By Sandra G. Boodman
Washington Post Staff Writer
Tuesday, March 6, 2007

While some physicians pride themselves on their business acumen, few are as unabashedly entrepreneurial as David Louis Matlock, the board-certified obstetrician-gynecologist regarded as the driving force behind vaginal cosmetic surgery.

Even fewer approach what Matlock says is his $12 million annual income from his medical practice and other business ventures. That figure is more than 45 times higher than that of the average obstetrican-gynecologist, according to a 2006 survey compiled by the American Medical Group Association.

Matlock said he operates each week on about 10 patients who wait months for an appointment. Many are drawn by his regular appearances on the E! network makeover TV show "Dr. 90210." (On the show and in interviews, Matlock gives his age as 47, but records show he is 55.) Matlock says most of his earnings are derived from patient fees and royalties. According to SEC filings, he owns stock options in a company that makes the lasers that he requires trainees, whom he calls "associates," to buy.

Recently Matlock formed a television production company that is trying to sell a reality show called "DocStars," featuring him.

"I've always been a successful businessman," said Matlock, who received an MBA in health care from the University of California at Irvine in 2000. "I understand the value of branding."

Matlock said his licensing agreements are necessary to protect his intellectual property rights. "I understand how to capitalize on an opportunity. Why should I give it away?"

But critics say the surgeon's unorthodox methods are antithetical to widely accepted medical practice.

Prospective patients, said Thomas Stovall, a past president of the Society for Gynecologic Surgeons, have no way of evaluating Matlock's claims because his results have not been peer-reviewed or published: "They go on the Internet and up pops this Web site and they read a few testimonials and think it sounds great." .

"Even if it doesn't violate ethics, it's sleazy," said V. Leroy Young, a St. Louis plastic surgeon, referring to what he calls Matlock's "hypermarketing." Young said he considered Matlock's patient fees, which can run to $50,000 for the package of procedures dubbed the "Wonder Woman Makeover," to be "astronomical" and "indecent."

Officials at the American College of Obstetricians and Gynecologists (ACOG) have not taken a position on laser vaginal surgery. In 2004, its ethics committee expressed concern generally about patients' ability to give informed consent as well as "the use of a business model that aims to control the dissemination of scientific knowledge."

Matlock rejects such criticisms. He said he plans to publish studies soon, but not in peer-reviewed journals that would require him to disclose his techniques. His patients, he added, sign a consent form detailing more than 40 potential complications, including incontinence and intractable pain.

Matlock said he thinks his critics are jealous of his financial success. "I'm a monopoly," he said. "A monopoly can charge what they want. I'm using the same business principles as Microsoft."

In recent years Matlock's activities have attracted the scrutiny of the Medical Board of California, records show.

In 1998 the board sought to revoke his license, charging him with insurance fraud, dishonesty, creation of false medical records and gross negligence in connection with his treatment of two patients.

In 2000 Matlock signed a settlement agreement with the board that placed him on probation for four years but did not require an explicit admission of wrongdoing. Two years later his request to terminate the probation was denied after an administrative law judge found that Matlock had tried to "mislead the Board" by not disclosing that he had been sued for malpractice while he was on probation and had "clearly withheld information." His license was fully restored in 2004.

Matlock said the disciplinary action was the result of a misunderstanding. "It was completely unfair, and I honestly think race had something to do with it," said Matlock, who is black.

In the past 10 years, records show, Matlock has been sued for malpractice 10 times in Los Angeles County Superior Court. According to ACOG, ob-gyns are sued an average of 2.6 times during their careers.

Matlock said that five of the lawsuits were settled at the recommendation of his insurance company, with payments ranging from $8,000 to $150,000. In a sixth case Matlock said he refunded a patient's $6,500 liposuction fee after she was rushed to Cedars-Sinai Hospital for a cardiac problem that arose during surgery. Two cases were dropped by the plaintiffs before trial, he said, and two others were resolved without payments.

Lawsuits, he said, are a risk for doctors in his specialities. Matlock said the largest payment made to settle a case on his behalf was $225,000 paid in 1993.

"The average payment for an ob-gyn is $500,000," Matlock said, adding that the lawsuits brought against him were "nuisance cases." ·