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The flashy red Lamborghini is no longer on the road. Models and exotic dancers no longer answer his ads in Exotic Dancer and fly in from New York City for discount breast jobs. The six-figure-plus income has dried up.

Anthony Steven Pignataro no longer appears on "CBS This Morning." He's not quoted in the Washington Post, Chicago Tribune or Investors Business Daily. He's no longer trying to install a hair replacement system he invented -- and still wears -- that snaps his curly brown wig into place using bolts imbedded in his skull.

He's the only medical doctor in Western New York ever indicted and sent to prison for the death of a patient under his care. He no longer is referred to as doctor, stripped of his medical license in four states.

And just when it seemed that he could sink no lower, Pignataro, 41, the son of a prominent physician and a Nichols School graduate who returned to his hometown to practice medicine, found himself in the middle of another mess last week.

His wife, Deborah, 42, lies temporarily paralyzed in the intensive care unit at Mercy Hospital, suffering from arsenic poisoning so severe that toxicology experts say they are surprised she is still alive.

To make matters worse, their two children, 9 and 12 years old, were temporarily taken away from him last week in Erie County Family Court and put in the custody of his wife's brother and his wife. Social services officials said the children's safety could not be guaranteed in the Pignataros' West Seneca home where someone was poisoned.

Pignataro is not considered a suspect, but neither is he clear of suspicion.

As anyone who has ever watched a cop show knows, the first person police always suspect is the spouse.

But to have a suspect, you first have to have a crime. And while District At
torney Frank J. Clark said there is no question that Mrs. Pignataro was poisoned, investigators first have to prove there indeed was a crime.

And then they have to find a motive.

Pignataro's conviction in the death of Sarah Smith, a 26-year-old paralegal who died in September 1997 following breast augmentation surgery in his office, did not exactly endear him to the community.

After he pleaded guilty to criminally negligent homicide, Pignataro reported to West Seneca police that he received telephoned threats and that threatening messages were spray painted on a fence and doors at his home.

"Was there an opportunity for an outsider who would have access and be able to do it over an extended period of time?" Clark asked of the poisoning. "Common sense would argue against it. And why does it end up in something ingested by a single person?"

The amounts of arsenic found in Pignataro and his children, later testing showed, were within normal ranges. The children were kept briefly in a hospital for observation only, authorities said.

Pignataro has cooperated with police, but has remained silent about the case since the discovery of his wife's poisoning. He declined to comment as he left Family Court Thursday.

Investigators, meanwhile, are learning all they can about arsenic, one of the oldest and deadliest poisons known to man.

"Ingestion or inhalation of high doses of arsenic can produce pain, nausea, vomiting and diarrhea," says the National Coalition Against the Misuse of Pesticides.

It causes skin lesions, abnormal heart functions, damage to kidneys and the liver, impaired nerve function and hearing loss. It eventually leads to death.

In short, experts say, it is a horribly painful way to die.

Arsenic, however, is fairly common. It's found in wood preservatives, pesticides and herbicides and is also used in the manufacture of glass and semi-conductors.

While intentional arsenic poisoning is more common in the southern United States -- where agricultural pesticides and old-style, colorless and tasteless liquid rat and ant poison are more available -- it's rare in this area.

Only after Mrs. Pignataro's third trip to the hospital, when she became critically ill in early August, according to those close to the case, did a curious physician run a relatively rare test on her. It showed she had ingested a massive amount of arsenic.

Clark said investigators are uncertain whether she received a small amount of arsenic on a regular basis over a long period of time -- allowing it to accumulate in her body -- or if she received a large dose, either all at once or within a short time.

"Right now, we're awaiting analysis of her hair samples to see how long ago she was exposed to the contamination," Clark said.

By analyzing hair samples, scientists are able to learn what chemicals are present in the body, and through the hair's growth rate, learn when chemicals were introduced.

At the same time, state police technicians are analyzing seven containers of materials that toxicologists removed from the Pignataro home last week under the supervision of West Seneca Detective Capt. Florian Jablonski.

"I drove those to the State Police in Olean myself," Jablonski said. "They're going to run a quick test on them, and if anything shows positive, they'll send it to a lab."

But even when the hair samples come back and the lab results are in, authorities may not know much more than they do now.

"We have to do it circumstantially, there is no direct evidence," Clark said. "Then we are in a more conventional investigation mode. Who had the opportunity, the motive?"

Police were at first stymied in their investigation, saying Mrs. Pignataro prevented them from entering the house to look for possible sources of the poison.

At the time, Mrs. Pignataro was in the hospital and her husband was no longer living in the house. Investigators said he moved in and out of the home at various times since he was released from prison last December.

The couple admitted in court that their marriage has been strained by his conviction, the resulting publicity and his prison term.

"My husband has lost his career, his self-esteem and his self-worth," Mrs. Pignataro said in a letter to State Supreme Court Justice Ronald J. Tills. "He has been stripped of everything that is important to us. I have lost the man I married . . ."

The Pignataros had reconciled and applied to the court in May to have his probation transferred to Florida. His two brothers offered him a $50,000-a-year job managing their Dairy Queen franchises.

In the transfer application made by attorney Anne Adams, Pignataro said he had no income, was depleting his savings and was unemployable here. He included a number of rejected job applications in which he still referred to himself as a medical doctor.

Ms. Adams told the judge that Pignataro served four months of his six-month sentence, getting two months off for good behavior, and completed 250 hours of community service at a riding stable that helps the disabled. She said the family wanted to start anew in Florida.

She also cited the telephoned threats and spray-painted messages at his home, and said his son and daughter were being harassed by other children because of their father's troubles.

Tills rejected the request on July 30, saying Pignataro had served too little of his probation. He told the lawyer to reapply later.

Denis A. Scinta, who this week became Mrs. Pignataro's attorney, stressed that it was important not to read anything into her slow decision to cooperate in the poisoning investigation.

"When the police first contacted her, Mrs. Pignataro was in the intensive care unit," Scinta said. She was hardly in a position, he said, to make a decision.

In addition, even Clark admits that Mrs. Pignataro might have been hesitant to immediately agree to any request by his office. It's the same prosecutors who obtained the indictment of her husband and presented enough evidence to persuade him to plead guilty to criminally negligent homicide.

The prosecutor in the Pignataro case, Frank A. Sedita III, is heading the poisoning investigation and was present in Family Court last week to monitor the proceedings concerning the Pignataro children.

"Given her mental and physical distress," Clark said, "maybe she was focusing on things other than this."

Mrs. Pignataro is also a defendant in a lawsuit filed against her husband by a former patient.

A Clarence woman sued Pignataro and his wife in November 1997 for $1 million, claiming that Pignataro allowed his wife to perform a procedure on the woman that ended up burning her.

The suit filed by Denise Cullinan said she went to Pignataro to have sun spots on her chest and face removed, and that he recommended she have a chemical peel. The procedure involves an acid solution to remove skin blemishes.

But she said Pignataro never performed the procedure, instead entrusting it to Deborah Pignataro who, according to the suit, "was unqualified and unlicensed." The woman said she received permanent burns on her forehead, chest, collarbone and hand.

Pignataro filed an immediate reply, saying the procedure was done under his supervision and could be performed by anyone.

But the patient and her sister then both filed sworn affidavits, saying that not only did Pignataro not supervise his wife on the day of the alleged burning, he was not in the office. Mrs. Pignataro could not reach him by phone or by pager, they said.

Pignataro's former attorney, Carmen P. Tarantino, said last week that he had represented him in more than 15 lawsuits filed by former patients.

Attorneys in February settled the suit filed by the family of Mrs. Smith for an undisclosed sum.

Clark said he hopes that lab tests and hair samples will help solve the case.

But the district attorney also said prosecutors may never learn what really happened: "That's a very distinct possibility."

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