BAD MEDICINE: The Butcher of South Beach by MAXIM magazine

He fought to clear his head. Undefined terrors from the operation he had just undergone seemed just out of his reach. Throughout the surgery, he experienced a trippy sensation of being trust down a tunnel that exploded with light and color. He imagined meeting his daughter and grandfather there. “Donde estoy?” he kept asking them. “Where am I?”

Now he remembered. He was a patient of Reinaldo Silvestre, a tall, imposing Cuban-born plastic surgeon he’d gone to for pectoral implants to boost his fading bodybuilding career.

But what should have been an hour-and-a-half surgery had somehow stretched longer than four hours. Surely that wasn’t right. And surely it wasn’t right that he had woken up repeatedly during the operation, moaning in pain. Vivid, disturbing details poked through the narcotic haze. He remembered fingers poking endlessly inside a large jagged wound in his chest.

He remembered a crude-looking instrument — could that really have been a spatula? –probing the incision.

He tucked his chin to look down at his surgery. Jesus, Baez thought. The implants look like.. they’re too big, aren’t they? What the fuck is going on? With the agonized, slo-mo movements of a drugged man, Baez gingerly touched his chest. Moments before sinking back into unconsciousness, Alexander Baez made a startling but very real discovery.

He was the new owner of a pair of C-cup breasts.
In the coming weeks, Baez would learn that he was far from the only victim of Silvestre. From the spring of 1998 to May ’99, dozens, perhaps hundreds, of people ventured into Ocean Health Center in search of a cosmetic fix. They fell into the hands of the mysterious 58-year-old man who called himself Dr. Reinaldo, even though he was unlicensed to practice surgery or any other kind of medicine in the United States.

Armed with flattery, cajolery, and a con man’s gift for fakery–but unencumbered by any discernable medical skill–Silvestre managed to pass himself off as a successful plastic surgeon in the nation’s 12th largest metropolitan area. For at least 16 months, he plundered the rich and vainglorious of Miami Beach, leaving behind a trail of maimed victims and scarred lives.

“The man was a butcher,” says Enrique Tones, an investigator with the Department of Health’s Unlicensed Activities Office. “The techniques he used were those of a medical examiner working on a corpse.

It’s unlikely that Silvestre’s criminal career could have flourished anywhere but the multicultural free-fire zone of new south Florida. The vast influx of immigrants has created an ideal breeding ground for predatory frauds. Members of the Cuban community in search of professionals naturally turned to their own, and as a rule were loath to check references.

Moreover, Silvestre set up shop in a city defined by its culture of narcissism, where flesh, not fashion, is what truly matters. In sex-drenched South Beach, women wear bikini halters and men go shirtless simply for trips to the corner grocer. Pursuit of the body beautiful has reached the level of mania. It isn’t surprising that half of all complaints against unlicensed doctors in Florida involve plastic surgeons. There’s so much money to be made. A license is just a technicality.

An American Nightmare

Investigators are still trying to figure out who Reinaldo De La Concepcion Silvestre really is and how he managed to pull off his charade for so long. He claimed to have trained in medicine at the University of Havana, but a transcript has yet to surface.

From what authorities have been able to learn, Silvestre’s career as a “surgeon” began in a different theater—one of war. When a Cuban expeditionary force fought in the Angolan civil war in the late ‘80s and early ‘90s, Silvestre apparently worked as an army doctor. It is safe to say that unless you prefer your rhinoplasty clone with a machete, whatever medicine he practiced on the killing fields of Luanda was a long way from the delicate cosmetic surgery in demand in Miami Beach.

Coming from Africa rather than Havana made gaining entry to the United States a relatively easy proposition. Shortly after his arrival in 1992, he began treating patients in his home, joining the growing list of unlicensed health professionals that are flooding south Florida.

By 1997, five years after he arrived in America virtually penniless, Silvestre had hooked up with a 49-year-old realestate agent named Sophie Bozza. The couple moved to Hibiscus Island one of the exclusive yacht heav enclaves just off Miami Beach in Biscavne Bay. Their small two-bedroom home lay in the less desirable interior of the island, but Silvestre’s patients didn’t realize that. All
they saw was an unqualified American success story.

In December 1997. Silvestre opened Ocean Health Center, a surgical office. Just down the hall from Bozza’s Sunshine Realty It was another prestigious address. But the building was situated at the low-rent eastern end of the street, among shoe stores and discount electronics outlets. Using fliers and word of mouth. Silvestre pursued clients in greater Miami’s 600,000-strong Cuban community. The animated, sociable Bozza was the perfect shill for Silvestre’s business.

Silvestre duped established local physicians into lending him legitimacy A few real doctors were listed as associates; one, Manual Lozaro Romero, M.D., received mail at the office. But the only work done at Ocean Health was by Silvestre.
Still, Silvestre had trouble gaining access to the necessary medical and surgical supplies, so he was forced to improvise. Operations at Ocean Health Center were macabre, makeshift affairs employing instruments that would be more at home in a master chef’s kitchen. Or a torture chamber.

Screams from the OR

In June 1998, a Cuban-born woman from Hialeah, Florida, named Jeannette Bernai drove across the causeway to Miami Beach and headed for Ocean Health Center. She was looking for a good cosmetic surgeon. Bernal, a 31-year-old mental health professional who had left work since becoming a mom, had heard about Silvestre from a psychologist cousin who said she had known Silvestre at Fahardo Hospital in Havana.

When Bernal met Silvestre, she was impressed. “He was very intelligent and well-spoken,” Bernal recalls, talking through a translator. “Totally the opposite of vulgar. He seemed like a person who knew what he was talking about.”

Silvestre recommended implants. Bernal paid Silvestre $4,500, half in cash, and made an appointment to have the operation on June 20, 1998. Still, after her first visit, it occurred to Bernal that the offices seemed to be hidden from the world, tucked back along a corridor on the third floor. And there were never people in the waiting room.

But Silvestre himself was imposing enough to brush aside all doubts. At six feet and sporting a full salt-and-pepper beard, he exuded confidence. With Bozza posing as his wife of 20 years, they were the picture of an established professional couple.

On the day of the operation, Bernal brought her cousin along. Silvestre’s staff most likely consisted of at least two people that day: 56-year-old Julio Montesdeoca, who acted as anesthesiologist; and an unidentified male nurse. They summoned up the requisite appearance of medical professionals, appearing in scrubs and latex gloves.

Sitting uneasily in the tiny waiting room, Bernal’s cousin was distressed to hear moans, sobs, and screams coming from the operating room. The nurse hurried out of the OR to soothe her.

“Not to worry” he told her. “She doesn’t feel anything. She’s just having a bad reaction to the anesthesia.” But the drug Bernal had been given was not an accepted adult anesthetic at all. As was customary at Ocean Health, Bemal had received the animal tranquilizer Ketamine. Widely known as Special K on the club circuit, where partyers ingest it for its trancelike effects, the drug is sometimes used on children, but rarely as a standalone general anesthetic.

As she lay on the operating table, Bernal reacted strongly to the drug’s psychotropic effects, effects that would linger for days. “I remember being thrown into a long dark tube in my mind,” Bernal says. She babbled nonsense during the operation about being on a boat and bleeding through her shirt.

When Bemal awoke, Silvestre declared the surgery a complete success. Her breasts, he said, were “beautiful, perfect.” Still groggy, she was driven home by her cousin.

In the days following the operation, the clumsy cross-stitched sutures Silvestre had given her began to open. On July 5, Bernal went back to Ocean Health to get her stitches removed. Silvestre took out only a few of them, leaving the rest in a desperate attempt to close the swollen incisions. Although Bernal noticed with distress that her breasts now seemed lopsided, the left bigger than the right, Silvestre again told her that the implants were “perfect” and would heal soon.

“No big deal.’ That’s what his catch phrase was,” Bernal recalls. Because Silvestre said it to her so often, “they are the only words I know in English.” But Bernal’s incisions would not heal. The next months were a downward spiral of more problems, more assurances from Silvestre—and more operations. The flesh began to decay around the infected sutures, giving off a malodorous stench. Bernal was returning to Silvestre almost daily now, and he would snip away the punky skin with a pair of surgical scissors.

The nightmarish conclusion to Bernal’s dealings with Silvestre came on November 15, 1998. She sat on the edge of the operating table in the little gray-walled room at Ocean Health. Silvestre seemed undecided about whether to give her general anesthesia; eventually he administered only local.

Opening the infected sutures once again, Silvestre began to force his way under the skin of her chest. Bernal reeled from the intense pain—and from a deep sense of violation. “It was very difficult emotionally to see someone’s hand inside my breast,” she remembers. Still using only local anesthetic, Silvestre used staples to close the wound. “I cried like I had never cried in my entire life.”

She would never again allow Silvestre to operate on her. Her breasts, she says, had become “grossly deformed,” misshapen masses of scar tissue. The nipples were no longer visible—they had been turned under the folds of her breasts by the repeated surgeries. Bernal had stopped thinking in terms of doctors to solve her problems. Now she was thinking about lawyers.

Holiday Special: Boob Jobs, Half-Price!

After the Bernal debacle, Silvestre sought to protect himself In an attempt to put himself on firmer legal footing in case he found himself in court, Silvestre took his first and only step toward legitimizing his practice. On November 19, 1998, he completed the initial application to become certified as a doctor in the state of Florida.

He then took the first of numerous exams given to prospective M.D’s. He failed four times and never again pursued his medical license. “To Reinaldo Silvestre, the application was simply a matter of red tape,” Torres says. Throughout this period, Ocean Health continued its activities unchecked. Silvestre had directed Sophie Bozza to actively crawl for clients. It was the 1998 Christmas season, and Ocean Health was offering holiday specials on boob jobs to help drum up business.

One person Bozza called was a pretty, 26-year-old Miami model named Mileydi Pimienta, who had first contacted Silvestre about breast enlargement in March 1998. Silvestrc quoted her a price of 86,000—too high. But on December 1, 1998, while Pimienta was at the beauty salon where she worked, Bozza called. “You’re in luck,” she said. ‘We’re having a Christmas special, a 50-percent-off sale: It’s only $3,000.”
Pimienta had the surgery, and complications similar to Bernal’s soon set in. Her sutures suppurated, leaking a thin liquid which was at first pink and eventually turned yellow. When she returned to Silvestre to have them attended to, he resorted to a makeshift arrangement to intubate the wounds.

“He cut one of the fingers off of his surgical gloves and used that as a drain,” Pimienta recalls. Silvestre would stuff one end of the glove’s latex finger into the incision, allowing the discharge to leak through. Silvestre had Pimienta keep the bizarre rig in for two weeks, requiring her to come in to change the latex finger every day—Christmas and New Year’s included.

There were other problems. “One breast was big, one was small,” Pimienta recalls. “The implants were rotating inside me. I had a lot of pain.” One breast resembled a lump of clay. Silvestre constantly reassured her. “He played with my emotions,” she says. “He made me feel as though the problem was with me, because he said that I was anemic and diabetic or had AIDS. It was all my fault.”

As she waited one afternoon in the Hibiscus Island house to see Silvestre, — Pimienta spied a legal document in a pile of papers on his desk. Checking to see she wasn’t being watched, Pimienta gingerly slipped the paper out and examined it. It indicated that a woman named Jeannette Bernal had sued Silvestre for malpractice. For Pimienta, already contemplating her own suit against Ocean Health, this was big news. It meant she was not alone.

The Case Builds

Bernal had trouble finding a lawyer. She was broke and unable to work because of the pain from her operations. She was also unable to have sex, and her boyfriend, the father of her child, began seeing other women. Eventually he left her.
Then Bernal met Spencer Aronfeld, a young Coral Gables. Florida, lawyer. The Chicago-born, Kansas-raised Aronfeld had a reputation for taking on lost-cause cases other attorneys would not touch—including a bruising baffle against the deep-pocket lawyers of Disney World. Although Aronfeld was unsure about the financial prospects of the case, he agreed to take it on. “This lady’s breasts resembled a double mastectomy when she came to me,” he says. “They didn’t look like human breasts.”

The lawyer at first thought the case was a typical medical malpractice suit against a well-insured plastic surgeon who had botched a simple breast-implant operation. But Silvestre’s attorneys told Aronfeld that their client was uninsured. At that point all the money went out of the case. No insurance meant no insurance company to sue.

Aronfeld had hit a brick wall. But when Pimienta walked into his office in June 1999, trailing a hulking bodybuilder who said he was a former Mr. Mexico, everything changed. As Baez took off his shirt and showed what The Butcher of South Beach had done to him. Aronfeld realized he wasn’t in Kansas anymore. This one was south Florida all the way.

A Mutilation Caught on Tape

Baez met Silvestre in spring 1999 at Pancho Villa, a Mexican restaurant a few blocks from Ocean Health. Baez worked as a musician there, but his real passion was bodybuilding. Baez liked the smooth, well-groomed Cuban and his gabby wife. Silvestre flattered him. “You’re an excellent singer, Alex,” he said. “What are you doing here in Miami? With seeming casualness, Silvestre mentioned his Hibiscus Island home and told Baez that he spoke several languages, talking about his experiences all over the world. “Immediately you think this is a very, very successful doctor,” Baez says in his halting English.

The next time Silvestre returned to the restaurant, Baez mentioned that he wanted to take care of some small indentations in his chest that he felt might hold him back if he returned to bodybuilding competition in the over-40 category.

Silvestre told him pectoral implant surgery wouldn’t be a problem: Baez would be out of work for only a week and back at the gym lifting weights within a month. He quoted a price of $2,000, which, he said, covered only his expenses and the fee for the anesthesiologist. The operation was a go.

In a moment of bizarre overconfidence, Silvestre asked Pimienta and her boyfriend, David Gonsalez, now working as a driver for Silvestre, to document the surgery on video. “I’m attending a Boston plastic surgeons’ conference,” Silvestre said. 1 want to use this tape to show the other surgeons my work.”

Pimienta and Gonsalez thought a video would be the perfect document in the malpractice suit they were contemplating against Silvestre. They agreed to do it themselves and on April 12, 1999, convened at Ocean Health with their camera. If they felt at all conflicted about their role in standing by while another patient became victim of medical mutilation, they hid it well.

Baez was nonplussed when he showed up at Silvestre’s clinic for what he considered a routine surgical procedure. He found the office filled with people, “like a party,” he recalls.

I suppose it’s OK, Baez thought at the time. “I’m Mr. Mexico and maybe [Silvestere] was telling himself, OK, I’m going to put a couple of implants in Mr Mexico. Time for a party.”

Montesdcoca administered the Special K. A local FM station provided an eerie soundtrack of classical music. Silvestre opened a two-inch incision in Baez’ right breast, just below the nipple—instead of in the armpit, where pectoral implants are normally inserted. Throughout the early stages of the surgery. Silvestre seemed to delight in reaming the wound with his hand—fingering the hole to enlarge it.
Then Silvestre sliced through Baez’ pectoral muscle—a disastrous and unnecessary move. To do it to a bodybuilder is tantamount to cutting the Achilles tendon of a sprinter.

Pimienta, witnessing all but intent on obtaining evidence did nothing to stop it. “I didn’t know what was happening she says. “I didn’t know how bad it was for Alex.
The proceedings were punctuated every so often by the drug-induced incoherent moans of the patient. “Donde estoy?” Baez sounded like a tape played at slow speed.
“I couldn’t talk,” Baez says. “but I made a big effort because it was important for me in that moment to know where I was. I was asking “What’s the story?”

To open the incision further, Silvestre wielded a tool that resembled a cake cutter, its dirty wooden handle bent per perpendicular. He inserted a deflated female breast implant under Baez’ skin, filling it with saline. Bozza joked in Spanish; OK, we have the Mexican Johnny Weissinuller here, and we’re going to put these implants in like a Mexican taco with chili.”

It was after midnight when Silvestre finally finished, sewing up the incisions with amateurish cross-stitching and neglecting the crucial step of closing the interior tissue. “Those are things that a first-year medical student would know, Tones says.
In the following days, Silvestre told Baez not to worry that the implants seemed large. “This is a normal inflammation, Alex,’ he said. You have a great deal of muscle. When I put this implant in, you have a very big inflammation because you are very hard meat—muscle.

Over the next few weeks, Baez waited for the inflammation to subside and the implants to assume their normal shape. They never did. Six weeks after the surgery, with the pain in his arms subsiding, he stood in front of a mirror and struck a competition pose. What he was seeing, he finally forced himself to realize, was not the “very hard meat” of a bodybuilder but soft, rounded C-cups. “I couldn’t see my torso, my back, because I had a big moon in my chest,” Baez says, ”It was the first time I knew for sure this was a female breast.”

By that time Baez no longer had Silvestre to denounce, to sue for malpractice—or to tear limb from limb. On May 6, 1999, Silvestre had fled the country. He had simply vanished.

The Doctor Is out…of the Country

Most law enforcement investigators believe Silvestre fled to a Caribbean or South American country. His native island is the most likely possibility. There’s no extradition between Cuba and the U.S., and Cuba’s Stone Age media make it unlikely that Silvestre’s face has been splashed across TV and newspapers there, the way it has been in the U.S. and Mexico.

In the wake of Silvestre’s disappearance, a fourth victim came forward. She is a Colombian woman who had gone to Ocean Health for an eyelid nip and tuck. She, too, was mutilated, rendered unable to shut her eyes completely.

Aronfeld arranged for reconstructive surgery for all four known victims of The Butcher of South Beach. A top surgeon, Dr. John Cassel of Miami’s Baptist Hospital, donated his services. Pimienta returned to modeling; Baez returned to the gym. Both have permanent scars. Cassel reconstructed Bemal’s breasts from skin left over from a tummy tuck.

Aronfeld filed a class-action civil suit on behalf of Baez, Bemal, and Pimienta and possible Silvestre victims. He hopes to widen his suit to include the city of Miami and the makers of the implants. Without such deep-pocket targets, he is left to sue a shuttered operation without assets and a con-man fugitive whom police have so far been unable to locate.

Silvestre, if brought to justice, faces life imprisonment. Bozza and Montesdeoca are due to stand trial soon in Miami on charges of practicing medicine without a license and aggravated battery. If convicted, each faces a minimum of 15 years in jail.

The news of Alexander Baez’ mutilation was banner- headlined in his hometown of Mexico City. His children were baited on the playground with cries of “Your papa had titties!”

“I want to kill this fucking guy” Baez says of Silvestre, “because I trusted him.”
And, odds are, in a large Spanish-speaking city somewhere, a solidly built man with a smooth professional, demeanor has set up shop as a physician letting it be known he is seeking clients. An odd thing, though: His jaw is white and untanned, almost as if he has shaved off a beard…

SpencerAronfeld practices with Spencer Aronfeld & Associates in Coral Gables, Florida.