09x08 - Bad Medicine

[bunniefuu]

Narrator: a series of medical
mix-ups left one woman dead and

Her doctor in prison for
negligent homicide.

But that wasn't the entire
story.

In a single strand of hair, a
forensic toxicologist found

Evidence of another medical
mystery -- one that made

Headlines around the world.

Hi! Say, "happy halloween!"
Ralph!

Happy halloween!

Happy halloween!

Who is that guy?

Narrator: 1997 looked like it
would be a banner year for the

Pignataro family.

Dr. Anthony pignataro had a
thriving medical practice, a

Wife, two children, and social
standing.

That's great, ralph.

Narrator: dr. Pignataro was
also an entrepreneur.

He invented and wore the snap-on
toupee, held in place by four

Bolts drilled into the skull.

He's always been different,
and he just came up with this

Idea -- I could say off the top
of his head, but...

I remember laughing about it.

It was the subject of many,
many jokes, around the family

And even when he was around.

But he was dead serious about
it.

Narrator: his medical
practice consisted primarily of

Cosmetic surgery, which he
performed in his office.

One of his patients was


Mother of two scheduled to have
breast augmentation.

Dr. Pignataro had no
anesthesiologist or registered

Nurse present.

His only assistants were his
wife and a licensed practical

Nurse.

Sarah smith was feeling pain,
so dr. Pignataro ordered a

Little bit more sodium pentathol
to dull the pain.

When he did that, her system
started shutting down and she

Was losing oxygen.

She's not breathing!

At that point he broke scrub,
and I remember him tapping her

On the chest and calling out
her name, but there was no

Answer.

And then all hell broke loose.

Narrator: sarah smith was
dead, the result of too much

Anesthesia with no
anesthesiologist to monitor her.

And there was no ventilator to
help her breathe.

I knew that things would
never be the same, once this

Happened.

Narrator: when local
prosecutors learned about the

Incident, they conducted an
investigation.

They learned that dr. Pignataro
was not a board-certified

Plastic surgeon.

In fact, he wasn't a plastic
surgeon at all.

He did train for ear, nose,
and throat, but did not finish.

So, technically, it did not make
him an ear, nose, and throat

Doctor.

He didn't finish all the things
necessary to become one.

Narrator: medical experts
told investigators that

Sarah smith would have survived
if dr. Pignataro had the proper

Resuscitation equipment.

The procedure that
sarah smith was undergoing, a

Transumbilical breast
augmentation, was a very

Invasive procedure, and should
have been done in a hospital

Setting or a certified surgical
area.

Narrator: dr. Pignataro
claimed that deaths from

Anesthesia do occasionally
happen.

Nevertheless, prosecutors
charged him with manslaughter.

To avoid a trial, he plead
guilty to criminally negligent

Homicide.

He was fined $5,000, sentenced
to six months in prison, and



He also lost his medical
license.

Although it seems hard to
imagine, the pignataro's

Problems were far from over.

Narrator: when tony pignataro
was released from prison he had

Difficulty finding a job, since
his medical license was revoked

And the terms of his parole
prevented him from leaving the

Area.

For years, he had went to
school, done residencies, he'd

Gone quite a few years to do
this, and that was taken away

From all of us.

Narrator: to make matters
worse, vandals spray-painted the

Word "k*ller" on the side of the
pignataro's home.

He claimed to have received
death threats, but he didn't

Know where they were coming
from, other than, "you're gonna

Pay for sarah smith's death."

Narrator: tony realized he
would never get his medical

License back.

The stress took its toll, and
the pignataros separated.

Her life was falling apart
after the sarah smith case.

Her husband couldn't find work.

He was probably depressed in his
own right, because he had lost

His ability to support his
family.

Narrator: a few months later,
the couple reconciled.

Tony pignataro's mother
supported them financially, or

Their situation would have been
far worse.

Anthony pignataro came from a
good family.

His father was a well-respected
and excellent surgeon in

Buffalo.

Mother was a fine person.

I guess life was handed to him
on a platter.

Narrator: after the
pignataros' reconciliation,

Debbie started to feel ill.

I had thought I had the flu
for months, just maybe a little

Case of the flu because I would
get nauseous and vomit and just

Not be myself.

Narrator: initially, neither
her husband nor her doctors knew

What to make of it.

I was having trouble walking
where I couldn't lift my legs.

There was numbness in my legs
and my hands.

I diagnosed myelodysplastic
state, possible myelodysplastic

State.

The neurologist diagnosed
possible guillain-barrz.

The gastroenterologist diagnosed
pancreatitis.

And we just -- we didn't know
how to bring it all together, so

We were all puzzled.

Narrator: tony thought
debbie's gallbladder should have

Been surgically removed, but her
doctors disagreed.

I was so weak and my
condition was so grave that I

Probably would have died on the
table, I was told.

But she got better.

And when she got better, we
relaxed and said, "well, this

Isn't going to happen again."

Narrator: but debbie's
symptoms returned again and

Again.

The pain was getting worse.

Even more disturbing, her
daughter started to experience

The same symptoms, but not
nearly as severe.

Throughout that summer,
debbie's condition deteriorated.

She had severe memory loss and
was relegated to a wheelchair

Because she was no longer able
to walk.

Once again, she was admitted to
the hospital.

This time, dr. Snyderman
analyzed a sample of debbie's

Bone marrow under a microscope.

I looked once, I looked
twice, and I couldn't believe my

Eyes.

It looked like something that I
remembered reading about in

Medical school.

Narrator: debbie's red blood
cells had degenerated, a

Condition known as keriorexsis.

I ran down to the library and
I got out a book on toxicology

And I also went on to something
called "medline," on the

Computer.

Narrator: the medical
literature described some

Possible causes.

When her doctor factored in her
other symptoms -- numbness of

Her hands and legs,
disorientation and nausea -- the

Answer became clear.

I was able to complete the
description of arsenic in my

Mind, and it fit her perfectly.

Narrator: arsenic is a
heavy-metal poison, and not one

You normally encounter.

Further testing indicated debbie
had a arsenic level of 29,580

Micrograms per liter, one of the
highest ever recorded in a

Living person.

Almost sounds like a mistake
in a lab reading, but it wasn't.

The amount I had, I shouldn't
be here.

Usually, if a person has
between 50 and 100 milligrams

Per liter in their system, they
could die from it.

It's a miracle that she
survived it.

Narrator: she was immediately
put under 24-hour security

Protection.

But the question remained -- how
was she poisoned, and who wanted

Her dead?

Narrator: when
debbie pignataro was diagnosed

With arsenic poisoning, doctors
also tested her husband, tony,

And their two children.

Their daughter had higher than
normal levels of arsenic in her

System, but her son and husband
were normal.

Well, our first thoughts were
we needed to look at the source

Of water for that area of
west seneca.

Narrator: prior to 1900,
arsenic was the primary

Ingredient in embalming fluid
and had caused groundwater

Contamination near several older
cemeteries.

Tests showed no such problem in
the water supply near the

Pignataros' home.

Investigators began to suspect
that debbie may have

Intentionally poisoned herself.

It made me very angry.

I mean, if anybody knew me, they
would know that I would never do

This to myself.

I mean, first of all, I wouldn't
do it to my children.

Second of all, it's just -- if I
wanted to hurt myself, I

Wouldn't do it this slow,
torturous, painful way.

Narrator: tony suspected
sarah smith's family may have

Had something to do with the
poisoning.

Sarah smith was tony's patient
who had died during surgery.

Anthony thought that
dan smith was trying to get even

With him for taking his wife
away from him and he thought

Enough to say, "well, maybe then
dan was trying to take my wife

Away from me."

Narrator: investigators
searched for arsenic throughout

The pignataros' home.

We searched the house top to
bottom, looking for arsenic --

Pesticides, insecticides --
anything that may contain

Arsenic.

Anything that looked suspicious,
powdery, was taken to be

Analyzed at the lab, and came
back negative.

Narrator: detectives
interviewed debbie's daughter,

Since she too had some of the
same symptoms as her mother.

They asked her what she ate on
the day she became ill.

There was soup left on the
kitchen table, and she ate some

Of it.

That night, she was vomiting.

Narrator: debbie then
remembered an important

Detail -- that tony made the
soup that day.

He brought me the bowl, and I
remember saying, "I can't eat

All this."

He said, "no, eat it, it's good
for you."

Narrator: their daughter
found some of that soup left

Over on the stove and took some.

To find out exactly how long
debbie had been ingesting

Arsenic, doctors decided to
study her hair.

Arsenic can bind to keratin,
which is the major protein in

Hair.

So as the blood circulates
through the body, and it

Circulates to the root of the
hair follicle, some of the

Arsenic will become incorporated
in the hair follicle.

Narrator: when poison
circulates in the body, it comes

Into contact with the hair
follicles, so traces of the

Poison will remain in the hair
as it grows.

Since hair grows approximately
one centimeter per month, a

Strand of hair can identify
exactly when a person was

Poisoned.

First, debbie's hair was divided
into pieces, each one centimeter

Long.

We first need to convert it
from the solid hair sample to a

Liquid hair sample, and we do
that by adding some acid to it

And digesting it in a specially
designed microwave oven.

Narrator: using atomic
absorption spectrophotometry, a

Beam of light is passed through
each hair sample.

When that light is absorbed,
the amount of light that is

Hitting the detector on the
other end decreases.

That change in the intensity of
light that's reaching the

Detector is directly
proportional to the amount of

Arsenic in that sample.

Narrator: the
computer-generated results were

Startling.

Debbie started receiving
small doses of arsenic in may of


July of 1999, she received a

Large dose which was
approximately 80 times what a

Normal human being should have
in their system of arsenic.

Narrator: this time line
excluded members of

Sarah smith's family as possible
suspects because they had moved

To the midwest after sarah's
death.

Investigators had only one other
suspect with a possible motive.

Narrator: the scientific
analysis of debbie pignataro's

Hair told a horrific story.

The people who did the hair
analysis asked when the funeral

Was.

I remember they just couldn't
believe that someone with this

Level was still alive.

Narrator: debbie's hair
established a time line of the

Poisonings.

In march of 1999, when tony and
debbie were living separately,

Debbie had no poison in her
system.

The couple reconciled in may,
and in debbie's hair grown that

Month were the first signs of
arsenic poisoning.

The largest dose of arsenic was
administered in july.

This coincided with debbie's
hospital visit in which tony

Recommended removing his wife's
gallbladder, a procedure medical

Experts say debbie would not
have survived.

When questioned by police, the
couple's daughter, lauren,

Remembered something.

Around this time, she saw her
father setting small traps

Around their home.

When we asked her, "can you
tell us what that bait was," she

Said she didn't know what it
was, except that it was little,

Round tins that he set out on
the floor.

Narrator: only one
manufacturer made insect

Repellent in small, round tins.

The president of the company
revealed their product contained

Arsenic.

He told me that two of those
hand stacks, which would contain

Four tins, would be enough to be
fatally toxic to a 150-pound

Man.

Investigators found this brand
of insecticide in a store not

Far from the pignataros' home.

You don't want to believe it.

You don't want to believe that
someone you loved and lived with

Could actually do this to you.

There's no -- there's no answer.

I don't know.

Narrator: a check into tony's
background provided a possible

Motive.

He became associated with a
few cons in prison and was able

To get involved with heroin.

And he kept in contact with one
particular person who would

Supply him with his narcotics
after he got released from

Prison.

Narrator: and investigators
discovered tony was having an

Affair with another woman after
he was released from prison.

Friends say tony feared his
mother's reaction.

His mother was against
divorce, and if he had divorced

Debbie he would have been cut
out of any will from his family.

Narrator: but money wasn't
the only motive.

In the pignataros' home,
detectives found a manuscript

Tony had written, entitled,
"md: mass destruction."

It was about tony losing his
medical license and what was

Described as "the conspiracy
against him."

It was a story about how he
was wronged by the medical

Community and by the judicial
system and, you know, by

Everyone on earth.

The great wrong that they did to
anthony pignataro.

Narrator: investigators
believe this entire episode

Might have been a ploy for
pignataro to get his medical

License back.

He gave debbie poison.

She developed gastric symptoms.

He then tried to convince her
doctors to perform gallbladder

Surgery that she wouldn't
survive.

Had debbie died during surgery,
tony could argue, as he did in

Sarah smith's case, that people
occasionally die in surgery and

That he shouldn't have been
singled out.

And in tony's eyes, that
would have vindicated him.

"See, my own wife died under a
doctor's care, in a hospital

While having surgery."

And that's what we felt was his
prime motivation.

Narrator: but why didn't she
die from the massive dose of

Arsenic?

Medical experts say this was
miscalculation.

When tony gave his wife smaller
doses of poison, she developed a

Tolerance for it, so the higher
doses later had less of an

Effect.

I'm sure he was thinking, "I
can't believe she's still alive.

I can't believe I gave her so
much and she's still here."

I think he just got panicky, and
it wasn't working, so I think

That's when he just figured,
"I'm just gonna give her a

Massive dose and be over with."

Narrator: apparently, his
daughter's ingestion of the

Arsenic was unintentional.

Investigators believe tony
vandalized his own home to make

Debbie's illness appear to be
retaliation for sarah smith's

Death.

He deserves to be injected
with as much arsenic as he gave

Me.

He deserves to go through the
hell that I went through, and

The pain.

That's what I feel he deserves.

When I asked tony if he tried
to k*ll his wife, he looked down

At the table and told me, "I can
understand why some people might

Think that."

But he never said, "yes," and he
never said, "no."

Then he changed the subject and
continued to look me in the eye.

Narrator: when faced with the
scientific evidence,

Tony pignataro confessed.

He plead guilty to attempted
first-degree as*ault and was

Sentenced to 15 years in prison.

Pignataro promised to tell where
he obtained the arsenic and how

He administered it, but he never
honored that part of the plea

Agreement.

Although debbie survived massive
doses of arsenic which were


Dose, she will continue to

Suffer side effects for the rest
of her life.

The nerve damage and lack of
fine motor skills are permanent.

I can't believe any human
being would do this to someone

That they even cared about.

I mean, maybe he didn't love me
anymore, but there's other

Alternatives.

You don't, you know, do this to
someone -- the mother of your

Kids.

The hair on her head was the
key evidence that pointed to --

Again, only one person could
have done it.

In the long run, his
arrogance is what got him

Convicted -- you know, thinking
he had outsmarted everyone, he

Outsmarted himself.