FRAMINGHAM -- The young Brazilian women said they got the telephone number and address from friends, who got them from other friends. They were told to call a woman named Celia who could set up an appointment for cosmetic surgery in a Framingham basement. And they were told to bring cash, as much as $3,000.
Over the last several years, according to law enforcement officials and customers, a Brazilian couple ran an illegal cosmetic surgery clinic from a condominium, sedating patients with prescription drugs in order to perform stomach-reducing liposuction, to plump women's lips, and to sculpt their noses. Prosecutors said that the couple, Luiz Carlos Ribeiro and his wife, Ana Maria Miranda Ribeiro, both 49, had traveled between Brazil and Massachusetts, and are here on a 30-day work visa.
Their business, which apparently was common knowledge among many in Framingham's Brazilian community, unraveled Sunday night after the death of a young Brazilian woman and the hospitalization of another after they underwent liposuction in the makeshift basement clinic on a massage table covered with sheets.
Luiz Carlos Ribeiro, who says he is a physician in Brazil, pleaded not guilty in Framingham District Court yesterday to charges of practicing medicine without a license and to illegal distribution of narcotics. The Massachusetts Board of Registration in Medicine said that he is not licensed to practice medicine in the state, nor does it have a record of his applying for a license. His wife, who prosecutors said acted as his nurse during the procedures in Framingham, also pleaded not guilty to illegal distribution of narcotics.
It could not be determined yesterday whether Luiz Carlos Ribeiro holds a Brazilian medical license.
Prosecutors identified the dead woman as Fabiola B. DePaula, 24. Investigators said the second woman, whom they did not identify, has been hospitalized for a severe infection after she received liposuction, for which she paid $3,000.
Investigators said they could file more serious charges, including manslaughter or murder, pending the results of an autopsy, probably next week.
Middlesex District Attorney Martha Coakley urged people who have been treated by the Ribeiros to see a licensed doctor and call police. Investigators are trying to pin down the identity of the woman, called Celia, who made the appointments, and how the Ribeiros are connected to the family that lived in and owned the condominium in the Bishop Garden complex.
Coakley said the Ribeiros have been coming to Framingham periodically for at least two years. ``There are probably a large number of individuals who learned of them by word-of-mouth who have sought and obtained treatment," she said.
Illegal cosmetic surgery by unlicensed doctors appears to be a growing problem in the United States, and authorities have discovered similar underground clinics in California and Florida in recent years. They are especially prevalent in immigrant communities, where women may not have the money to pay for surgery from a licensed physician and where strong community networks easily circulate the names of illegal practitioners who speak the immigrants' language.
Members of the Brazilian community said yesterday that young women from Brazil are especially easy prey, because such a high priority is placed on physical beauty there and because plastic surgery is common and the doctors who perform it there are well respected.
``The desire to look right is so big," said Denise Speziale, a Brazilian immigrant who owns the Profilo Day Spa in Westborough. ``There are people who will take advantage of women who can't travel to Brazil or who don't have the resources, because aesthetics are so important in Brazil."
Among Brazilians in Framingham, the Ribeiros' business appeared to be well known.
Renata Lagares, 28, said in an interview conducted in Portuguese that a friend told her about the illegal clinic. Luiz Carlos Ribeiro injected her lips, did a procedure on her nose, and performed liposuction on her midsection Saturday, which took two hours.
``My lips turned black, and they began to hurt, so I went to the MetroWest [Medical Center] Sunday night," she said. She said that doctors gave her antibiotics for an infection and that the Ribeiros charged her $1,400. ``I never heard of anything bad happening to anyone in the whole time he's been doing this," she said.
Lagares said the basement was tidy and contained a small brown sofa and a washer and dryer. In the middle of the room was a massage-style table covered with white sheets. ``A friend of mine, she had the liposuction done while I was there, and she bled a lot," Lagares said. ``The sheets were covered in blood, but when it was over, he took the sheets and put them in the washer."
Another woman who lived nearby asked not to be identified because she did not want it known she was considering cosmetic surgery. She said she visited the Ribeiros on Saturday because she wanted to discuss having liposuction. She said about five women waited in the basement that day, including DePaula. ``It wasn't a dirty basement," the woman said. ``He would put on new sheets for each patient."
She said DePaula was planning to travel to Texas and wanted to look good for the trip.
``I told [her] that if I die, who was going to take care of my children," said the woman, speaking in English and Portuguese. ``She told me that my husband would, then she hugged me and told me not to worry, that we were not going to die, that everything would be fine and that we would come out looking beautiful. We laughed, and I told her good luck." The woman said she called her brother in Brazil, who talked her out of having the procedure. De Paula, however, went ahead with the procedure on Sunday.
Court papers detailed what happened.
Police said that Paulo and Ana Sielemann live in the condo with their daughters, including Maristela Pena Bourges, and that the family was home on Sunday afternoon.
Bourges, whose bedroom is in the basement of the condo, told investigators that her mother rushed into her bedroom, saying that a girl was sick and that she needed her daughter to drive her to the hospital.
When Bourges walked out of her room, she said, she saw DePaula lying on a massage table on her back. Bourges helped her father carry DePaula to a car, and they drove to MetroWest Medical Center.
They arrived at 4:50 p.m., and Bourges came into the emergency room and told staff that she had a friend in the car who was not breathing, staff said. When a nurse went out to the car, she found Luiz Carlos Ribeiro giving CPR to DePaula.
Bourges told emergency room staff that Ribeiro had injected her friend with glucose, lidocaine, and another substance and that 10 minutes following the injections, her friend began coughing and then stopped breathing.
Doctors tried to revive DePaula for 18 to 20 minutes, but she never regained consciousness.
Investigators searched the condominium later Sunday and said it appeared to have been wiped clean, Assistant District Attorney Lee Hettinger said during the arraignment hearing yesterday. However, investigators used special tests to find extensive residue from blood on the floor, Hettinger said.
``There was a tremendous amount of blood protein on the floor in the basement," said Hettinger, adding that investigators found a set of surgical tools used in liposuction procedures in a Dumpster.
The Ribeiros appeared with court-appointed lawyers and spoke in Portuguese, communicating with the judge through a translator.
Ana Maria Miranda Ribeiro wept during the proceedings. The judge ordered that Luiz Carlos Ribeiro be held on $250,000 cash bail. His wife is being held on $50,000 cash bail.