HAPPIER TIMES Charles and Krystal Ballard before her death from a surgical site infection.

Krystal Ballard, a 27-year-old staff sergeant in the United States Air Force, went to the Silk Touch medical spa in Eagle, Idaho, to have excess fat removed from her midsection and added to her buttocks. Four days later, she was dead, the victim of an apparent post-procedure infection. Silk Touch must now pay her husband Charles Ballard $3.8 million after the Idaho Supreme Court recently upheld a lower court's finding that staff at the medi spa failed to properly disinfect and sterilize the instruments used on Ms. Ballard.

Anesthesiologist Brian Kerr, MD, opened Silk Touch in 1999 and began offering liposuction and fat transfers after being trained on the procedures in 2007, court records show. On July 21, 2010, Ms. Ballard arrived at Silk Touch for her procedure, which was uneventful. Two days into her recovery at home, Ms. Ballard called Silk Touch complaining of intense pain in her buttocks. During a subsequent exam that day, Dr. Kerr determined the wounds appeared to be healing normally and he didn't think an infection had occurred. He still prescribed a course of antibiotics and an anti-inflammatory steroid to help manage the pain. Later that night, Ms. Ballard awoke in terrible pain and had difficulty breathing. She was taken to a local emergency room, where tests revealed signs of an acid-base abnormality, an elevated white blood cell count and renal failure.

The next morning, Ms. Ballard was airlifted to St. Alphonsus Regional Medical Center in Boise, where an ER physician noted she had abnormally low blood pressure, an elevated heart rate and potential multi-organ failure. She was transferred to the ICU, where later that evening she went into cardiac arrest multiple times and died. A subsequent autopsy revealed the presence of unknown gram-negative bacteria in fat tissue in Ms. Ballard's right buttocks. The coroner concluded she died because of sepsis with probable toxic shock syndrome caused by the bacteria.

Charles Ballard sued Dr. Kerr and Silk Touch for failing to properly disinfect and sterilize the reusable devices used during his wife's procedure. He alleged the dirty instruments introduced the bacteria into her buttocks and ultimately led to her death. An expert witness also testified that the bacteria found near the injection site was located deep in the fat tissue and ran parallel to the skin, which indicated the injection was the only plausible way the bacteria could have entered Ms. Ballard's body.

The defense countered that signs of infection would have also appeared in Ms. Ballard's left buttocks if bacteria were introduced from contaminated equipment used during the procedure. Dr. Kerr, who says Silk Touch uses hospital-grade instrument cleaning solution, does not accept the contention that the instruments he used on Ms. Ballard were contaminated. He also points out that there was never frank evidence of infection — tissue swelling, pus or tissue breakdown — and that the expert witness who testified on behalf of the Ballard family was a direct local competitor who at the time of the trial had performed 12 liposuctions and zero fat transfers.

Dr. Kerr doesn't want the loss of Ms. Ballard's life to be glossed over with legal discussions about the case, but says he disagrees with the Supreme Court's ruling and was frustrated with what the judge would not let him divulge during the malpractice trial. For example, he couldn't share that he had performed thousands of liposuctions and fat transfers with no complications before Ms. Ballard's procedure. He also claims Ms. Ballard decided to hide the procedure from her husband and suggests that decision may have caused her to not fully comply with post-op care instructions. Dr. Ballard admits, however, that he can't be certain that was the case.

"This was an unfortunate outcome and everyone understandably wants to find a reason or cause," says Dr. Kerr. He says the only change his practice made after the tragedy was emphasizing with patients the importance of disclosing procedures and post-op care requirements to their loved ones.

"It's OK if they want to hide procedures from family members," he explains. "But not involving them in their care is now a deal-breaker for us."

Scott McKay, the attorney for Charles Ballard, could not be reached for comment.

Daniel Cook