STITCH-UP

It's a cold winter afternoon in New York, and Gustin Reichbach is not happy. In a deep, ponderous Brooklyn accent, the judge tells his audience, "I have been assigned, through a wisdom not of my own, to preside over these consolidated cases."

The court officers and lawyers assembled before him have never seen anything quite like this. One hundred and eighty cases have been lumped together, to be presided over by Judge Reichbach, a 48-year-old ex-Yippie with the slogan up against the wall, your honor, the brooklyn revolution has begun pasted on his office wall. A lawyer who once represented Abbie Hoffman, icon of Sixties' radicalism, Reichbach is now a judge in Brooklyn's small- claims court, and it is his solemn duty to preside over the preliminary hearings in a swathe of cases which could see the life savings of a courtroom full of people migrate into the absorbent bank account of a plastic surgeon.

More than a hundred people are milling around, unsure of whom they are supposed to meet, of why, precisely, they have all been called together. A young, clean-cut lawyer approaches a man in Hassidic clothing, a tall, bearded fellow with a scar on the ridge of his nose, and asks, "Are you one of the lawyers?" "No," the man replies nervously. "I'm looking for my lawyer." He scans the benches, looks over the triple chins and the bulbous noses, the women in fake-gold jewellery and the men in respectable jackets, and takes a seat.

The majority of the onlookers, however, have no discernible oddities about their person. They can be divided into two groups: the tense-looking laymen and women, craning their necks to hear every detail, and the lawyers, people with nothing more to lose than a small retainer.

This case may not have the made-for-TV glamour of the OJ Simpson trial. It isn't as macabre as the Long Island Railroad Massacre case, in which the accused killer, Colin Ferguson, dismissed his attorneys after they claimed he was insane, and proceeded to represent himself. Instead, in Room 509 - in front of a court the judge only half-jokingly describes as "the lowest court in the land" - the small sagas of ordinary Americans are being played out, and the workings of America's medical and legal underside laid bare.

``Tsjesus Christ,'' exclaims an elderly gent, in a long-drawn hiss of utter contempt for the proceedings. A few rows behind, a nervous woman with a worried expression starts telling her neighbour how everyone in the room should combine to sue the man responsible for bringing them here for the distress he has caused.

That man is Dr Frederic J Cohen, a black-suited, bespectacled plastic surgeon, who is sitting impassively in the official enclosure at the front of the courtroom. The ruddy-faced doctor peers through his goggles like a mole unexpectedly caught in the glare. From the front, it looks almost as if he cannot understand what all the fuss is about: all he wants is money. From behind, the former patients Cohen is suing have a view of the fat, rough-looking skin of the doctor's neck as it slides over the pressed white collar of his shirt.

The doctor has recently been forced by a heart condition to give up his practice. So, naturally, he's been thinking about how to pay for his retirement. After all, the average yearly income of a doctor in the United States is only $177,000.

Dr Cohen came up with a solution: he looked through his old files, and decided to sue former patients - not for failing to look beautiful enough to enhance his reputation, but for bills he claimed had never been fully paid. And then he set his lawyers, Messrs Rosenthal and Sitder, to work.

In the past two years, 180 ex-patients received summonses announcing that they were being sued thousands of dollars for expenses relating to operations performed as long ago as 1987.

How could this occur?

Well, back in the days when the plastic surgeon dedicated to the Hippocratic oath, he would present potential patients with estimates of how much their surgery was likely to cost. They would then sign statements promising to pay the bills, or to make up the difference if their health insurance did not cover the full cost. In most cases, the estimates were reasonable, the operation was performed and the patients heard no more about the bill; they assumed their insurance had taken care of it.

Unfortunately for them, it turns out the bills were generally outlandish - far, far above the estimates. The insurers - as is common practice in the profit-dominated world of US medicine - paid large proportions of the bill (in fact, way more than the true cost of the procedure) and left the rest unaccounted for. Until recently, that was the unspoken compact between insurers and doctors: the doctors would make up ridiculous bills, the insurers would pay most of what the doctor demanded - symbolically leaving a portion unpaid - and the people who had to buy the insurance ended up with ever-increasing premiums.

Everyone grew rich apart from these "consumers", who had little option but to pay the higher premiums. Generally, the doctors would accept what the insurance company offered. Not so Dr Cohen.

One New York gent waves around a letter Cohen's lawyers had sent to his daughter. They were suing her for $4,795, following minor outpatient surgery in 1989 that the doctor had estimated would cost $1,100 to perform. Little did she know that her insurance company had been billed $10,950, and had only coughed up slightly more than $6,000. Now the doctor wanted justice performed.

Another woman was being sued for $8,500 for having her child's earlobe repaired, despite a slew of doctors assuring her lawyers that it should have cost no more than $1,000.

But what if the ex-patients do not have this money? The lawyers are in a generous mood. Sitder, a bulky, greying man, exuding an air of well- fed arrogance, confides that they are perfectly prepared to work out payment schedules over a period of months. He takes a handful of M&Ms out of his suit pocket and plunges the ball of pink flesh and chocolate into his mouth. ``We're reasonable people,'' he declares.

Not that the lawyer is enjoying this case, he is quick to point out. He's never seen anything quite like it, and he'd rather be doing something else. He'd rather not disclose his name, in fact. But he's representing a client, what can he do? That's the law.

He pops another handful of M&Ms into his mouth and calls, "Freddie! It's time to go." The doctor picks up his plastic brown attach case and heads out of the courtroom with the lawyer. This is just the beginning...