The Deepest Cut

All over Kansas City one fall evening, dieters tuned in to KMBC Channel 9 for a Healthwatch report that promised information on a weight-loss miracle. Thanksgiving was approaching, and those extra holiday pounds couldn’t be far behind. Channel 9 reporter Kelly Eckerman said just what overweight people wanted to hear:

Imagine that you could eat whatever you want and still lose 20 to 50 pounds a month. Believe it or not, it’s happening to people who are not on diets or an exercise routine. Instead, they are trying a different approach.

That approach was an innovative operation so effective that some experts predicted it would replace all other types of weight-loss surgery, Eckerman said.

In that November 2000 broadcast, Eckerman told viewers that physician Timothy Sifers was the only surgeon in the metro area performing the duodenal switch, a procedure touted as the most advanced of the obesity surgeries that had evolved since the crude stomach-stapling operations of the 1980s. Over the years, doctors had discovered flaws in some procedures: The Roux-en-Y technique caused patients to vomit if they ate too quickly or didn’t chew thoroughly enough; adjustable gastric banding sometimes failed to result in weight loss; and biliopancreatic diversion could be accompanied by ulcers, chronic diarrhea, gas and major nutrient deficiencies. After the duodenal switch, though, patients lost at least as much weight as with the other procedures but didn’t suffer as many complications.

“These people tend to be able to eat pretty much all they want to, but they still lose the weight,” Sifers told Channel 9. Eckerman interviewed one of Sifers’ patients, a 400-pound woman who said she’d just had the duodenal switch and was excited about her projected weight loss. Eckerman emphasized that the new type of surgery had no “annoying” side effects.

Watching in his south Kansas City home, Marion Bonura thought he had found the answer to his lifelong struggle with fat. In his early fifties, Bonura was so big that he couldn’t zip his fly or trim his own toenails. His profession didn’t make it any easier — a fourth-generation restaurateur, Bonura, with his wife, ran Luigi’s Restaurant on Holmes Road in south Kansas City, and they had helped their youngest son, Luigi, open the elegant new Trattoria Luigi’s in a renovated design studio on the Plaza. (That restaurant closed in the spring of 2001.)

Bonura wanted to escape the constant culinary temptation. After the segment ended, he went to his computer and started researching the duodenal switch operation. A few weeks later, he called Sifers’ office in Mission and set up an appointment for a consultation.

“He wanted that surgery really, really bad. It was all he could talk about after he’d seen it on TV,” recalls his wife, Marian Bonura.

Marian went to her husband’s consultation with him in January. They did everything together. At their restaurant six days a week, she cooked pasta while he chatted up customers and handled the business. Construction workers were building their dream house, and before it was finished they’d sneak in, put on old records and dance on the marble floors. Even their first names, Marion and Marian, were almost indistinguishable.

As they sat together in Sifers’ waiting room, Marian Bonura had misgivings. She thought the operation was too risky. A nurse led the couple into a consultation room, and soon Sifers walked in. Marian remembers that he looked as if he’d just arrived from a beach vacation. His hair was bleached blond, and he wore multicolored floral surgical scrubs. Sifers pulled out a marker and some paper, Marian recalls, and drew diagrams of different types of surgical procedures.

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“There were three of them Sifers told us about. He said the third one was the best surgery of all: the duodenal switch. I’ll never forget the name,” she says.

Bonura was ready to sign the consent forms and write a check for $15,000 — $9,000 for Sifers and $6,000 for Overland Park Regional Hospital — because his insurance would not cover the surgery. But his wife expressed doubts. She says she told Sifers that her husband had a history of blood clots and was taking the blood thinner cumidin. Other health problems had been brought on by obesity: He had inflamed veins in one leg, he suffered from kidney stones and he couldn’t walk up a flight of stairs without getting winded.

“Sifers said no problem, it would be a walk in the park,” Marian Bonura recalls.

Sifers’ receptionist scheduled Bonura for surgery almost immediately, and Bonura handed over the cash, Marian Bonura says. On the day her husband went into the hospital, he told her he was scared. “Then don’t do it,” she told him. “We can go home right now.” But at that moment, nurses arrived and wheeled him off to the operating room.

While she waited, Marian Bonura says she wondered whether she should have stopped him.

He’d been in her life since the 1960s, when she was 25 and answered a help-wanted ad for a waitress at his family’s restaurant. Back then, Luigi’s Restaurant and Cocktail Lounge was downtown, across from Katz’s drugstore at 10th Street and Main. Six days a week, she went to work there. One day the young waitress walked into the kitchen, and there was Bonura, stirring a pot of spaghetti sauce. He looked at her and professed his love. “He had big old tears rolling down his cheeks,” she recalls.

When they married, Bonura was not yet twenty. He was a big man but not fat. Over the years, though, as his wife cooked his favorite foods — fried chicken and apple pie — he gained weight.

One summer in the late 1970s, Bonura announced he was going on a diet. It was the first of many. Bonura tried an early version of the low-carb diet; his wife weighed every portion of meat, vegetables and cottage cheese. He lost ninety pounds but later gained it all back and put on even more weight. Later, he tried a high-carbohydrate, low-fat diet. Then he saw Channel 9’s report.

“This doctor was like God to Marion. It was like God coming down from heaven and saying, ‘Marion, I’m going to give you a new life and another chance,'” Marian says.

The surgery seemed to go well. But afterward, when Bonura started having trouble breathing, staffers in the intensive-care unit put him on a respirator.

In his hospital bed, Bonura seemed restless. He moaned when he slept. He said the water he sipped felt like it was trickling around inside him, Marian says. His temperature began to rise. Then a black liquid started oozing out of the incision that ran the length of his belly. “It was a horrible black goo,” Marian says. “It was like a black, black blood. And it was all over him and all over the bed.”

Sifers called in an infection specialist, who prescribed antibiotics. But the dark fluid kept flowing, Marian says. One night more than a week after surgery, when the drainage seemed especially copious, Marian says she demanded that a nurse call Sifers at home. The nurse phoned but reported that Sifers had refused to come in. “The nurse told me that he had said there was no reason for him to come in, and he’d run tests on him in the morning,” Marian recalls.

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She slept restlessly in the chair in his room that night and left at 5:30 a.m. to go to their restaurant. Before she left, she says she squeezed her husband’s hand and told him she’d be back as soon as she could get away. “I’ll be here,” he said.

Marian says she was in the kitchen standing over bubbling vats of pasta when the phone rang at 7:30 a.m. It was Sifers. All he said was, “We have a problem.”

Bonura was dead.

“I truly feel deep down in my heart that he would still be here if he had not fallen for that doctor’s lying to him about the surgery,” Marian says.

During late 2000 and early 2001, Sifers claimed in television interviews (by then a segment had also aired on KSHB Channel 41) and told patients that he was performing the duodenal-switch operation. In fact, he was not, according to depositions taken from Sifers in a lawsuit one of his patients filed last summer.

Instead of the duodenal switch, Sifers was actually performing an older procedure, the biliopancreatic diversion. That technique is associated with more side effects and complications than the duodenal switch, according to the American Society for Bariatric Surgery, of which Sifers is a member. The lawsuit, filed in July 2002 by Lori Hollinger, accuses Sifers of deceptive sales practices, fraud, medical negligence and battery.

Sifers stopped telling patients he was performing the duodenal switch in early 2001, he said in depositions. He also said that Overland Park Regional Medical Center (which was then owned by Health Midwest) stopped allowing weight-loss surgeries there later that year. But he continued to do biliopancreatic diversions at Shawnee Mission Medical Center, owned by Adventist Health Systems, which is affiliated with the Seventh Day Adventist Church.

Sifers, through his wife, Celina, declined to talk to the Pitch for this story, citing the pending litigation against him. Sifers has testified that he performed weight-loss surgeries on 300 patients between the fall of 2000 and the fall of 2002. The Pitch has confirmed that at least three of Sifers’ patients believed they were undergoing the duodenal switch but actually received different treatments.

The 55-year-old doctor has been practicing weight-loss surgery since its early days. He graduated from the University of Kansas Medical School and was first licensed in 1975. According to his résumé, Sifers completed a fellowship with the American College of Surgeons, where he received specialized training in weight-loss surgery in 1981. His résumé also includes a yearlong position as chair of surgery at Shawnee Mission Medical Center in the early ’90s. Now, he also trains KU Med surgical residents as a clinical assistant professor in the school’s department of surgery.

Patients who have posted comments on obesity Web sites say Sifers has a confident, straightforward manner and describe him as a “straight shooter” who “doesn’t sugarcoat anything.” His own Web site reassures patients that “Dr. Sifers and his staff are committed to working together to provide the highest quality patient care. We offer personalized attention and patient education tailored to each individual’s needs.”

Although some patients say he comes off as gruff, many also say he answers their questions thoroughly and emphasizes the importance of “aftercare” — strictly following the prescribed diet and coming in for regular checkups. “He is truly dedicated to making life for the heavy person longer and much better quality. He has saved and given me back my life and for that I will always be grateful,” one patient writes on an online forum. Another woman adds, “Loved the scrubs (a mottled purple and teal, really cool.) Very professional, knows his stuff.”

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For Lori Hollinger, surgery with Sifers led to three years of misery and a lawsuit.

In the fall of 2000, when Hollinger heard that Channel 9 was going to report on weight-loss surgery, she left her telecommunications consulting job early the day of the broadcast to make it home to Belton in time to watch. She had spent years trying fad diets and calorie-counting programs — Jenny Craig, NutriSystem, Weight Watchers, a cantaloupe diet — but could never lose the weight she’d started putting on during two pregnancies when she was in her twenties.

At age 38, Hollinger weighed 250 pounds. Being heavy didn’t stop her from being active — she loved to go boating with her husband at the lake house they’d bought in the Ozarks, she lifted weights and she sometimes went four-wheeling. “But I just didn’t feel comfortable with myself,” Hollinger tells the Pitch. “I wanted to feel better about myself.”

Hollinger had researched weight-loss surgery on the Internet. Most of the procedures had major drawbacks. But then she discovered the innovative duodenal switch.

She learned that an Ohio doctor, Douglas Hess, had developed the duodenal switch in 1988 to try to remedy some of the problematic side effects of other weight-loss surgeries. The duodenal switch involved reducing the size of the stomach to force a patient to eat less. (Within a year, though, the stomach stretched enough to hold a small but normal meal.) It also rerouted the small intestines to keep enzymes and bile (which break down fat) from mixing with food so that the patient’s body would absorb fewer calories and nutrients.

The duodenal switch removed the part of the stomach that produces the most acid, cutting the risk of ulcers. This was important to Hollinger because she was prone to ulcers, having had them as a child. Also, she liked the fact that unlike other surgeries, the duodenal switch left a fully functioning stomach with a pyloric valve that controlled the release of food and gases from the stomach into the small intestine. Other operations removed the pyloric valve, allowing stomach contents to rush into the small intestine and sometimes cause an unpleasant effect known as “dumping syndrome” when the patient ate sweets or carbohydrates. As a result of dumping syndrome, some patients suffered shortness of breath and rapid heartbeats; some passed out.

That doesn’t happen with the duodenal switch. “It’s the best there is right now,” says Robert Rabkin, a San Francisco surgeon who has been practicing since the 1970s. He began doing the duodenal switch in the ’90s. Rabkin, a graduate of Stanford Medical School and a former Harvard University teaching fellow, developed a less-invasive laparoscopic technique for the duodenal switch. Now popular among patients who want that procedure, that operation has brought Rabkin so much success that he rarely performs any other type of weight-loss surgery.

Hollinger wanted the duodenal switch. The decision to have surgery was an especially serious one. Her mother, who’d always been hundreds of pounds overweight because of a thyroid problem, had died of a bleeding ulcer after a primitive stomach-stapling operation in the early 1980s, she says. “My mom was basically a guinea pig,” Hollinger says. “So this was not a decision I took lightly.”

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Because the duodenal switch was relatively new and complicated, Hollinger thought she’d have to travel to the East or West Coast or to Spain or Brazil — both countries have respected surgeons who perform the duodenal switch (usually for less money than it costs in the United States).

When she saw Sifers on TV, she was ecstatic.

The morning after the news segment aired, Hollinger says, she called Sifers’ office but kept getting a busy signal. When she finally got through, the receptionist told her that the phones had been ringing constantly, mostly with callers who had seen Sifers on TV. Hollinger says the receptionist asked two questions: “How did you hear about us?” and “How will you be paying?” Hollinger said she would pay in cash and scheduled a consultation, which would cost her $200. Then she’d pay $10,750 for the surgery.

In the meantime, Hollinger says, she talked on the phone with other area women she had met in an obesity support group on the Web. Two of the women had seen the news spot and made appointments, too.

“I had done a lot of research on the duodenal switch, and I didn’t know there was a doctor in Kansas City who did it. I was surprised,” says one of the women, Mary Ann Bell.

During their consultations, Sifers drew diagrams, talked about the advantages of the duodenal switch and handed them brochures about the duodenal switch, Bell says. Sifers explained that he would make a cut in the stomach, remove about three-fourths of it and leave the pyloric valve intact — the distinctive characteristic of the duodenal switch.

“He said that one of the big advantages of the duodenal switch was leaving the pyloric valve intact, and that that really helped avoid acid reflux and a whole host of other side effects,” Peggy Harness says. “I was gung-ho and game. He convinced me.”

Hollinger says she was able to get a surgery date almost immediately — December 15.

Hollinger says her surgery at Overland Park Regional Medical Center went well, lasting less than two hours. In a lot of pain but otherwise fine, she stayed in the hospital for three days. When she got home, however, she received a conference call from two friends who said they had been questioning Sifers about his operations. “You’d better sit down,” one of her friends said. “We have some bad news for you.”

Sifers was not doing the type of surgery he claimed he was doing, the women told her. Instead, he was doing an older operation called a biliopancreatic diversion, which leaves the patient with a “pouch” (instead of a functioning stomach with a pyloric valve) and a greater risk of side effects, including bleeding ulcers, diarrhea, bloating, flatulence and dumping syndrome, they told her.

Stunned, Hollinger hung up the phone. The next day, she says, she called Sifers’ office and tried to get some answers from the receptionist. She says the receptionist insisted that Sifers had performed a duodenal switch on her. She says she called several more times over the next few days but never got to talk to Sifers. Finally, Hollinger says, a staff member admitted that Sifers had performed the older operation.

In the meantime, Hollinger’s friends, who had both made down payments on their surgeries and scheduled them for early January, were demanding refunds. At first, Bell says, Sifers told her she could have a week to think about whether she wanted the surgery. But she says she told him she’d already made up her mind. “Instead of apologizing, he just got more and more arrogant with us,” Bell says. “He said, ‘Do you realize that procedure [the duodenal switch] would cost twice as much as what you’re paying for?'”

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When Hollinger went in for her first checkup a week after surgery, she says she was ready to face Sifers. “I was livid. I wanted to know what in the hell he had done to me,” she recalls. Sifers told her he had done a “little bit of a different procedure,” she says.

By Christmas Day, she says, she was having trouble keeping down liquids, Jell-O and soft eggs. Then she started running a fever that climbed to 102 degrees. Pain stabbed through her abdomen to her back and shoulders. A few hours later, her husband, Rick, took her to the emergency room. After CT scans and tests, doctors found an infected abscess near her liver. They put her on antibiotics and started draining her wound. After five days in the hospital, she went home.

In mid-January, Hollinger says, she developed familiar symptoms and ended up back in the hospital for a week, diagnosed with another infection. Within days, yet another infection flared up, and she spent two more weeks in the hospital, this time at Shawnee Mission Medical Center.

Bell and another woman who had cancelled her surgery with Sifers decided to put themselves in another doctor’s hands.

After getting their refunds from Sifers, the two women scheduled surgery in Alcoy, Spain, with Aniceto Baltasar, a respected surgeon who had performed the duodenal switch since the mid-’90s. At the end of January 2001, while Hollinger was battling infections, they flew there for the surgery, which they were able to get for just $10,500 (including plane ticket) partly because of a favorable exchange rate.

“He was wonderful,” Bell says of Baltasar. “He was very caring, just the complete 100 percent opposite of Dr. Sifers.” When Bell started bleeding excessively after surgery and required a transfusion, she says, Baltasar stayed nearby. Since the surgery, both women have lost weight without any complications, Bell says.

Hollinger, however, could barely eat anything without vomiting, and constant diarrhea forced her to bathe between trips to the bathroom. Finally, Hollinger decided she could not seek treatment from Sifers anymore. Desperate for a referral, she found another Kansas City weight loss surgeon, Thomas Helling, who agreed to see her at St. Luke’s Hospital. (Helling no longer does weight-loss surgery, according to his office staff.)

Before she could make it to her first appointment with Helling, another infection flared up, and she met him at the St. Luke’s emergency room. Helling cut through skin and nerves to remove a grapefruit-sized abscess, leaving a bloody hole in the middle of Hollinger’s stomach — a hole that took seven months to heal, according to her lawsuit. Over the following months, he cut out more infections and a bleeding ulcer and repaired two hernias, the lawsuit says.

Hollinger had expected to go back to work in March, but she says she never made it and eventually lost her $100-an-hour telecommunications consulting job. Reluctantly, she and Rick sold their vacation home in the Ozarks and their boat.

By the following year, Hollinger had withered to 115 pounds. Helling finally agreed to try to reverse her initial surgery as much as possible, she says. Although the surgeon could not replace the missing pyloric valve, Hollinger’s medical records show that he rerouted her intestines to their “normal anatomic position.” Hollinger says Rick had to tell her 14-year-old daughter that there was a chance her mom could die.

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Hollinger and several other patients who were considering Sifers as their surgeon say they checked his credentials. The Kansas State Board of Healing Arts lists Sifers as a licensed general surgeon with “no derogatory information on file.” That means Sifers has never been disciplined by the board, which investigates complaints and can suspend or revoke licenses, says Mark Stafford, the board’s general counsel.

But in the year following her weight-loss surgery, Hollinger returned to the hospital fifteen times, had seven surgeries and accumulated $450,000 in medical bills, according to her lawsuit. (Her insurance considered the hospitalizations the direct result of elective surgery, so they were not covered, she says.) She and Rick began arguing more. Hollinger’s daughter, Pam, had a hard time dealing with seeing her mother so sick. After family counseling, Hollinger filed for divorce (a decision she now says she regrets), and Rick moved out.

After the reversal operation, her health began to improve slightly. Hollinger says she gained back some weight, and her fingernails and hair began to look healthier. But she still has problems with diarrhea — she keeps spare underwear in the glove box of her truck and in a desk drawer at work. A hernia prevents her from lifting weights and throbs when she tries to shovel snow or mow the lawn. And a bleeding ulcer forces her to pop Tums daily. She can’t drink milk; she can’t eat salad or any kind of roughage. She can’t have a steak unless it’s chopped into tiny pieces. She says she vomits four or five times a week.

“I know when my feet hit the floor in the morning what kind of day it’s going to be. And if I get up green, it’s going to be a long day,” she says.

In February 2003, unable to pay the nearly half-million dollars in medical bills that she owed, Hollinger filed for bankruptcy in Jackson County Court.

Last summer, she filed her lawsuit against Sifers. The suit alleges that Sifers negligently failed to adequately inform Hollinger of the risks of the surgery he was performing. Sifers’ biliopancreatic diversion caused permanent injury, Hollinger claims. She charges that he “knowingly, and with the intent to defraud,” lied to her and other patients about the type of surgery he was performing, causing physical and emotional suffering and a loss of income.

In depositions, Sifers testified that he saw little difference between the biliopancreatic diversion and the duodenal switch. “I just used the terms interchangeably at that time,” he said. He added that he sometimes called his surgery a duodenal switch because it was “easier to say.” (Sikes was first deposed in November 2002; in another deposition a year later, he said that he had performed one duodenal switch in the previous year.)

That bothers Rabkin, the San Francisco surgeon. “I’d say that’s a very big deal,” Rabkin says of Sifers’ use of terminology. “It’s absolutely unacceptable. Loose and fast doesn’t go along with surgery. Surgery is very exact, and it’s very precise, and you have to be accurate and let people know exactly what you’re doing.”

On February 16 of this year, Channel 9 ran a much different story about Sifers. That night, the station reported that some patients scheduled for biliopancreatic diversion said the hospital had abruptly cancelled their surgeries without explanation. The hospital had issued a vaguely worded statement, and Channel 9 reported that Sifers told the station he was still waiting for an explanation.

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Presumably, patients who were set to have biliopancreatic diversion would have been informed of its risks. Nonetheless, in its statement, the hospital noted its “full and ultimate responsibility to ensure the quality of care that is provided at Shawnee Mission Medical Center.” The statement went on: “Sometimes we are forced to make difficult decisions based on all of the information available, but we always do so in what we believe to be the best interests of our patients. Further research is under way to determine if this procedure should be reinstated at Shawnee Mission Medical Center.”

A hospital spokeswoman declined to clarify the statement for the Pitch or to specify who suspended the surgeries, when the decision was made or what prompted the change. She said the hospital would not release any further statements but would inform patients after deciding whether to reinstate the surgeries.

Channel 9’s most recent report showed patients holding signs outside the hospital, angry that they’d been denied their surgeries.

Lori Hollinger wishes she’d never had hers.

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