The Love Surgeon: A Story of Trust, Harm and the Limits of Medical Regulation

James Burt practiced obstetrics and gynecology as a licensed physician in Dayton, Ohio, from 1951 until he voluntarily surrendered his medical license in 1989. In the mid-1950s, he began experimenting with variations on episiotomy, a once common obstetrical surgery experienced by women during childbirth. A decade later, in the wake of research on female sexuality published by Masters and Johnson and his self-proclaimed reports of patient satisfaction, Burt’s surgical procedures had evolved into what he called “love surgery”— a surgical procedure that he claimed assisted with child birth and improved the subsequent experience of sex for the patient. Burt’s procedure included rebuilding and tightening tissue in and around the vaginal area and female circumcision.

As Rodriguez’s book makes clear, despite Burt’s claims of patient satisfaction (he described them as “ecstatic with the results”) and minimal post-surgical complications, ambiguity and uncertainty — and in some cases, pain and suffering — were more apt descriptors for what transpired over the course of several decades. Scores of women came forward with complaints against Burt’s practices. Their allegations included his failure to disclose the true nature and extent of his “procedure.” In some instances, his patients had no idea that anything more than an episiotomy had been performed. Other Dayton-area physicians later observed the physical alterations and harm to these women once their post-surgical complications became so pronounced that they had no choice but to seek medical care.

One patient’s experience, Janet Phillips, serves as a focal point of the narrative — in part because her post-surgical complications typified that of many women but also because she persisted where others did not in pursuing legal avenues when the conventional intra-professional guardians (hospital, medical society, state medical board) proved seemingly unwilling or unable to take appropriate actions.

Rodriguez traces Burt’s controversial career with an eye toward historical context. It is precisely this contextualization that makes her analysis so compelling…and at the same time challenging in its own right for the reader. Rodriguez acknowledges that a conventional recounting of Burt’s career and practices would cast him as an anomaly, an outsider within his own profession; and that while the profession and medical regulation proved tardy in holding him accountable, still the system worked in ultimately removing him from practice. Love Surgeon offers no such comforting reassurances.

Instead, Rodriguez’s book makes clear that these conventional guardians failed. Indeed, without the critical role played by other parties such as Public Citizen, local and national news media, the civil court system and state legislatures, Burt may well have been allowed to quietly retire with his reputation largely intact to all outward appearances.

Rodriguez deftly places key threads in this story within a critical historical context, e.g., the concept of informed consent; medical paternalism; acceptance of variations on standard surgery; definitions for standard of care; notions of human (and specifically female) sexuality. This is particularly critical as several aspects of Burt’s surgery and his career seem to fall into what we can recognize now as transitional periods involving surgical procedure, informed consent and evolving sensibilities in terms of expectations for medical regulation both in Ohio and nationally.

For the reader who is a state medical board staff or board member, what one sees in The Love Surgeon is a retrospective look into the emerging landscape for medical regulation as they would know and recognize it today. The book serves as a powerful reminder of the complexities and general messiness associated with complaints and disciplinary cases involving quality of care — qualities often exacerbated by the inherent power differential between patient and physician. As Ms. Phillips observed, “I trusted him, he was the doctor.”

This reader came away from The Love Surgeon with a sense of profound sadness. Many people recognized (or strongly suspected) something was amiss with Burt’s practices; yet often fellow physicians, administrators and others felt a sense of fear and powerlessness (whether justified or not) in challenging an overarching medico-legal regulatory system that seemed to expel closer scrutiny from its orbit with an almost centrifugal force. Burt’s victims suffered from similar feelings as well as a sense of personal shame at the damage wrought to their bodies.

Human experience as it is lived lacks the retrospective clarity we enjoy in reading about past events. It offers none of the clear boundaries and tidy demarcation points we see so clearly when looking back. Sarah Rodriguez’s Love Surgeon offers a cautionary reminder of such limitations while still presenting a plausible case for holding accountable those people and institutions in positions of authority to have mitigated this slice of life’s messiness and injustice.