Mundstock kept in shape by jogging five miles a day, but she had never liked her thighs. Her 5-foot-4-inch, pear-shaped body had always had a tendency to gain weight. Mundstock wondered if liposuction could even her out. She clipped the column and put it in her dresser drawer, pulling it out every few days to read again. After a couple of months, she made an appointment with Dr. Eric Swanson, a plastic surgeon who owned the advertised clinic.
"I thought any doctor that wrote for that column must be pretty good," Mundstock says now. "It said 'Ask the Experts.'" She decided to let him take a few years off of her face, as well as fat from her thighs.
Ten months later, on Halloween 1995, Mundstock would no longer consider Swanson much of an expert. When she swung open the front door to drop candy into the bags of costumed children, Mundstock was the scary one.
"Ooooh, cool face, lady!" one boy exclaimed.
"After they left, I just set the bowl outside on the porch with a note," Mundstock recalls.
Swanson is a cosmetic surgeon practicing in Leawood. He has spent the last six years battling malpractice lawsuits, bankruptcy court and the Kansas and Missouri medical boards.
This past March, Swanson asked the Kansas Board of Healing Arts to lift the restrictions it had placed on his medical license three years ago. That board denied Swanson's request. The Missouri Board of Healing Arts had disciplined the doctor in January, warning that if he ever opened an office in Missouri again, his license would immediately be subject to one year's probation. Swanson appealed that ruling.
Mundstock's case is among many the two medical boards have considered.
When she first went to Swanson's College Boulevard office in January 1995, Mundstock says, "The waiting room was packed, so I thought he must be good." She chatted with Cindy Swanson, the doctor's wife, who worked at both of Swanson's offices. Cindy Swanson reassured Mundstock that Eric Swanson was a great doctor. He'd even done procedures on her own breasts, Cindy told her.
Mundstock says the young, softspoken doctor seemed sure of himself and his surgical skills. They discussed liposuction. Then Mundstock asked him about a TCA chemical peel -- a trichloroacetic acid solution that could minimize fine wrinkles around her mouth -- which she'd read about in a brochure in the waiting room.
Swanson told her he could do the chemical peel and the liposuction in the same appointment for around $4,000. Mundstock would likely be back to work within two weeks.
After the chemical treatment, Mundstock's facial skin was supposed to crust and peel off within a week to ten days. After that, she expected, she would have beautiful, glowing skin. The change would be so subtle that people would notice she looked good, though they wouldn't know quite why.
But for months following her chemical peel, Mundstock looked as if she had suffered a hideous sunburn. Later, the burn turned into a scar like a bright red moustache and beard.
"It got worse as time went on," Mundstock says. "I quit sleeping because it hurt so much. Every day I would wake up and jump up and go look in the mirror and see if maybe [the redness] was all gone."
The redness would eventually go away on its own, Swanson assured her on several follow-up visits. He prescribed a cortisone cream and told her to be patient.
"My doctor says I'm going to heal," Mundstock told her coworkers. One flight attendant, a New Age adherent, tried to heal Mundstock, laying her hands on Mundstock's burned face and willing her into wellness Louis Hay-style, but it obviously didn't work.
"Honey, what happened to you?" passengers inquired.
Mundstock could no longer face hundreds of people each day. She took an office job with the airline and, three months after her surgery, got another opinion from a doctor her sister recommended in Toledo, Ohio.
"You're in trouble," he told her.
Mundstock returned to Leavenworth and got a third opinion from a doctor at her husband's Army base. That doctor referred her to Dr. John Searles, who was then the chief of plastic surgery at KU Medical Center's burn unit. Searles informed her that she had a hypertrophic scar -- a thick, red, raised scar -- above her lip. He fashioned a special mask that he told Mundstock she should wear night and day to help her skin heal.
The trauma took its toll. She lost weight, dropping from 130 to 106 pounds. "I couldn't eat. I couldn't sleep," Mundstock says. "When I finally would fall asleep, I'd have bizarre nightmares of being hurt."
Mundstock's husband, Jack, accompanied his masked wife to the gym and to stylish restaurants. The couple had previously enjoyed speeding along the highway in Jack's blue Mitsubishi sports car, loving the attention. Now drivers passed the flashy car and gawked at the woman wearing a mask with a metal bar poking from her mouth.
Finally, nine months after her cosmetic surgery, a few days before Halloween, Mundstock's new plastic surgeon told her she could take off the mask. She began a long series of monthly cortisone injections, and the doctor later used laser treatments on the red and broken veins around Mundstock's mouth from the painful shots.
By the time Mundstock sued Swanson in August 1996, two other women who'd had similar experiences had also filed lawsuits. A relative of a woman who had died in 1995 after Swanson performed liposuction and abdominal surgery also filed a wrongful death suit that summer.
Those would be the first of twenty medical malpractice lawsuits filed against Swanson between 1996 and 1999. Swanson has always vigorously denied the allegations that he was negligent in his patient care. In depositions, he speculated that the three women who developed hypertrophic scars and bright red or unnaturally pale splotches might have exposed themselves to the sun too soon after their chemical peels, which could be disastrous to the sensitive skin.
"There was evidence that she was a tanning-bed user," Swanson testified of one scarred woman. But the doctor could not produce that evidence -- though he testified that he'd noticed post-surgery tan lines on two of the women, he hadn't made note of that important observation anywhere in the medical records of their follow-up visits.
One of the women who sued Swanson had been a friend, close enough that she and her husband had one year shared an intimate Valentine's Day dinner at the Swansons' home. The doctor had performed eyelid surgery on the woman's husband, and the procedure had gone so well that she'd ordered a chemical peel for herself a couple of months later.
Swanson had played tennis with the woman's husband at the Indian Hills Country Club. The two couples had danced at Lyric Opera Balls and mingled at society functions. That friendship, however, would not withstand the legal battle.
The patient who died, Ruth Ann Young, had been obese, asthmatic, hypertensive and an insulin-dependent diabetic. She had hoped Swanson could fix her bulging belly.
"She started crying, and she related to me how much of a problem this was for her," Swanson testified in court records. "It wasn't just cosmetic. It was the quality of her life." At first, Swanson was reluctant to operate on the woman. He told her to come back after she'd lost twenty pounds. She returned a few months later, seventeen pounds lighter, carrying a letter from her internist clearing her for surgery.
The three-and-a-half hour surgery at North Kansas City Hospital, which included liposuction and the abdominoplasty, went poorly. After Young developed severe breathing problems, the anesthesiologist called another doctor, Dr. Steve McCray, to the operating room.
"He told me that he had asked Dr. Swanson to stop the operation ... I agreed and said to Dr. Swanson that he needed to stop and quit this foolishness because we couldn't ventilate the patient," McCray testified in depositions.
McCray described Young's abdominal wall as being "tightened to the point where all her intra-abdominal contents were forced into a different location, primarily putting great pressure on her heart and diaphragm and lungs." He testified that, in the recovery room, he had told Swanson to go back to the operating room and reverse the stomach operation, but that Swanson told him, "I am not going to do it. I am going to my office."
After Swanson left the hospital, McCray said, Young entered the intensive-care unit, where "she continued to ooze a significant amount of blood. She continued to remain acidotic. And she -- her blood pressure was not adequate. Multiple times the ICU nurses tried to call Dr. Swanson, and multiple times the house supervisor tried to call Dr. Swanson, and I tried to call Dr. Swanson. And his office nurse said that she had notified him but that he wasn't coming until he got his office taken care of."
Swanson returned later, operated again on Young's stomach and returned her to the intensive-care unit. Swanson was so concerned that he stayed overnight at the hospital. The next day, several of Young's organs failed, and she died. Swanson's insurance company settled the resulting lawsuit out of court, paying Young's relative $550,000, according to court records.
(At a later hearing prompted by complaints to the Missouri medical board, however, McCray's testimony would not be heard. The board's attorney failed to notarize McCray's affidavit, leading a judge to rule it inadmissible. In transcripts of that same hearing, however, Swanson remembered the operation much differently. "During surgery, I overheard the anesthetist talking about her ventilatory pressures, that they'd gone up during surgery," he said. "When I was doing the abdominal repair of the muscles, I asked, 'Did my [first operation] do anything to increase those pressures, and I was told no.")
Six of Swanson's lawsuits were settled out of court in 1997 and 1998. Swanson's medical-malpractice insurance company and the Kansas Health Care Stabilization Fund (a state agency funded through premiums from doctors and hospitals for extra coverage) paid more than $2 million to the plaintiffs, according to settlement agreements in the lawsuit files. Among the substantial settlements was $500,000 for Colleen Mundstock.
Swanson's medical career seemed to begin with great promise. By one account, he was almost like the TV character Doogie Howser. Born December 31, 1960, Swan Eric Swanson's late birthdate meant he was always younger than most of his schoolmates. Swanson dropped his delicate first name as a child, opting to go simply by "Eric." Swanson graduated two years early from a high school for gifted children in Toronto. After he'd completed only two years of college, Swanson started medical school at the University of Toronto in 1979.
Swanson received his medical diploma in 1983, was accepted for a one-year internship at the University of British Columbia, Vancouver, then completed his residency in plastic surgery at the University of Toronto. He finished a cosmetic-surgery fellowship in Canada before coming to the United States, where he began a six-month fellowship in reconstructive microsurgery at Southern Illinois University.
Swanson left that fellowship after only three months, however. One of his professors had yelled at the young doctor in front of his peers during a troublesome surgery, and Swanson handed in his resignation letter the next day. The caseload had been lower than he had expected, Swanson wrote; he alluded only briefly to the humiliating operating-room incident.
By June, he had accepted a position in Kansas City with Dr. Frederick McCoy, a plastic surgeon with an office near the Country Club Plaza. Court records show that McCoy fired Swanson after two years, citing personality conflicts between Swanson and one of McCoy's associates.
Swanson then shared an office with another plastic surgeon on the Plaza for the next three years. At the same time, he was director of the residency program in plastic surgery at the University of Missouri-Kansas City from 1991 to 1993 and director of the cleft-palate clinic at Children's Mercy Hospital from 1991 to 1995. Apparently, Swanson did well as a reconstructive plastic surgeon.
According to a 1994 article in The Kansas City Star, one of Swanson's patients at Children's Mercy was a boy whose arm had been mangled in a car wreck. The boy's arm had dangled by one thin artery when Swanson operated on him the first of seven times. Two years after the accident, though, the smiling boy tossed the opening pitch at a Royals game while Swanson watched from the stands.
When Swanson heard about a ten-year-old Afghan refugee who had been burned in a Soviet bomb attack, he treated the boy's fused fingers, mutilated arm and scarred face at no charge. He reconstructed a race-car driver's arm after it had been nearly torn off in a crash.
Gradually, though, Swanson moved his practice toward the more lucrative field of cosmetic surgery.
Most cosmetic surgery isn't covered by health insurance, so doctors rather than insurance companies set the fees. The procedures are costly: about $5,000 for a facelift and $3,000 for breast augmentation. Tummy tucks run between $4,000 and $5,000. A new nose costs about $3,000.
In 1994, Swanson opened two offices, one on Clay Edwards Drive, next to North Kansas City Hospital, the other on College Boulevard in Overland Park, where he specialized in cosmetic surgery. Swanson cranked up an aggressive advertising campaign for his burgeoning practice, buying ads in regional issues of Sports Illustrated, Time and Newsweek. In 1994, he began advertising in the Star.
He budgeted around $100,000 a year for Star ads. On the "Health Talk" page, he wrote question-and-answer-style ads promoting his procedures. In one "before" photograph for a 1996 ad titled "Laser Skin Resurfacing -- The New Treatment for Aging Skin," a forlorn-looking woman has craggy lines above her lip and below her eyes. The "after" photograph, however, shows a much-improved woman with a smoother face and fluffier hair.
"This treatment is now being used in patients who may be in their thirties and forties, who have wrinkles from sun exposure, who may not need a facelift," Swanson's ad copy read. But the woman in the picture -- Swanson's elderly mother -- wasn't a product solely of Swanson's laser, as the ad implied. She'd also had a facelift, in addition to other cosmetic procedures. (The Kansas medical board would later publicly censure Swanson for the misleading ad, according to medical board documents.)
Swanson's ad campaign was successful enough to attract plenty of new patients with high expectations. Eventually, that brought him another round of lawsuits, too.
As Swanson's legal troubles worked their way through the courts, depositions revealed more troubling facts about Swanson's background. Although Swanson had abandoned his microsurgery fellowship at Southern Illinois, he listed it as having been "completed" on some applications for hospital privileges.
Swanson had also touted the unfinished fellowship in the Newsweek and Sports Illustrated ads and in at least one version of his résumé. He listed a book he'd once worked on with a professor as being "in press," though no such book was ever published.
Swanson's ads claimed he was "American Board certified," but even that was misleading. Swanson was certified with the American Board of Facial Plastic and Reconstructive Surgery but not the American Board of Plastic Surgery, which is what the term "American Board certified" generally implies. Swanson applied twice to take the ABPS exams, but technicalities regarding his Canadian training meant that he would have had to spend several years repeating a second residency to even take the exams.
The ABPS is the only body within the American Board of Medical Specialties that certifies the entire range of plastic surgeries. Because Swanson wasn't certified by the ABPS, he wasn't American Board certified for liposuctions, abdominoplasties or any other plastic surgeries below the neck, according to ABPS requirements. (In June 2000, the ABFPRS revoked Swanson's certification.)
By March 1996, Swanson was seeing about a hundred patients a week.
Since 1992, the number of Americans receiving cosmetic surgery has tripled. As the techniques grew more advanced and accessible, patients' expectations rose. At the same time, plastic surgeons began to notice more clients who seemed to have unrealistic ideas about what their bodies could become. For some men and women, cosmetic surgery is an attempt at a quick fix for deeper psychological problems. Those who suffer from "body dysmorphic disorder" may go from surgeon to surgeon, hoping first that a new nose will bring happiness. When that doesn't help, it's on to new breasts.
In 1999, a doctor presented a study at a plastic-surgery conference, claiming that patients who sought facial plastic surgery were more likely to have personality disorders than the rest of the population. "Some groups are at high risk of being discontent and being involved in a lawsuit," warned the study's author, Dr. Henri Gaboriau.
Even as Swanson settled his first batch of lawsuits in 1998, a second wave of dissatisfied patients were taking their cases to malpractice attorneys.
One patient, who asked that the Pitch not use her real name, had gone to Swanson for a consultation in 1996. "Renée" had been interested in liposuction to remove fat from her knees, hips and stomach; laser resurfacing to minimize wrinkles around her eyes and mouth; surgery to smooth bags beneath her eyes; and an inner-thigh lift to tighten the loose skin on her thighs.
Those procedures would have cost about $11,000 if they'd been done separately, but in depositions, Swanson said he quoted Renée a fee of about $8,000 if she combined them all in one treatment. Renée went ahead with the surgery, and on every follow-up visit she had complaints.
She didn't think the incision Swanson had made in the crease between her leg and groin was healing properly. At one point, she thought her eyelid was infected. Something wasn't right, Renée told Swanson. Her genitals hurt, as if one side were being pulled. She found it difficult to sit. After a couple of months, Renée was inconsolable, according to depositions.
"I'm deformed," Renée told Swanson, adding that she looked like the bride of Frankenstein. Swanson offered to do a revision on the inner-thigh incision, but Renée refused to go back. In court records, Swanson told Renée's attorney that her expectations hadn't been realistic. "She brought a magazine with her at one of her postoperative visits and showed me pictures of young models with slender legs and asked me why she didn't look like those models," Swanson said.
Two years later, in 1998, Renée filed a malpractice lawsuit -- one of four malpractice suits filed against Swanson that year -- alleging that Swanson's work had caused terrible deformities to her entire vaginal area and that she had suffered incredible pain and gynecological problems. Renée, whose lawsuit is pending, would not comment on her case.
But lawsuits didn't prevent Swanson from expanding his practice. That year, he built a $3.45 million "state-of-the-art surgical center" a block from Town Center Plaza in Leawood.
By all appearances, Swanson seemed to be a wealthy man. He and his wife owned two $1.5 million homes -- one in Briarcliff West in North Kansas City and the other in Naples, Florida. The doctor drove a leased Mercedes.
But in September 1999, Swanson filed for Chapter 7 bankruptcy. At the time, his credit-card debts exceeded $60,000, and court documents indicate Swanson was more than $4.9 million in debt to other creditors. He owed $79,000 to the Star and $88,000 to Southwestern Bell Yellow Pages.
Six months before his bankruptcy filing, Swanson and his wife had moved from their $1.5 million home in North Kansas City to a $1,000-a-month Leawood apartment. A bankruptcy trustee later sold the house for $950,000.
Swanson persevered. In December 2000, a limited liability corporation, Surgery Center of Leawood, headed by an ophthalmologist named Dr. Joseph Simone, bought Swanson's building for $2.7 million and leased it back to the financially troubled doctor.
Swanson's bankruptcy brought him a reprieve from the eleven lawsuits still pending against him. Those suits cannot proceed until a judge lifts a bankruptcy stay imposed by the court.
In January 1999, the Kansas Board of Healing Arts decided that there were reasonable "grounds to revoke, suspend or otherwise limit Swanson's medical license."
There was the patient who had died. There were three women who had developed scars after their chemical peels. There was Renée, who claimed that her genitals were deformed. Among the twenty counts against Swanson, one alleged that he had intentionally altered medical records. And another questioned his advertising claim that he was American Board certified.
The Kansas medical board is a fifteen-member body, made up mostly of physicians, whose mission is to "utilize the least restrictive yet effective means to protect the public from incompetence, unprofessional conduct or other proscribed practice." After two board committees reviewed his case, Swanson, his lawyer and the board's attorneys drew up a settlement agreement in lieu of a hearing -- thus avoiding testimony by Swanson's former patients and expert witnesses on his competence as a physician.
There was no hearing on whether the complaints were valid, says Lawrence Buening, executive director for the Kansas Board of Healing Arts. Swanson agreed to only three of the counts against him: for negligence in two of the chemical face peels (Mundstock's complaint was not one of them) and for writing an incorrect prescription. The other seventeen counts were dismissed without further investigation. Swanson was ordered to pay the board $40,000 to cover legal fees.
The board banned him from performing TCA chemical peels, as well as liposuction on morbidly obese patients. He couldn't perform liposuction, abdominoplasty and thigh lifts on a single patient in one operation. His practice would be monitored by an appointed physician through October 2001.
Swanson signed an agreement admitting negligence on the three counts in return for having the other seventeen dropped. Such agreements are "very common," says Buening. He characterizes a doctor's agreement with the board as similar to an out-of-court settlement in a civil case or a plea bargain in a criminal case.
Buening says Swanson's twenty counts are "more than normal" but says the board doesn't keep statistics on the number of complaints it receives about doctors.
In June 2000, Swanson and his attorney defended his medical license in a hearing prompted by complaints to the Missouri Board of Healing Arts, which sent Swanson's case to the Missouri Administrative Hearing Commission, a state agency that rules on disputes between individuals and other state agencies. That group found cause to discipline Swanson on five counts. Two of the commission's findings of negligence were for Mundstock and Renée, whose complaints had been dropped by the Kansas medical board.
The eighteen counts in Missouri were "probably higher than usual," says Tina Steinman, executive director of the Missouri Board of Healing Arts. "Any time the board disciplines a physician, it's considered to be a serious matter."
The findings against Swanson prompted the Missouri Board of Healing Arts to warn Swanson in January that if he ever opened another office in Missouri, his license would immediately be subject to a year of probation. (This would be in addition to the seven years' probation the board had already imposed on his license in 1999, after his disciplinary action in Kansas.) Swanson appealed that ruling to the Cole County Circuit Court, which could still override the medical board's decision.
The Kansas medical board had mandated that an independent doctor watch over Swanson's practice through October 2001. The board allowed Swanson to keep performing certain surgeries for which he'd been disciplined, though he had to hand over medical charts for 20 percent of those patients. But in March of this year, when that board denied Swanson's motion to end the limitations on his license, it said Swanson had submitted only one or two medical charts a month during the last three years -- far less than 20 percent. The board decided not to lift the restrictions on Swanson's license.
Swanson is not the only one living with restrictions. Today, Mundstock still has blotches of white scar tissue above her lip. Her thighs are bigger than ever, she says, but that's OK.
"I think I learned a big lesson," says Mundstock, who now works as a psychiatric nurse. "Just to accept myself."
Swanson declined to speak with the Pitch for this story.
Swanson hasn't had any new lawsuits filed against him since 1999, the same year the Kansas medical board restricted him from doing some of the procedures that originally landed him in legal trouble.
"[Plastic surgery] is the only specialty in medicine where the doctor can do everything right and still not have a good outcome," says Dr. Mark Gorney, a retired plastic surgeon and current medical director of the Doctors Company, the largest medical malpractice insurer in the United States. "What people don't understand is that how you scar is between you and God. It's part of your genetic package."
Gorney admits that twenty lawsuits filed against a doctor in four years is "more than the average" but says, "I don't think you can judge whether a person is competent by the number of lawsuits [filed against him or her]." A plastic surgeon can expect to have some kind of legal encounter (not necessarily a lawsuit) every two and half years, Gorney says.
Only two of the malpractice lawsuits against Swanson have actually gone to trial, and both resulted in verdicts in Swanson's favor. (One plaintiff has been granted a new trial.)
"Most medical malpractice cases are lost [by the plaintiff]," says Steve White, president of the Missouri Association of Trial Attorneys. White has tried many malpractice cases, he says, and turns down 95 percent of people who come to him hoping to file a lawsuit against a doctor.
"Some are frivolous, but most of the time the resulting damage is inconsequential when compared to the cost of prosecuting the case," says White, who adds that the simplest of cases can still run up tens of thousands of dollars in legal fees, in part because of the cost of medical experts needed to testify.
Swanson has always maintained that he warned patients up front about potential complications. At the Missouri hearing, members of his office staff backed him up. One of Swanson's nurses, Kathy Aasmundstad, told the board, "If anything, he wanted us to inform them of as much as we could. I'm never to downplay it, and we always felt as nurses we'd like to make them expect the worst. It's much easier to deal with patients who are thinking, 'This isn't nearly as bad as everybody told me,' than if they say, 'Nobody told me.'"
Court records reveal that Swanson blamed his legal and medical-board woes on envious colleagues and negative publicity, such as TV-news "Public Defenders" and "Call for Action" reports.
"I don't know anybody in this area that has done the volume that I have done," Swanson said in a deposition. "[Anybody] that's been subjected to the kind of professional animosity and jealousy that I have, that's been subjected to a news story against me, that's had very aggressive plaintiffs' attorneys going after me ... these are all factors that go into the fact that I have [so many] lawsuits.
"I feel that I'm a good doctor, and I think that it's an unfortunate reflection on things that have very little to do with the practice of cosmetic surgery," Swanson continued.
One local cosmetic surgeon, who spoke to the Pitch on the condition of anonymity, says other plastic surgeons saw their own lack of success reflected in the windows of Swanson's ostentatious office.
"That building to a lot of doctors was a sore point," he says. "Everybody wanted to have a building like that, but nobody could afford it. And his parking lot was always full."
The anonymous surgeon described his local colleagues as "a cut-throat, back-stabbing bunch" who delighted in "Swanson-bashing" sessions in hospital lounges. "When the opportunity existed to badmouth him, some plastic surgeons took the opportunity to do that instead of thinking, 'There but for the grace of God go I,'" says the doctor.
Swanson declined to allow the Pitch to interview patients who have been happy with his work. His Web site, however, includes streaming video with impassioned testimonials.
"My stomach is flat, and it's just the way that I'd always imagined it would be," says one trim woman, while the soothing strains of Pachelbel's Canon play in the background.
"It's changed my life.... It's made a huge difference," says a tearful woman who underwent rhinoplasty for a nose she had never liked.
"He's a delightful, talented, wonderful, professional man," says an elderly woman. "Anyone can turn themselves over to him and feel perfectly at ease. He's just wonderful."
Outside the Swanson Center for Cosmetic Surgery in Leawood, a bronze statue of a ballerina stands on pointed toe atop a waterless fountain. One taut leg stretches backward above her head. Toned arms stretch toward the sky, reflected in the green-tinted floor-to-ceiling windows that line the front of the building.
Inside, scented candles burn beside an arrangement of lilies. An ornate chandelier dangles from the high ceiling, and soft lighting accentuates an oil painting of a single flower. Within a thick block of frosted-glass sculpture, the face of a beautiful woman leans to kiss an equally beautiful man.
Two women await their appointments with Dr. Swanson.