'Name And Shame' Results In Lawsuit'

Facing criticism

Cosmetic surgeon sues over postings by a former patient

By Anne Barnard, Globe Staff, 9/24/2002

It's not every day that a doctor sues his patient, but Dr. Joel J. Feldman, a face-lift specialist and former board member of the American Society of Aesthetic Plastic Surgery, felt that he had no choice.

Lucille Iacovelli, a gardener from Cape Cod, had posted dozens of messages in Internet chat rooms, calling him a ''butcher.'' She posted pictures of her face, showing what she called bad results from cosmetic surgery that Feldman supervised at Massachusetts General Hospital. The last straw came in March, when a South Shore woman walked into Feldman's office at Mount Auburn Hospital, brandished Iacovelli's photographs, and canceled her surgery.

Feldman sued Iacovelli for defamation in Suffolk County Superior Court, contending she had purposely contorted her face in the photos and subjected him to ''public scandal, infamy, and disgrace.'' In May, he won a court order requiring her to remove any misleading photos or defamatory statements from the Internet; the case is pending.

Feldman v. Iacovelli is an extreme case, but it highlights sensitive issues in cosmetic surgery, where every procedure is optional, success is subjective, and patients wear the results on their faces. And it points to new anxieties in the doctor-patient relationship: When can doctors shut down criticism with legal action, and when does patient empowerment veer into harassment?

Iacovelli, 52, who lugs around an accordion file of medical journal articles on plastic surgery, said Feldman was trying to silence her after she went public with concerns she could not get addressed within medicine. She said it made sense to use a medium increasingly used both to advertise and to critique cosmetic procedures, the Internet.

''Originally, I admit, I wanted to name and shame them,'' she said of Feldman and other doctors involved in her care. ''Now I want to warn other people: This is a dangerous business. If something bad happens, you may never be able to get any answers.''

But Iacovelli's case is complex. Her surgeons suspect she suffers from a psychological disorder that distorts her view of her body and of surgical results they say are normal. Before the court order, a Suffolk County judge already had barred her from contacting Feldman or the two younger surgeons who did her face lift and nose job, Dr. Daniel N. Driscoll and Dr. Melissa R. Schneider. That ruling came after she sent letters, saying they should ''rot in hell'' and offering to mail them her severed head after her death so they could dissect it and find out what went wrong.

The dispute comes amid a push for more openness about bad medical outcomes. State medical boards, including Massachusetts', have posted more malpractice and discipline records on the Web. Nonprofit organizations rate doctors; one group, Public Citizen, compiles a list of ''Questionable Doctors.'' Patient Web sites, overflowing with chat about ''good'' and ''bad'' doctors, have proliferated, especially in cosmetic surgery, an out-of-pocket business where every doctor's livelihood depends on good reviews from patients.

But doctors fear that the information could be taken out of context, misinterpreted by laypeople, or used as a vehicle for revenge by disgruntled patients, regardless of the merits of a case.

''There has to be some outlet for patient discussion,'' said Driscoll, 38, who performed Iacovelli's face lift and worries that she will unfairly damage his Newton-based practice. ''But there's a lot of room for misrepresentation.''(You can say that again!  Like breach of informed consent, and doctors' tossing out lies to patients as medical fact, because they think patients will not know the difference.  I did.) 

At the same time, observers of cosmetic surgery say the balance of power still rests with doctors, and that it is hard for patients to get objective evaluations of surgeons' work.

Joan Kron, who writes Allure magazine's Scalpel News column and has covered cosmetic surgery for 10 years, said there is lots of biased information on such Web sites as Faceforum.com. But most of it, she suspects, is not criticism but praise, planted by doctors' office assistants or friends.

Criticism of doctors is ''even smaller than a drop in the bucket'' in the sea of promotional Web sites that helped triple the number of annual cosmetic procedures between 1997 and 2001, said Deborah Sullivan, an associate professor of sociology at Arizona State University and the author of ''Cosmetic Surgery: The Cutting Edge of Commercial Medicine in America.''

''The vast majority of media coverage of cosmetic surgery is nothing more than an infomercial,'' said Sullivan.

Between Iacovelli's Web campaign and her doctors' court filings, her medical record has become unusually public. Court records and interviews with Iacovelli, Driscoll, and Feldman paint a complex picture:

Iacovelli had two surgeries at Massachusetts General Hospital, both performed at discounted rates by surgical residents, under the supervision of senior doctors. Driscoll did the face lift in November 1997, supervised by a senior doctor who has since died; eight weeks later, Schneider did the nose job as Feldman looked on.

At first, Iacovelli was pleased; pictures show her beaming, with a smooth neck and face. Later, she grew dissatisfied. The pictures she posted on the Web, taken a year after surgery, seem to show her neck looking wrinkled again. (my note:  My neck was not sagging and "wrinkled" BEFORE the facelift; clearly visible in Dr. Driscoll's pre-op photos)

Feldman said her pose exaggerated the problems; Iacovelli denies it. Feldman says face lifts that start to sag after a year are within the spectrum of expected results, especially on patients with Iacovelli's ''stretchy skin''; (my note:  facelifts do not create unsightly sagging not present BEFORE the facelift, making the patient appear 20 years OLDER in one year.  The comment about "stretchy skin" is LUDICROUS.  Why is this so called "stretchy skin" confined ONLY to the areas undermined in the facelift?  Skin on my forehead and chin, untouched by surgery, is certainly not sagging.)  Iacovelli believes her face sagged because the second surgery came too soon after the first.

Iacovelli wanted to sue, but a lawyer told her he could not get an expert witness to back her argument. Her psychotherapist, Ted Powers of Plymouth, urged Feldman to meet with her about corrective surgery, according to a letter Iacovelli showed the Globe. But an MGH psychologist diagnosed her with body dysmorphic disorder - in which patients with an unrealistic body image seek excessive surgeries - and prescribed therapy instead. (my note:  They deceived their own therapist.  They never told her anything about my case or showed her a single pre-op photo showing the damage.    Any normal, attractive woman would be distressed at such results.  I agreed to see the MGH therapist in good faith.  They never informed me that she was a BDD specialist.  My every interaction with MGH was tainted with DECEPTION by its doctors and attorneys.)

Still, Feldman said, he almost contacted her: (Then why didn't he?)''All I wanted to do was make her happy.''(He initially denied that anything was wrong, in the single meeting I had with him in October 1998, 8 months after my rhinoplasty.  I had to wait 6 MONTHS before he finally met with me, and even this was only "granted" after written requests. ) But he pulled back when her letters became frightening. (letters written after ONE YEAR of respectful written requests to meet with him, complying to his demand that I meet with the MGH therapist, even though the initial agreement was that I go to MY OWN therapist.  Of course, they didn't like what MY therapist had to say, which was, essentially, that I was justified in my distress at their stonewalling and failure to address my concerns. After meeting with Dr. Wilhelm, the MGH BDD therapist, and realizing I had been duped (as was she) regarding the purpose of the meeting, I DID send the following note:)  ''Enjoy your [smile] while you still can,'' she wrote to all three doctors. ''It may be permanently wiped off your face when you least expect it.'' (which is EXACTLY what THEY did to ME.  They ruined my smile and made it grotesque.  That particular note began:  "A SMILE IS A PRECIOUS THING"   They ruined mine when I LEAST EXPECTED IT.  Why should they consider my remark FRIGHTENING? They DID wipe my smile off MY face", so, of what does that make THEM guilty?)
Iacovelli, who is known as The Flower Lady at a golf club in Mashpee, where she works as a gardener, says she never would have turned violent.

Barred from contacting the doctors, Iacovelli moved her campaign to the Web. And when Boston Magazine named Feldman a top surgeon, she said, she slipped her pictures into copies ''in every newsstand, in every Stop & Shop - everywhere!''

Meanwhile, she had a third surgery in Indiana, which left her face and neck looking smooth but, she says, left her with painful neurological problems. And the Mass. General doctors moved on, viewing the case as a reminder to screen their patients carefully. Their lawyer, William J. Dailey III, said they always had Iacovelli's interests at heart. ( They had one interest only.. in never admitting they did anything wrong and protection of their reputation, while they engaged in every underhanded, sleazy tactic to discredit me with their LIES)

But after a patient's daughter went online to look up Feldman's address, and found Iacovelli's photos instead, he decided to sue to defend ''my reputation and the caring that I've given to my patients.''(This woman contacted me and said she canceled her surgery with Dr. Feldman because she was  distressed at the disparaging remarks he made about me.. calling me "crazy Lucille" and worse.  She told me she didn't care if he was the best surgeon on earth.  She would never allow a doctor operate on her who displayed such disrespect for ANY patient as he did for me.) 

After the court order this summer, Iacovelli took down the chat-room postings. But the photos can still be found in a Hotmail account that anyone can access if Iacovelli gives them the user name and password.
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Anne Barnard can be reached at abarnard@globe.com.