But the state took no action. It did not stop Dangl from performing surgery. Five months later, in September 2003, when Julie Rubenzer showed up for her breast augmentation, she likely had no idea about these critical allegations, and she didn't know that, contrary to the written consent form from Dangl's office, no one trained in administering anesthesia was dedicated to that task alone in his operating room as she went under.
The surgery went well for about two hours. Then, while still under what an expert later called "a dazzling array of anesthetic agents," Rubenzer was propped up so the breast implants could be adjusted.
According to Matt, "As soon as we laid her down, she just crashed on the table" and went into cardiac arrest. Dangl, he says, "threw a tantrum. He just stood there and he said, 'I don't need this today.' "
Matt says Dangl forced air into her lungs with an Ambu Bag, a disposable artificial ventilation bag. But when he stopped, Rubenzer's heart wasn't beating.
"I said to him, 'Doctor, she is flat-lined. She needs chest compressions.' He said no, don't give chest compressions. He was afraid it would mess up her surgery."
Matt says Dangl only allowed CPR when he was told that Rubenzer's fingers were turning blue. Her heart started again, but because it had been stopped for so long, her brain was starved of oxygen. By the time paramedics got her to the hospital, she was in a coma.
Rubenzer never woke up. Her parents, Don and Maureen Ayer, took her home to Wisconsin, where she died, her body curled in a fetal position, the day after Christmas. They still had no idea what had happened in the operating room. But through a series of circumstances, including some alert reporting by WFTS in Tampa, Matt came forward, and the incredible events in the operating room began to become clear.
To Matt, the most painful recollection was that he had not been allowed to start chest compressions when Rubenzer stopped breathing. "If we were allowed to give those chest compressions, she would be walking around today."
Dr. Rod Rohrich, president of the American Society of Plastic Surgeons, doesn't know the specifics of Rubenzer's case, but he offered these tips for anyone who is planning to have plastic surgery:
1. Interview several doctors, and pick one certified by a board recognized by the American Board of Medical Specialties.
2. If you're not going to a hospital, be sure someone trained in anesthesiology is present, that the surgeon has privileges at a nearby hospital and that the operating room meets state regulations, with emergency equipment in case of a crisis.
"In America, it's amazing," he said. "Most women spend more time finding a pair of shoes than they do finding a cosmetic surgeon. You can take the shoes back, you can't take your face back or your life back."
For Rubenzer's parents, that cold reality has led to one very bitter question: Why was Dangl allowed to operate with formal charges about his competence hanging over him?