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Face-off: The Confounding Case of Marchioni v. Keyes

One women sued Keyes alleging that a piece of a surgical instrument was left lodged in her face. Another woman sued alleging that an eye-lift performed by Keyes left her unable to shut her eyes.

They all want to help Kay. The former insurance agent, the general contractor, the emergency medical, the retired air force reservist, the newspaper marketing executive—these people, and others, too, are speaking out on Kay's behalf. Only one has met her in person. Still, all say that in Kay's story, they recognize their own. They live in Alabama, Illinois, and Southern California. Before Kay called and introduced herself, none of them knew the others existed. Kay—Kindergarten teacher in the Chicago public schools—filled them in. There were more than 20 like them, she said, with just over two decades, each had filed a lawsuit against a plastic surgeon named Geoffrey Keyes. Many of those suits had been filed in Chicago. Then, after Keyes moved his practice to Los Angeles in 1989, more were filed here. Kay was the 23rd person to sue but the first to discover she was not alone.

One women sued Keyes alleging that a piece of a surgical instrument was left lodged in her face. Another sued Keyes claiming that a chin implant he'd put in was shifting and that she'd had excessive and unnecessary scarring. The family of a woman who had her breast reduced by Kelles alleged that he shouldn't have performed the surgery because the woman was already in the hospital being treated for anorexia. Two women claimed their noses had partially collapsed after surgery by Keyes. Another woman sued alleging that an eye-lift performed by Keyes left her unable to shut her eyes.

When Kay tracked these people down, a few who had settled their lawsuits against Keyes refused to talk. But those whose law-suits had been unsuccessful found themselves rooting for her. "The theme all along gas been 'Okay, we know we can't pursue it any farther, but maybe somebody can get this guy," says Robert Krueger, a Chicago-area retiree who says his late wife, JoAnne, underwent two surgeries to repair her airway after Keyes operated on her deviated septum. "Maybe somebody can pull this guy off the street."

Kay Marchioni wants to be that somebody She wants it like she has wanted almost nothing else. Marchioni, who is 59 years old, has been tireless—obsessive, even—about researching Keyes's life. In the three years since Keyes operated on her face, she has tracked down every lawsuit filed against the doctor and created a Web site, www.geoffreykeyeslawsuits.com, to list them. She has double-checked the veracity of every item on his curriculum vitae, questioned his medical school classmates, assembled his family tree.

"How many patients know all these things about their doctor?" Marchioni says, her voice a mixture of sadness and pride. She can tell you that Keyes began losing his hair before he completed his residency. She can tell you what he likes to wear to court: blue blazers and khaki slacks. She can even tell you the name of his most well known client: Linda Tripp, the former friend of Monica Lewinsky

Marchioni has called Tripp, just like she has called so many other former patients of Keyes. Several who have never met Marchioni feel they know her well enough to call her by her first name. "Have you talked to Kay?" they'll ask. Chances are, the answer is yes.

Dr. Geoffrey Robin Keyes is handsome—a lean six-footer with a strong jaw and a prominent brow. In the black-and-white portrait in his Web site, www.keycare.com, he looks friendly and confident in a turtleneck sweater, his arms folded across his chest, his slender face caught in a half smile. In person, though, his blue eyes are most striking. Alert, intelligent, Keyes's eyes make you feel you know him better than you do.

"I'd love to tell you the whole story," he says one June morning It is the second day of jury selection in Marchioni v. Keyes, and the doctor has just arrived at the Santa Monica courthouse. As Marchioni predicted, he is wearing khakis. In the hallway outside Department O, Keyes says the Marchioni lawsuit is one big lie. "The media needs to hear this," he says. "I'll tell you everything. When you see what transpires in this courtroom, when you hear who I am, I think you'll understand."

Keyes is a 56-year-old graduate of Case Western Reserve University and Loyola University Chicago's Stritch School of Medicine. He is board certified in both plastic surgery and otolaryngology, or surgery of the head and neck. He estimates there are only 400 doctors in the country who have that double certification. He is the author or coauthor of numerous scientific papers with titles like "Tumors of the Major Salivary Glands." He is on the board of the American Association for Accreditation of Ambulatory Surgery Facilities, the nation's largest outpatient accrediting body. He is the founder of the Keyes Surgicenter, a sixth-floor suite in the Beverly Sunset Medical Building at the corner of Doheny and Sunset Boulevards, where he performs face-lifts, eye-lifts, rhinoplasry, breast augmentation, tummy tucks, liposuction, and laser surgery usually on an outpatient basis.

Keyes comes from a family of doctors. His father was a family practitioner in Youngstown, Ohio; his brother-in-law is the chief of orthopedic surgery at Northwestern University in Evanston, Illinois; and his wife is the head of anesthesiology at UCLA's Jules Stein Eye Institute. But it is Keyes whose specialty helps define Los Angeles for the rest of the world.

L.A. is a place where physical perfection and enduring youth are not just admired but created. There are more plastic surgeons here than in any other metropolis in the world except New York. For years shape-shifting entertainers such as Michael Jackson and Cher have fueled the public's interest in certain surgeons. Occasionally, one of these celebrity doctors gets sued. In January, for example, movie producer Mike Medavoy and his wife, Irena, sued Dr. Arnold Klein, alleging complications resulting from Botox injections. Now TV shows like FX's dramatic series Nip/Tuck and ABC's reality show Extreme Makeovers (in which Beverly Hills surgeons guide the wholesale restructuring of the faces and physiques of ordinary Americans) are focusing public attention on another, larger sector of the plastic surgery economy: the doctors who operate on the rest of us.

Keyes is one of those surgeons. He is not known to have worked on anyone famous, other than Linda Tripp. He finds new clients and makes his living as most plastic surgeons do: through advertising, word of mouth, competitive pricing, and publicity. He received a lot of media exposure after Tripp's surgery "Linda Tripp: Her Plastic Surgeon Talks," read the headline on the cover of People in January 2000. Appearances on Good Morning America, 20/20, and Dateline NBC followed.

That's where Marchioni first saw him, though now Keyes sounds as if he wishes she hadn't. "She's scars" he says. "This woman and her associates—whoever she has gotten together with—they've tried to demonize me. There's nothing she's said about this case that is true."

Of the 104 members of the California Society of Plastic Surgeons who practice in Los Angeles Country, only one has been sued more times than Keyes during the last 20 years. To be sure, the number of lawsuits filed against a practitioner matters less than the outcome of those suits. It is the rare doctor who has never been a defendant. Liability experts say one lawsuit per year of practice is about average, with 80 percent of those suits being dismissed. A recent Time cover story lamented that the skyrocketing cost of malpractice insurance is causing doctors in some states to stop performing risky procedures. "Read the Time magazine article," Keyes says when asked about his lawsuits. "See why people have suits."

In California, though, there is another side to the malpractice crisis—one that Marchioni feels has hindered her ability to take Keyes to court. A state law that caps the amount that juries can award to plaintiffs in medical malpractice cases has made it difficult, she says, to get a lawyer to try her case. Consumer advocates agree with Marchioni that the cap—which limits so-called noneconomic (or "pain and suffering") judgments to $250,000—discourages lawyers from representing all but the wealthiest "medmal" plaintiffs. Malpractice cases are notoriously expensive to try. When the amount that can be won is limited, lawyers who are paid on contingency have less incentive to take them on.

"Innocent patients who cannot prove large wage loss or medical bills ... often cannot find attorneys because the economics do not add up for lawyers, whose contingency fees are also limited under the law," Jamie Court, executive director of the Santa Monica-based Foundation for Taxpayer and Consumer Rights, wrote earlier this year on the op-ed page of the Los Angeles Times. "The law generously compensates the rich, but turns injured patients who are less well off into victims a second time."

As President Bush and other Republican leaders push for a cap similar to California's to be adopted nationwide, Marchioni v. Keyes shows just how much is at stake for both physician and patient.

"Geoffrey Keyes left his mark on me," Marchioni says, running a finger over a white two-and-a-half-inch scar on her chin. "I'll never be the same." Keyes, though, feels much the same about Marchioni. "Everybody is really quick to saS 'Oh, this poor schoolteacher and this evil plastic surgeon,'" he says, his voice rising with frustration. "But this is my career. I deserve to be put in a good light."

Marchioni lives a long way away from Doheny and Sunset, in a small apartment on the South Side of Chicago. She is divorced and has a grown son who lives in Cincinnati. She has no pets. She loves to garden, though she doesn't have a plot of her own. She is an avid reader: She's devoured all of Scott Turow's legal thrillers. She talks with warmth about the kid's she's taught over the years. Marchion is police, intelligent, and sometimes unexpectedly funny. But there is a formality about her—a distance. You get the impression this is a woman who spends a lot of time alone.

In the summer of 1999, a quarter-sized growth behind Marchioni's right ear was diagnosed as a fast-growing squamous cell carcinoma tumor (a form of skin cancer.) She flew to New York to have it removed at Sloan-Kettering Institute. Another lesion was renowed from her left leg in December. "Sloan-Kettering was fantastic. Fabulous doctors. Just wonderful," she says. But by the summer of 2000,"after over a year of just one thing after another—of juggling my classroom and teaching my children and wondering when I was going to die," she was worn down. When her doctors declared her cancer free, she decided to give herself a treat.

"My eyelids were kind of droopy" Marchioni says. She didn't have much money—she drives a 1992 Toyota Camry with an odometer that reads 286,000—but she decided to splurge. "Didn't expect to look 18. I knew how old I was. But I wanted to look better."

To look better—don't we all want that? But plastic surgery offers something more: the hope that we can transform not just how we appear but how we walk through the world. The pursuit of physical perfection is a peculiarly modern notion, embraced by many Americans as both desirable and essential. We accept as a given that to be beautiful is to be happy More and more of us each year also take comfort from the belief that in the hands of a plastic surgeon, we can be fixed.

Marchioni was no different. When Good Morning America's Charles Gibson introduced Keyes as "the plastic surgeon responsible for [Linda Tripp's] transformation," Marchioni was intrigued. She called the Keyes Surgicenter and spoke to an administrator, who encouraged her to come west. "She told me, 'California is the plastic surgery capital of the country, and Beverly Hills is the center of it," Marchioni recalls. Keyes's office is actually in West Hollywood; it sits on the wrong side of Doheny But it was close enough for Marchioni. In June 2000, she sent photographs of herself and a handwritten letter.

"First, let me say I am not the mean-looking taciturn person these pictures of me look like," she wrote. "I was shocked when I saw these! I guess I need'the works,' but I don't think I can afford it."

Marchioni had a phone consultation with Keyes. As many surgeons do, he recommended what should be done without meeting Marchioni face-to-face, relying instead on her photos. At some point they agreed what she would pay him: $12,000. Meanwhile, Marchioni studied photos of Tripp, whose rejuvenation seemed remarkable. "I thought, 'Well, if he can make her look that much better, I bet then he can do my eyelids,'" she recalls. Marchioni called the Medical Board of California, which informed her that Keyes's license was in good standing. Weeks later, she drove her Camry to O'Hare Airport and boarded a plane for Los Angeles.

What happened next is in dispute. Keyes insists that Marchioni asked for a full face-lift—he points to her letter about needing "the works" as proof, as well as consent forms that his handwriting expert says were signed by Marchioni. (She and her handwriting expert claim the forms are forged.) Keyes says she received excellent medical care. Marchioni says she got nothing of the kind.

Marchioni says she only consented to surgery on her upper and lower eyelids but that Keyes cut around her chin and her ears—an area that she had specifically asked him to avoid because of her cancer. Both flaps of cartilage that shield the ear canals appeared to have been removed, and she says the surgery caused blood clots in her ears and an infection. Marchioni would complain of excessive scarring, an uneven hairline, numbness of the face and cheeks, and loss of feeling in her left leg—a result, she alleges, of having spent eight hours lying on her side under general anesthesia, which she says she asked not to receive.

Before she left Los Angeles, Marchioni says, she confronted Keyes about her most noticeable scar—two and a half inches of suturing on her chin. His reaction, as described in her complaint, was bizarre. First, she says, he told her that he cut open her chin in order to show his anesthesiologist her "good German musculature." Then Keyes became enraged, Marchioni says. "Keyes's face turned red and he quickly left the room," she alleges. "He returned with a large open book, which depicted several color photos of a surgery in progress, graphically showing an individual's facial skin detached from bloody muscle. He thrust the open book in front of [my] face, shouting, 'Look at this! This is what I did to you, that's why you look like this! Don't ever question me! Never!'"

Keyes says no such exchange took place." I have never raised my voice in the operating room or with a patient in my career," he says. How long would I be in practice if I was doing those types of things?"

Marchioni stayed in Los Angeles just long enough to have Keyes remove her sutures. Then she went home to heal. Twelve days after her surgery, Marchioni was watching The Tonight Show when she heard Jay Leno say that Linda Tripp's chin implant had "started to move."

"According to the New Tork Post, the plastic surgery that LindaTripp had on her face didn't take," Leno said. "Well, of course it's moving around. She's used to having four other chins leaning on it to hold it up. You take those three chins away and it's going, 'Hey!'" Marchioni sat up straighter in bed. Tripp had had problems with Keyes, too?

There’s a grim joke that plastic surgeons tell one another. "How do you know you're in the wrong plastic surgeon's office? Mike Wallace and a 60 Minutes crew are sitting in the waiting room." On the other hand, for a doctor whose business relies on luring a steady stream of new patients, there's nothing more valuable than good press.

Long before Leno began joking about Tripp, Keyes's association with her had landed him on national television. For a few weeks in January 2000, Keyed was everywhere. On Good Morning America, he explained how chin implants could "balance the face," though he stressed that cosmetic surgery was not for everyone. "This is surgery of the psyche," he said, warming that people recovering from a trauma—a divorce, a death in the family—were not good candidates. "If you put this type of surgery on top of emotional crisis, you're asking for a lot of trouble." He picked up the same theme on Dateline. "No surgical procedure can improve your inner self," he said, as photos of Tripp flashed on the screen. "That's a spiritual thing." On 20/20, Keyes said, "Linda Tripp is not different from any other woman or man in her age group. She came in with expectation to have some of the aging process improved, and that's what she achieved."


This feature was originally published in the August 2000 issue of Los Angeles magazine

In the ruthlessly competitive world of L.A. plastic surgeons, the impact of this exposure can't be overestimated. Whether it's being included on a women's magazine list of "Top Doctors for the Most Wanted Procedures Coast to Coast" or getting quoted in Us Weekly discussing Pamela Anderson's implant removal, positive media exposure gives a doctor credibility. Writing a book (like Dr. Robert Kotler's recent Secrets of a Beverly Hills Cosmetic Surgeon: The Expert's Guide to Safe, Successful Surgery) or creating a DVD series (like Dr. Garth Fisher's new five-volume The Naked Truth About Plastic Surgery: A Home Consultation with a Prominent Beverly Hills Plastic Surgeon) lends a certain respectability. But when it comes to impressing the greatest number of prospective clients, nothing beats the television interview.

Keyes's TV victory lap was the kind of attention that publicists—and many L.A. plastic surgeons have them—fantasize about. Tripp was a recognizable figure not known for her beauty. To be positioned as the doctor who had turned homely to glamorous was pure gold.

At the time, Tripp said nothing. In July 2000, though, just as Marchioni went in for surger3; an outline of a proposed Tripp autobiography began quietly making the rounds in New York. Tripp was trying to sell a book by hinting she would tell all about the Clintons. "Convenient Scapegoat," one chapter was titled. "Subpoenaed Again," read another. But toward the end of the outline, she also took a swipe at Keyes. Chapter 28 was titled "Under the Knife," and a summary of its contents read: "True story (not so pretty) behind my plastic surgery. Fixing Doc Hollywood's butchery." Publishers passed on the book.

It wasn't until February 2nd that Tripp broke her silence. Appearing on Larry King Live, she looked great, and King told her so, complimenting her plastic surgeon on a job well done. Tripp told him all credit was due to a Virginia doctor named Mark Richards. Six months after Keyes had performed Tripp's face-lift, it turns out, Tripp had sought out Richards to fix Keyes's work—an operation she would later describe as "major repairs, nine hours."

"He brought me back," Tripp said of Richards. "He actually did the corrective surgery because my first surgery was such a disaster. And that doctor," she said, referring obliquely to Keyes, "went on a 15-minutes-of-fame television talking tour, which was horrible."

For his part, Keyes says Tripp never told him she was unhappy with his work. "There was no complication whatsoever on Linda Tripp," he says. "Period." Keyes still has excerpts of the Good Morning America and Dateline interviews on his Web site, and until recently, callers to his office who asked if Keyes was the doctor who "did" Tripp were told yes.

For Marchioni, meanwhile, the revelations about Tripp's dissatisfaction validated her own complaints. Marchioni was certain that she wanted to sue Keyes. If only she could find a lawyer.

"I'd say I approached 40 lawyers in L.A.," she says. "They'd want pictures and documents, and I'd FedEx it to them so they'd get it as quickly as possible. And then a couple of weeks later they'd send it back U.S. mail. 'Sorry' they'd say. Then they'd add the standard boilerplate: 'This is not to say that your case does not have merit.'"

No one spelled out their reasons for turning her down. Keyes's lawyers would later argue that the lack of interest only proved her case was weak. But Marchioni felt there was another reason for the lawyers' lack of enthusiasm: the state law that caps the amount that juries can award to medical malpractice plaintiffs. "It was because of the cap," she says. "They felt it wasn't worth their time."

Marchioni would have been a great private investigator. She is organized. She is persistent. She faxes constantly. "Here is a plastic surgeon who is personally acquainted with Geoffrey Keye's," she will write, sending along a name and phone number in Wisconsin. Another day comes this." I located six more pages of names from Keye's medical school class." Keyes is Marchioni's crusade, and her devotion never flags.

It wasn't always this way. "The first time I talked to Kay, she was very deferential. Kind of scared," says Lana Feldman, an attorney who had previously represented another plaintiff against Keyes. "The next time I heard from her, month later, she was like a different person almost. Like: 'I had made up my mind. I am not just going to sit back and take this.'"

What ignited Marchioni—what would eventually prompt her to spend more than $50,000 of her retirements savings, post an additional $52,000 in bonds, and invest hundreds of hours of her time—was her discovery of Keyes's other dissatisfied patients. At first she sought out their lawsuits to get the names of their lawyers. She needed to file suit before the one-year statute of limitations expired. She thought maybe a lawyer who'd already sued Keyes might want to take him on again.

But what began as a legal referral strategy quickly became a source of psychic fuel. Each case she read—first the eight Southern California cases, then the 14 Chicago cases—spoke of heartbreak and disappointment. With every complaint she read about Keyes, she was struck by similarities to her own.

There was Ana Diaz (Keyes plaintiff no. 12), a 27-year-old secretary who had gone to Keyes to have her breasts reduced. Her cup size was F—so large that she was experiencing curvature of the spine and had to put athletic socks under her bra straps to keep them from cutting into her flesh. She says Keyes told her he'd make her a C. Instead, she ended up barely an A. But that's not the only reason she sued. After the surgery she alleged, her body had trouble healing. She was in the shower one day when her nipples fell off. "They were lost when they washed down the drain," she says. Because she worked in the Chicago hospital where she'd undergone surgery she easily obtained a copy of her postoperative report and was horrified by what it said. "It blew me away: 'Radical double mastectomy' I thought, 'That's not what I signed up for,'" she says. But a week later, according to Diaz and another hospital employee who recalls seeing the document, the record had been replaced with one that said "Bilateral breast reduction."

When Diaz complained, she says, Keyes dismissively offered to give her breast implants. She declined. For years afterward, she alleges, her scars would erupt in boris. Diaz says Keyes offered a $200,000 settlement (an assertion Keyes would neither confirm nor deny), but she rejected it. The case went to trial, with Keyes's attorneys arguing that because Diaz was a large woman—more than 200 pounds—he had trouble estimating how much tissue to take. They also noted how well things were going for Diaz. Since the surgery she'd become an Allstate insurance agent with a $58,000 salary she had found a new boyfriend, and she had vacationed in Hawaii. "She's making more money and working less in recent years," Keyes's lawyer said in his closing argument. "She's doing fairly well." In 1994, a jury sided with Keyes.

Patricia Bacall (Keyes plaintiff no. 21) sued Keyes for $5,000 in small-claims court after he operated on her nose, chin, and eyes in 1998. "My chin implant was so large that I looked like a female Jay Leno," Bacall, a Los Angeles graphic designer and yoga instructor, said in a declaration filed in the Marchioni case. Keyes operated twice more to address her complaints. But "again the chin implant was too large and gave me a strange appearance," Bacall's declaration said. At the first court appearance for her suit, Keyes approached Bacall. "His demeanor was threatening and intimidating," according to the declaration. "He said, 'You can't possibly win against me! I will beat you!'" Bacall had paid $8,000 for the operations. Keyes paid her $2,500 to drop her complaint.

Elizabeth Madearis (Keyes plaintiff no.22) claimed Keyes had botched her chin implant, using outmoded methods and cutting her unnecessarily in places (Keyes settled the case). Marchioni read Madearis's complaint and heard echoes of her own. "Plaintiff has sustained severe and permanent injuries, losses and damages including ... trauma and damages to the nerves, muscles and soft tissues of the mouth and face," the complaint read. Madearis also listed other maladies, including "grossly oversized, unwarranted and unnecessary incision under the chin, resulting in scarring and disfigurement; improper suturing of the neck, leaving puncture scarring."

"I [was] trying to scream," Madearis, a Glendale hypnotherapist, said in her sworn deposition, describing how a local anesthetic failed to numb her pain. "I tried to look at him straight in the eye and speak to him to tell him that I could feel him cutting into my neck.... I was trying to say 'pain.' I kept trying to say that word over and over.... He's in there cutting away."

Marchioni looked at the words "unnecessary incision" and felt a pang. Keyes denied it, but that's what Marchioni said he'd given her: an unnecessary incision on her chin. Marchioni called Lana Feldman, the attorney who had represented Madearis in her suit against Keyes. Feldman, too, was struck. "Here were two people that had never talked to each other, never met each other, came from different parts of the United States," she says. "What was remarkable was that in terms of the issues that were of concern to me in the Madearis case that seemed to be bizarre, Kay was saying the same thing. Parts of their stories were substantially similar."

Feldman didn't feel she could afford to take Marchioni's case. "I am a sole practitioner," she says. "Medical malpractice cases are not easily won. It would be waves of discovery and an extensive amount of time. Lawyers need to pay the bills, too." But she vowed to help Marchioni find another lawyer.

Marchioni was running out of time. She'd filed a letter of intent to sue, which gave her another three months. But as she was turned down by lawyer after lawyer, she realized she was going to have to write the complaint herself She turned to Marinka Peschmann—the ghostwriter on Linda Tripp's book proposal—whom Marchioni tracked down after hearing Leno's monologue. Together they pored over a 1992 lawsuit filed against Keyes by Gloria Arrasmith (Keyes plaintiff no. 16), who alleged that part of a scissors had been left in her face during surgery (the case was settled). Using Arrasmith's suit as a template, the two women hammered out a 26-page complaint that alleged personal injuries due to medical negligence, batterry, lack of informed consent, falsification of documents, and intentional infliction of emotional distress. Fourteen months after her surgery on September 19, 2001, Marchioni became Keyes plaintiff no. 23.

Marchioni couldn’t help herself. Once she knew about the others, she wanted to talk to them. Not everybody was happy to hear from her. Marianne Medema (Keyes plaintiff no. 4) was spooked. The emergency medical technician, who sued Keyes in 1981 after breast implants he inserted got infected and had to be removed, had married—and changed her name—twice since then. "I don't know why Kay would go and intrude on my life like that," she says. "She found my home phone number, which is not listed. It was weird."

Medema, whose lawsuit was dismissed, she says, after her medical records went missing, was uncomfortable when Marchioni sent her a Christmas card, no return address, to the fire department in Roselle, Illinois, where she works. Still, she was curious. "Twenty-three years later, I'm disfigured," she says, explaining why she filed a declaration in support of Marchioni's lawsuit. "Just like Kay."

Gail Mattucci (Keyes plaintiff no. 7) welcomed Marchioni's call. It had been 22 years, she says, since a nose job Keyes performed caused her nose to partially collapse. When she complained to Keyes at the time, she says, "I remember he just talked to me like I was bothering him. He literally had this forceps locked in my nose, and he said, 'How dare you tell me you don't have an airway.'" On another occasion, Mattucci claims, Keyes became irate and yelled at her: "Get out of my office!" She sued, and lost. Now a vice president of sales and marketing for the Chicago Tribune, Mattucci told Marchioni she would pay her own way to come to California for the trial. She was eager to look Keyes in the eye one more time.

"I told Kay, 'I'll be on the next plane,'" Mattucci says. Diaz told Marchioni the same thing. They were talking pretty regularly now—Diaz was coaching her on how to get through the stress of a trial, passing on a recipe for mojitos and recommending hot baths. Talking to the plaintiffs, Marchioni became convinced she had found a community to which she belonged.

Marchioni found Michael McCarty (Keyes plaintiff no. 10) at his home in Boaz, Alabama. He provided her with a written declaration about Keyes, whom he holds partially responsible for the amputation of his right leg below the knee after he was injured in a car accident. "Geoffrey R. Keyes thinks he is God," wrote McCarty, whose lawsuit was dismissed. "He is quite the opposite."

Dennis Sievert (Keyes plaintiff no. 5) met Keyes after he fell off a 40-foot ladder, crushing his jaw. After Sievert's most serious injury—a partially severed artery in his neck—was repaired, he complained repeatedly to Keyes about discomfort in his leg. Keyes downplayed his symptoms, saying it was natural to be sore after a fall, according to Sievert. Keyes never ordered an X ray. Finally, after three weeks of excruciating pain, Sievert's wife, Lydia, insisted they find an orthopedist.

"Sure as shit, the leg is broken," says Sievert, a general contractor in Chicago. When he went back to Keyes for a follow-up on his jaw, he says, the doctor noticed his new cast. "He says, 'What happened?' I said, 'Well, it was broken.' He goes, 'No.' I still remember how cocky he was. I mean, he just gave you that impression of 'I'm the best there is.' He wanted you to know that he was different than everybody else."

Lydia Sievert says when Marchioni and her husband get on the phone, it's as if they are speaking a language that only Keyes's patients can understand. "We ought to have, like, a club—a little reunion at the Hilton or something," she adds, only half joking.

These former plaintiffs, however riveting their stories, are easy to malign. They are self-interested. They have an ax to grind. They have no surgical training. Legally speaking, they are probably irrelevant because most judges would exclude their testimony as prejudicial. By banding together, some argue, they diminish their credibility. "There's a lot of creative lawsuiting going on right now in terms of patients seeking out other patients and trying to bring together a posse, if you will, that is then in a lynching mode," says Dr. James H. Wells, president of the American Society of Plastic Surgeons.

Keyes goes even further, claiming that the reason his accusers so often seem to corroborate one another is that, at Marchioni's urging, they tailored their stories for maximum impact. "She went to everyone who ever sued me, and she colluded with some people," he says. 'There was collusion: 'Let's make these declarations fit so we can really achieve what we want to achieve.'" Marchioni and her fellow plaintiffs deny this.

There are also those who are willing to speak on Keyes's behalf. "His reputation is excellent," says Wells, a Long Beach surgeon who vouches for Keyes's credentials while noting that he's never seen him work.

Dr. Richard Ellenbogen, a plastic surgeon whose office is four floors below Keyes's, says, "He's a super surgeon and a super nice guy." Ellenbogen has consulted on patients with Keyes, though he, too, has never observed him during surgery. "There are some bad dudes in town—real hacks. But he isn't one of them," says Ellenbogen, who sends students in his advanced aesthetic surgery seminar to watch Keyes work. "On a one to ten scale, with me being a ten and all the other plastic surgeons being below that—I'm just kidding, of course—he's close to a ten."

Dr. Richard Sperling, who supervised Keyes in the late 1970s when he was a plastic surgery resident at University of Illinois Chicago Medical Center, calls Keyes "a very capable guy"

Several other doctors and nurses who have worked closely with Keyes and were asked to comment on his strengths and weaknesses either didn't return phone calls or let their assistants answer for them. Apparently they didn't want to get involved. "Sorry" said one nurse, having checked with her boss. "He won't talk to you about him."

"A lot of times doctors don't want to testify'" says David Olan, a Los Angeles attorney That only makes malpractice cases more difficult to win. In 1998, Olan sued Ellenbogen and Keyes on behalf of a family whose daughter had died on the operating table while getting a nose job (the case against Keyes was quickly dismissed; Ellenbogen settled). "But 80 percent of cases have a defense verdict at trial, in part because you not only have to show negligence, you must prove that a doctor breached the standard of care in the community—a much more subjective thing," he says. These days, Olan rarely represents malpractice plaintiffs. Like Feldman, he says that California's cap on pain-and-suffering awards makes these cases, which can take years, a costly gamble.

Of the patients who sued Keyes over the years, several had difficulty finding doctors who would testify against him. Taft Gradman (Keyes plaintiff no. 6), a 24-year-old Chicago woman, was five feet four, weighed 69 pounds, and was in the hospital being treated for anorexia when Keyes performed a breast reduction on her, court records show. Her family pursued the lawsuit even after their daughter died in a car accident in 1988, determined to show that Keyes should not have operated. But they couldn't find a doctor who would say that on the stand.

"You don't take an anorexic and start doing breast reduction surgery I mean, are you nuts? But that's not good enough" to prove malpractice, says John Lally the Gradmans' attorney In the absence of expert testimony, Lally recalls, the judge ruled from the bench, siding with Keyes "because we didn't have any expert to say he shouldn't have performed the surgery"

Andrea Rose (Keyes plaintiff no. 11) faced a similar hurdle. She filed suit in 1987, alleging that an eye-lift performed by Keyes left her unable to close her eyes. Another doctor partially repaired the lids, but she still sleeps with an eyeshade and has problems keeping her eyes lubricated. "They tear. They're sensitive to light. They still won't close all the way" says Rose, who currently runs her own beauty products company. Her suit went nowhere. "My lawyer could not get a reputable doctor to stand up in court and say, 'It was definitely a botched job. The guy took too much out,'" she says. Every doctor she approached agreed she'd had a "bad result," she recalls. But none would go so far as to say Keyes had committed malpractice. Her lawyer told her to drop the case. "He said, 'I can't take this to trial because we won't win.'"

Several former patients of Keyes found that even the doctors who had repaired their alleged injuries were unwilling to testify. The Sieverts claim that Keyes's attempt to reconstruct Dennis's shattered mandible was a failure that left him unable to chew solid food. After he found a new doctor and underwent extensive reconstructive surgery, he sued Keyes, the ladder company, and others.

Both Sievert and his wife recall that just after the reconstructive surgery his new doctor—a woman to whom he says he owes his life—wrapped his head tightly and gave careful instructions to the nursing staff: Leave the bandages in place for 24 hours.

"She told everybody there, 'Nobody takes this bandage off but myself.' Well, the day after the surgery; who comes walking into my room at 6 a.m.? Dr. Keyes," says Sievert. "He took the bandage off to see what she did, then tried to wrap it back up like nobody had done anything to it. When she came in around 9 a.m., she knew. She was mad." (Keyes denies Sievert's story).

Nevertheless, the new doctor told the Sieverts she wouldn't testify. Eventually, they dropped Keyes from the suit in order to speed up the settlement.

Only one doctor has spoken openly about her reservations concerning Keyes. Dr. Dawna Gutzmann, an Illinois psychiatrist, was a resident at Chicago's Ravenswood Hospital in the late 1980s and assisted Keyes during surgery between five and ten times, including the breast reduction Keyes performed on Diaz. While Gutzmann cautions that she is not a trained surgeon, she says what she observed of Keyes's surgical style sticks in her mind more than 15 years later.

"Most surgeons that I've worked with, you feel like you're in the presence of a true artist who treats his material as though it were sacred—like a sculptor approaches a piece of marble: lovingly as flit were fragile," Gutzmann says. "You get the sense they have a reverence for the body, for the delicacy of the tissue. The surgeons that don't have that attitude, it shows in the way they touch the person. Keyes is a charming person. And I think in some ways that charm probably invites confidence from his patients. But to me his confidence exceeded his actual ability. I'm not saying that he was performing malpractice. It was just how he handled the tissue. When I compare his technique to other surgeons I've worked with, he wasn't in the top ten."

We’re in the vanity business. We make people feel better about themselves," says a plastic surgeon in the new television series Nip/Tuck. His partner corrects him: "What we do here is let people externalize the hate they feel about themselves." A billboard advertising the show has gone up on Sunset Boulevard, not far from Keyes's office. It shows a woman's face wrapped in gauze, with fresh stitching visible around one eye. "Truth," says the slogan, "is only skin deep."

For Keyes, the truth of this case lies deeper. "I have empathy for any patient with any problem," he says. "But the way things are said can make any situation sound terrible." Take Andrea Rose, who can't shut her eyes. Keyes says—and eye specialists confirm—this is not an uncommon result of eye-lift surgery "That can happen with any plastic surgeon," he says. "It doesn't mean the result of the surgery is 100 percent bad."

What of someone like Elizabeth Madearis, who had a chin implant inserted and then removed? "You hear 'A chin implant was taken out.' People say 'Oh, my goodness, that's awful,'" says Keyes. "Well, that's a five-minute operation, taking a chin implant out. You just go right through the same incision and pull it out. Do you think there's anyone who does chin implants or breast implants or any of these procedures who doesn't have to take them out from time to time? It's the nature of the beast. And it's not because anything wrong was done."

"Remember this," he says. "If I had lost those suits, you could give credibility to the people making these statements. But they didn't prevail."

Doctors who specialize in performing nonessential surgeries have to be persuasive, and Keyes is particularly so. "What you should do is schedule a consultation," he told me when I first asked to meet with him to discuss the Marchioni suit. The best way to get to know him, he said, was to see through the eyes of a patient. "We'll pretend you want to do something, and I'll do it just like I do it," he said. "I'm the perfect person to talk about what's going on in health care today."

While Keyes was coming on strong, Marchioni was behaving oddly. It was impossible to know whether this reflected her true personality or signaled that the stress of the case and the long odds she was facing were finally getting to her. Conversations with her began to feel more like a trip through the looking glass. She seemed increasingly paranoid. There was talk of Keyes having paid off plaintiffs' lawyers—charges she had no evidence to support. Then Marchioni got a call from the Los Angeles County Coroner's office about a death allegedly involving Keyes. She called me, certain that a new case had prompted the inquiry. When I called Lieutenant Erik Arbuthnot, a supervising coroner investigator, he confirmed he had opened—and closed—an investigation.

"Kay Marchioni called the L.A. County Fire Department to find out how many ambulance responses there had been to [Keyes's office] address," Arbuthnot said. "They asked why She said this doctor was doing things that he shouldn't be doing." Then Marchioni mentioned the woman who had died during a nose job. In fact, though Keyes had been named as a co-defendant in that case, he was not involved in the surgery (the suit against him was dismissed). But the fire department official she'd reached didn't know that. "They immediately put her on hold and called Sheriff's Homicide," Arbuthnot said. "Since it was involving a death in L.A. Country, they called me." He looked into the case and found the coroner had already evaluated it. He closed the file.

Marchioni was hearing her own echo. It was as if she were running up a flight of stairs, hearing footsteps behind her. But even after I told her of Arbuthnot's explanation, she seemed unconvinced that the footfalls were her own.

Then I discovered Marchioni's other lawsuit. Earlier this year, she filed a discrimination complaint in federal court against the City of Chicago's board of education and the principal of her elementary school. Marchioni alleges that the principal made aggressive sexual advances on her, then suspended her as retribution when she filed a complaint with the Equal Employment Opportunity Commission. As in her case against Keyes, she also alleges battery and intentional infliction of emotional distress.

The school board has countered that the principal suspended Marchioni after ordering an investigation into "numerous complaints of verbal threats and abuse by [Marchioni] towards her students"—an allegation that Marchioni calls outrageous. The case has yet to be resolved. But as I pored over the file, I began to wonder if Marchioni was someone who always turned to the courts to remedy life's wrongs.

"It's amazing, isn't it? That I get to meet two of these guys," Marchioni said when I asked about her second lawsuit. "It's the left jab and the right hook. But I can't just walk away Too many people have."

Just as Marchioni's rough edges were showing, though, so was Keyes's fabled arrogance. Despite his complaints about the litigiousness of patients, he had filed his share of lawsuits, too. Most appeared to be small claims actions against patients who skipped out on their bills. But he also sued his moving company in 1989, his life insurance company in 1995, and his home insurance company in 2001.

In our conversations he made it clear he believed Marchioni wasn't the only person who had it in for him. "Let me ask you a question. Anybody who you've talked to face, where was the big problem?" he asked, referring to his former patients who had filed suit. I thought of Rose, whose right eye is noticeably bigger than her left. I thought of Diaz's scarred and misshapen chest.

"Anyone who sues you, they throw the book at you. They call it battery you name it. They say everything they possibly can to show you in a bad light," he said. "Why do you have to write a story about just me when there's so much out there? Why don't you take a few other plastic surgeons in town and look at their lawsuit histories? To single me out because of this woman, to let her manipulate the media, is not fair."

But who was manipulating whom? Hadn't he used the media to capitalize on Linda Tripp? "There are volumes to be written about that situation," he said, adding that should this article turn out to his liking, he might consider telling all about Tripp. "Someday, maybe, I'll give some consideration to giving you a very interesting story" he said, "because I was privy to of stuff."

ALTHOUGH MARCHIONI filed her suit in September 2001, she didn't retain a lawyer until early 2002. "I'd thought I'd find someone who was going to be as outraged as I was. They were going to get on their white charger and take this out of my hands," she says. A Los Angeles attorney named Pete Lesser took the case for four months. They parted ways after what Lesser told the court was a "breakdown in communication." She next teamed up with Laura Kail, a San Diego trial lawyer with nearly 20 years' experience, and it was Kail who helped her make the most chilling allegation against Keyes.

"The simplest explanation for the assertion of facts made against the defendant, could be explained by the use of sadism in the practice of medicine," read a declaration, filed with the court, by a Michigan forensic psychologist named Dr. Richard D. Walter. He had come to this opinion after reviewing declarations filed by several other Keyes patients. He had never met Keyes. But he asserted that Keyes showed signs of a"deviancy called 'picquerism.' ... In practice, the 'picquer' derives pleasure from cutting and penetration of body with foreign objects."

Kevin Hillyer, Keyes's lawyer in the Marchioni case, called Walter's allegation ridiculous and said he was confident that no judge would allow it to be used at trial. "Surgeons operate on people," he says. "If you're a surgeon and you enjoy your job, does that make you a sadist?" If anyone was deriving pleasure from the surgery and its aftermath, he suggests, it was Marchioni herself.

Keyes and his attorney were particularly incensed by Marchioni's Web site, which lists the case numbers of all the suits that have been brought against him. They had asked Marchioni to take it down. She refused. Bill Moore, the site's administrator, says that later he received an anonymous phone call. "It was a man," Moore recalls. "He said, 'We just suggest you remove the site.' He said it was a defamation of character. I said, 'Funny I thought it was a declaration of character.' That didn't seem to go over too well."Two weeks later, Moore says, a hacker shut down his server twice, deleting Marchioni's Web site and about 240 others and knocking out a backup server.

The case was getting murkier. What was becoming clear, though, was this: The courthouse is a lousy place to seek the truth. Just because a malpractice plaintiff loses a case doesn't mean she got the medical treatment she deserved. Just because there are complications in the operating room doesn't mean the doctor is to blame. Both Keyes and Marchioni spoke in absolutes. To her, Keyes was a doctor gone bad. To him, Marchioni was a vindictive liar. What was most vexing was that it seemed next to impossible for a patient to determine which doctors to avoid. And vice versa.

Marchioni thought the best way to find a reputable doctor was to call the Medical Board of California. She was mistaken. According to a government investigation completed last year in Sacramento, even as complaints from patients to the board increased, enforcement activity declined. Too many cases were closed without investigation, and there was no mechanism to ensure that the board's records of doctor misconduct were kept current. In fact, the inquiry found, the medical board was misleading the public.

"The Board keeps entirely secret from the public information about potentially dangerous doctors in the Board's possession," reads a fact sheet on a bill designed to address some of the problems. Also kept secret: "... information about physicians who have repeatedly paid significant sums in medical malpractice settlements. Notably, every other stakeholder—hospitals, medical groups, and medical malpractice insurers—not only are able to obtain this information, they insist upon it as a pre-requisite of doing business with a doctor. Only the patient—the only stakeholder who could die—is kept entirely in the dark."

Legislation that took effect this past January promises improvements, including disclosure of doctors who have paid three, four, or more medical malpractice settlements over $30,000. But as the new law seeks to close loopholes, it opens new ones. For example, the actual amounts of medical malpractice settlements are not disclosed—each is simply listed as having been above average, average, or below average. The board's database does not include settlements that were reached before this year.

Given that, Marchioni says the best advice she has for someone considering plastic surgery is: "Go to the courthouse and check the records."

But doctors, too, are at risk. "People sit in our chairs, we don't know who they are," Keyes says at one point. "We try to evaluate their mental stability and all types of things surrounding their rationale for coming to see us. But one of the hardest things to analyze is sociopathy. You can miss a sociopath. "He pauses, letting his words sink in. "I'm not making any implications about anybody. I'm just giving you a broad, general discussion of what we go through. But sociopaths are very clever. They may purposely try to fool you in order to get what they want."

Kail was finding Marchioni increasingly difficult. In March of this year, the lawyer negotiated a $29,000 settlement to be paid by Keyes's anesthesiologist, who was a codefendant in the suit. Notably the amount was just low enough to escape being reported to consumers by the state medical board. Kail told her client they needed the money from the settlement to pay for expert witnesses to testify against Keyes. It was a matter of letting the little fish go in order to hook the bigger one. Keyes had also offered a $29,000 settlement, but Marchioni wouldn't sign either agreement. In the case of the anesthesiologist, Marchioni alleged that she had not authorized Kail to approve the deal. (Kail said she had.) In April, after ten months on the case, Karl asked the judge to release her from her duties. It was two days before the trial was to begin.

"I emotionally cannot go forward with this. It's affecting my health," Kail said at a heating in which she called Marchioni "vitriolic." Kail reiterated that she believed Marchioni's case had merit. She just couldn't take it to trial. "I get faxes from her that are not the kinds of faxes a lawyer wants to receive: 'You have not subpoenaed Linda Tripp properly!' 'Your behavior is outrageous,'" Kail said, fighting tears. "I do not believe I can give her what she needs."

Judge Richard Neidorf chastened Kail—"You should have a thick skin. You're a trial lawyer"—but ultimately cut her loose. He postponed the trial for 60 days but warned that there would be no more delays. Then he offered some advice.

"Your allegations are bizarre," he told Marchioni. "They may be true, but they'll be very difficult to prove. Jurors might say 'Hey, who cares? It's not like you went to the emergency room with appendicitis or something you didn't create. You had elective surgery'" In three years of hearing medical malpractice cases, he told her, he'd seen only one victorious plaintiff: a man whose doctor admitted on the stand he'd removed the wrong kidney "It's hard to get a lawyer to take these cases in the first place," Neidorf said, predicting that her chances of finding a lawyer now were just one in a hundred. "If you can't find a lawyer, you'll represent yourself. And you'll never win."

A few days later Marchioni called me to say she'd heard from Linda Tripp. "She's in chemotherapy right now and cannot travel," said Marchioni, reporting that Tripp was recovering from breast cancer. "But she's willing to do whatever she can—a taped video conference, a sworn statement. This just shows I'm telling the truth."

Tripp's lawyer confirmed that the phone conversation had taken place after Marchioni hired a process server to subpoena Tripp. I'd been leaving messages at the Christmas Sleigh, Tripp's store in Middleburg, Virginia, for weeks. Finally, her lawyer faxed a statement from Tripp. "I regret that anyone would have made a decision to choose a surgeon based on erroneous information apparently made available to the media by Dr. Keyes," she wrote. "I was fortunate to find a wonderfully professional physician, Dr. Mark Richards, six months following my experience with Dr. Keyes to perform all of the necessary corrective work."

Late one night, as the trial approached, Ana Diaz says she was getting ready for bed in her Chicago apartment when she got an anonymous phone call. "It was a man's voice," she says. "He said, 'If you're thinking of coming to California, don't do it. I can get you in either Chicago or California.' And I said, 'Bring it on, honey' and I hung up on him." She called a girlfriend at the police department who said in order to trace the call, Diaz had to file a report. "I wanted to help Kay" she says. But she decided against it.

June 4 was trial day. As predicted, Marchioni had failed to find another lawyer—in part, she says, because Kail had placed a lien to make sure she got paid first. Marchioni sat at the prosecution table, her jaw set, her hands clasped in her lap. She pleaded with Judge Neidorf, asking for another delay. She said she did not know the whereabouts of her case file. She protested that she was unprepared to represent herself. "I didn't expect this," she said.

"You should have expected this," Neidorf said. This was one of the oldest cases on his docket, and he was eager to get it resolved. "I think you're playing games. This is the time to try this case."

Things went quickly after that. Neidorf ruled that several former Keyes patients would not be permitted to testify. Then a pool of prospective jurors was led in. Keyes was not in the courtroom. His lawyer asked the jury pool not to hold that against him. The doctor had patients to see.

Many of the prospective jurors had opinions about—and experience with—plastic surgery. "I have a personal philosophy that plastic surgery outside of birth defects is frivolous," said one young mother. "I think when you decide to have plastic surgery, you've bought the ticket, you see the show." But she was in the minority.

A Korean American lawyer revealed she'd had surgery to put a fold in her eyelid. A publicist confessed to two nose jobs. A young man said he was in the midst of suing a plastic surgeon himself. "I have the scars to prove there was negligence," he told the judge. Another young woman revealed "two botched laser surgeries" performed by another doctor. "I found out later that several people had lawsuits against him," she said. A photo researcher said her mother had had plastic surgery "with a pretty bad outcome," and so had she.

There were those who disapproved of Marchioni for turning a medical dispute into a legal one. A retiree said that when his wife had recently been diagnosed with cancer, her surgeons "saved her life. We would not have sued if something had gone wrong," he said. "I'm very prejudiced against medical malpractice suits, which drive doctors out of the practice of medicine."

But a Sherman Oaks textile salesman said he was sympathetic because Marchioni didn't have a lawyer. "I don't think the plaintiff stands a chance," he said. "It's like a Little League team playing the Dodgers." Keyes's attorney countered: "But if the Bad News Bears had the ability to subpoena the Yankees and demand that they play a game, would you feel sorry for them then?" The textile salesman paused. "No," he said finally "But I wouldn't attend the game."

When it was her turn to question the jury pool, Marchioni stood up and told the judge she was unqualified to serve as her own lawyer. Too late, he said. She asked the jurors nothing, but occasionally wiped away tears. During a break, out in the hall, she said, "I feel like I'm going to my own execution."

The next day, June 5, Keyes came to court. He wore a dark blazer, a gray dress shirt, cuffed khaki trousers, and a stem face. Marchioni wore pink. Defendant and plaintiff did not greet each other. He took a seat behind his lawyer. She sat alone, a single orange file folder before her on the wooden table. Neidorf swore in the jury delivered some pretrial instructions, and then asked Marchioni to call her first witness.

"I don't have anyone to call," she said.

"Do I hear a motion?" the judge asked. Keyes's lawyer moved for dismissal. Three years and tens of thousands of dollars had been spent. Marchioni looked dazed. Keyes shifted in his seat. Neidorf picked up his gavel. "Case dismissed," he said.

Four days later, on June 9, Keyes's assistant called me to cancel my consultation with the doctor. On June 11, attorneys for Keyes and his anesthesiologist asked Neidorf to issue a judgment of nonsuit because Marchioni had called not a single witness. He did so. The order serves as a decision on the merits in Keyes's favor and enables the surgeon to try to collect about $30,000 in court costs from Marchioni. (His attorney's fees will be paid by insurance.)

"I won the lawsuit in short order," Keyes says, "because there was no aspect of it that was true."

They had all tried to help Kay but in the end, she had no one but herself. Keyes's attorney says that was her own fault. "We were prepared to show that she has had a falling-out in one way or another with everyone she comes across," he says.

Still, Marchioni wasn't the only one responsible. "You would never want to do cosmetic surgery on someone who has just gone through a divorce, just had a loss, a death in the family had some major emotional crisis," Keyes had told Good Morning America. Yet wasn't Marchioni, a recent cancer survivor who'd been in the hospital only six months before, just such a person? When I raised this with Keyes after the trial, he scoffed. "She was a few years down the pike from that problem," he said. "I was a head and neck cancer surgeon for 14 years. She had skin cancer. That presented no risk."

A few weeks after the dismissal, I received a fax from Marchioni. Now she was suspicious of me, too. "How horrible it will be," she wrote, "if I have not only been victimized by Dr. Keyes but then am subsequently victimized by Los Angeles magazine."

In July Keyes's lawyers got busy. One called Bill Moore, telling him to take down Marchioni's Web site or risk legal action. Another sent a summons to Patricia Bacall, whose 1999 lawsuit Keyes had settled. Keyes is suing her for breach of contract, alleging that when she submitted a declaration in the Marchioni case, she broke the confidentiality agreement she'd signed when she got her $2,500 check. If Bacall's defense—that she filed the declaration only because she was subpoenaed by Marchioni's attorney—doesn't hold up, she will owe Keyes at least $50,000.

Keyes is also considering filing one more lawsuit. According to one of his lawyers, the defendants would be Marchioni and "those acting in concert with her." The charge: defamation and malicious prosecution.