Baytown, and east Harris County in general, is an orthopedic surgeon's paradise. People who do manual work for a living are frequently injured, and their most serious injuries usually involve backs, knees, shoulders, elbows, and hands-the domain of orthopedics. Most of these people also carry generous amounts of state-regulated workers' compensation insurance, which involves a sort of bargain between the laborer and the employer: A worker gives up the right to sue if he is injured in exchange for long-term medical care and disability benefits, including partial replacement of lost wages. Each year workers' comp in Texas covers roughly 200,000 injuries, for which 240 insurers pay out some $2 billion in benefits. The workers themselves pay nothing, and there is no limit to how much medical care they can receive. Most of these patients have real injuries. But a small percentage engage in what is known euphemistically as symptom magnification (i.e., faking it or exaggerating pain) to take advantage of the system. It is a bitter irony that many of them ended up in the offices of Eric Scheffey, who would one day become the largest single biller in the program. In later testimony, Scheffey recalled that in Baytown his practice "took off like a rocket and continued along that vein…A lot of workmen's compensation patients predominated my practice and continued to do so, at least ninety percent." Under workers' comp rules, Scheffey was required to get a second opinion for every surgery. He always managed to find one.

He established his surgical practice at three Baytown hospitals: Humana Hospital Baytown, Gulf Coast Hospital, and San Jacinto Methodist Hospital. He was immediately popular. A strikingly handsome man, with olive skin, brown eyes, and a thick shock of dark, wavy hair swept back from a widow's peak, Scheffey had a soft voice, a Texas accent, and a warm, engaging manner. His patients and colleagues found him friendly, charismatic, and very persuasive, particularly when talking a patient into an expensive surgery. In the words of one patient, he "could talk a monkey out of his last peanut." He had a way of saying just the right things. According to Margaret Pieske, a former patient, Scheffey once held an X-ray up to the window, saying, "We'll use God's light." "I immediately liked him," she said, "because I thought he believed in God."

Still, the hospitals where he worked soon started to notice his odd work habits. At San Jacinto Methodist, for example, he repeatedly canceled scheduled surgeries. He also failed to keep appointments with patients or keep accurate medical charts. Internal hospital memos from as early as 1983 show that the medical staff was worried that Scheffey's erratic behavior might be the result of drug use. And he was not always the well-mannered and charming young doctor. In one nurse's report from 1984, he was described as "very ugly and sarcastic toward me." The nurse added that "his speech was very slurred and irrational."

Even more disturbing, Scheffey came to be known as a surgeon whose patients lost a great deal of blood."The losses were massive," says Priscilla Walters, an attorney who has been involved in twenty lawsuits against Scheffey. "Sometimes almost all of the patient's blood had to be replaced. The surgeries he was performing, in the hands of a competent surgeon, did not result in much blood loss- usually about one hundred cc's, or three ounces. One of my clients lost four thousand cc's [more than a gallon] during a back surgery." Scheffey so often emerged from the operating room covered with blood that he earned a nickname: Eric the Red.

Scheffey was woefully ignorant of one of the most important areas of surgery: hemostasis, or the control of bleeding. In depositions from lawsuits, two of Scheffey's former colleagues said that since he did not know how to use conventional techniques to control bleeding, Scheffey resorted to primitive ones, notably the wildly liberal use of bone wax and Gelfoam sponges. Bone wax is a substance used to stop bone from bleeding. Gelfoam sponges are soaked in a coagulant called thrombin and are used to stop general bleeding. Most surgeons require less than one tube of bone wax during an operation. Scheffey often used ten. In a single operation, most surgeons might use one or two five-by-seven-inch Gelfoam sponges. Scheffey once used seventeen. "Since he did not know how to control bleeding, he used bone wax like Bondo," says Hartley Hampton, a Houston attorney who has represented more than a dozen of Scheffey's former patients.The application of bone wax in those quantities, according to a 1992 deposition from Dr. Baltazar Benavides, who had assisted in many of Scheffey's operations, can create a breeding ground for bacteria that cause the sorts of infections that plagued so many of Scheffey's patients.

Tywater's death was thus a logical outcome of Scheffey's incompetence. But it was also related to another of the doctor's personal quirks. On the day after Memorial Day, a security guard at Montgomery Ward found Scheffey in green surgical scrubs, with shoe covers, a cap, and a lab coat crammed with hundred-dollar bills and reported that he was "pacing real fast, swearing and cussing, pulling things off the shelves." Trailed by the security guard, Scheffey then went to the cash register and put eight toy dolls, four hundred-dollar bills, and his car keys on the counter and walked out of the store. Scheffey, as it turned out, was out of his mind on cocaine. Police later found thirty grams of the drug- about $3,000 worth-in his Jaguar. He was arrested, pled guilty to criminal possession of cocaine, and received a ten-year probation and a $2,000 fine.The state medical board restricted his license and put him on its own ten-year probation, which included drug tests, counseling, and the requirement that he be monitored by other doctors. Shortly after the incident, Scheffey checked himself into a California drug rehabilitation center.

The story, in all of its lurid detail, made the newspapers in Baytown and Houston.Though reporters never drew a direct connection between Scheffey's arrest and the death of Tywater four days earlier, the two events were connected. In a later deposition, a doctor who had worked with Scheffey testified that the staff at the hospital where Tywater had died believed that Scheffey was taking drugs and that nurses had struggled to wake a drugged Scheffey in the doctors' lounge just before he operated on her. Scheffey admitted in a medical board interview in 1986 that he had been using cocaine for eighteen months prior to his arrest.

His promising career quickly unraveled. Scheffey lost his hospital privileges at the three Baytown hospitals. The number of medical malpractice suits against him (including one from Tywater's husband) was steadily rising, from one in 1982 to thirteen in 1986. By that same year he had, for the third time, flunked a test that would have made him a board-certified orthopedic surgeon. Meanwhile, word had spread in the tight-knit medical community that he was an inept surgeon who performed unnecessary surgeries. At the age of thirty-six, he was a professional pariah. His career should have been over.

Until the early 2000s, doctors in Texas were rarely removed for lack of medical competence by the Texas State Board of Medical Examiners. They were frequently reprimanded and probated, as Scheffey was, for substance abuse. They could lose their licenses for committing crimes (though at one point the state had nineteen felons practicing medicine). But they almost never had their licenses suspended or revoked for what is known in the industry as a "standard of care" violation. In fact, a doctor could be sued, as Scheffey was, dozens of times, and be the subject, as Scheffey also was, of wave after wave of complaints and still keep his license.

Which is exactly what Scheffey did. Only six months after his spectacular downfall, he even managed to find a hospital that would let him operate: a small facility in inner-city Houston called