FEATURE FROM ISSUE # 200 (August 2012) | IN THIS ISSUE REFER TO FRIEND PRINT THIS ARTICLE
Dr Raju Raj Pandey's clinic looks like any regular clinic from the outside, however, once inside you are greeted by photographs of Nepali noses, eyes, foreheads and other body parts, before and after surgery. Pandey is a cosmetic surgeon.
All over the world cosmetic surgery is an emerging business. especially in Western countries, celebrities are getting older by looking younger. Noses are shrinking, breasts are growing, wrinkles are vanishing, the skin is tightening, and the tabloids keep us up-to-date about which super star tried out the latest facelift method. In Nepal, however, cosmetic surgery is still in its infancy. “We do about three to four upper eyelid surgeries per week,” says Pandey who is the founder of the Nepal Plastic Surgery Hospital. “In centres in Bangkok they performed about 50 to 100 eyelid surgeries per day.”
Although in Nepal cosmetic surgery is still an unknown concept to many, demand is gradually growing. especially young girls knock at Pandey's door, asking for bigger eyes and smaller noses. “It takes time, but slowly people are coming,” Pandey says.
Plastic surgery can be divided into two broad categories: reconstructive and cosmetic surgery. Reconstructive surgery helps after accidents, for example to treat burn injuries. In Nepali villages, where open fire cooking is common, children playing around open fire often become victims. Reconstructive surgery is sometimes necessary for survival.
Cosmetic surgery, on the other hand, is a surgical intervention based on the patients' wish to modify a part of their body for aesthetic reasons and usually unnecessary for survival.
Insurance plans in Nepal don't cover cosmetic surgery and patients need to pay out of their own pockets. some hospitals financed by aid organisations provide reconstructive surgery for people in Nepal who cannot afford the treatment. the Sushma Koirala Memorial Hopsital in Salambutar, Sankhu, is one example.
The most popular among cosmetic surgeries in Nepal is the 'Mongolian eyelid surgery', says Pandey, who studied medicine in India, earned a master in surgery in Nepal and went to Bangkok for special training in plastic surgery. During the surgery, fat, excess skin and muscle from the eyelid are removed to make the eyes appear bigger.
Dr Jaswan Shakya (pictured left) earned a bachelor in medicine and a master in surgery in Russia and got special plastic surgery training from South Korea. he works part-time at the Nepal Skin Hospital, where certain types of cosmetic surgery are offered. Shakya says Nepalis living abroad in the UK or US come back to Nepal for the surgery. “It is more than five times cheaper here in Nepal than in Europe or the US,” he says.
Costing between Rs 20,000 and 30,000, the Mongolian eyelid surgery is not only the most popular but also the cheapest surgery in Nepal. it is considered a very simple surgery. Lasting about one hour, the patient can walk normally home on the same day.
Botox, in turn, a very popular method in Western countries to reduce wrinkles, is very uncommon in Nepal. Instead of a surgery, it requires the injection of expensive medicine. a botox injection costs Rs 10,000 to 12,000 and needs to be repeated every three to five months. “For celebrities, it is okay, they earn for their faces, but from normal people, it is too expensive,” Shakya says.
Other cosmetic surgeries in Nepal, mainly offered at Nepal Skin Hospital are nose surgery, hair transplantation, face lift, breast implants, ear surgery, scar revision or tattoo removal.
Pandey says the reasons why patients want cosmetic surgery are manifold. those coming for a Mongolian eyelid correction are often young girls around 20 or 22. he says some of them want to work as stewardess and think they need the correction. “New eyelids doesn't mean that they will automatically get the air hostess job,” Pandey warns.
However, he agrees that for some jobs, a little correction can be helpful. “You might apply for a job and the employers might tell you that you are too old for the job, because of your receding hairline. In such cases we offer hair transplantations,” Pandey says.
Some girls even bring pictures of models to his office. “They tell me 'make me look like this model',” Pandey says. “But I usually tell them that it is not possible. Everyone has a unique face structure that we cannot change.”
But it isn't just young girls who are rushing to cosmetic surgery clinics. Men are interested in nose corrections or hair transplantations. Both men and women above 50 perform upper eyelid corrections because of their age. “For them it's functional,” Pandey says.
Based on his experience with patients, Shakya says cosmetic surgery patients in Nepal are still not under as much societal pressure to look a certain way as people in the West. “This is the difference between Europe and Nepal,” he says. “In Nepal they do the surgery out of their own will, in the US or in Europe, they are pressurised to follow certain trends and look like celebrities. but I am sure this obsession to look like celebrities will soon be felt in Nepal.”
Both Pandey and Shakya have had patients who had second thoughts about surgery. Every surgery entails risks such as bleeding or swellings and Shakya says he meets patients at least three or four times where he talks to them in detail about the procedure and side-effects and precaution. “Cosmetic surgery is not an emergency surgery. the patient must understand the situation,” he says.
Shakya recommends his patients to watch videos and read articles about cosmetic surgeries first before making a decision they might regret later on. “If there are complications after breast surgery, we might have to remove the implant, and the patient loses 2000 Euros,” he says.
Pandey also tells his patients to reconsider cosmetic surgery and 25 per cent of them eventually change their mind.
Despite being a plastic surgeon, Pandey still believes in natural beauty. “I believe that it is the nature which makes you who you are,” he says. “You can't challenge nature, you can only modify things.”
View PDF | Print Viewby: Gareth HoyleTotal views: 22 Word Count: 327 Date: Sat, 17 Sep 2011 Time: 6:08 AM
Plastische Chirurgie Zürich is famous for reconstruction or improving the injured, lost or defective body parts through surgery. until recently, many people considered plastic surgery as an eccentric luxury. There are some people who go too far in this process that sometimes they lose their identities or even lose their lives in their pursuit of perfection. It absolutely depends on the each individual’s opinion whether they really want to go for surgery or not. To get a successful treatment or surgery first you need to have a consultation with the doctor along with preliminary examination. the Plastische Chirurgie Zürich are very experienced in both cosmetic surgery which deals with improving the patient’s features on purely aesthetic level and also reconstructive surgery where the surgeon tries to correct the deformed or abnormal physical features. these doctors have excellent skill and knowledge in the design and surgery of flaps, grafts, tissue transfer and replantation. Winterthur is the city located in the northern Switzerland which means northeast of Zurich. the Schönheitschirurgie Winterthur is renowned certified plastic surgeons who can help you to fulfill your dreams by enhancing the beauty and confidence. There are many non surgical treatments for face, skin and body as well as surgical procedures such as breast correction, facelift, eye correction, nose surgery, hair implantation, liposuction, tummy tuck, weight loss and many more services these surgeons can offer to help the people achieve the results they wanted. unlike other providers, the Schönheitschirurgie Winterthur chooses the surgeons based on their experience, knowledge and expertise. They have performed numerous procedures on cosmetic surgery and consider that every patient is important for them. Patient’s satisfaction and safety are the most important priorities and concerns and we strive very hard to achieve it. If you are planning to undergo any of these procedures then please visit the office or call us to get all the information.
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This is the second installment of a four-part series.
In April 2003, Robert Ambrosino murdered his ex-fiancée – a 22-year-old aspiring actress – by shooting her in the face with a .45-caliber pistol.
Then Ambrosino turned the gun around and killed himself.
Soon after, Ambrosino’s corpse entered the United States’ vast tissue-donation system, his skin, bones and other body parts destined for use in the manufacture of cutting-edge medical products.
But before they entered the system, Michael Mastromarino, owner of a New Jersey-based tissue recovery firm, needed to solve a couple of problems.
He didn’t want to have to report that Ambrosino had perished in a murder-suicide. And he didn’t want anyone to know that Ambrosino’s family hadn’t given permission for his body to be used for tissue donation.
Mastromarino solved both problems the same way: He lied.
He claimed Ambrosino died in a car accident. And he claimed that Ambrosino’s family had agreed to donate his tissue before the rest of his remains were cremated.
Mastromarino was the leader of a now-infamous human tissue trafficking ring that fed an international trade in body parts. along with tissues from Ambrosino’s corpse, he stole parts from grandmothers, electrical engineers, and factory workers, as well as from the remains of famed journalist Alistair Cooke.
The disgraced dental surgeon from Brooklyn supplied the raw material for products used for a host of surgical operations – from knee repair to plastic surgery and cosmetic implants. He was a ground-level player in an industry that makes its profits by harvesting human tissues mostly from the United States, but also from Slovakia, Estonia, Mexico, and other countries around the world. One of Mastromarino’s top buyers was Florida-headquartered RTI Biologics, a processor of American, Canadian and Ukrainian body parts that trades among the high-tech companies on the NASDAQ stock exchange.
Years after Mastromarino was sent to prison and the publicity in his case quieted down, his story has been given new life by a lawsuit filed in a Staten Island courthouse. New York Supreme Court Judge Joseph J. Maltese has given the green light for RTI to stand trial Oct. 22 in a civil case that will delve into what the company knew – or should have known – about Mastromarino’s body snatching.
Evidence already filed in court raises questions about whether RTI was simply a victim of Mastromarino’s fraud, or whether it eschewed common sense in favor of its bottom line. An investigation by the International Consortium of Investigative Journalists (ICIJ) shows that the evidence in the case – and in other body-stealing scandals across the globe – also raises larger questions about the conduct of an industry that recycles more than 30,000 human bodies each year.
Police in places including Hungary and Ukraine, and North Carolina and Alabama in the U.S., have alleged that tissue suppliers stole tissue, committed fraud and forgery, or took kickbacks to pad their pockets. These cases suggest that Michael Mastromarino wasn’t the only body wrangler who has bent or broken the rules in the drive to supply the industry with flesh and bone.
A fantastic product
Mastromarino, now 49, is doing time at a maximum-security prison outside Buffalo, N.Y., serving a sentence of up to 58 years. He describes himself more as a human tissue broker than a body thief.
“This is an industry. It’s a commodity. Like flour on the commodity exchange. It’s no different,” Mastromarino said. “I cut some corners. but I knew where I could cut corners. we were providing a fantastic product.”
For more than three years until his crimes came to light in late 2005, Mastromarino’s firm supplied bones and other tissue to RTI’s nonprofit subsidiary, RTI Donor Services, and four other U.S. companies.
Mastromarino was familiar with RTI’s operation from his previous career as one of the busiest dental surgeons in Manhattan. He regularly used products derived from cadaver bone on his patients and, in that capacity, he had signed a consultancy agreement with the company in 2000 to help further refine RTI’s products.
But Mastromarino’s personal life was falling apart. He started injecting prescription painkillers to sooth an old football injury, became an addict and got busted for drug possession. He tried rehab three times before giving up his medical license.
Familiar with the industry and good with a scalpel, Mastromarino opened his own human tissue recovery company. He called it Biomedical Tissue Services.
The process was easy. Mastromarino filled out a form downloaded from the website of the Food and Drug Administration, the agency that regulates the industry in the U.S.
He didn’t have to wait for the FDA to inspect his facilities. He began supplying body parts right away – with more than a little help, he said, from an industry leader, RTI Donor Services.
“RTI set me up,” Mastromarino testified in a pending civil case. “They then said, ‘Listen, we can get into your business, we can get you started, we can open up your own business.’”
‘Santa’s naughty list’
The parties signed a supply contract in March 2002.
Not long after, Mastromarino’s colorful language and short fuse led to complaints from RTI staff. there were also rumors about his alleged involvement with organized crime, according to testimony of Caroline Hartill, RTI Donor Services’ vice president of quality assurance.
Michael Mastromarino, serving a sentence of up to 58 years, describes himself as a human tissue broker rather than a body thief. Photo: ICIJ
Court documents outline that RTI executives were concerned enough to hire a lawyer to run a background check on their new business partner.
“The good doctor has been on Santa’s naughty list for quite some time,” the lawyer, Jerome Hoffman, wrote in December 2002. “I would strongly encourage you not to do business with someone that has this kind of resume.”
A few weeks later Hoffman further urged RTI to give Mastromarino “the required 60 days notice under the current contract and not sign a new contract.”
RTI didn’t heed the lawyer’s advice.
Instead, on Feb. 11, 2003, Caroline Hartill signed an amended contract with Mastromarino’s firm.
In the new contract, his name was replaced with a freshly licensed doctor who lived in another state and with whom Hartill had never spoken. the doctor served as the medical director of Mastromarino’s firm – according to the signature on paper at least.
Hartill testified in the pending civil case that the amended agreement was simply a routine part of accreditation with the American Association of Tissue Banks, an industry body that oversees some of the biggest tissue banks in the U.S. she said her company wanted the medical director to take Mastromarino’s place on the contract because RTI determined it “would like to have more direct interaction with some of the other key principles [sic].”
RTI discounted the law firm’s concerns, she said, because if Mastromarino had “turned his life around, then who was I to pass judgment on him?”
Mastromarino recalls events differently. He testified Hartill and another RTI executive called him confidentially. they worried about competitors discovering his background and using it against the company, they said. And that’s why, Mastromarino said, his name came off the contract.
“Okay, whatever you guys want to do to make it comfortable,” Mastromarino told them, according to a deposition he gave in the current civil case.
The company refused interview requests from ICIJ and did not respond to detailed questions provided more than a month before publication.
RTI turns to corpse wranglers for a simple reason: it needs dead bodies to turn a profit.
“We cannot be sure that the supply of human tissue will continue to be available at current levels or will be sufficient to meet our needs,” RTI warned stockholders in securities filings. “We expect that our revenues would decline in proportion to any decline in tissue supply.”
And it isn’t alone.
More than 2,500 companies registered with the U.S. government rely to varying degrees on the fees they charge for crafting implants made from human tissue.
The world’s largest human-tissue bank, Musculoskeletal Transplant Foundation, took in nearly $400 million in revenues in 2010.
MTF is set up as a tax-exempt nonprofit, like most organizations that recover the tissue from donors located through hospitals, funeral homes and morgues. Most recovery outfits supply processing companies like RTI, which clean the pieces and mill them into usable implants. the processing companies in turn distribute them directly to hospitals or use an outside vendor such as medical device giant Zimmer to ship them around the world.
Players bid for exclusive access to U.S. donors. For example, medical device company Bacterin announced last year that it “successfully secured rights of first refusal of human tissue with multiple recovery agencies.”
Competition has spawned bitter court battles. MTF sued Bacterin last year for hiring former employees who, the lawsuit alleged, used their inside knowledge to pitch a rival bone product to MTF customers. “The very foundation of MTF’s business is under direct attack,” MTF argued in its complaint.
Publically traded NuVasive sued MTF and its partner Orthofix, accusing it of infringing on a patent for stem cell-laced bone implants. And nonprofit LifeNet Health sued Zimmer over reimbursement fees for processing bone plugs.
RTI gets tissue directly through its nonprofit subsidiary, RTI Donor Services, and has also obtained tissue from other nonprofit tissue banks in at least 23 states.
The Alabama Organ Center is one of RTI’s suppliers. it was embroiled in scandal this spring when its second-in-command, Richard Alan Hicks, pleaded guilty to accepting kickbacks from a funeral home in exchange for tissue recovery contracts.
“There are too many loopholes. there are too many temptations. There’s too much money out there,” Hicks’ attorney Richard Jaffe told ICIJ in June. “This industry is out of control.”
The University of Texas Health Science Center at San Antonio has also recovered tissue for RTI. Its contract includes a fee chart – attaching different prices to the same tissue based on the donor’s age. RTI reimburses the recovery bank $1,755 for a 20-year-old femur; but $553 for the same bone from an 80-year-old.
In 1984 Congress passed the National Organ Transplant Act, making it illegal to buy and sell human organs and other human tissues. but it allowed charging “reasonable” fees for recovering, cleaning and distributing those parts.
Younger tissue is stronger and can be more lucrative for tissue processors because it can be used for higher-value grafts. neither RTI nor the University of Texas responded to repeated requests for clarification about why the same tissues would carry such varying fees.
ICIJ turned to Christina Strong, a lawyer for organ procurement organizations (OPO) and tissue banks including tissue giant MTF. ICIJ asked whether there could be any reason other than the quality of the tissue itself for a bank to pay more for younger tissue.
“I have not found a satisfactory answer that makes me like this,” she said, pointing to the contract. “I do not like this. I would say to my OPO, ‘Don’t sign that.’ “
Strictly confidential
With so much competition for American cadavers, some companies seek raw material overseas. That’s created a fertile market in Eastern Europe for body brokers and other middlemen who can help supply the tissue trade.
One of the middlemen was Igor Aleschenko, a Russian coroner working in Ukraine. In coordination with Ukraine’s ministry of health, he launched BioImplant, a state-owned tissue procurement center to supply Tutogen, a German medical products company.
Bioimplant supplied Tutogen with tissue. but Tutogen executives raised internal questions as early as 2001 about whether it should pull out of Ukraine, according to an internal memo marked “Strictly Confidential!!!!”
Aleschenko was asking for more and more money to play the role of intermediary between the regional satellite morgues around Ukraine and Tutogen in Germany.
“The flow of money is difficult to track,” the memo read. “Direct control over our resources is impossible.”
Staying in Ukraine would be high-risk, the authors determined.
“We can’t control the activities of the middlemen, and commitments are not being honored,” the memo said.
But the relationship did not stop.
The courtyard outside NIK1 morgue in Ukraine, which was registered in the U.S. as a tissue bank. Photo: Konstantin Chernichkin/Kyiv Post Over time, 25 Ukrainian morgues registered with the FDA, each listing Tutogen’s German phone number on its registration forms. Since 2002, BioImplant and Tutogen have collectively exported to the United States 1,307 shipments of tissue – mostly bone, skin and fascia sent from Germany.
Families in Kiev first began complaining to police in 2005 that a morgue that was supplying Tutogen’s needs was taking tissue without proper consent. the criminal case was closed after an initial investigation. Prosecutors determined that, under Ukrainian law, they couldn’t prove a crime had been committed if they couldn’t prove that the tissue had been transplanted into someone, court records show.
Three years later Ukrainian police investigated another Tutogen supplier – this time in central Krivoy Rog. those charges were dropped after the director of the morgue died while the jury deliberated in his criminal trial. then in February of this year, police raided the Nikolaev morgue in southern Ukraine.
Some families claimed they were tricked, pressured or threatened into consenting. Police said in some cases signatures had been forged.
Aleschenko has reportedly slipped out of Ukraine for his native Russia. the Ministry will not respond to questions about his whereabouts.
Roman Hitchev, the founder of a major Bulgarian tissue bank and now president-elect of the European Association of Tissue Banks, said he was invited to Ukraine a few years ago at the request of the regional government in Odessa. Officials wanted to operate a bank similar to that of Tutogen suppliers in Kiev. Hitchev said he left, unconvinced.
“They didn’t have legal infrastructure, laws. Regulations were insufficient,” he said. “There was too much vagueness, too much uncertainty concerning who’s responsible in terms of control, traceability. I don’t like what I saw, and I just walked away.”
The market for fresh bodies in former Soviet republics was alluring enough that even Michael Mastromarino – the New York dental surgeon turned body broker – tried to get in on the action.
He had connections in Kyrgyzstan. He flew there to meet with a top prison official. the official wined and dined him, Mastromarino said, and promised to sell him the bodies of executed inmates.
Mastromarino went home, energized at the prospects for new supply and revenue streams. He asked the FDA about importing tissue from the country.
The FDA was concerned about the risk that tissues harvested from Kyrgyzstan might carry Creutzfeldt-Jakob disease, a fatal neurological disease akin to mad Cow disease.
It gave Mastromarino an answer he didn’t want to hear: “No.”
So he had to be satisfied with his domestic sources of bodies. For a time, that was fine. Business was good, and he managed to avoid too much scrutiny from his buyers or regulators.
During audits of Mastromarino’s company by the FDA and RTI, no one tried to verify whether consents obtained from donors’ families were legitimate. Consents were often marked as having been taken by phone. U.S. law requires telephone consents be recorded, but no one double-checked to see if he was actually recording the telephone consents – or even getting them at all.
A Pennsylvania grand jury later condemned the entire inspection process. “If the lies in the records claimed compliance with regulations, that apparently was sufficient,” its 2007 findings read.
Even as Mastromarino’s company was passing inspections and booking profits, outsiders raised concerns about his business practices. Maryann Carroll, director of the New Jersey association of funeral directors, complained to RTI that Mastromarino was approaching funeral homes using RTI letterhead.
“Maryann feels like this reimbursement is excessive and looks like he’s buying donors,” an RTI employee wrote executives, according to undated correspondence detailed in court records. “She claims that if the press gets ahold of this story and slams the donation, then RTI will be dragged into this and her association will state that this is the second time that we were notified and did nothing.”
RTI’s nonprofit Donor Services unit signed a new contract with Mastromarino in June 2005.
RTI didn’t know at the time it signed the new contact, the company later said, that criminal investigators had begun looking into Mastromarino’s operations.
RTI wasn’t the only big company wanting to do business with Mastromarino.
In August 2005, LifeCell Corporation, a provider of skin grafts for burns, plastic surgery and bladder slings among other procedures, invited Mastromarino to its headquarters in New Jersey. it told him it could pay close to $10,000 per body if he could supply the skin from at least 400 donors a year, according to a copy of the presentation. That could have been worth millions of dollars a year to Mastromarino.
Two weeks after making its pitch, LifeCell received a letter from the Brooklyn District Attorney. Police in New York had been investigating Mastromarino’s body-stealing ring for months, after discovering forged consent forms at a Brooklyn funeral home. the DA asked LifeCell to forward any information it had relating to Mastromarino’s firm.
LifeCell did not respond to specific questions posed by ICIJ. In a statement the company said “It was LifeCell’s extensive donor review process that detected irregularities with Biomedical Tissue Services consent documents in September 2005.”
On Sept. 28 – three weeks after prosecutors asked for LifeCell’s records – Dr. Michael Bauer was clearing donor charts for LifeCell. He had always handled the donors provided by Mastromarino’s firm. but he had never tried to independently verify information. He was unaware, he later said, of the ongoing police investigation, but that night something made him do what he’d never done before. He tried calling the number for one of the physicians listed in a donor file.
He got a pizza parlor instead.
In the scandal that followed, LifeCell, RTI, Tutogen, Lost Mountain Tissue Bank and Central Texas Blood and Tissue recalled a total of 25,000 products – 2,000 of which had been sold overseas to Australia, South Korea, Turkey, Switzerland and other countries.
Live fast, die early
An x-ray of an exhumed body stripped of body parts with PVC pipe in place of leg bones.Mastromarino’s case brought a spate of bad publicity to the industry. the unwelcome attention flared up again in August 2006, when a similar case broke in North Carolina.
Phillip Guyett had been working in the tissue industry for more than a decade, starting in California, then branching out to Nevada and, eventually, North Carolina.
Along the way, Guyett discovered that the best way to find young, healthy corpses was by trolling county morgues and funeral homes in lower-income locales with high crime rates, or by targeting cities like Las Vegas, where young people act stupid and die early.
Like Mastromarino, Guyett smoothed the process of selling off body parts with creative record keeping. He forged information on donor files, in one case selling hepatitis-infected tissue with a clean vial of blood from a different corpse.
“It’s ridiculous. I should never have been able to start a recovery business,” he told ICIJ in a recent interview in prison.
“I submitted the form online and in three days I was an official recovery tissue bank registered with the FDA,” he says is a book written about his career. “It’s harder to sell a hot dog on the street than it was to recover transplant tissue.”
Guyett pleaded guilty to three counts of fraud and is serving eight years in a federal prison.
The Mastromarino and Guyett cases prompted U.S. Senator Charles Schumer, a New York Democrat, to push legislation to help rein in the tissue-processing industry. the proposal would have required that new tissue banks meet minimum standards and undergo regular inspections by the FDA. it would also have required the federal government to define “reasonable” fees – a change companies tell shareholders could endanger future revenue.
His bill died because of hard lobbying by the industry, Schumer said. “They said it wasn’t needed. they said that ‘Everything is under control,’ but I had real doubts,” he recalled. “The bottom line here is, what we saw happen in the Brooklyn funeral home could well be happening in lots of other places both here and abroad, and there’s no real protection.”
“Nothing is going to change,” he said. “There are too many people making too much money.”
Pointing the finger
After pleading guilty to avoid a possible 8,673-year prison sentence at trial, Mastromarino told prosecutors that his buyers – RTI, Tutogen and LifeCell – were not simple victims of his crimes. “Just look at how it works,” he told them.
Prosecutors said they didn’t find evidence to corroborate his claims. but families of the desecrated dead are now pressing civil charges accusing RTI of negligence – “not so much exactly what they knew, but what they should have known,” plaintiffs’ lawyers explained to the judge during the lawsuit’s pre-trial combat.
If the case does make it to trial, as scheduled, in October, Mastromarino’s story is expected to be a centerpiece of the plaintiffs’ evidence.
Important enough to the plaintiffs’ case, in fact, that lawyers for RTI Biologics fought to have his testimony thrown out. Mastromarino had already pleaded guilty to defrauding RTI and Tutogen, attorney Nancy Ledy-Gurren told Judge Maltese. He can’t turn around and point the finger at them now, she said.
Judge Maltese disagreed.
“You basically want to muzzle Mastromarino from saying anything that involves what your clients said to him – that dialogue that raises the specter of ‘What did they know and when did they know it?’” the judge told the company’s lawyers during hearings last fall.
In the judge’s view, just because the district attorney never prosecuted the executives from the bigger companies doesn’t necessarily mean they didn’t “participate in an enterprise.”
At the least, the judge said, the victims’ families have a right to argue: “They should have known. I mean, how could they be so naive?”
This story was co-reported by National Public Radio (USA).
TOMORROW: Traceability Elusive in Global Trade of Human Parts; Abusing the ‘Gift’ of Tissue Donation
Contributors to this story: Thomas Maier and Mar Cabra
About this project:
Skin And Bone: the shadowy Trade In Human Body Parts is an eight-month project by the International Consortium of Investigative Journalists (ICIJ), a global network of reporters who collaborate on in-depth investigative stories that cross national boundaries
ICIJ found the business of recycling dead humans has grown so large over the past decade that you can buy stock in publicly traded companies that rely on corpses for their raw materials.
Skin and bones donated by relatives of the dead are turned into everything from bladder slings to surgical screws to material used in dentistry or plastic surgery.
Distributors of the merchandise can be found in much of the world. Some are subsidiaries of billion-dollar multinational medical corporations.
ICIJ discovered that patients aren’t always told that the product they are getting originated from a corpse. this led to a more complex issue – how does the industry source the raw material it uses in its products?
The ICIJ’s investigation relied on more than 200 interviews with industry insiders, government officials, surgeons, lawyers, ethicists and convicted felons, as well as thousands of court documents, regulatory reports, criminal investigation findings, corporate records and internal company memos.
ICIJ also conducted analysis on registered tissue banks, imports, inspections, adverse events, and deviation reports filed with the Food and Drug Administration, the US agency that polices the trade. ICIJ obtained the data through records requests to the FDA.
Palantir donated the use of software and assisted reporters in analyzing and visualizing data, as well as provided interactive and still graphics for ICIJ and partner publications.
The project was unveiled at the Google Ideas INFO Summit.
Reconstructive plastic surgery has a lot of benefits despite being viewed as a purely aesthetic oriented aspect of medicine. these benefits are not wholly focused on augmentation or aesthetics; they can truly be beneficial for the patient.
Breasts: these body parts are among the most reconstructed parts of the body. although many people think that breast augmentation is solely focused on aesthetics, this reconstructive procedure is often used to restore form and function to a woman. Many women suffer from breast cancer and other conditions that may require them to have an operation done to remove them. When the initial condition or disease is resolved, another operation may be performed to augment the area and restore the form and some of the function of the breasts. The woman will have the appearance of having two mammary glands and her clothes will appear as such. even the appearance of a new nipple and areola may be reconstructed through grafting and the application of a tattoo. unfortunately, not all function will be restored, especially those pertaining to breastfeeding in many cases.
Cleft Palate Reconstruction and Cleft Lip: both a cleft lip and a cleft palate can be corrected and remedied at some degree with the use of reconstructive plastic surgery. While extreme cases are often handled by surgeons who specialize in such operations, simple cleft lip operations can be performed by a plastic surgeon. The procedure for such operations is to wait for an ideal age before subjecting the child to it. The cleft lip is usually tackled first before the cleft palate. in almost all cases, the reconstruction of both cleft lip and cleft palate may require several operations. Not all procedures may have the desired effect or there may still be some semblance to a cleft lip for some individuals.
Facial Surgeries: there are many different types of operations focused on the face. The cleft lip and cleft palate ones are included in these. One other type that some consider as plastic surgery is the rhinoplasty. This procedure is focused on the nose and is usually aimed at improving a person’s appearance by altering the nose. on the other hand, reconstructive plastic surgery on the nose can also be beneficial by freeing the individual from chronic snoring by removing blockages, easing breathing, improving a person’s voice and helping with the sinuses. other facial surgeries can include ear surgeries and scar tissue surgery for those who suffered from skin disease, acne and other trauma on the face.
Cosmetic plastic surgery is the surgical technique of correcting or restoring body parts and their functions. The word plastic arises from the Greek expression plastikos, which means ‘to mold’. Plastic surgery additionally involves molding or perhaps shaping the body functions and parts, because of enhancing the appearance of your individual or for restoring a deformed body part and its functions. Appropriately plastic surgery is grouped into two major fields, cosmetic surgery regarding enhancing looks and beauty, and reconstructive surgical procedure, which is carried out when considering restoration of broken body parts.
Reconstructive plastic cosmetic surgery is mainly performed regarding severe burns, accidents, congenital and developmental abnormalities of organs, infections or diseases and for cancer or tumor removal. A brief history of plastic surgery, specifically reconstructive purposes, goes to 2000 Bc, India. Today, we now have witnessed an increase in very good of plastic surgery, generally for cosmetic purposes. No doubt plastic surgery can effectively reshape the body parts to give you a beautiful and young seem, free of wrinkles along with scars and thus boost your morale. nevertheless, several bad or negative effects may also be associated with the process, which can vary from financial to physical and psychological effects.
Bad Effects of Plastic Surgery
Plastic surgery is an extremely expensive method, , involving skin grafting. It can placed tremendous financial pressure on you and your family. even though accessing the cost of plastic cosmetic surgery, people often often take into account the cost of the particular surgery only, and also completely overlook the unexpected cost that can happen from postoperative complications. Individuals also forget to take into consideration the cost of postoperative medications, which in turn can’t be avoided, as it can certainly result in further difficulties. In all, plastic surgery is a costly and complicated affair and considerable treatment and precautions have to be followed after this medical procedures.
Plastic surgery involves numerous surgical risks such as pain, infections, allergies, nausea and vomiting, which are commonly associated with any kind of surgery. Along with these, drug effect, implant rejection, skin tones, blood clots, skin necrosis and also nerve damage on the particular area are some of common bad outcomes of plastic surgery that may bring about many complications. The procedure may produce further risks for cigarette smokers, as they are more likely to confront problems like postpone in healing injuries, increased risk of an infection, bruising, scarring and also pulmonary problems.
Plastic surgery isn’t only used for vanity purposes. in fact, it has been used to save a lot of people from physical injury. in places like Manhattan, there are a lot of accidents, such as car accidents. apart from the broken bones, people actually get their faces and body parts totally wrecked in these predicaments. thanks to plastic surgery in Manhattan, victims of these accidents will be able to recover, both physically and emotionally.
If you look back, grave car accidents and similar situations can cause faces to be disfigured. Not only bones, but ears, nose or teeth can possibly be affected. Some even arise from the accident, possessing a face that is unrecognizable. with the trauma combined with this terrible ordeal, patients’ lives will change. Some don’t even recover.
In Manhattan, a number of people fall into the hands of accidents. Car accidents aren’t the only cause. Others include being a victim in car theft, getting beat up, falling and many others. with this, numerous people are rushed to the hospital every day. Thankfully, reconstructive surgery can save the day.
Thanks to today’s technology, it’s not difficult for plastic surgeons to recapture your old look. although there might be some changes, they will still be able to minimize the damage done from the accidents. Cosmetic dentistry and rhinoplasty, to name a few, are some of the procedures that a patient can undergo after a horrible accident.
If you know someone who’s undergone a similar situation and are worried about the money, you should tell them that if they discuss this with their insurance agent, they will be able to obtain financial aid. Majority of the people who undergo surgery do not really pay for a hundred percent of the bills. in addition to this, some doctors actually allow a different payment scheme, depending on the situation.
Remember, however, that not all surgeons are reliable. Before opting for this, you should definitely look up the doctors practicing plastic surgery in Manhattan.
Cleft/lip palate, crushed bones, scars from burns, flattened breasts due to mastectomy, and birth deformities of body parts. these are just some of the problems treated using reconstructive surgery or corrective surgery, a special type of surgery that restores abnormal structures of the body.
The role of cosmetic surgery is mainly to enhance appearance and boost self-esteem by reshaping normal body parts and is not usually covered by medical insurance. Reconstructive surgery, on the other hand, is performed to correct abnormal structures of the body that were the result of developmental abnormalities, congenital defects, disease or infection, and trauma, and is usually covered by health insurance. the main purpose of reconstructive surgery is to improve function. although aesthetics is also one of the considerations.
Reconstructive surgery is performed by a plastic surgeon, a doctor who had studied specialist
surgery for a number of years and is qualified to perform invasive surgical procedures. In Australia, for instance, doctors who finished a bachelor in medicine or bachelor of surgery degree, cannot be called plastic surgeons.
Plastic surgeons are qualified to perform both cosmetic surgery and reconstructive surgery. Aside from those already mentioned above, other medical issues that may require reconstructive surgery are the following:
for men and women
after accidents or trauma
Tumor or skin cancer removal
Finger or limb reconstruction or reattachment
Knee or elbow reconstruction following injuries sustained during sports
If you are looking to have reconstructive surgery, choosing a qualified plastic surgeon is crucial. the best way you can do this is to make sure that the plastic surgeon in question is a member of a professional organisation. these professional societies have strict code of ethics and qualification standards that members abide by. the members of these organisations also only perform reconstructive surgery or cosmetic surgery in accredited medical facilities.
In the United States, they have the American Society of Plastic Surgeons (ASPS) whose members have completed at least five years surgical training with a minimum of two years in plastic surgery (cosmetic surgery and reconstructive surgery). Canada has the Royal College of Physicians and Surgeons of Canada, Quebec Association of Specialists in Plastic and Aesthetic Surgery, Canadian Society for Aesthetic (Cosmetic) Plastic Surgery, and the Canadian Society of Plastic Surgeons.
In the United Kingdom, one of the main organisations for plastic surgeons is the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS). Topnotch Australian plastic surgeons are members of the Royal Australian College of Surgeons (FRACS) or equivalent. FRACS membership is the standard qualification requirement before an Australian plastic surgeon can perform plastic and reconstructive surgery in private and public hospitals.
Dr Bradley Medling is a Plastic Surgeon in Nashville, TN providing a range of Surgery procedures. for more information visit .
For some of us, achieving the ideal body through diet and exercise alone just doesn’t seem possible. Thankfully, there a number of cosmetic surgery procedures that we can pursue in order to get the body shape and tone that makes us look and feel our best. But perfection comes at a cost. Read on to learn more about determining the costs involved for getting cosmetic body shaping procedures, such as liposuction and tummy tucks.
The cost of plastic surgery varies greatly depending upon the type of procedure you’re getting, where you live, the qualifications of the surgeon, and whether or not you can rely upon your medical insurance to pay for some of the expense. the good thing is that there are cosmetic surgery loans and financing available that can help you get the body of your dreams without having to spend a fortune. But before you get to that part of the process, here are some guidelines and general estimates for how much a liposuction or tummy tuck procedure might cost you.
In terms of liposuction, which is the procedure where excess fat is removed from underneath the skin, prices will vary based upon the body parts were the procedure will be focused. for example, breast liposuction typically runs between $3000-$7500. To have this procedure done your thighs can run anywhere between $2000-$5000. And when it comes to the abdomen – which is by far and away the most popular place to get liposuction done – you’re looking at a cost of around $3000-$7500.
An abdominoplasty (more commonly known as a tummy tuck), will have a wider price range attached to it, because this kind of surgery is very specific to your current body type, and the type of contouring and shaping you’re interested in. This is because a tummy tuck not only removes excess fat, but skin is also removed, which adds an extra layer of possible complications of surgery. Tummy tuck prices typically range between $3000-$8000, but again, much of this estimate will be based upon your unique body type and the specifications that you and your doctor make when it comes to the actual body contouring.
It’s also important to keep in mind that if you live in a city where there’s a higher demand for plastic surgery, such as places like new York City or Los Angeles, your costs will potentially raise significantly. So consider consulting with a plastic surgeon in a smaller town before committing to any cosmetic surgery procedures.
Genetics can sometimes be cruel. For various reasons, some people’s DNA gets jumbled in the womb, making for awkward and disfigured body parts. two of the most common congenital defects include cleft palates and lips. Fortunately, modern science and medicine has made it possible to correct many cosmetic and physical congenital defects by means of plastic surgery.
Cleft lips and palates occur in roughly one out of every 800 births. A cleft lip means that the right and left sides of the lip have not grown together as they should. In some cases, it can look like a whole piece of skin is simply missing right below one of the nostrils to the bottom of the upper lip. There can even be cleft on both sides of the lip in severe cases. A cleft palate is when the roof of the mouth has not fully grown together, leaving a space or whole at the back of the palate. both of these conditions can cause serious problems for people in childhood and adulthood if not corrected. they may have a difficult time eating most foods, learning how to speak properly and they may contract frequent ear infections and other illnesses.
In order to fix a cleft lip, children must be at least two and a half to three months old. A plastic surgeon will manually pull and stitch the skin together like the DNA should have done in the first place. the cosmetic surgeon makes a cut on either side of the cleft reaching up into the nostril. the skin and muscle is then stretched together and sown up in the cosmetic surgery to create one uniform piece of skin across the upper lip.
For those with cleft palates, the plastic surgery is much more complex and extensive. Most plastic surgeons will wait until a child is at least nine or ten months old before attempting the surgery. the procedure involves cutting the tissue on either side of the cleft separation. the surgeon then brings the tissue and muscle from both sides together and sutures them in place.
Recovery from both procedures involves pain and soreness at the plastic surgery sites. the cosmetic surgeon will provide the patient with a prescription for pain managing medication that should deaden the pain during the healing process. If the procedure is performed on a child, the doctor may require the use of elbow restraints to refrain the young one from creating more pain by rubbing or scratching the repaired areas. After cleft lip surgery, the cosmetic surgeon will instruct you to remove the bandages after a day or two. the stitches will either dissolve or the doctor will pull them out after several days. After cleft palate surgery, the patient may not be able to eat normal foods or comfortably drink on his or her own, so many will have to be fed with intravenous tubes for the first couple days.
Even though surgery always comes with risks and the recovery is never fun, it is amazing what cosmetic surgery and plastic surgery can accomplish for those with cleft lips and palates. In many cases, their scars will fade to be almost imperceptible and they may learn to speak just as clearly as the any other person. Modern plastic surgery has made it possible for those born with lip and palate deformities to lead normal, unaffected lives
Here is a “sun screen” check list to “apply” at all times. Stay away from sunbathing between 10 a.m. and 2 p.m.? Check! Wear your sunscreen? Check! Look for moles and watch for changes in their composition? Check! get your moles checked regularly? What? please get them checked if they change color and shape. always.
Not all moles are cancerous, of course. and most will not turn into anything to worry about, but it is still wise to have your body checked for moles, during a physical. there may be one or two that we can’t see; and it is best to have them professionally checked, periodically – and to have those that are found, monitored. of course, there are those of us who don’t see any point in keeping a mole around … for ANY reason. we are not emotionally attached to them. They do not enhance our features in any way. They do have the capability of rubbing on clothing or other body parts and causing discomfort. and they could, potentially, ‘go bad’ at some point. So why keep them around?
If you have a similar outlook on moles – have your family doctor or dermatologist locate all of them and give you a ‘Mole Map’ that you can take to a qualified plastic surgeon or mole removal specialist to discuss their removal. if the moles are in places that will never see the light of day, or are very tiny and can be removed by freezing or cauterization (burning) – your family doctor may be able to do them. But, if they are in a place where you could potentially have a small scar (especially on the face, neck, lower arm, leg or hands) – it is best to consult with a plastic surgeon about excision, and have a professional oversee the process, so as to minimize any scarring. and even if they look harmless, a good doctor will always insist upon sending them in to be biopsied – to make absolutely certain that they are benign. you are now mole-free and worry-free. Check!
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This is the second installment of a four-part series.
