Last Dance, Last Chance

superiority.
     
    “The first time I ever really thought about Pignataro,” Sedita recalled, “was when the D.A. called me in and said, ‘This is a very unusual case. I want you to think about it.’ I was on my way to a death penalty conference, and we agreed we’d talk about it when I came back.”
    It would turn out to be not one case, but three—and they were the most memorable of Sedita’s career to date.
     
    Pat Finnerty and Chuck Craven had located everyone who was in the basement operating room when Sarah Smith stopped breathing except for Tom Watkins, the high school junior from Nichols School. The private school attended by the scions of Buffalo’s richest families was very protective of Tom and reluctant to let detectives talk to one of their students. It was November 1997 when Finnerty and Craven finally met with Tom, his attorney, Terry Cotters, and Frank Sedita.
    Sedita explained to Tom that they weren’t trying to incriminate him in any way. He said, “Listen, I don’t know what the attorneys have told you, but we’re not interested in prosecuting you. We just want to find out what happened that day.”
    As soon as Tom and his mother understood that they simply wanted to know the teenager’s recall of the operation, “The dam opened up,” Sedita said.
    The investigators quickly understood that Tom had been in the operating room as a gofer. Sedita asked if Tom had ever assisted with the intravenous sedatives.
    Tom shook his head, obviously relieved. He was clearly very intelligent and quite willing to talk to them. He said that Dr. Pignataro had come to Nichols in late spring looking for someone who would be an “intern” at his office over the summer vacation. Tom was interested and visited Pignataro’s office, where he observed him doing a hair transplant. Where most people might be nauseated, Tom was fascinated. He wanted to be a doctor himself one day. He began his “internship” in late June, 1997, and earned $5 an hour for working three to six hours a day for four or five days a week. He said Dr. Pignataro paid him periodically by check.
    Tom said that some of his duties were to sterilize the surgical gowns and instruments and help the nurses set up the surgical trays. He was allowed to watch many operations, including breast augmentations. He agreed with the other witnesses that the breast patients were usually given pills and water upstairs, and then walked to the operating room in the basement. The doctor, Tom said, kept all medications in a safe, sending him or one of the nurses to get them. On occasion, he—or a nurse—had mixed them, but always with precise instructions from Dr. Pignataro.
    As for machines to monitor the patients’ condition, the only machines Tom ever saw the doctor use during the operations were the pulse oximeter and the blood pressure cuff.
    He recalled that during July Dr. Pignataro had gone to California to learn the new technique of inserting breast implants through the navel, and Tom said the doctor was very excited about it. He had bought some new equipment to tunnel under the skin. Pignataro never measured or marked the skin of a patient before he started cutting.
    Sedita asked Tom about the pulse-ox machine. Tom said that he had been present two or three times when a patient’s oxygen level had dipped below a 70 percent reading during surgery. When that occurred, the doctor had rapped the patient on the head or on the sternum and then had the patient given oxygen by a mask. But they always came back. He said the doctor was never worried if the reading was in the 80s. The men questioning him knew now that readings below 85 percent were dangerous.
    For Sarah Smith’s surgery, Tom recalled that it was Mrs. Pignataro who had become concerned about the patient’s lack of oxygen, but that the doctor kept right on with his operation, not even glancing up. Debbie Pignataro had quickly put an oxygen mask over the patient and had tried to get her husband to check on Sarah. She sent Tom to get nail polish remover so they could see the color in Sarah Smith’s nail beds more accurately. He brought it to her and then they could see that the patient’s nail beds weren’t pink, and her oxygen reading didn’t go up.
    Finally, the doctor had “broken scrub,” gone to the patient’s ear, and shouted at her to breathe. Mrs. Pignataro had frantically tapped her on the chest, but there was no response.
    Tom felt that it had taken about ten to fifteen