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Doctoring the Web 

A plastic surgeon has positive online reviews. But not from that patient who died.

Wednesday, Sep 15 2010
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"Finally I have found a good plastic surgeon!...She did a great job fixing other doctors [sic] mistakes," one reviewer wrote. "She actually operated on the right parts, what a refreshing change...She cares about doing a good job for the patient, not about her ego, unlike many of the male plastic surgeons. She is very sweet, knowledgeable...highly recommended!"

The next two reviews both complimented Rajagopal's artistry. "The Best in the Buisness [sic]!" one claimed. "Treats patients with care, comfort, and knowledge. Performs outstanding, if not miraclulous [sic], work and has a superior artistic side which helps to perfect a patients [sic] aesthetic desires."

When brought to Swapceinski's attention, the last one struck him as phony. "Sounds like ballot stuffing," he says. "I am going to remove it."

There's no way to know whether those reviews were written by real patients, yet they are available to a very large number of readers. Swapceinski says his site gets about 1.1 million visitors per month, and has been growing between 50 and 100 percent each year since it was started in 2004.

Although Swapceinski and his colleagues have considered a variety of methods to keep reviewers honest, he says many were flawed. Requiring users to log in means only that they can do so by creating a throwaway Yahoo or Gmail address, which can be done in two minutes. Still, if a doctor ends up with a total of 25 or more ratings — which is considered "suspicious activity" on the site — users who want to rate that doctor are forced to log in.

Also suspicious: when the rating is written in technical language or discusses things patients wouldn't normally know, like the doctor's education, attendance at the latest conferences, number of procedures he or she has done, etc. Some reviews read just like ad copy.

"It's so blatant sometimes," Swapceinski says. "I can look at the domain name of the IP address, and it will actually have a static IP with the doctor's office name right in it." Although he sometimes wonders whether the patient rated the doctor while still at the office, he knows something is up when three reviews under different names appear from the doc's office in a matter of five minutes. "That doesn't look believable," he says.

Despite how obvious the fakery may seem to be, it's nearly impossible to prove who's behind it. That's one reason the agencies in place to prevent fraudulent medical advertising — the Federal Trade Commission, state medical boards, and state attorney generals' offices — have seen very few of these kinds of cases.

California's medical board hasn't handled anything like the Lifestyle Lift case, according to spokeswoman Debbie Nelson. "We don't receive many complaints regarding false advertising," she says. "But of the ones we do receive, many are physicians complaining about other physicians."

Similarly, the state attorney general's office has not pursued cases tied to medical astroturfing, according to spokesman Evan Westrup. "If people are aware of these practices occurring in California, we encourage them to file a complaint with our office," he says.

Mitchell Katz, a spokesman for the FTC, said his agency hasn't handled any of these cases either. He noted that it might be difficult to prove that advertising was unfair or deceptive if the identity of the person who posted it was unknown. Still, he says, "If you feel you have information about a person misrepresenting on the web ... report that to the FTC. That could be a deceptive act in commerce."

Katz's advice to consumers is to be wary of what they read, "especially when it comes to the web."


There are places on the Internet where reliable information about doctors can be found. Those are the websites of state medical boards. A visit to the Medical Board of California's website and a search for Usha Rajagopal turns up some disturbing information. According to medical board documents, Rajagopal is on probation for making mistakes that put Nooria Aminy in a "vegetative comatose state."

Starting around 2000, the 35-year-old Aminy had visited Rajagopal's office more than 10 times, according to the documents. Most of her procedures involved collagen and Botox injections. But on June 7, 2005, Aminy was scheduled for a surgery that would involve transferring fat from her stomach into her forehead. Apparently, after a brow lift that Rajagopal had performed, Aminy's forehead had been creasing between her eyebrows.

According to medical board documents, the first mistake Rajagopal made was to "advise the patient to eat on the morning of surgery, complicating her risks of nausea/vomiting, and respiratory arrest." This is important during a surgery where the patient is given narcotics to alleviate pain.

Numerous drugs were used in Aminy's procedure, including lidocaine. The drug is described in the medical board documents as "a known cardiotoxin." The documents also indicate that Rajagopal mixed four times too much lidocaine into a solution that was one-third of the usual volume, and she mixed that solution in a basin rather than the standard bag.

After Rajagopal injected the concentrated solution into the patient's stomach, Aminy got sick. "I feel like throwing up," she told the doctor. Rajagopal put ice packs on Aminy's face and neck as the patient dry heaved. No nurse or anesthesiologist was present, and nobody was monitoring Aminy's vital signs. "This failure prevented early detection of an adverse effect of the narcotics," the medical board documents reported.

When Aminy stopped talking and slipped into unconsciousness, Rajagopal requested a nurse. Then she told someone to call 911. When Aminy's vitals were finally recorded again, it became clear that her blood pressure had dropped and she wasn't getting enough oxygen.

When the paramedics arrived, Aminy's heart was slowing down. They used the defibrillator, but by the time she arrived at the hospital, she was comatose. The medical board documents say she sustained a severe anoxic brain injury, and would spend the rest of her life unconscious with a feeding tube.

About The Author

Ashley Harrell

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