Demi died three days after cosmetic surgery in which she received ‘deplorable to completely non-existent’ post-operative care
A mum-of-three who died after a butt lift (BBL) procedure in Brazil was subjected to “frankly barbaric medical practice” in which she received “deplorable to completely non-existent” post-operative care, a coroner has concluded.
Demi Leigh-Regan Agoglia, from Salford, had traveled to Turkey for the procedure in January after seeing ads on social media for Istanbul-based Comfort Zone. The 26-year-old died in an Istanbul hospital on January 8, three days after the operation and a catalog of poor care, an inquest found.
Assistant Coroner John Pollard found she died of “accident”, “contributed by negligence”. He vowed to write to the health secretary “to stop this frankly barbaric medical practice being carried out at such low standards”. Manchester Evening News exhibitions.
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Ms. Agoglia traveled to Turkey to undergo “BBL” surgery on January 4 and underwent surgery the following day. The operation took place without “proper informed consent” and after “mandatory” pre-operative procedures, said Prof Pollard, who criticized the Turkish authorities for “refusing to cooperate with the coronavirus process”.
Professor Pollard said: “I find the post-operative care to vary from dismal to completely non-existent”, adding that by the time she was taken to hospital after her collapse, Mrs Agoglia was already in an “irrecoverable state”.
The inquest in Bolton found that Mrs Agoglia was described as healthy but had been diagnosed with ADHD and bipolar disorder. Her mum, Christine Tydd, said the day before her daughter was due to fly to Turkey, he told her she didn’t need to go because “she was a beautiful girl”.
Mrs Tydd told the inquest: “She said she wanted to go. She was self-conscious about her appearance – she didn’t change her mind.” Ms Agogliai and her then-partner, Bradley Jones, flew to Turkey on January 1 this year and were due to return on January 8, the day she died.
Ms Tydd said she received a text message from Mr. Bradley who said “gone”. She said she and other family members had been talking to Ms Agoglia via FaceTime in Turkey and the day before she died, she was “laughing and joking”.
Mrs Tydd added: “She said apart from the bruise on her stomach, she had the bum she always wanted. She said she was in a bit of discomfort but that was it. She said she was fine and just wanted to get home.”
Mr. Jones, in evidence, said Ms Agoglia found ‘Comfort Zone Surgery’ advertised in Turkey either on Facebook or Instagram and had “decided to book herself”. Saying Ms Agoglia did not need the procedure, he said: “I didn’t want her to go, I didn’t want to go with her.”
She told the court she had wanted the surgery “for quite some time” and said he had asked her not to, but added she had seen “some celebrities advertising the surgery”. Ms Agoglia, however, booked the surgery three months in advance, according to the inquest.
Mr. Jones told how they traveled to Turkey and were set up in a “residence villa” by Comfort Zone with others undergoing surgery. They were taken by taxi to Avrasya Hospital, near Istanbul, the next day. They drew blood from Demi, she said, and put a dress on her.
He was then taken into surgery, returning to a room they were given four and a half hours later. Mr Jones said: “He was shivering and very, very cold. It was terrifying to watch.”
The inquest heard hospital staff put a heater on the floor with tubes running under her sheets to warm her. They stayed the night and were taken back to the villa the next day in the same taxi.
The staff, said Mr. Jones, came to the villa to check if Mrs Agoglia could get up and empty her drains, but said they had to stay in Turkey for five days under the deal.
Mrs Agoglia, the inquest heard, complained of chest tightness on the fourth day after the operation, but Mr. Jones said they were only given a WhatsApp number to contact the hospital. The inquest heard that “strangely”, he was fed a cucumber by staff at one stage.
Mr Jones eventually said Ms Agoglia could not breathe properly and collapsed on the floor of their villa room after trying to stand up. Mr. Jones said her face turned white and her eyes watered, adding that she thought she was having a seizure. The inquest heard a “member of staff” who arrived after Mr Jones and others tried desperately to get help.
Ms. Agoglia then reentered the same taxi and was taken back to the hospital, receiving CPR during the journey. The investigation revealed that she was taken to hospital and Mr Jones was placed in a separate room.
He said he was told she was in intensive care, but a surgeon and a doctor later told him “they did everything they could, but Mrs. Agoglia was dead.” The inquest heard that Mr. Jones was then taken to a consulate, where it was reported that the nurses involved were unqualified. He said the paperwork was missing and the hospital had signed a “fitness to fly” document.
Mr. Jones told the inquest: “I felt the aftercare was terrible. Not many checks were done. The ‘fit to fly’ letter was done immediately.”
Dr Omar Tillo, a consultant plastic surgeon giving expert evidence, said the procedure involved transferring fat tissue to the hips and buttocks to give a fuller figure, but said there were strict rules, policies and procedures in the UK.
He agreed with Coroner John Pollard that Ms Agoglia’s surgery and whole experience was “lacking care and due diligence”. Dr. Tillo hit out at the lack of pre- and post-operative care, questioned a signed consent form and criticized the lack of documentation.
The notes provided by the hospital were dated incorrectly and Dr Tillo said no indication of “informed consent” was given. He added: “Maybe he didn’t even know what he was signing.
“The care at the villa appears to have been substandard. There were unqualified people making decisions. It’s a list of things you expect to be done.”
Dr Tillo, who questioned whether the case amounted to “homicide”, also criticized a “severely inferior response” when Ms Agoglia collapsed. The interrogation, however, was heard Bolton The coroner’s court tried repeatedly to get statements from the hospital, the medical authorities in Turkey and the surgeon who carried out the procedure, but coroner Hannah Hargreaves said: “We have had no response to any emails.”
The cause of death following a post-mortem examination was given as indeterminate, but the inquest found the “most likely” cause was a microscopic fat embolism, where fatty tissue leaks into blood vessels.
The medical examiner Mr. Pollard said Ms Agoglia’s care was “effective” and criticized “the lack of information”. He said he would write a “letter of concern” to Health Secretary Wes Streeting, MP, saying his investigation revealed cases like Demi’s were happening “on a regular basis”. But, he added, the government has no jurisdiction over hospitals abroad.
The inquiry heard more than one million “medical tourists” visit Turkey each year. Speaking outside court, Mrs Agoglia’s sister Chloe said: “The only thing I would say is people should not have this surgery.”
Professor Pollard said it was “indicative of a poor standard of care” that he was taken by taxi rather than an ambulance, describing how Dr Tillo had “cleared out all the failings and failings that he was able to assess from the evidence and sparse documentation that he has at his disposal”.
The doctor had found that there was no record of admission to the ITU or any tests and scans carried out, all of which were necessary, the court was told. Prof Pollard noted that the main medical cause of death was “miniature fat embolism” and returned a conclusion of “misfortune”, saying his negligence had contributed.
He added: “I feel something further needs to be done to stop this frankly barbaric medical practice being carried out at such low standards that it would certainly not be tolerated in the UK.”
