By many accounts, Dr. Michael Tavis was a popular plastic surgeon, committed to his profession and kind enough to provide free reconstructive surgery to needy youths in Petaluma, the Northern California town where he practiced.
"He had a real passion for doing to patients what he did for them--sometimes reconstruction, sometimes improving someone's image," says an employee at a Petaluma hospital who knew him.
But in recent years, the 53-year-old doctor had also suffered his share of troubles, including lawsuits filed by patients claiming their surgeries hadn't given them the results they expected. Then, in April 1997, the Medical Board of California accused Tavis of gross negligence and incompetence in caring for two patients.
But perhaps no patient was as disgruntled as Theresa Mary Ramirez, 46, who reportedly had undergone breast reconstruction by Tavis and later sued him, unhappy with the outcome. Her lawsuit was dismissed, but she was not ready to give up.
On the morning of July 3, 1997, Ramirez allegedly entered Tavis' office and, according to police reports, shot Tavis several times and his office manager once. The office manager survived; Tavis did not.
Last year, Ramirez pleaded not guilty. In July, Ramirez was judged competent to stand trial, according to the Sonoma County District Attorney's office. The trial is set to begin Oct. 13.
The case strikes fear in the hearts of the nation's plastic surgeons. Tavis is the latest in a trio of plastic surgeons during this decade to meet a violent death at the hands of patients--sometimes not even their own.
Dr. Martin Sullivan, a surgeon in Wilmette, Ill., was murdered in 1993 by a man who selected his name at random from a phone book and made an appointment. Posing as a patient, Jonathan Haynes opened fire and shot Sullivan as soon as the doctor introduced himself, according to Wilmette Police Department reports. Haynes was reportedly angry that plastic surgeons create "fake Aryan beauty." He was found guilty and is on death row in Illinois.
In 1991, Dr. Selwyn Cohen, a surgeon in Bellevue, Wash., was preparing to speak to a local women's group when Beryl Challis, a disgruntled patient with a revolver, ambushed him in his office and then killed herself.
While most surgeons specializing in cosmetic work have not faced a gun barrel, many can relate incidents of patients so angry they telephoned death threats or smashed office furniture.
Physicians in other specialties--notably emergency medicine and psychiatry--are generally considered at higher risk of being hurt or killed by angry, violent or disturbed patients, experts say, although statistics of the number of physicians murdered by patients are not kept by the American Medical Assn. or by medical specialty organizations. According to the U.S. Department of Labor, Bureau of Labor Statistics, 11 physicians were killed on the job from 1992 to 1996, but no details are available on their area of specialty.
Although the actual risk of being killed by a patient is small, the topic is much on the minds of plastic surgeons. In May at the annual meeting of the American Society for Aesthetic Plastic Surgery in Los Angeles, a big draw was a one-hour panel discussion titled "Identifying and Understanding the Psychologically Disturbed Aesthetic Surgery Patient."
The April issue of the Plastic and Reconstructive Surgery journal featured an article calling for more study on what motivates people to seek plastic surgery and asking whether it may be inappropriate for some.
Meanwhile, practicing surgeons debate whether violence is increasing or people are simply more aware of it. Dr. Brian Kinney, chief of plastic surgery at Century City Hospital, believes there is at least more potential for violence.
"The number of unhappy patients has risen," he says, blaming the increase in part on what he terms "unreasonable claims--almost hype" from practitioners and advertisements promising too much. Patients can begin to believe anything's possible, given the right surgeon.
Also, procedures have gotten more sophisticated.
"What we're trying to do is much more complicated these days, so the more intricate the procedure, the longer the list of potential complications," says Dr. Mark Constantian, a plastic and reconstructive surgeon in Nashua, N.H., who had experiences with three violent patients in a span of a year and a half.
As the number of people having cosmetic surgery has increased, doctors wonder whether the pool of potentially violent patients, in turn, has increased as well.
More than 2 million Americans underwent cosmetic procedures in 1997, according to the American Society for Aesthetic Plastic Surgery. From 1992 to 1997, the number of cosmetic procedures tracked by the American Society of Plastic and Reconstructive Surgeons increased by at least 50%.