Dr. Anthony Pignataro
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In the late 1990s, a young woman goes in for a routine plastic surgery procedure. She's a wife and a mother of two small children. But tragedy strikes, and the young woman doesn't make it out of the surgery alive. Shortly after the patient's death, the wife of the doctor in charge of the surgery falls ill with what appears to be some sort of intentional poisoning.

Was this revenge for the botched cosmetic surgery that cost an innocent woman her life? Or was this something else entirely? Only the forensic evidence could decide. This week on Forensic Tales, we cover the story of Dr. Anthony Pignataro. ♪

Welcome to Forensic Tales. I am your host, Courtney. Each Monday, we release a new episode that discusses real, bone-chilling true crime stories and how forensic science has been used in the case.

Some cases have been solved through cutting-edge forensic techniques, while other cases remain unsolved.

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Hey guys, thank you so much for joining me on this brand new episode of the show. I hope you guys and your families are continuing to stay safe and healthy right now. I know we're all hoping that everything goes back to normal or as close to normal as possible sooner rather than later.

I know I guess the silver lining in all of this, at least for me, is to really appreciate everything that I was probably taking for granted before all of this COVID-19 stuff happened. So hopefully you've been able to find a silver lining as well.

So the story that I want to cover on this week's episode is actually another doctor story. Now we covered the case of Dr. John Schneeberger in episode 19 of Forensic Tales. So if you haven't listened to that episode yet, I highly recommend giving that episode a listen right after this one.

So from the moment Anthony Pignataro was born, he knew he wanted to grow up to become a doctor. Anthony grew up in a household watching his father, Ralph Pignataro, become a very well-respected and successful surgeon throughout the city of Buffalo, New York.

And he knew from a very young age that he wanted to follow in his father's footsteps. And he also wanted to become a highly successful doctor himself.

And in 1978, Anthony was attending college at Lehigh University, which is a fairly small private university in Pennsylvania. And he still had high hopes of going on to attend medical school.

But he found himself struggling to get accepted into any credible medical schools, not just right there on the East Coast where he was living. He was struggling to get accepted into pretty much any medical school. So his next best option was to accept an offer to attend med school at the San Juan Bautista School of Medicine on the island and U.S. territory of Puerto Rico.

which I just want to say that I have been to Puerto Rico twice, to both vacation and to race triathlon. And I have to say, I don't think San Juan is a bad place to be at all. The island of Puerto Rico is absolutely beautiful, great people, and even better food.

So Anthony settled in to the city of San Juan and finally began his dream of becoming a doctor, just like his father had been growing up as a kid. And he was dedicated to his studies. Before he even left for medical school, he met 21-year-old Debra Rago, and the two hit it off almost instantly.

But Debra knew just how much becoming a doctor meant to Anthony. So she knew that she would have to put their relationship on hold and wait for him to finish med school. And that's exactly what she did. While Anthony was in Puerto Rico studying, she stayed home and she waited for him.

Anthony finished medical school in San Juan, Puerto Rico, and he returned back to the States where he and Debra were finally able to be together. So in 1985, Debra and Anthony decide that it's time to make their relationship official and the two get married.

After getting married, Anthony started working at a local New York hospital as a surgeon. And during these first few years, fellow doctors and co-workers of Anthony started to notice that he wasn't exactly the best doctor in the world. Not only because Anthony came off as arrogant, but also because he was a very good doctor.

but because when put to the test, he didn't really seem to know much about medicine at all. Now, of course, Anthony is still in his first few years as a doctor, and some thought, well, maybe what he learned in medical school isn't exactly translating to the real world, and maybe he just needs a little more experience.

But Anthony thought quite the opposite, actually. And after just a few years, he ends up leaving the hospital to open up his very own plastic surgery practice in the Buffalo suburb of West Seneca.

Anthony, at this point in his life, really had everything going for him. By all accounts, he had a great marriage with Debra. The couple had a son and daughter together. They purchased a nice home near his plastic surgery practice in West Seneca. He reportedly drove around in a red Lamborghini, really just living the good life.

And while Anthony Pignataro's plastic surgery practice was thriving, he also became a self-made entrepreneur. At the time, in the late 1990s, there weren't many options for men when it came to hair loss. And Anthony himself was dealing with this problem. He actually started to lose his own hair starting around the age of just 23 years old.

And now in his late 30s, to solve this problem, Anthony invented a snap-on toupee for men who were suffering from hair loss. And after trying pretty much everything with glue, with clips, weaves, nothing seemed to really work. And that's when he came up with the idea of a snap-on toupee.

So the snap-on toupee, which Anthony actually became his very own first patient with, involves surgically implanting titanium sockets to the top part of the skull. And then after the bone is fused, which takes about 12 weeks, gold snaps are screwed into the sockets.

And then for the actual hair piece itself, a plastic mold is taken of the patient's head, which is then sent off to have human hair individually sewn on.

And then once the hairpiece is sewn together and it's styled the way that it wants to be, the hairpiece is then attached to the gold snaps on top of the head. And then there you go. You've got the snap-on toupee. So once Anthony performed the procedure on himself and he saw a great deal of success,

he was able to recruit over 100 men and many from across the country to travel to Buffalo and have Anthony perform the procedure on them. And this snap-on toupee became a huge business. On top of the plastic surgery practice for Anthony and his family,

Each hairpiece and procedure would cost the patient around $4,000. So he was literally bringing in thousands and thousands of dollars each month from both the snap-on toupee invention as well as the plastic surgery practice.

Now, with a thriving medical practice, a profitable invention, and a complete family life at home, Anthony Pignataro was feeling pretty good about himself. Not just as a father and a family man or an entrepreneur, he especially felt good about himself as a doctor.

And he felt so good about himself that he figured that to save a little money around the plastic surgery office, he wouldn't hire an anesthesiologist or a registered nurse because he thought, why pay all of this extra money when I can perform the work of an anesthesiologist and a nurse for my own practice?

So when it came time for a plastic surgery procedure, Anthony would administer the anesthesia to his patients, and then he would basically act as both the doctor and the nurse during surgery. So in 1997, 26-year-old and mother of two young children, Sarah Smith met with Dr. Anthony Pignataro to schedule a breast augmentation procedure.

So on the day of the procedure, Sarah Smith showed up at Dr. Anthony Pignataro's office for what should have been just a routine breast implant surgery. She showed up, she saw the doctor, and she saw the doctor's wife, Debra, who at the time thought was the nurse.

So she really didn't have any reason to be worried or concerned. Now, of course, she's probably a little anxious. I know any surgery will do that. But Sarah Smith must have believed that she was in good hands with Dr. Pignataro. After all, he was a renowned plastic surgery in West Seneca, and he was a self-made entrepreneur in the medical field.

But shortly after Dr. Pignataro started the breast augmentation procedure on Sarah, he noticed that his patient was starting to show signs of some distress. And shortly after, she actually stopped breathing.

And the doctor didn't have a ventilator in his office. He really didn't have any proper medical equipment to deal with this sort of reaction. Dr. Pignataro at this point had absolutely no option but to call 911 himself on his very own patient.

26-year-old mother and wife Sarah Smith passed away even before paramedics could arrive at the medical practice. Breast augmentation surgery is a fairly routine and safe procedure. It is extremely rare for complications to occur, especially complications as severe as death.

So authorities ordered an autopsy to be performed on Sarah Smith to try and figure out exactly what could have gone wrong with this simple and routine procedure. The medical examiner in the case found a large amount of anesthesia in Sarah's body, an amount described as well above the normal or safe levels you would see in a surgery like this.

And not only did authorities find the amount of anesthesia in Sarah's body troubling, they also found it disturbing that Dr. Pignataro didn't staff anesthesiologists, he didn't staff any registered nurses at his practice, he didn't even have a ventilator. He didn't have anything that what you would find in a type of medical practice like his.

After a short investigation, authorities were certain that if Dr. Anthony Pignataro had the proper medical equipment and proper medical staff, Sarah Smith would have never died from the surgery.

and authorities argued that Sarah's procedure should have been done in a hospital or at the very least done in a proper medical office with all of the appropriate equipment and resources. Anthony's office didn't have any of it. The state of New York charged Dr. Anthony Pignataro with manslaughter after learning that on top of the lack of proper medical equipment,

He also wasn't even a board-certified plastic surgeon. It turns out Anthony had only brief experience as an ear, nose, and throat doctor. He didn't have any experience as a plastic surgeon.

On top of the criminal charges, the New York State Health Board ended up charging him with 30 counts of professional misconduct in the case.

Anthony Pignataro pled guilty to criminal negligent homicide for Sarah Smith's death. He was sentenced to pay a $5,000 fine, serve six months in jail, and was ordered to complete 250 hours of community service.

And of course, he did end up losing his license to practice any type of medicine in the state of New York. After serving his six-month jail sentence, Anthony got out and had a lot of trouble finding a job.

He found it especially difficult to accept a job because he was used to making a lot of money, both from his medical practice and from his snap-on to pay business, which now he wasn't making any money.

But Deborah, his wife, stood by his side. Even after the death of Sarah Smith, the time that he spent in jail, the loss of all of the family money, Deborah remained right there by Anthony's side. She was there taking care of the two small children. She was out there helping Anthony find a job, etc.

She was doing pretty much everything she possibly could to hold down the family. Now, even though Deborah was doing everything she possibly could for her husband, Anthony was caught having an affair with another woman. And in March 1999, Deborah decided to separate from Anthony.

but they didn't stay separated for long because Deborah took Anthony back just within a few short months of the affair. In May, 1999, Deborah started to feel very ill and

she was experiencing some really bad flu-like symptoms. And these symptoms went on for weeks and weeks without getting any better. Now, I think most of us have had the flu sometime before in our lives, and we know what that feels like. So to have those kinds of symptoms for weeks on weeks is a nightmare.

And besides the flu-like symptoms, Debra also started to notice that her hands and feet started to feel numb.

it was like her symptoms would get really, really bad. And then they would feel like they would start to go away for a little while. And then, bam, the symptoms would be worse again. And this, like, cycle would go on for weeks for Debra without any idea or clue as to what could be causing them. But Debra wasn't the only one in the Pignataro home that started to feel sick.

Deborah and Anthony's daughter started to experience some of the same symptoms as Deborah, but her symptoms didn't seem to be as bad as her mom's. Now, of course, she was feeling terrible, but it wasn't as severe as how Deborah has felt for weeks by this point.

Now, by the time that Debra's daughter started feeling sick herself, Debra could no longer walk on her own and she was forced into a wheelchair to get around. Once being a doctor himself, Anthony decided that it was time to admit his wife into the hospital, that the symptoms were just no longer looking like they could be just the flu. Something had to be seriously wrong with Debra.

When Debra was admitted to the hospital, her doctors ran every test that they could possibly think of to try and figure out exactly what was going on. Her symptoms just seemed like they would come from out of the blue and no one could figure out how or what was making her so sick. One of the tests that the doctors performed on Debra was a bone marrow test.

And Debra's bone marrow test came back with some pretty unusual results. Debra's doctors discovered that underneath a microscope, her red cells appeared to be degenerated. So the next question needed to be, well, what could possibly be causing her red cells to become so degenerated?

Debra's doctors began suspecting that the damage to her red blood cells just might be a result of some sort of poisoning. We often see in poisoned victims that their red blood cells are damaged in the process.

So in order to test this theory, doctors performed a number of different tests on Debra to try and figure out if she had ingested any type of substance that could cause this amount of damage to the red blood cells. But when the test results came back, no one could have ever suspected what was really going on inside of Debra's body.

The tests on Deborah's blood came back positive for the presence of arsenic, a highly toxic poison. Now, the arsenic levels found in Deborah's body were some of the highest levels ever seen in a living human being. The amount of arsenic in her body should have easily killed her.

Arsenic is naturally present in groundwater pretty much across the entire world, but the inorganic form of arsenic is extremely toxic.

If you ingest arsenic at any amount of large quantities, you will experience the toxic effects almost immediately, which some of the symptoms can include extreme vomiting, damage to the nervous system, blood and circulation, and eventually high doses will pretty much certainly lead to death.

Deborah's husband, Anthony, was right there by Deborah's side in the hospital. And even though he lost his medical license the year before, after the death of his former patient, Sarah Smith, he made a suggestion to Deborah's doctors. And he suggested that in order to treat the poisoning, Deborah's gallbladder should be removed.

But Debra's doctors weren't too sure that removing her gallbladder would be the best treatment. And the doctors thought that it was even riskier to perform a surgery like that because of how weak Debra was. Her doctors thought that a surgery like that could even kill her.

So to try and figure out how Debra could have been ingesting arsenic, they also tested Debra's son and daughter and also her husband Anthony. Maybe the water in the house was contaminated. They just had no idea at this point. The arsenic test on Debra's daughter also showed high levels of arsenic.

But when they tested Debra's son and Anthony, doctors were surprised to discover that they didn't have any levels of arsenic in their blood system. The only two people in the family with high levels were Debra and her daughter, the only ones who were experiencing any type of symptoms. Tests on the family's water supply came back negative for the presence of arsenic.

So the question in the minds of the doctors and now the police became, was intentionally giving Debra and her daughter arsenic poisoning? At first, it was suspected that maybe Debra was poisoning herself along with her daughter. But that theory really didn't make much sense.

Debra had no reason to want to harm herself, and she really didn't have a reason to want to harm her own daughter. So the next theory came from a very unlikely source.

The next possible theory was that maybe the family of Sarah Smith, Deborah's husband Anthony's patient who was killed during surgery, might have had something to do with the arsenic poisoning. Possibly as some sort of revenge for what had happened to Sarah.

Now, at the time, I don't think this theory was too far-fetched. I mean, Sarah Smith's family was completely devastated by what happened to her, especially because it was at the hands of Anthony Pignataro. And I mean, as a way to get back at the doctor, maybe someone in the Smith family was behind the poisoning?

There's a huge problem with that theory, and that's because the Smith family had moved away after Sarah's death. Like, they moved several states away from the Pignataro family, making it practically impossible for them to be responsible for poisoning Debra or even her daughter. So if it wasn't Debra poisoning herself, and it wasn't the Smith family,

Who could have possibly wanted to do something like this to the Pignataro's? The police, who were now heavily involved in the case, started to ask the family questions about what they were eating before they started feeling sick. Arsenic is a substance that can be easily slipped into food or possibly drinks even without the victim knowing that it's there.

So that's why the police really suspected that the arsenic that Debra and her daughter were consuming was probably coming from their food. So police sit down with Debra and ask her, the last time that you got really sick, do you remember what the last thing was you ate? Maybe for breakfast or dinner, anything that you may have eaten or drank beforehand?

And it takes Debra a moment, but then she's like, well, my husband Anthony made some soup because I had been feeling so sick lately and the only thing that sounded good was soup. But this information really didn't seem to have much value to the police.

They really needed to find out exactly how long Debra had been ingesting the arsenic in hopes that it would lead them to a cause of it all. So to figure out how long someone has been ingesting the arsenic, forensics can study our hair and particularly our hair follicles.

And that's because when we ingest poison, the poison circulates throughout our body. And as it circulates throughout our body, it actually comes in direct contact with our hair follicles. So the poison will actually remain present in our hair even after our hair starts to grow out.

And this is really helpful because our hair grows. It can help forensics tell exactly how long and when the body came into contact with the poison. A forensic test of Deborah's hair found that she had consumed over 29,000 milligrams of arsenic, which is just an insane amount.

And by analyzing the presence of arsenic in the hair follicles, forensics could precisely pinpoint that Debra had started consuming small amounts in May 1999. And then she started consuming 80 times the normal amount of arsenic consumption.

This is exactly the same time that Debra and her husband, former Dr. Pignataro, reconciled their relationship after the jail sentence and the affair. The first sign of arsenic was immediately following their reunion.

The largest amount of arsenic consumed was in July, the same time that Debra was admitted into the hospital and when Anthony suggested to doctors to remove her gallbladder. The police suspected that Debra's husband, former Dr. Anthony Pignataro, was intentionally poisoning his wife with arsenic, and they believe he was using soup.

the only food that sounded good while feeling sick to do it. Police traced the arsenic purchase back to Anthony from an ant insecticide purchase that he had made back in May 1999, right before Debra started getting sick. Anthony Pignataro was arrested for the intentional poisoning of his wife, Debra, and daughter.

Prosecutors in the case found evidence that suggested that the reason why Anthony asked the hospital doctors to perform surgery to remove Deborah's gallbladder was because the arsenic would have certainly killed her during surgery. And in Anthony's eyes, the medical community would see that it was normal for operations to kill people sometimes.

just like with what happened with his former patient, Sarah Smith. Anthony Pignataro was poisoning his wife with arsenic in an attempt to absolve himself of Sarah Smith's death. Anthony pled guilty to first-degree assault in the arsenic poisoning of his wife, and the judge in the case, Judge Mario Rossetti, sentenced the former doctor to 15 years in prison.

During his time in prison, and despite the fact that he pled guilty in the case, Anthony has continued to claim that Debra poisoned herself in an attempt to commit suicide. And again, despite the guilty plea, he has never taken responsibility for either Sarah Smith's death or his wife's poisoning.

Anthony Pignataro has maintained that what happened to Sarah Smith at his medical practice was simply a result of surgery. He continues to believe that he did absolutely nothing wrong in the procedure and he's not the cause of Sarah's death. Anthony was released from prison in 2013 and when he got out of prison, he returned back to his hometown of Buffalo, New York.

But by this point, he was no longer going by Anthony Pignataro. He had changed his name to Tony Hoyt. So, I mean, I guess you can't blame him for wanting to change his name here, especially after everything he's done.

So under this new name of Tony Hoyt, he opened up his own business called Tony Hoyt Cosmetic LLC. And I just want to point out the fact that cosmetic is spelt with a Q-U-E on the end.

So the company he opened up in 2013 sold a line of skincare creams that was advertised as being, quote, formulated by one's own DNA-derived plasma. And on the company's website, Pignataro referred to himself as a licensed doctor who fully endorsed the skincare products.

But the skincare business wouldn't exactly be around too long. Because shortly after opening, the Erie County District Attorney opened up a formal criminal investigation into the business. And shortly after launching, Anthony Pignataro took down the website in 2017.

Now, I thought the story of Dr. Anthony Pignataro ended there after his second release from prison, but it turns out it does not end there.

Just last year in February 2019, several news channels reported that the former doctor who now went by Anthony Hoyt is listed on eldercare.com as a local caregiver in the state of Florida. The website reportedly describes Anthony as quote, a trustworthy senior caregiver in South Florida.

Now, as the news broke out about the twice incarcerated doctor coming out as an elder caregiver, the New York State District Attorney, John Flynn, reported saying, quote, he is notorious up here in Buffalo. And now, unfortunately, he is becoming notorious down in South Florida. The residents of South Florida need to be concerned about this man, end quote.

more disturbing than the fact he acts as a caregiver to older people is the fact that on the website, Anthony claims to charge $3,500 a month for his services and that he claims that he has extensive patient experience, which includes administering medication.

This is all coming from a former doctor who was first serving a prison sentence for killing his patient, Sarah Smith, and then serving a second prison term for poisoning his very own wife. Despite his past and history, the ego of Anthony Pignataro seems to be kept at an all-time high.

According to a local Florida news station, the New York State Prosecutor's Office has notified the local district attorney in South Florida regarding Anthony Pignataro's profile on eldercare.com. And local authorities are monitoring for potential criminal conduct. So as of now, that's where the story of Anthony Pignataro ends.

Of course, with someone like Pignataro, I think we'll be hearing a little bit more about him and his time down in South Florida. If there is any update in this case and the story of Anthony Pignataro, I will be sure to provide an update in a future episode of the show.

Forensic Tales is a Rockefeller Audio Production. The show is written and produced by me, Courtney Fretwell. Sources for this episode include Forensic Files Season 9, Episode 8, Forensic Files Now website, and local WSPN news.

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head over to our Patreon page, or you can email me directly at Courtney at ForensicTales.com to find out how you can become involved. Please join me next week. We release a new episode every Monday. Until then, remember, not all stories have happy endings.