Doctor with a dangerous edge
He could be straight out of Nip/Tuck, the US television drama about the exploits of a pair of plastic surgeons and their clients.
He is also a charlatan, although he considers himself something of a crusader with a noble heart. According to the New York Times, Sachs once gave his children's nanny and his own masseuse some very special Christmas presents.
Instead of the usual bonuses of $500 and $200, respectively, Sachs surprised them: the nanny got a nose job, the masseuse a facelift and eye-tuck all 'on the house'. "I've always felt Christmas is a very special time, and it never hurts to do more," he told the newspaper.
Sachs calls himself an expert on nasal procedures and has even written a medical textbook on the subject. By his own count, he's performed more than 30,000 such procedures over the last 25 years.
He's talked about his work on TV shows, including Oprah and Good Morning America, written articles about the nose and invented new procedures for nasal reconstruction.
He has called himself "a combination philosopher, priest and most definitely an artist", in his cosmetic work.
Three secretaries administer his booming practice in a sumptuous office on Central Park South in Manhattan. He has termed his operating room "a temple, a sacred place" and his operations "a symphony".
But there's another side to Sachs' record, one his patients and the public don't get to hear.
Dr Sachs has made 34 malpractice payments during the past decade more than any other doctor in New York and is banned from doing certain surgical procedures.
Only seven US doctors have made more malpractice payments; and four of these have been struck off.
Patients claimed he caused infections, mangled parts of their noses and removed others, punctured septums and left them with breathing problems.
According to the National Practitioner Data Bank, 14 of Sachs' patients won settlements totalling over $2 million.
One malpractice insurance company terminated Sachs' policy several years ago because of the suits. He's now covered by a state-run concern known as "the insurer of last resort" for doctors.
The New York state Health Department's Office of Professional Medical Conduct has never disciplined Sachs. He believes there is no reason he should be disciplined. "I'm a fine physician," he said. "I care about my patients, and I get sued."
He added that he may generate suits because he takes on tough cases. "It's not only enraging, it's confusing," he said.
He also said that "none of these cases was malpractice" and that many involved patients who had previous rhinoplasties nose jobs. Some of them had two or more that had been "wrecked", by other surgeons, he said.
He also contended that his malpractice insurers often settled to avoid the cost of litigation.
One of his patients, Rachelle Adler, consulted Sachs to improve the appearance of her nose and to solve breathing difficulties. She underwent surgery at New York Eye and Ear Infirmary, where Sachs was chief of the plastic surgery department.
By Sachs' account, Adler was pleased with her appearance, but still had problems breathing unless she was in a humid climate. She moved to Florida, but was unable to visit her family in New York, so, Sachs said, he performed a second operation.
"After the operation, I woke up in pain," she said. There was a lot of bleeding that continued into the next day.
"It was gushing out of me. I couldn't eat, I was throwing up bile. So he said, 'Come to my office'." There, she said, Sachs "ripped the packing" out of her nose, called her "a baby", told her to stop crying and sent her home.
Two days later, she was still throwing up, and Sachs met her at the New York Eye and Ear emergency room.
"They checked me in, and I was there for three days with all kinds of tubes in me," Adler said. "Every day he would come and pat me on the head and say it was all my imagination and it had nothing to do with the surgery."
Later, she said, radiological tests showed sinus inflammation was causing the vertigo that triggered her vomiting.
"I still get nosebleeds once the temperature falls below 60," she said. "I still get headaches. This is what he did to me. I can't breathe out of the right side of my nose."
Adler sued, claiming malpractice. "Here's a woman who has a beautiful nose, loves her nose, and she walks into New York State, and she can't breathe," Sachs said, describing the suit. "It's a little stuffy, a little dry, and she has a list of things. She can't breathe. She can't have sex, can't go to the toilet, can't go to the Mets game."
Sachs paused as his lawyer urged him not to be sarcastic. Adler won a $325,000 settlement on the day her case went to trial in May 2000.
"I literally fell over," Sachs said. "I mean that's an awful lot of money for a woman who is living a perfectly lovely life in Florida."
Another patient, known only as Kory M, won a $250,000 settlement after claiming that she suffered an infection as the result of a nasal valve reconstruction he did. She had numerous previous operations performed by other doctors.
Sachs discussed her case fully and showed photographs of her before and after her surgery. He said that she had undergone numerous previous operations, and that "the inside of her nose was collapsing".
"I didn't promise her very much, in all honesty," he said. Showing the "after" photo, he said "she looked slightly better".
Of the settlement she won, Sachs said, "I was flabbergasted. My lawyers said, 'Mike, we can't take this to trial'." Another patient, Jerome M, sued, claiming Sachs had improperly removed cartilage and deformed his nose. He won a $250,000 settlement.
Sachs said Jerome M had undergone numerous previous procedures, and his records show that for four months after the 1992 procedure, he was healing and happy.
But then Sachs' notes read, "patient unhappy with his nose". Sachs said that, at Jerome M's insistence, he performed two more procedures and then refused to do more.
Sachs is notoriously unable to wield a scalpel with reasonable skill. In 2000, the Daily News identified him as one of New York's worst doctors because he had been sued 28 times and paid damages in 11 cases. The department let Sachs skate and, predictably, he sliced and diced until he racked up 34 malpractice payments.
At which time, state authorities swung into action not to strip Sachs of his licence, but to help him keep earning a living. Sachs can still practise medicine, but if he wants to perform complex operations, he has to be supervised by a competent physician.
The Sachs investigation was carried out by Daily News journalists Russ Buettner and William Sherman.
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