SEPT. 4 UPDATE: Four months after this story posted, Dr. Rian Maercks contacted the Miami Herald to respond to the allegations made by the Florida Department of Health. Maercks’ response has been added to the story below.

A Miami plastic surgeon denies injecting a patient with three times the proper maximum dose of an anesthetic during a comprehensive cosmetic surgery, as a state complaint accuses him of doing.

Also, Dr. Rian Maercks says his anesthesia administration had nothing to do with the patient’s death three days after the surgery, and says the Florida Department of Health administrative complaint doesn’t blame him for the woman’s death.

The complaint, filed March 25, began what could be the first disciplinary action against Maercks in the 16 years he has been licensed in Florida. When there will be a final resolution — whether exoneration, reprimand or fine — is unclear. Florida’s medical discipline process can move slowly or gets stalled.

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Maercks has been board certified by the American Board of Plastic Surgery since November 2018. He calls the complaint’s claim “a false allegation that involves a scientific misrepresentation.”

Anesthetic for a combination plastic surgery

The Maercks Institute has held office surgery registration license No. OSR 1681 under Maercks’ name since May 24, 2022, which allows “surgery with moderate/conscious to deep sedation.” A previous license under “The Maercks Institute” shows as “Closed.”

According to the complaint, a patient referred to as “J.T.” showed up at The Maercks Institute, 3050 Biscayne Blvd., on Jan. 18, 2023, for these plastic surgery procedures: rhytidectomy (facelift); blepharoplasty (eyelid surgery); abdominoplasty (tummy tuck); rhinoplasty (nose job); breast lift; genioplasty (work on the chin); liposuction; and body contouring via fat grafting.

During the surgery, the complaint said, Maercks injected 400 mg of Marcaine and 532 mg of Exparel, each the brand name version of a local anesthetic bupivacaine. That’s 932 mg of bupivacaine injected into J.T.

“The maximum dose of bupivacaine as an injection is between 225 mg and 266 mg,” the complaint said. “The maximum amount of bupivacaine that should be administered to a patient in a 24-hour period is 400 mg.”

READ MORE: Miami plastic surgeon’s bad injection caused butt lift death, state says

Maercks said he injected nothing, but used tumescent liposuction.

“With tumescent, you use large volume (of anesthetic) placed into fatty tissue with epinephrine,” he explained. “Epinephrine slows down blood vessels and, obviously, delays absorption. Then, with liposuction, much of the volume you put in is removed before systemic absorption.”

Maercks said of the aforementioned 932 mg, 740 mg was removed, leaving 192 mg applied to J.T. That would be well under the guidelines.

“One of the major scientific misunderstandings in this case is the [Department of Health] expert has no familiarity with the use of Marcaine or Exparel in a tumescent nature,” Maercks said. “In fact, his only concern is he believes tumescent use of Xxparel and Marcaine are unfounded, have no clinical documentation and are dangerous. This is simply not true.

“This is how cutting-edge plastic surgeons are delivering pain-free care.”

Maercks countered the opinion of the Department of Health expert, American Board of Plastic Surgery board certified Dr. John Obi, with that of board certified Beverly Hills plastic surgeon Daniel Gould.

“This method of combining Exparel with standard bupivacaine in tumescent anesthesia is well supported in the literature, aligns with manufacturer guidance, and is something I have used safely in hundreds of procedures over years of high-volume surgical practice,” Gould wrote.

Post surgery problems

The surgery lasted from 12:44 p.m. to 8:21 p.m, the administrative complaint said. While in a post-anesthesia care unit over two hours later, the complaint said, “J.T. became agitated and removed her IV. She was given 1 mg of sedative Versed at 10:56 p.m., then another milligram at 11:20 p.m.”

Maercks’ version: this happened after J.T.’s discharge from the post-anesthesia care unit.

“J.T. experienced a significant drop in her blood oxygen saturation,” the complaint said. “At 11:59 p.m., Miami Fire Rescue was summoned to the facility. At 12:15 a.m., [Maercks] and staff initiated CPR due to J.T.’s weak pulse and further blood oxygen desaturation. At 12:18 a.m., Miami Fire Rescue arrived and performed CPR on J.T., who no longer had a pulse.”

After 15 minutes of CPR got J.T.’s blood flowing again, she was taken to Jackson Memorial Hospital’s Ryder Trauma Center.

“It was determined that patient J.T. had suffered an irreversible anoxic brain injury,” the complaint said. “Patient J.T. expired on Jan. 21, 2023.”

An “anoxic brain injury” describes what happens with the brain gets oxygen deprived.

Maercks said while there’s no definitive answer to what happened, he said Marcaine toxicity couldn’t be involved because that would be an immediate heart stoppage, not a stoppage taking three days.

“Whatever happened was a cardiopulmonary event, which can happen when we’re in our sleep, when we’re walking our dog,” Maercks said.

“Certainly, the stresses of anesthesia in surgery could exacerbate that. That’s why we do extensive cardiac workup, like I did with this patient. This patient was cleared. We talked about risk. There is increased risk in every way for combined procedures. We know that. We talk about it with our patients.”

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