By the time a judge ordered a dissatisfied facelift patient to remove the "false and offensive statements" she'd posted about her cosmetic surgeon on various websites and fined her $40,000, the surgeon's business had taken an incalculable hit and the patient was dead by her own hand. A nightmarish Indiana case shows the potential hazards to professional reputations in the age of the internet.

After Lucille Iacovelli underwent surgery with Barry Eppley, MD, she complained that the procedure had obstructed her airway and caused her breathing difficulties, say court records. Dr. Eppley had never heard of such an outcome, and neither had any of the experts he later consulted. But he addressed Ms. Iacovelli's concerns by telephone, mail and e-mail for a year before cutting off contact due to her "bizarre and irrational" behavior.

Ms. Iacovelli began to air her grievances against Dr. Eppley. Her complaints went far beyond the usual bad reviews posted to physician-rating websites, however. She started a site, losingface.net, that accused him of malpractice. It generated more than 100,000 hits. She also created websites with addresses featuring his name that directed visitors to negative accounts of patient experiences. A video tirade she posted to YouTube attracted more than 280,000 views. Her online crusade even got her featured in a television documentary.

Dr. Eppley found he was hemorrhaging new patients as a result of this barrage of bad publicity. Every month, he said, 1 or 2 patients canceled appointments with him. He sued Ms. Iacovelli for defamation in federal court. Ms. Iacovelli, who'd never filed a malpractice suit over her outcome, argued that her comments were not defamatory but part of an "educational campaign."

The judge granted Dr. Eppley a temporary restraining order that barred Ms. Iacovelli from posting comments about him online. He also issued a preliminary injunction ordering her to remove defamatory information from her websites. She refused to do so and was cited for contempt. "It was very difficult to get all the postings removed," says Dr. Eppley's attorney, Todd A. Richardson. "There are probably still some postings up there."

A summary judgment later concluded that Ms. Iacovelli had "made numerous false and offensive statements about Dr. Eppley on public websites" and stolen his internet identity to attract and deter his potential patients. He awarded Dr. Eppley $40,000 in damages and court costs and issued a permanent injunction against Ms. Iacovelli.

But she was no longer alive, having committed suicide 16 days before the ruling was issued. Her ill will lives on, though, since one of her sites is operated by an offshore company not under U.S. jurisdiction.

To avoid this type of net nightmare, Mr. Richardson says, some physicians have hired reputation management firms to police the internet and have begun asking patients to sign pledges in advance of surgery that they'll refrain from internet commenting afterward.

Leigh Page