6 women, babies dead. Botched circumcisions. Catastrophic injuries. Why this baby doctor practiced for decades

The birthing suite at Good Samaritan Medical Center resembled “something out of a movie, like a murder scene,” Jorge Douglas Miranda Romero recalls.

Moments earlier, he’d watched his wife, Onystei Castillo-Lopez, give birth to their second child, a healthy baby boy. He would be named Jorge, like his father.

But something wasn’t right.

After holding her son for about five minutes, Castillo-Lopez said she wasn’t feeling well.

And then the blood wouldn’t stop.

Her husband watched the surreal scene unfold.

“I was scared,” he said. “There were two or three garbage bins full of gauze.”

Castillo-Lopez was barely conscious when her husband spoke to her for the last time, as she was taken to surgery to stop the bleeding.

The surgery was too little, too late, the Florida Board of Medicine later found.

Castillo-Lopez, a 40-year-old medical assistant who loved to travel, died after a postpartum hemorrhage, suffering cardiac arrest and organ failure in the early morning hours of July 26, 2017. Her doctor, who had left the hospital to change his blood-stained scrubs, returned in time to see his patient die, according to court documents.

Neither the husband, who is known as Miranda, nor his wife were aware that Dr. Berto Lopez had had his medical license restricted by the state of Florida three months earlier.

Miranda tears up when he talks about breaking the news to his then 8-year-old daughter, Priscilla, telling her she had a new baby brother, but her mother was gone forever.

“He didn’t care." Parents of two baby boys claim Palm Beach County doctor botched circumcisions

What to know: 5 takeaways from Palm Beach Post investigation into baby, mother deaths under Florida doctor's care

Who is Dr. Berto Lopez? Average OB-GYN faces 2 or 3 lawsuits during a career. This Palm Beach County doctor had 9

Castillo-Lopez had joined a long list of women and children who died or were catastrophically injured while in the care of Lopez.

Lopez, 63, on advice from his attorneys, said he had no comment for this story.

Over the 33 years that he practiced medicine in Palm Beach County, records examined by The Palm Beach Post link him to 14 serious injuries of women and children, including six deaths. Lopez has been named in four disciplinary cases and nine malpractice actions, including suits over the deaths of two infants, an injury to another and an 18-year-old mother who died in the 1990s. The average OB-GYN faces two or three lawsuits during a career.

Many of the deaths and injuries were linked to routine procedures. Many went undetected by the state, never generating a complaint or disciplinary action.

Most occurred after voters passed a constitutional amendment intended to prevent dangerous doctors from practicing:

• There was Joyce Rivers, 56. Her small intestine was punctured during an outpatient procedure, and she died of complications from it, according to the Palm Beach County Medical Examiner's Office.

• There was Ashley Perez. The 29-year-old mother died from internal bleeding following a C-section and tubal ligation after a misdiagnosis, according to Florida Health Department (DOH) documents.

• There was Dominic Shelton, a baby boy who suffered severe brain damage, leading to cerebral palsy after a delayed cesarean section, a lawsuit says.

• There was Matthew Dixson, a baby boy born with a broken arm and permanent nerve damage, because a C-section wasn't performed, a lawsuit says.

• There was Joann Catlett, 47, incapacitated for six months after a hysterectomy during which her ureter, the duct that carries urine from the kidney to the bladder, was nicked. She sued.

• There was a woman the state identifies only as L.R., age 32. She suffered a postpartum hemorrhage after a tubal ligation, DOH documents say. She lost 6 liters of blood but lived.

• There was Baby R.R.R., who lost his penis in a circumcision, a lawsuit says.

• And there was Baby G.L., whose parents say lost a third of his penis in another.

The Board of Medicine had heard complaints about Lopez concerning three patients — one who had died — but the doctors on the panel allowed him to keep practicing until Castillo-Lopez’s death came in front of them.

It wasn't until February that the state of Florida stripped Lopez of his license.

Why did it take that long for the state to act?

Gaps across the state’s medical disciplinary system allow dangerous doctors to practice medicine, leaving patients unprotected, a Post investigation has found.

In 2004 Florida voters overwhelmingly passed a “three strikes” constitutional amendment to weed out incompetent doctors by revoking their licenses after three malpractice findings.

In the face of strong opposition to the new law from the health care industry and insurance lobbyists, however, state legislators made changes to the amendment that undermined it even as they put it into effect.

Among the barriers to using the law were formidably rigid requirements for findings of malpractice that would count as a strike. Getting one strike, let alone accumulating three, was made nearly impossible under the changes.

The new law did nothing to counter the conflicts of interest already hobbling the medical disciplinary system, which relies on hospitals and other doctors to hold themselves accountable.

“I’ve been representing victims of medical malpractice for over 40 years and Dr. Lopez is the first doctor whose license was revoked as a result of causing death or destruction to a victim of a medical mistake,” said Gary Cohen, a Boca Raton lawyer who represented the family of Castillo-Lopez.

“Clearly, the system is broken and rigged in favor of the health care providers as opposed to the patient. Dr. Lopez is the poster child for this broken system.”

What is Florida's 3 strikes malpractice: Here's how dangerous doctors evade it

Berto Lopez’s career marked by patient tragedy early and often

Lopez immigrated to the United States with his family at a young age from Cuba. He graduated from the University of Georgia with a bachelor’s degree in chemistry, then attended the Medical College of Georgia in Augusta. He completed his residency at Emory University in Atlanta.

Records show he was licensed as a doctor in Florida in 1987 and settled in Palm Beach County. He became board-certified in obstetrics and gynecology in 1990.

Lopez had a prolific practice.

From 2010 to the time he lost his license, the practice billed $12 million through Medicaid, the federal and state health care program for people of low income, records obtained by The Post show.

He also earned, from 1999 to 2011, more than $1.1 million as a contractor for the Health Care District of Palm Beach County, which also provides medical care for low-income residents.

But Lopez has financial difficulties, records show. The Internal Revenue Service in February filed a judgment against him for $2.1 million.

He boasted of delivering about 30 babies a month — about twice the national average.

His résumé, submitted in a 2012 malpractice case, lists professional honors that include an outstanding physician award from then-Columbia Hospital — now the campus of JFK Medical Center North.

Lopez served on some review committees at hospitals in Palm Beach County examining undesirable medical outcomes of other doctors, according to his curriculum vitae.

Lopez was involved in four malpractice cases early in his career, records show.

He was one of two doctors sued over the death of a baby in 1988 at St. Mary’s Medical Center. She was born brain-damaged. Her name was Crystal Diane Hicks.

The lawsuit was settled two years later for an undisclosed amount.

Birthing fatality: Mother bleeds to death after childbirth; Palm Beach County OB-GYN loses his license

Circumcisions: Doctor botched newborn's circumcision after state opted to revoke his license, parents say

More: Florida Medical Board vows to address red tape gap after botched circumcision

In a deposition in another case, Lopez said that he consulted on the mother’s pregnancy and was accused of failing to order a timely cesarean section.

Records also show that he was sued for malpractice in 1993 involving the death of an infant, Earl Buchanan Jr. The suit was settled with Good Samaritan, and Lopez was dropped as a defendant.

In a deposition, Lopez said another surgeon delayed performing an appendectomy, and the baby was born prematurely — but no other doctor was sued, according to court records.

The Florida Office of Insurance Regulation lists two other malpractice settlements for $250,000 for each of the patients. One was for Samuel Mercedes, an infant.

Records show Mercedes had spina bifida, and multiple congenital problems. A judge who observed him said he was "severely impaired both mentally and physically." Lopez said in a deposition that the lawsuit was over a failure to detect the spina bifida in utero.

The other was for 18-year-old Nakia Gilmore, who died after giving birth in 1994. She had HELLP syndrome, Lopez said in a deposition, a life-threatening pregnancy complication.

Lopez stopped carrying malpractice insurance about 2003.

None of these allegations generated disciplinary complaints to the state Department of Health, which is responsible for investigating them and forwarding those with probable cause to the Board of Medicine to consider for disciplinary measures.

‘If he read the report, he would have realized there was still a baby in me’

Lopez showed up for the first time on the Board of Medicine’s agenda in 2004, the same year the three strikes amendment passed.

A 31-year-old patient, Michelle Hirt, was 17 weeks pregnant in 2002 when Lopez told her the baby was dead, that the heartbeat could no longer be detected. Lopez then performed a procedure on her at Palm Beach Gardens Medical Center to remove the fetus, according to Health Department documents.

After a follow-up visit the next week, Lopez checked a box in Hirt’s file that said she was “OK.”

Three weeks later, Hirt was at a friend's house and started cramping. She delivered the remains of her pregnancy in the bathroom.

She went back to Lopez with “a female fetus with normal head, neck, abdomen, legs and back,” according to the Health Department complaint.

“It was terrible. It was horrible. It was heartbreaking,” Hirt said.

The Health Department found Lopez performed an incomplete procedure, ignored the pathology report and failed to provide appropriate follow-up care.

“If he read the report, he would have realized there was still a baby in me,” Hirt said.

“We wouldn’t have filed a complaint if he said I’m sorry — but nothing,” Hirt said. “I was obviously distraught. After the fact, we didn’t hear anything from him. It was very strange.”

Lopez settled the complaint with the Board of Medicine, agreeing to pay a $10,000 fine, attend continuing medical education and perform 200 hours of community service. The board reprimanded him.

That final order in the Hirt case came down in April 2004, seven months before the three-strikes amendment was voted into law in November.

In 2005, the Legislature passed one of many restrictions to the amendment that prohibited counting any malpractice as a strike that occurred before voters approved the amendment.

This meant Lopez could continue his career with an apparently clean slate.

Loopholes for physicians’ protection leave patients in peril

Three strikes — the Public Protection Repeated Medical Malpractice Act — as finalized by legislators was the outcome of a very public war between trial lawyers and the powerful health care and insurance industries.

Voters passed the three-strikes amendment by a 71% margin.

The wording was simple: "This amendment prohibits medical doctors who have been found to have committed three or more incidents of medical malpractice from being licensed to practice medicine in Florida."

Doctors, along with insurance and health care lobbyists, however, complained that the law would lead to skyrocketing malpractice premiums, hampering their ability to do high-risk procedures. OB-GYNs were particularly vulnerable to frivolous lawsuits, they said.

The Legislature in 2005 heard the doctors, and the law that the voters had just passed got more complicated.

A court or agency has to make a final judgment of medical malpractice. Then the Board of Medicine – a dozen doctors and three consumer advocates — has to go one step further and use a stricter standard than courts use in malpractice suits to determine whether it's a strike.

Assistant Attorney General Ed Tellechea — the attorney for the Board of Medicine then and still today — said that at the time that an argument could be made that the Legislature “undermines rather than implements the constitutional provision.”

The state DOH doesn’t even keep track of how many doctors have lost their licenses because of three strikes, a spokesman for the agency told The Post.

Nicholas Romanello, a lawyer from West Palm Beach appointed to the board in 2016, said he couldn't recall one time that a doctor lost a license because of the three-strikes law.

“Three strikes? It is draconian. It does not allow the system to appropriately review physician conduct,” the former interim CEO of the health care district said.

The doctor disciplinary system and the three-strikes law are dependent on malpractice lawsuits and final judgments by a court or agency like the Board of Medicine.

But practitioners can avert strikes.

They can settle lawsuits before they are filed or they can settle complaints with the medical board without a finding of malpractice, which was what happened in the Hirt case. In a consent agreement with the board, Lopez neither admitted nor denied that he committed malpractice.

Doctors get a 90-day notice before the filing of a malpractice action in court. This requires the potential plaintiff to launch an investigation of the matter before a lawsuit is filed and was instituted to encourage settlement, according to The Florida Bar.

The public — and the Board of Medicine — almost never learn about these cases if they are settled because the lawsuit is never formally filed where it becomes a public record. If the case ends in settlement, the doctor often will insist that no judgment is entered.

“Even if there's an amount awarded by the jury, it doesn't mean that there's going to be a formal judgment entered,” said Dr. Steven Rosenberg, former chair of the Florida Board of Medicine and a West Palm Beach dermatologist. “And so, without a judgment, it doesn't count.”

Rosenberg said he could recall only a couple of three-strikes cases taken up when he was on the board from 2006 to 2019.

Jonathan Freidin, a Miami malpractice attorney, called the three-strikes law toothless. The Health Department often never learns of the medical mistake. It “just goes away,” he said. “It never gets on the radar for three strikes.”

If by chance a malpractice lawsuit does generate a disciplinary complaint put in front of the Board of Medicine by a DOH investigation, a doctor has another chance to settle.

Lopez did exactly that in three of the four complaints against him. He promised to pay some fines and take some continuing education classes.

Former University of Miami Law Professor Mary Coombs wrote in a 2008 paper that Florida was a case study on how not to accomplish malpractice reform.

She said the three-strikes law was “an ill-designed response to a real problem.”

Former Board of Medicine chair: Legal challenges hamper discipline

Even if the Board of Medicine takes a doctor’s license, a physician can challenge the decision in court.

“I think that the Board of Medicine needs to have more authority and that the legal opportunities that are afforded to doctors are a significant part of the problem, particularly the appeals process,” Rosenberg said. “The fact is that very often a Board of Medicine decision, including revocation, is not final.”

In addition, he said, the disciplinary process can stretch out, wasting time that is literally a matter of life and death.

The Health Department might not send the complaint to the board until years after a patient is injured or killed, often because the agency's actions are so dependent on malpractice lawsuits.

Once a complaint is filed by the Health Department, the process can further be dragged out if a physician requests an administrative law hearing where a judge will recommend the punishment to the Board of Medicine.

Defense lawyers for doctors opt for such hearings if they believe the board will revoke their client’s license, he said. Instead of appearing in front of 15 members of the board, they appear only before a judge who has little or no medical expertise, Rosenberg said.

Lopez fought the disciplinary complaint over Castillo-Lopez's death by taking it to the administrative court. The judge took nearly six months alone to make his recommendation after the final hearing.

In December, the administrative judge ordered Lopez’s license be suspended for one year. It had been more than 2½ years since Castillo-Lopez died. The board overruled him in February and revoked Lopez's license.

Nurse Ryan Gavagni Fiorentino was in the delivery room with Castillo-Lopez.

“I would ask that family who has lost their mother, that baby who will never know his mother, if one year of not practicing medicine is fair,” Fiorentino said when told of the administrative judge's recommendation.

Watchdog: Doctors, not patients, protected by boards of medicine

A finding of “three strikes” is not the only way a physician can lose his or her license.

In the fiscal year 2019-2020, 46 physicians in Florida lost their licenses either through revocation by the Board of Medicine or relinquishment. Fifty-two doctors had lost their licenses the year before.

More than 54,454 medical doctors are licensed in the state, according to the Health Department’s latest statistics.

Public Citizen in March ranked Florida’s Board of Medicine 21st in the nation for serious disciplinary actions.

“State medical boards are doing a dangerously lax job in enforcing their states’ medical practice acts,” the group said in its report looking at disciplinary actions per 1,000 physicians between 2017 and 2019.

Boards need to increase their reliance on the National Practitioner Data Bank, physician Dr. Sidney Wolfe and malpractice expert Robert E. Oshel of Public Citizen found.

The data bank is operated by the U.S. Department of Health and Human Services and contains medical malpractice payments and adverse actions involving health care professionals from hospitals and state licensing boards.

The American Medical Association has lobbied Congress to keep the public from accessing the data to look up doctors or hospitals, Wolfe told The Post.

But Public Citizen was able to use what is public to determine that Kentucky’s medical board is the best in the nation, with 2.29 serious disciplinary actions per 1,000 doctors.

Florida’s rate of seriously disciplining doctors — actions above just probation — is exactly half of Kentucky’s.

“That’s just inexcusable. It’s really endangering tens of thousands of people in Florida,” said Wolfe, who is a doctor in Washington, D.C. “It’s a real threat to the public.”

Composed largely of physicians, the Board of Medicine brings “inherent bias” to its considerations that can stack the deck against patient protection, Cohen, the lawyer for Castillo-Lopez’s family says.

“Have doctors as consultants, but don’t let doctors alone have all the power to police themselves,” he said

Adam Horowitz, a Fort Lauderdale attorney, agrees.

“It’s all skewed in favor of the doctors and health care professionals,” he said. “A lot of people give up along the way if you are an injured party and you want justice to happen.”

In their paper, published in March, Wolfe and Oshel recommended reducing the number of physicians on medical boards and replacing them with members of the public with no ties to the medical profession, hospitals or other providers.

The organization urged state governors to be committed to changing the culture of medical boards.

“Their first priority needs to be to protect the public from incompetent or miscreant physicians, not protect the livelihood of questionable physicians,” wrote Wolfe and Oshel.

Wolfe said states like California have tried to put more laypeople on medical boards but with little luck. Florida has three non-physicians on its board. Wolfe said it is only natural that a board made up of doctors will be more sympathetic toward physicians than patients.

“We've heard something called ‘there but for the grace of God go I’ syndrome,” he said.

That may be part of the reason the board is more likely to go after the most clearly aberrant cases, West Palm Beach malpractice attorney Susan Ramsey adds. That would include a doctor operating while inebriated or a physician who molests his patients before going after a medical professional who kills out of incompetence.

“When it comes to deviations of the standard of care, they are less aggressive,” she said.

'He said he didn’t have a crystal ball. I remember that clear as day.'

Known as “Joyful Joyce,” Joyce Rivers was a big woman with a big heart. She came from a large family, the ninth child of 10, and made sure she was always surrounded by people. She loved to feed them — family members, neighbors, friends of friends.

"Everybody in the community knew her. The church was packed with people from the community at her funeral," said Reejetta Miller, one of her three daughters.

Rivers went to Lopez to remove her ovary. Her small intestine was nicked, according to the Palm Beach County Medical Examiner's Office, in what was supposed to be minor surgery.

Daughter Sundalar Miller said once her mother was back in her hospital room the family noticed a brown fluid draining from the incision.

She died from complications of a perforated bowel at Good Samaritan Medical Center on July 21, 2012. She was 56. The medical examiner determined her death was an accident.

Her surviving children demanded answers from Lopez.

“He said he didn’t have a crystal ball. I remember that clear as day,” said Reejetta Miller.

Miller, the youngest daughter, said her mother’s death had a lasting impact on her family nearly a decade later.

“Every day I think about how my life would be different if she were here with me and my children,” Miller said.

Joyce Rivers’ daughters explored legal action against Lopez but hit a wall at the first step – hiring a lawyer.

Lopez was a frequent expert witness in cases against other doctors.

In a 2019 court deposition, Lopez said he had reviewed more than 1,000 cases. The Post found one malpractice case out of Mississippi where Lopez’s disciplinary history became an issue on appeal.

Joyce Rivers’ surviving adult children could not find a lawyer among the largest malpractice firms in Broward and Palm Beach counties because Lopez had been a professional expert witness for them.

“Once they found out who it was, they would say there was a conflict of interest,” said Shatasia Small, Rivers’ daughter.

“My mom was killed. Nobody put a bullet in her, but she went in for something so simple, something that’s done virtually every day, and she died.”

The Rivers case didn’t generate a strike against Lopez's license. There was no complaint from the Health Department, so her death was never presented to the Board of Medicine.

Woman undergoing a hysterectomy has her ureter cut

Lopez in 2012 performed a hysterectomy on Joann Catlett, a West Palm Beach resident.

“It was just horrible. It was horrendous. I went through six months of just laying on my back,” Catlett said. “He needed to be put out of business.”

Catlett sued Lopez in 2012. The expert in her case, a doctor from Mississippi, found Lopez failed to check the ureter and the bladder after removing her uterus.

Lopez blamed the patient, saying she knew the risks, having signed a release. When it came to the lawsuit, “that piece of paper was his saving grace,” Catlett said.

She said Lopez had no empathy.

“He was horrible. Just stone-faced. He had absolutely no feeling whatsoever,” said Catlett, who now lives in South Carolina.

Catlett said she settled her lawsuit for about $1,000.

There was no disciplinary action against Lopez, so it wasn’t a strike.

Berto Lopez as malpractice defendant: two babies, two lawsuits

Heather Shelton showed up at Indian River Medical Center on Jan. 12, 2011. She was more than six months pregnant, and her water had broken.

The mother-to-be was transferred to St. Mary’s Medical Center in West Palm Beach where she was handed over to the care of Lopez, according to a malpractice lawsuit.

During her care, Shelton was given an anti-clotting medication and had an allergic reaction, going into anaphylactic shock, according to the lawsuit.

Shelton then delivered a baby boy named Dominic by cesarean section. The 2.4-pound newborn was intubated after showing signs of respiratory distress.

Lopez was accused in the lawsuit of not doing a timely C-section after determining the fetus was in distress.

The child was diagnosed with multiple neurological deficits and cerebral palsy.

Shelton, contacted at her home in Brevard County, declined to comment on advice from her attorney.

Failure to perform a C-section was the issue when Lopez and Good Samaritan Medical Center were sued in 2014 by the Riviera Beach parents of Matthew Dixson.

Dixson was born with shoulder dystocia — a birth injury that happens when the baby’s shoulders get stuck inside the mother’s pelvis during labor.

The mother, who had diabetes, had gained 70 pounds during her 2011 pregnancy.

The baby’s upper arm bone was broken and he had permanent nerve damage in his shoulder, which can cause paralysis, according to the malpractice lawsuit.

Lopez missed signs that Matthew’s mother, Charisse Matthews, was at risk of giving birth to an oversized infant, the lawsuit claimed. Another doctor and Good Samaritan were also named as defendants.

Lopez, in a deposition, said there had been no cause to be alarmed by Charisse Matthews’ weight gain. He called the injury of her newborn son “unpredictable, unpreventable.”

The lawsuit, which was settled, claimed Lopez never personally examined the mother-to-be during her pregnancy, relying on a physician’s assistant, and should have ordered the necessary tests to determine whether a C-section was necessary.

No complaint was filed against Lopez in either the Shelton or Dixson cases, preventing the Board of Medicine from considering them for strikes against Lopez’s license.

How hospitals can hold doctors to account

Both births occurred at medical centers owned by Tenet Healthcare, and Lopez continued to have hospital privileges at Good Samaritan and St. Mary’s after those incidents.

Lopez said in a deposition that by 2011 he was almost exclusively working at those hospitals.

Doctors are granted hospital privileges for a specific practice of patient care based on their credentials and previous performance.

Wolfe of Public Citizen said hospitals are required to renew privileges every two years. One requirement is to check the National Practitioner Data Bank to examine a doctor’s adverse medical outcomes.

Hospitals are also required by the state to report serious adverse medical outcomes to Florida’s Agency for Health Care Administration, which can then forward those to the Department of Health for investigation.

So why did doctors not call out Lopez or pressure administrators about him?

Doctors are afraid that if they turn in a doctor and the hospital gets sued then they will lose privileges, a source with the Board of Medicine who spoke on condition of anonymity told The Post. Physicians also rely on their colleagues to cover for them with their patients when they're unavailable.

Several doctors who had worked with Lopez in recent years declined to comment.

'The beginning of a long string of mistakes'

The state of Florida would have another chance to hold Lopez accountable, in the death of 29-year-old mother Ashley Perez.

Perez appeared at Lopez’s office complaining of chest pain and showing signs of premature labor, records show. She was 36 weeks pregnant, the start of the ninth month.

Lopez himself drove Perez, then a mother of a 2-year-old daughter, across town to Wellington Regional Medical Center on the morning of April 21, 2014.

Lopez performed an emergency C-section and a tubal ligation on Perez, according to the Health Department complaint against him.

Perez’s blood pressure started to drop during the day and by evening she was in shock from internal bleeding. She couldn’t breathe on her own.

Lopez then misdiagnosed the bleeding as a liver rupture and started to get other doctors and surgeons involved. After talking to the on-call surgeon, Perez made arrangements to transfer his patient to the trauma unit at St. Mary’s Medical Center.

By the time Perez got there at 3 a.m., her condition had deteriorated.

The surgeon discovered that the bleeding wasn’t coming from her liver but from a blood vessel near the ovary. A stitch by Lopez in the tubal ligation had given way.

“But by then she had sustained massive, irreversible damage to her brain and organs from the ongoing hemorrhagic shock,” according to a lawsuit.

Perez died the next day. She left behind her husband, Edmundo, her daughter, Amalia, and her newborn son, Dylan.

Perez’s sister, Stephanie Joyce, said she still has plenty of questions: Why did Lopez drive her to Wellington Regional from his West Palm Beach office? Her sister lived in Juno Beach. If it was an emergency, why not call an ambulance?

“It was the beginning of a long string of mistakes,” Joyce said.

“The sequence of events from that point on was so rapid and spiraled out of control so quickly.”

How We Got The Story: A trail of patient deaths and injuries found in public records

The Department of Health filed a disciplinary complaint against Lopez, citing the misdiagnosis and his failure to perform immediate exploratory surgery to find the real source of the bleeding.

St. Mary’s and six doctors were sued over Perez’s death, including the chief medical officer of the hospital, Dr. William Jeffrey Davis.

Davis, in a deposition for the lawsuit, said Perez ended up at St. Mary’s because of an “amazingly horribly wrong” diagnosis by Lopez.

“The patient should have gone back to the OR at Wellington. They wouldn’t have had that 6½-hour delay. The patient would have been fine,” Davis said.

“It’s not appropriate to try to dump your problem off on other doctors,” Davis said.

“I think he misrepresented what his patient had. That’s what I think.”

He added, “I’ve known him to tell multiple lies.”

While all these other doctors were sued, only Lopez 's practice was restricted by the Board of Medicine for the death of the young mother.

The disciplinary complaint on Perez’s death was combined with another similar case the same year.

The mom in 2014 complaint who survived

A 32-year-old patient identified only as L.R. suffered from internal bleeding following a C-section and tubal ligation. Lopez failed to do a timely exploratory surgery at Wellington Regional Medical Center to find the cause of the bleeding, according to the Health Department complaint.

Unlike Perez, L.R. survived.

Lopez entered into a settlement in April 2017 with the medical board, agreeing that any surgery he performed in the future would be under the direct supervision of another doctor. He also was required to pay a $22,500 fine and agreed to further training and evaluation.

Lopez no longer had privileges at St. Mary’s after Perez’s death.

There was no indication in the final order approved by the Board of Medicine that a strike would be assessed against Lopez’s license.

Lopez was asked in a deposition in 2019 whether he had completed the Florida CARES or an equivalent evaluation and he said he had not. “They didn’t put a time limit on it to have it done,” he said.

The evaluation "provides a specialty specific assessment of a physician’s medical knowledge, decision making process, patient communication skills and level of psychological functioning," according to the University of Florida College of Medicine. It is designed to help organizations decide whether a physician "demonstrates the abilities and attributes to practice medicine in a safe and competent manner."

The consequences of these lapses in Florida’s disciplinary system are unfathomable for families who have lost loved ones in the care of Lopez.

“The impact of the loss is just layers and layers of grief," Perez’s sister Joyce said. "And we're still struggling, and of course every birthday you remember it. It’s really inescapable. And it's horrible that so many other people have been victims of this man.”

After a patient's death at St. Mary's, Tenet allowed OB-GYN to practice at Good Samaritan

At one time or another, Lopez enjoyed hospital privileges throughout Palm Beach County. After Perez’s death at St. Mary’s, only Good Samaritan in West Palm Beach was left. Both are owned by Tenet Healthcare.

Clare McKinlay, a retired midwife who worked alongside Lopez at Good Samaritan, told The Post that Good Samaritan's administrators didn’t want to hear about nurses’ concerns about Lopez’s competence.

One “pointed his finger at me and said, ‘You bring nothing to this institution. He brings money. Don’t forget that,’” she said.

McKinlay said Lopez broke protocol repeatedly.

For instance, she said, a nurse must be present to monitor the mother-to-be when a doctor induces labor by separating the amniotic sac.

“He would not tell anybody and just walk out of the hospital,” the midwife said.

Other nurses said they feared retaliation if they publicly criticized Lopez and asked their names be withheld from publication.

“I don’t miss the risk of working with him,” one nurse said.

Another nurse said her colleagues complained about Lopez. “He was an older doctor. He would take more risk than some of the new doctors,” she said.

“I am very happy he no longer delivers babies,” added Fiorentino, who was in the delivery room with Castillo-Lopez.

Cohen, who represented Castillo-Lopez’s family, said Lopez was a “big admitter” for St. Mary’s and Good Samaritan, drawing not only Medicaid patients but also those with private health insurance.

“They made an economic decision,” he said.

Mother lost two-thirds of her blood after cervix was punctured

Three months after Lopez was disciplined by the Board of Medicine over the death of Ashley Perez, Onystei Castillo-Lopez was giving birth at Good Samaritan under Lopez's care.

Anesthesiologist Dr. Reynold Duclas had met the couple before delivery, “when she was her normal self.”

Castillo-Lopez lost nearly two-thirds of her blood. Duclas said he estimated 2 liters of Castillo-Lopez’s blood saturated 20 towels. The average body has 4.5 to 5.5 liters of blood.

Her blood pressure was dangerously low — 55 over 27.

“I saw her moaning. She looked altered mentally,” Duclas testified in a deposition. “I mean, it was a scene to behold.”

Lopez said in a deposition that it was the patient who damaged her own cervix by pushing too early. He also said the hospital failed her by not giving her blood products in a timely fashion.

The doctor assigned to supervise all surgical procedures performed by Lopez — per the Board of Medicine’s order — was OB-GYN Dr. Alfred Tomaselli.

Physician who oversaw Berto Lopez: 'It was all a lie'

“I was really under the impression that if this guy had a medical issue, I would be there to take over, and that was the concern,” Tomaselli said in a deposition in the Castillo-Lopez case.

He said the chief of staff at Good Samaritan asked him to be in the operating room with Lopez. Before Castillo-Lopez, Tomaselli oversaw about 20 operations and had not always agreed with Lopez’s decisions.

In one case, Lopez had failed to get a urologist consultation during a hysterectomy. Later, Lopez told Tomaselli that the urologist had cleared the patient.

“A week later I found out from a colleague of mine who’s a general surgeon that a urologist was not consulted, that the lady’s ureters were blocked and that the lady’s kidneys had failed,” Tomaselli said in the deposition. He said he didn't know whether she had recovered.

The case cited by Tomaselli was similar to Catlett, who had suffered kidney damage after a hysterectomy.

“This patient was under my care, too. He (Lopez) told me he was going to do something that needed to be done for her,” Tomaselli testified. “He told me it had been done, and that she was clear, and it was all a lie.”

But a nurse had taken him aside and told him he had to be in the operating room if Lopez did a C-section.

“I asked her, ‘Do you know why this is?’ And she said, ‘I can’t talk about it. And I asked her the same questions, ‘On whose authority? Is this a hospital thing? Is this a state thing? And she said, ‘I can’t talk about it,’” Tomaselli said.

Castillo-Lopez, barely conscious, had signed a consent form for a total hysterectomy. Lopez, while in the operating room, did not perform a total hysterectomy. He left the damaged cervix and part of the uterus.

As a result, Castillo-Lopez continued to bleed after surgery. Lopez ordered the incision packed with gauze and went home, saying his scrubs were soaked in blood and he couldn’t find clean ones.

Overnight, Castillo-Lopez’s condition deteriorated. Nurses observed the patient gushing blood before she suffered cardiac arrest. Hospital staff spent 55 minutes trying in vain to revive her.

After the mother’s death, Tomaselli said he found out about Lopez’s patient history. He then told the hospital he was done supervising him.

“There are several cases with maternal deaths that I was not made aware of or didn't know about before, and I was a little bit unhappy about that — I was a lot unhappy about that,” Tomaselli said in the deposition.

In his deposition, Lopez claimed the hospital was at fault for Castillo-Lopez’s death, saying it did not have enough blood on hand for a proper transfusion.

Good Samaritan, the last hospital to allow Lopez to operate, suspended him, and Lopez said he then resigned.

In 2019, the hospital’s owner, Tenet, changed its policy to ensure that a physician who lost privileges at one of the chain’s hospitals would not be allowed to practice at any.

The change was not prompted by the final patient death linked to Lopez, a Tenet spokeswoman said, adding that he had not been a member of the medical staff at Good Samaritan since Castillo-Lopez's death in 2017.

“We are very proud of the award-winning OB program at Good Samaritan,” she said.

Lopez settled the lawsuit, but the Castillo-Lopez family had to go to court to tell the judge that Lopez wasn’t making payments. They got a judgment against him.

At his administrative hearing fighting the Health Department’s complaint, Lopez opened his defense, “Every four minutes a woman dies in this world because of a postpartum hemorrhage. Every four minutes. It's the number one cause of maternal mortality in the United States, in Florida, in Palm Beach County.”

Fiorentino was in the hospital room when Castillo-Lopez gave birth. She testified at the administrative hearing, as well.

“It was traumatic,” she recalled. “You don’t have a healthy mother die who just had a baby. I haven’t had that before and I haven’t had it since."

The three-strikes law was ill-conceived from the start, Freiden, the Miami malpractice attorney said: The Board of Medicine needs to be able to take away a doctor’s license if it finds him or her dangerous immediately — not under some arbitrary baseball analogy.

“If this were a pilot who crashed the plane, and they were negligent, do you think they'd get two more strikes after that?” he said.

hbaltz@pbpost.com

@jpacenti

Dr. Berto Lopez: a career dotted with multiple malpractice allegations

1988 — Crystal Diane Hicks, infant. Lopez, in a deposition, said he was accused of not performing a timely C-section, causing death.

1992 — Earl Buchanan, infant. Records available show settlement of a lawsuit filed against Lopez for his death.

1994 — Nakia Gilmore, 18, died following a procedure during childbirth. Records do not indicate the cause of death.

1994 — Samuel Mercedes, infant. Lopez failed to diagnose a neural tube defect and the baby suffered severe birth defects, according to court documents.

2002 — Michelle Hirt, 31. Lopez failed to remove her dead fetus, ignoring a pathology report, according to the state Health Department. Hirt said she gave birth to the remains in a friend's bathroom.

2011 — Matthew Dixson, infant. A malpractice lawsuit accused Lopez of not doing a C-section despite a mother at risk of having an baby who was too large. The infant was born with a broken upper arm bone and permanent nerve damage, the complaint stated.

2011 — Dominic Shelton, infant. The baby was born with major neurological damage. Lopez was accused of waiting too long to perform a C-section, according to court documents.

2012 — Joann Catlett, 47. Lopez was accused in a malpractice lawsuit of cutting Catlett’s ureter during a hysterectomy.

2012 — Joyce Rivers, 56. Her small intestine was punctured during an operation to remove her ovary, according to the Palm Beach County Medical Examiner's Office. She died.

2014 — Ashley Perez, 29. Died of postpartum hemorrhage due to an ovary stitch that gave way after a tubal ligation was performed, according to the state Health Department.

2014 — L.R., 32. She suffered a postpartum hemorrhage after a tubal ligation, according to the state Health Department.

2017 — Baby R.R.R. A malpractice lawsuit accuses Lopez of severing the boy's penis during a circumcision.

2017 — Onystei Castillo-Lopez, 40. Died of postpartum hemorrhage due to a punctured cervix, according to the state Health Department.

2021 — Baby G.L. Parents said a third of the baby's penis was severed during a circumcision.

HOW TO LOOK UP YOUR DOCTOR

Here are three databases in which you can look up your doctor and see whether he or she has disciplinary complaints or malpractice suits.

There is, however, no one database that is comprehensive so you have to look around.

For discipline, see the Florida Department of Health database

The Department of Health database is for any doctor licensed in Florida. If your doctor has had disciplinary problems, they will be here. Plug in the name of your doctor, then hit the "Discipline/Admin Action" button to see the complaints and punishment.

You can also find out a variey of other things about your doctor, such as where they went to school and whether they carry malpractice insurance. Keep in mind that most of this information, other than the disciplinary complaints, is self-reported.

How many malpractice lawsuits? Check out your local court database

You can also check out your local court database to see about malpractice suits filed against your doctor. For Palm Beach County, it is here. You can log in as a guest. If you click on a document you want, you can ask it to be unlocked and leave your email address. The clerk of courts will email you when it's ready, often in about a day.

The documents are locked by county clerks of court because of a Florida Supreme Court rule that requires it so that the clerk can redact confidential portions before the documents are released to the public.

Once you click on a malpractice lawsuit, Look for the document called "complaint" to see what the plaintiff alleges and find the document called "answer" to see what the doctor has to say about it.

In Martin County, the court database in here. In Broward County, you can look here. In any other Florida counties, look for the clerk of court case search. They should all be public.

Insurance database tells you about settlements

The Florida Department of Insurance has a database of settlements in malpractice lawsuits that insurers are required to report here.

The information here is scant. You would find the amount of the settlement and a brief description of the injury and the date it occurred. If there is a court case, the case number will also be there.

This article originally appeared on Palm Beach Post: West Palm OB-GYN lawsuits: Moms, babies died. Circumcisions botched.