Low-cost Dominican surgeries spark warnings by US- Wentworth Worldwide Limited

This undated photo, courtesy of the Brignoni family and posted to the instagram account belonging to Beverly Brignoni, shows a selfie she took at an unknown location. Brignoni was a young New Yorker seeking a less expensive way to enhance her appearance and she did what many other people are now doing: travel to the Dominican Republic for cosmetic surgery. It went horribly wrong. The 28-year-old died Feb. 20, 2014 from what the doctor told her family was a massive pulmonary embolism while getting a tummy tuck and liposuction at a clinic in the Dominican capital recommended by friends. Family members have serious questions about her death and want local authorities to investigate. (AP Photo/Courtesy of Brignoni Family)

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SANTO DOMINGO, Dominican Republic (AP) — Beverly Brignoni was a young New Yorker seeking a less expensive way to enhance her appearance and she did what many other people are now doing: travel to the Dominican Republic for cosmetic surgery.

It went horribly wrong. The 28-year-old died Feb. 20 from what the doctor told her family was a massive pulmonary embolism while getting a tummy tuck and liposuction at a clinic in the Dominican capital recommended by friends. Family members have serious questions about her death and want local authorities to investigate.

“We want to know exactly what happened,” said Bernadette Lamboy, Brignoni’s godmother. “We want to know if there was negligence.”

The district attorney’s office for Santo Domingo says it has not yet begun an investigation because it has not received a formal complaint from Brignoni’s relatives. Family members say they plan to make one.

Shortly after Brignoni’s death, the Health Ministry inspected the Vista del Jardin Medical Center where she was treated and ordered the operating room temporarily closed, citing the presence of bacteria and violations of bio-sanitary regulations. The doctor who performed the procedure and the clinic have not responded to requests for comment.

Brignoni’s death is unusual, but it is not isolated. Concerns about the booming cosmetic surgery business in the Dominican Republic are enough of an issue that the State Department has posted a warning on its page for travel to that country, noting that in several cases U.S. citizens have suffered serious complications or died.

The U.S. Centers for Disease Control issued an alert March 7 after health authorities in the United States reported that at least 19 women in five states had developed serious mycobacterial wound infections over the previous 12 months following cosmetic procedures in the Dominican Republic such as liposuction, tummy tucks and breast implants.

There were no reported deaths in those cases, but treatment for these types of infections, which have been caused in the past by contaminated medical equipment, tend to involve long courses of antibiotics and can require new surgery to remove infected tissue and drain fluid, said Dr. Douglas Esposito, a CDC medical officer.

“Some of these patients end up going through one or more surgeries and various travels through the medical system,” Esposito said. “They take a long time typically to get better.”

The Dominican Republic, like countries such as Mexico, Costa Rica and Thailand, has promoted itself as a destination for medical tourism, so-called because people will often tack on a few days at a resort after undergoing surgery. The main allure is much lower costs along with the promise that conditions will be on par with what a patient would encounter at home.

In 2013, there were more than 1,000 cosmetic procedures performed in the Dominican Republic, 60 percent of them on foreigners, according to the country’s Plastic Surgery Society.

The Internet is flooded with advertisements and testimonials from people who say they have had successful procedures in the Dominican Republic, and an industry of “recovery houses” has sprung up to serve clients, along with promoters who canvass for clients in the United States. The price is often about a third of the cost in the United States.

Dr. Braun Graham, a plastic surgeon in Sarasota, Florida, says he done corrective surgery on people for what he says were inferior procedures abroad. He warns that even if a foreign doctor is talented, nurses and support staff may lack adequate training.

“Clearly, the cost savings is certainly not worth the increased risk of a fatal complication,” said Graham, past president for Florida Society of Plastic Surgeons.

Brignoni was referred to the Vista del Jardin Medical Center by several acquaintances in the New York borough of The Bronx where she lived, said Lamboy and Lenny Ulloa, the father of the 4-year-old daughter she left behind.

“Supposedly, it was a high-end clinic, one of the best in the city,” Ulloa said.

The doctor who performed Brignoni’s procedure, Guillermo Lorenzo, is certified by the Plastic Surgery Society, but there are at least 300 surgeons performing cosmetic procedures who are not, said Dr. Severo Mercedes, the organization’s director. He said the government knows about the problem but has not taken any action. “We complain but we can’t go after anyone because we’re not law enforcement,” Mercedes said.

The number of people pursuing treatment in the Dominican Republic doesn’t seem to have been affected by negative reports, including a previous CDC warning about a cluster of 12 infections in 2003-04.

In one recent case, the Dominican government in February closed a widely advertised clinic known as “Efecto Brush,” for operating without a license. Prosecutors opened a criminal case after at least six women accused the clinic of fraud and negligence. The director, Franklin Polanco, is free while awaiting trial. He denies wrongdoing.

There was also the case of Dr. Hector Cabral. New York prosecutors accused him of conducting examinations of women in health spas and beauty parlors in that state in 2006-09 without a license, then operating on them in the Dominican Republic, leaving some disfigured. Cabral pleaded guilty to one count of unauthorized practice of medicine in October 2011 and returned to the Dominican Republic, where he still practices.

In 2009, Dominican authorities charged Dr. Johan Tapia Bueno with illegally practicing plastic surgery at his apartment after several women, including a local television personality, accused him of malpractice that left them with infections. Awaiting trial, he has pleaded innocent to charges that include fraud.

Juan Linares, a lawyer hired by Brignoni’s boyfriend, said he is still awaiting an autopsy report.

Because she arrived in the country late at night on a delayed flight and was on the operating table early the next morning, a main concern is whether she received an adequate medical evaluation before the procedure. Graham, the Florida surgeon, said sitting on a plane for several hours can cause blood to stagnate in the legs and increase the risk of an embolism.

Brignoni paid the Dominican clinic $6,300 for a combination of liposuction, tummy tuck and breast surgery. Lamboy said she had decided not to have the work done on her breasts and was expecting a partial refund. The woman, who worked as a property manager, had lost about 80 pounds about a year earlier after gastric bypass surgery.

Brignoni was clearly excited about the procedure. Her final post on Facebook was a photo she took of her hands holding her passport and boarding pass for the flight from New York to Santo Domingo.

“She wanted it so bad,” her godmother said. “It felt like she was going to have a better outlook on life, getting this done.”

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King’s IPO Begins Its Mega-Hit ,Wentworth Worldwide Ltd

King's IPO Begins Its Mega-Hit Dependency Saga

Photograph by Andrew Harrer/Bloomberg

There’s been healthy skepticism regarding the future of King Digital Entertainment(KING), maker of the mega-hit game Candy Crush Saga, in the months leading up to its initial public offering. And even though the company decided to offer shares relatively cheaply when trading started Wednesday, investors seem to think they’re not cheap enough. The company’s shares dropped more than 10 percent this morning.

The doubters are worried that King is a one-hit wonder. Candy Crush has been fantastically successful, of course, but tastes in mobile games are fickle. The company believes it can come up with another hit, describing in a Securities and Exchange Commission filing its belief in a “repeatable and scalable game development process that is unparalleled in our industry.”

The worrisome thing for King is that, by the standards of mobile gaming, the company already has more than one hit. King currently claims three of the top-grossing games in Apple’s U.S. app store.

“For King to hold several positions in the top 10 on mobile is a sign of maturity as a game publisher,” says Joost van Dreunen, chief executive of games industry research firm SuperData. But when it comes to apps, pretty much everything that isn’t No. 1 is a rounding error. The top 10 games make about 80 percent of the revenue, according to van Dreunen.

In the fourth quarter of last year, King said Candy Crush accounted for 78 percent of its gross bookings, the total amount paid by its users for virtual items and access to skill tournaments. In mobile, where King must succeed, the game accounted for 86 percent. This was despite the fact that another King game, Pet Rescue Saga, was the 10th-highest-grossing game in the U.S. at the time.

Assuming all of the rest of King’s revenue came from Pet Rescue, this means Candy Crush was worth well over six times the 10th-most successful gaming app. That’s an even bigger difference than in movies, another hit-driven business. The top-grossing movie of the fourth quarter last year, Hunger Games: Catching Fire,made about four times what the 10th-top-grossing flickCaptain Phillips, pulled in.

King can ride Candy Crush for a while yet: It made $567 million in profit last year—72 times what it made the year before, when Candy Crush was only the 10th-highest-grossing game in Apple’s marketplace. Nothing stays on top for long, though, and King saw the number of people who paid to play its games drop at the end of last year. The company said this reflected the “seasoning of our older games in certain markets among our more occasional customers. Simon Khalaf, the chief executive of app analytics firm Flurry, has found that apps rarely stay at their peak for more than a year, and games decline quicker than popular apps in other categories. “Gravity will eventually settle in and despite a massive marketing budget, even the very popular games eventually come down to 50 percent of their peak within 12 to 18 months,” he says.

Van Dreunen says King’s main challenge is to reconcile the unpredictable process of hit-making with the grinding demands of Wall Street. He predicts King will begin acquiring other game companies and use its expertise to increase the chances their games will rise to the top. This is a fraught path, as Zynga (ZNGA) demonstrated by overpaying for developers who had already made the one hit they had in them. To please investors once the inevitable Candy Crush fade arrives, whatever King comes up with is going to have to be more than a mere hit.

Wentworth Worldwide Limited News