while not perfect, was by all accounts, a happy one. In early nineteen ninety seven, Sarah underwent surgery to correct a deviated septum. While there, she had a bump on her nose removed. The operation went smoothly, and she was thrilled with the results. The success emboldened her to pursue something she had long wanted, breast enhancement. She once joked to her mother in law, how could I have two kids and no boobs? Everyone, including Dan, thought she was beautiful as she was. Dan opposed the surgery partly because he saw no need for it and partly because because he feared the risks, but Sarah was determined.

1:01:03 After a promotion at work, she set aside money for the procedure. When she was ready, she called a couple of doctors. Doctor Peter Callamel quoted a price of six thousand dollars, But then Sarah heard from a friend of a friend about doctor Anthony Pignataro. He could do the surgery for one thousand dollars less because he could do it in his own office, avoiding anesthesiologist and hospital fees. In early August nineteen ninety seven, twenty six year old Sarah walked into Pignataro's office for a consultation. He immediately put her at ease. He recommended the new trans umbilical breast augmentation technique, the one he claimed would soon be standard everywhere. He told her she was getting in early at a special price. Blood work was done, the risks explained, the forms signed. Her surgery was scheduled for Monday, August twenty fifth, at nine thirty am. Just a few days before, at a family pool party, Sarah leaned over to her mother in law and whispered, with a smile, take a good look, because this is the last time I'll look like this in a bathing suit. On the morning of August twenty fifth, Dan drove Sarah to Anthony Pignataro's office, carrying a book to pass the time while he waited.

1:02:12 After giving Sarah the usual handful of pills and taking her to the operating room, Anthony suggested Dan leave and run some errands. Dan was reluctant, but Anthony pressed it was clear that he wanted him gone, so Dan left inside ther Anthony was assisted by his LPN twenty two year old Janie Krause, his wife, Debbie, and his teenage intern, seventeen year old Tom Watkins. Jane managed the IV adding drugs when Anthony instructed. Debbie was told to monitor the pulse ox simeter and blood pressure. Tom was there mostly to observe and run errands. Once the pills took cold, Janey injected six se seeds of sodium pentathol and three c seeds of versaid into Sarah's IV. Anthony began the procedure, then directed a second injection of seven c seeds of fizodium pentathal. Later, when Sarah muttered out several times, Anthony ordered a third injection another seven ccs. Moments later, the pulsock simeter alarm began to shriek. Sarah's oxygen level had dropped below eighty five. Any trained surgeon would know the priority was immediate get oxygen into the patient, but Anthony ignored it. He told Debbie the wire was probably loose and to jiggle the monitor. He then instructed Debbie to get some nail polish remover to remove the polish on Sarah's nails so that he could see the nail bed better.

1:03:33 Debbie grew alarmed as she watched Sarah's lips turn blue her skin gray. She told Anthony almost at the same time the blood pressure alarm began sounding. Sarah had stopped breathing. She was in cardiac arrest. Anthony finally stopped operating and called for an AMBU bag, the handheld resuscitator standard in any or, but there wasn't one. He sent Tom scrambling to find one. All the boy could find was a chill ldren's size AMBI bag useless, Anthony injected Lyda Kane then tried to force open Sarah's airway with a flat piece of metal. Debbie began chest compressions Finally, Anthony told Tom to call nine one one. When paramedics arrived minutes later, the scene was chaos. Janey was pumping compressions, Anthony was fumbling with a coat hanger, trying to fashion it into an airway device. The EMTs quickly took over. They searched for a crash cart, there was none. They loaded Sarah onto a gurney and into the ambulance. Only then did she finally receive oxygen. They managed to shock her heart back into rhythm, but it had been nineteen maybe twenty minutes since Sarah Smith had last drawn a proper breath, far too long for her brain to survive intact. When Dan Smith returned to Pignatara's office, Debbie met him at the door. We've had a little problem, she said. Your wife wasn't breathing, But she's breathing now. She's on the way to the hospital. Debbie drove him there. At first, Dan wasn't overly worried. It was inconceivable that anything serious

1:05:05 could have happened to his healthy, twenty six year old wife during a routine procedure. That changed the moment he arrived at the hospital, A priest and a nun were waiting for him. They led him to the ICU, where Sarah lay motionless, attached to machines. Dan fell to his knees and shock. He called his mother and Sarah's Both rushed to the hospital. One look from a nurse told Dan's mom how bad it was. The nurse pulled her aside and whispered, get a lawyer, a good one. This guy has put five people in the hospital in the last few weeks. I don't know if that's true that he put five people in the hospital, but definitely there was the story we told earlier, and I think there may have been a couple others as well as Dan and his family waited in anguish Anthony and Debbie arrived.

1:05:48 Debbie seemed dazed. Anthony, on the other hand, kept insisting everything would be fine. He even began planting excuses suggesting Sarah might have been taking medications that he hadn't known. The next day, doctors leveled with Dan there was no chance of recovery. If Sarah lived, it would be on life support in a vegetative state. Dan couldn't accept it. He spent every possible moment at her bedside, clinging to hope Anthony kept showing up too, but his presence unnerved the staff. Eventually, Dan had Sarah's former law firm intervene and a court order was issued barring Anthony from the hospital. On Labor Day, September one, nineteen ninety seven, seven days after her surgery, Sarah was removed from life support. She was gone. She left behind her husband Dan and their two children, Nathan, aged seven and Amanda, just four. Not long after, the doctor who had treated Terry Lamarty picked up the phone and called her. Do you know what a lucky woman you are? He said, that son of a bitch just killed a twenty six year old mother of two. He gave her the same handful of pills he gave you. She went into cardiac arrest on the table and never came back. And that is where we are going to end part one.

1:07:02 Well, that was really a horrible situation that was really tough to listen to. It's a really scary story because we just trust doctors innately. I mean, we just assume that when we go see a doctor or a surgeon in this case, that they're qualified, they know what they're doing, they've got it under control. And I think most people don't really think much more about it than that. Well, I think this was a super extreme case too. Yeah. Absolutely, I mean, the vast majority of surgeons are highly qualified and experienced, but yeah, it's unusual. But still we just take it for granted, you know. Yeah, every time you go under anesthesia, you assume that you're going to come out, and you know, every day people don't.

1:07:43 Yeah. One thing I read that surprised me is and this is in nineteen ninety seven, that many patients don't realize that once doctor is complete medical school, they can practice any specialty, including surgery, even though they might lack advanced training. I think that's maybe gotten better over the years. There are maybe a little more regulations and requirements in place, but at the time that that was the case, that it's really it's scary. Yeah. My understanding is that surgeons today need fifteen to twenty thousand hours or some huge number like that of practicing or not practicing, but observing and learning before that they can perform a surgery on their own. Yeah, and again I think, like I mentioned earlier, I think cosmetic surgery was a little bit of more like the Wild West back then as well, that there just was not as much oversight over it, and so yeah, it's really frightening. Let me just ask you a couple of questions. When you think about Anthony's character and his story so far, what are the warning signs that stand out the most to you that kind of raised your red flags for you?

1:08:46 Well, his ego and narcissism, right, like he needs to be right more than he needs to take care of his patients and do what's right by his family, by his patients, you know. Yeah, just just not a good guy. No, not a good guy, not a team player, incredibly arrogant. I'm really curious how many well how many hair transplants did he do were people satisfied with the results, And how many cosmetic procedures did he do where people recommended him, Like you said that, Sarah, that a friend of a friend recommended him. I didn't mention it, but the friend of the friend was the nurse that worked for Anthony. She was like roommates with her husband's sister or something like that.

1:09:28 So we're not sure if he even had any procedures that were successful. Well, he did a lot of the hair transplants, at least that's what when he was interviewed and kind of did his media rounds the hair you know, piece attachment thing. He said he did like one hundred or more of those. I don't know if that was true, but I think he did quite a few of them. And honestly, I think that surgery is probably relatively easy compared to like the trans umbilical breast augmentation, because you're just kind of, you know, drilling a little bit into bone, which sounds scary, but I think it's actually not as common plicated. Okay, I know I'm not going to have it done. I'm not having anyone drill into my skull for any reason. Yeah. No, it's the same one question I wanted to ask you.

1:10:10 I'm sure Dan felt awful about this. He he didn't want Sarah to have the surgery because he thought she didn't need it, for one, but he was worried about the risks. But she really wanted to have the surgery. And I'm curious as a as a spouse, like if I wanted to go get my nose done, for example, but you were worried about that and didn't, like, how hard would you push versus being like, it's your decision to do that. Well, I feel like plastic surgery is safer today, right, So if you really wanted to get something done, I wouldn't stand in your way. I really like your nose, your chin, though, I think you could use like a chin implant. Maybe. I just I really don't think that most plastic surgery needs to be done. Makes me sad that so many people hate their faces and their bodies.

1:10:56 I mean, I'm not I don't know how to explain, like, I'm probably average looking, but I don't really care. I mean, I don't know. You're far better than average looking, first of all. But second, I think even then, I think these procedures were by and large very safe. So even if Dan was worried about it, you know, I think there wasn't There wasn't that much reason to worry. So if Sarah wanted to have it done, I. Would imagine dropping. If I were dropping you off in a basement to have you know, a major surgery, I would be pretty scared. That would be a little bit of a warning sign, I would think. Although there are surgery centers everywhere, and I don't think Dan ever probably went down to the basement to look at the operating room. I think people don't know what to look for either. They're not like, oh, you don't have a you know, this particular piece of equipment or whatever. So it's fair not.

1:11:43 Having the crash cart is that's pretty scary. That is pretty scary. Yeah, I wouldn't know to look for that. But no, absolutely not. You trust your doctor. Yeah. I did do a little bit of research on what has changed in terms of regulations for cosmetic surgery, specifically because one of the newspapers I read at the time that this happened said that there's really no consensus on standards for office based facilities or surgery centers where cosmetic procedures are routinely done. Offices are largely unregulated. Accreditation is voluntary, and so offices escape scrutiny of insurers because they're not done. You know, it's not a big hospital chain. But since then, there are some things that have changed.

1:12:26 There is some increased oversight, like professional associations have developed and they provide practice advisories, they recommend safety protocols. There's more of an emphasis on safety culture, staff training, emergency protocols. There are more states that have some regulation around cosmetic surgery. So in twenty twenty two, fewer than thirty states had laws governing office based surgery. But that's a lot more than I think there were at the time in nineteen ninety seven, So it's definitely becoming more common that there are regulations around this type of thing. I believe that Kanye West's mom died during cosmetic surgery, oh really. And Joan Rivers died during a procedure, and she obviously had a lot of plastic surgery, but I think her cause of death was during a procedure to treat voice changes and acid reflux. But I think she was not in a hospital. I think she was in some sort of surgery center too. So I mean, it does happen. And if these are high profile cases that we know about, I'm sure there's a lot more cases and you know, less high profile people.

1:13:32 Yeah, for sure. I hope that no one listening is, you know, driving to get some procedure done today and listening to this episode, because that would be quite scary. Yeah, just check your check your doctor's credentials. Then part two, we'll talk more about what actually happened, why Sarah didn't make it through surgery, and then we'll talk about what happened after. I don't know if we've ever talked about this before, but you have to answer something. If you were to get cosmetic surgery, what would you get done. I have to answer something. I don't have to answer something. You can't tell me that. I have to answer something.

1:14:13 Well, that's a good question, I think. I mean, you're lovely, you were very handsome. Man. I was doing a little bit of research on different procedures, and I think I would go with the high deaf liposuction, which I'm sorry, high deaf liposculpture. So it's different than liposuction. It actually sculpts your ab muscles to give you a six pack through searchery. Really, yes, I think that would be a good one. Wow. So you you were saying that you have never thought of it, but then you're like, well, I'm going to get high deaf ab surgery. Yeah. When I was researching, I was like, oh, that sounds like something great. I would like to see the results. Yeah, I'm not sure how well works. Okay, Well, then I guess you have to answer the same question.

1:14:56 I mean, I am a mom, so I think most most women would answer your you know, boob job, tummy talk, but I honestly, in the next year, I really do want to get botox. So yeah, I'm afraid that I'm gonna go get botox and they're gonna be like, oh honey, it's too late for you. Why what what is I'm not even sure what botox does. It just like smooth a zero. Right here, they're called elevens. Between her eyes. Yeah, like that bad. I mean, I'm not a young person, but yeah, it's just kind of I know now you're not. That's all you're going to see. Now. We started go fund me reaching to the plastic surgeon. Yeah, so it's just I wouldn't get fillers, but just you know a little bit, uh, just you know, just get those creases out. Yeah. Yeah.

1:15:47 I found a few other unusual procedures, so let me throw these out there too. And I watched the Real Housewives on you probably I probably know all of them. It's shocking to me how insecure people are, like out their hands, like there's like hand surgery you can get now, and just like everything. Well, here are a few that I thought were kind of interesting. Belly button surgery. If people have an audie up, you can get surgery to turn it into an inny. It's called an umbilico plasty. Chubby cheek surgery. Sometimes if people have chubby cheeks, it makes them feel like they look like a little kid when they're not. I guess, And you can get surgery to remove your chubby cheeks. Gummy smile repair, Like your smile has too much gum showing, you can get that fixed. I guess.

1:16:31 Well, I had in vizzileline. I finished over a year ago, and I think my smile, I don't think you even really noticed, but I think my smile was probably a little gummier before. I think it looks nice or not. You never even noticed. I didn't. And then the last two I had were eyelash transplants, which surprised me. If you like, when you get older, you sometimes lose your eyelashes, like they become less thick, and you can get transplants done for that. And then the last one is dimple creation. If you always wanted to have dimples, you can have dimples surgically. We have one dimple, which I think is kind of weird too. I never noticed that. It's hardly like to be. It's so sad, it's not very observing, so hard to look out that this is different because it's it's not like surgery. But people are having freckles tattooed on.

1:17:24 Oh really Yeah, people used to want to get rid of their freckles. Yeah, people like lemon juice and stuff. Now you're thinking of Judy Bloom's book Freckle Juice that I probably read in second grade. I don't think I've read that, but maybe. So we spent a lot of time together, obviously, but you never look at me. That's okay. No, So I have a list of things like that, we topics that we wrapped the show up with, and I have one here that I meant to talk about a couple of weeks ago and I didn't. But it's Dolly Parton's taco bell order. Okay, do you want to know what Dolly Parton, who I guess had some medical issues this week. We can't lose Deli Parton.

1:18:05 No, she is just she's a national treasure. She has a treasure. Jane Goodall, this week she deserved to live forever. Dolly Parton should live forever. Well, what's her taco bell? Her taco bell go to order is a Mexican pizza and a soft Taco. Supreme that used to feed pretty much my go to. So when I saw this and I was like, gosh, I know you were a big fan of the. Mexican I would do a Mexican pizza and a bean burrito. So, after thirty five years on the menu, the Mexican Pizza was taken out in twenty twenty two, but after a public outcry and a change dot org petition, it was brought back. It's back. Oh, I didn't realize it was better brought back. Maybe it's not brought back everywhere, but.

1:18:47 You realize now you're putting a seed in my mind that we're going to have to get. Taco Bell for I know what I saw Taco Bell in my notes. It was I am a little hungry. Yeah, all right. I think people worry about our diets in general and worry that we don't take good care of ourselves. Yeah, what do you have to say about that. I think we're not bad. We like to joke about it. We do like treats here, we eat. Them on the podcast. I think we're pretty healthy during the week. Yeah, don't worry about us. Other than the ice cream that someone ate out of the food that I was saving. I can't believe you're bringing that up at this point the episode. It was a little shocking.

1:19:28 I guess I should have added that to my apology. I wasn't upset. I was just kind of shocked because I think we went to the grocery store a couple of weeks ago and like a Saturday night probably, and we were like, oh, yeah, let's get some ice cream. Yeah, we got a couple of Little Pine and. I got like the most expensive ice cream, and it was really expensive. But I'm like, well, I'll lead it in like three sections. And then I honestly thought you kind of forgot about it. So I was like, ah, and that's true, because you're more of an ice cream meter than I am. And sometimes I am like, hey, I ate a little bit of this, but you can have the rest. But this ice cream was so good. It was from a blank Slate creamery in Anna Arbor and they sold pintes at the local market. But yeah, that was really good. Shout out to Blake Blank Slate. Yeah, sorry, I forgive you.

1:20:16 I forgive you. That's the most important part. Thank you. Well. If you want to listen to part two of this episode, join us on patreon dot com slash Love Mary Kill. For five dollars a month, you get early ad free access and a monthly bonus episode and our eternal gratitude. Actually, regardless, if you're listening to this podcast, our eternal gratitude. Please rate, review, follow, and subscribe. Find us on social media and YouTube now, or send us an email at Lovemarykill at gmail dot com. Thanks again, Christy for the case recommendation, and thanks again Teresa for the snack. We really appreciate it. Until next time, don't kill your husband and don't kill your wife. Hi, I'm rich and I'm teen.

1:21:47 I know that was gonna happen. Okay, what did that do at this time? Oh? Sure, okay,