Mary Jeanne Altieri had surgery on her right shoulder in 2005 to repair a torn rotator cuff but said the pain never subsided. Her orthopedic surgeon, Dr. Spyros Panos, prescribed medication, physical therapy and eventually, another surgery.
Altieri, now 65, worked as a receptionist in the same medical office as Panos in Dutchess County New York for more than eight years. Their families knew each other. She described him as a wonderful person and friend and said she completely trusted him as a doctor. So when he recommended the second surgery in 2009, she said she never questioned it.
But when Altieri's pain worsened she sought a second opinion, and then another. The third doctor told her that he was able to explain why her shoulder wasn't getting better: Panos had never operated on it, she said.
"I felt betrayed. I felt anger," Altieri said, recalling her emotions when she was informed of the alleged nonexistent surgery. "And I felt so stupid for not being more aware of what was going on."
Experts say that unless another doctor uncovers the telltale signs of a previous surgery – or lack thereof – it is nearly impossible for a patient to know whether a surgery has actually occurred. Even other medical professionals who are in the room at the time of surgery can't always say with certainty that the surgeon has performed an intended procedure.
"You can see the surgeon has put the scope in during a knee operation but you can't necessarily tell what's being done because a lot happens very quickly, said Dr. David Mayman, a hip and knee surgeon with the Hospital for Special Surgery in New York City. "With many simple procedures it would be quite easy to say you have done something and not do it."
Mayman noted that many hospitals have stringent quality control safeguards in place to reduce medical malpractice and error. For example, HSS requires surgeons to take pictures throughout a surgery to back up their operative notes and provide visual evidence of their work. With more complex procedures such as joint replacements, hardware must be procured from a central "materials management" department and then serial numbers and bar codes must be meticulously recorded both in the patient's chart and the hospital's database, Mayman explained.
Before an operation, the surgeon and the medical team are supposed to meet and review a detailed checklist of the procedures being performed. That way, the entire operative team is on the same page and aware of what should be occurring, Mayman said.
Dr. Timothy Morgenthaler, the chief patient safety officer for the Mayo Clinic, said one way patients can protect themselves from deceptive surgeries and other medical mismanagement is to carefully check the reputation of the surgeon and hospital and get recommendations from trusted, knowledgeable sources.
"Many institutions have published records available to the public showing outcome data and success rates to give you some level of confidence," he said.
According to the Federation of State Medical Boards, all states keep at least one public database of disciplinary actions against surgeons and other types of doctors. However, some states don't enter a surgeon's name into the database until there has been a legal judgment against him or a criminal conviction, said Drew Carlson, a spokesman for the group.
Morgenthaler said if you've done your homework, getting a second opinion isn't always necessary for routine procedures but he stressed that patients need to take responsibility for their own medical care by carefully reviewing medical records and asking questions until they are confident they understand test results and diagnosis. Patients should red flag any discrepancies between a condition and the surgeon's recommendation before proceeding.
Morgenthaler added that a good surgeon takes the time to explain exactly what the patient is consenting to have done before a surgery. After the surgery, the surgeon should explain to the patient or an advocate what procedures were performed and offer insight into the recovery process. If the surgeon is unwilling to communicate these things or explain why a recovery isn't going as planned, that's the time to seek a second opinion, Morgenthaler advised.
As for Alteiri's alleged faked surgery, Dr. Howard Luks, the orthopedic surgeon who said he discovered it, said it was a bone that initially gave it away.
"The surgeon's notes said that he had removed two centimeters of bone in both of the surgeries. This particular bone doesn't grow back and I could plainly see that no bone had been removed," he said.
Luks also said he wasn't entirely surprised by this discovery. He said he'd already seen more than a dozen former Panos patients who were supposed to have had certain procedures performed but clearly had not. In some instances, Luks said hardware or sutures that should have been in place according to medical records and plainly visible on X-ray or at revision surgery, were missing.
There are more than 261 civil lawsuits pending against Panos, Dutchess County, N.Y., Supreme Court documents show and there is an ongoing criminal investigation by the state though Panos has not been charged. Panos and his legal counsel declined to comment on any allegations against him to ABC News. Charles Rock, Altieri's attorney said that Panos has responded to the lawsuit and has denied all allegations. Should the case go to trial, Rock and JT Wisell, an attorney for 154 of the plaintiffs, each said they planned to call Luks to testify as a "subsequent treating physician."
If proven true, the Panos case is extreme but not the only recent example of a doctor performing phantom or needless surgeries. Indiana plastic surgeon Dr. Mark Weinberger was convicted of fraud earlier this year after subjecting more than 280 of his patients to unnecessary or phantom surgeries.
Altieri said her shoulder still hurts but she's chosen not to have any additional surgery. And, although Panos also performed two knee replacements and a hip replacement on her, she has not had those joints reevaluated.
"I almost don't want to know if there's anything else. But I hope no one else ever has to go through this. To have such love and confidence for a doctor and then he does something like this, it kind of rips your heart out."