Dr. Kristine Brecht was a licensed physician and surgeon who was board certified in family medicine. She was the sole owner and operator of Aesthetic Rejuvenation Spa (ARS) located in Burien, Washington. Dr. Brecht performed both surgical and nonsurgical procedures at ARS. Staff at ARS included a receptionist and medical assistants.
Nasra Elmi was interested in getting cosmetic surgery and found Dr. Brecht on YouTube. Dr. Brecht talked about cosmetic surgical procedures she performs including arm lifts and tummy tucks. Elmi viewed photos on the ARS website of arms and stomachs showing small incisions.
On August 1, 2020, Elmi saw Dr. Brecht for a consult to discuss getting a tummy tuck, liposuction, arm lift, and breast lift. During the consult, Elmi disclosed her diabetes and that she was a smoker. Elmi also signed consent forms.
Dr. Brecht performed two surgeries on Elmi with the aid of two medical assistants, Jackeline Lopez and Maria Arce. Dr. Brecht performed an abdominoplasty and liposuction on Elmi on September 1, 2020. Dr. Brecht performed an arm lift, breast lift, and liposuction on Elmi one week later, on September 8. For both surgeries, Dr. Brecht used local anesthesia and oral sedation rather than general anesthesia. Elmi was instructed to take Ambien, oxycodone, Phenergan, and lorazepam prior to surgery and then during surgery she was given more oxycodone and lorazepam. Dr. Brecht did
not establish intravenous access to Elmi during the surgeries.
The incisions from the surgeries did not heal properly and kept opening. The incision on Elmi’s left arm ran from her armpit to her elbow and opened twice in several places. After several follow up appointments, Dr. Brecht determined Elmi had an infection. Elmi eventually stopped seeking treatment from Dr. Brecht. The surgeries and resulting scars and wounds required Elmi to seek ongoing treatment elsewhere.
Unrelated to her treatment of Elmi, on August 4, 2021, Dr. Brecht entered a stipulated order with the Washington Medical Commission (WMC). Dr. Brecht agreed in the order that she committed unprofessional conduct under RCW 18.130.180(4) related to the treatment of nine patients. Also unrelated to her treatment of Elmi, on October 22, 2021, Dr. Brecht entered a stipulated order with the Department of Health (DOH) where she agreed that between October 2019 and January 2020 she performed cosmetic surgical procedures such as liposuction and arm lifts, and operated an ambulatory surgical facility without a license. As a result, Dr. Brecht was restricted from performing any procedures that required sedation and was prohibited from operating as an ambulatory surgical facility.
Elmi sued Dr. Brecht for medical negligence, lack of informed consent, breach of promise, and violation of the Consumer Protection Act (CPA), ch. 19.86 RCW. Elmi’s husband, Robert Blanton, claimed future loss of consortium. Elmi sought damages, costs and treble damages under the CPA, attorney fees, and interest.
Dr. Brecht moved in limine to exclude evidence of or reference to the disciplinary proceedings before the WMC and the DOH as irrelevant to proving breach of the standard of care, as improper character evidence, and as cumulative evidence that would confuse the jury and be unfairly prejudicial. The trial court denied the motion to exclude the DOH order; the parties agreed to a redacted version of the order which was admitted as exhibit 260. The trial court also denied the motion to exclude the WMC order and determined it was admissible under ER 404(b) and relevant to the standard of care and Dr. Brecht’s way of treating patients. The parties agreed to a redacted version of the WMC order which was admitted as exhibit 261.
On August 4, 2023, the jury found in favor of Elmi on all claims. The jury awarded $11,000,000 to Elmi for past and future damages and $2,000,000 to Blanton for loss of consortium. The jury also determined the financial loss under the CPA to be $34,186. On August 23, 2023, the trial court entered judgment in the amount of $13,034,186. On September 25, 2023, the trial court entered findings of fact and conclusions of law awarding fees and treble damages and entered a supplemental judgment in the amount of $79,000 in attorney fees and $25,000 in treble damages. Dr. Brecht appealed, arguing that the trial court abused its discretion by improperly admitting evidence of prior conduct under ER 404(b).
In its July 21, 2025 unpublished Opinion, the Court of Appeals of the State of Washington Division One stated, “even if we agree with Dr. Brecht that admission of exhibit 261, the statute, Karenin’s testimony, and Kodis-Fisher’s testimony was improper under ER 404(b), the error was harmless considering the evidence as a whole … the challenged evidence is of minor significance considering the evidence as a whole. There is no reasonable probability that exhibit 261, the statutory language, the testimony of Karinen, and the testimony of Kodis-Fisher materially affected the outcome of the trial. Thus, any error in admitting the evidence under ER 404(b) was harmless.”
“Unlike in Ambach, here there was a marketing plan that targeted patients who were motivated to have surgery. Although the advertising in this case did not occur exactly like the advertising in Williams, Elmi presented sufficient evidence to persuade a rational fair-minded person that Dr. Brecht used deceptive public advertising in her business. The evidence is also sufficient to persuade that such practices caused Elmi to agree to the procedure and hand over her money. Viewing the evidence in the light most favorable to Elmi, we conclude substantial evidence supports the verdict and the trial court did not err by denying the motions for judgment as a matter of law and directed verdict on the CPA claim. We affirm.”
Source Elmi v. Aesthetic Rejuvenation Spa, No. 85851-3-I.
If you or a loved one have suffered serious harm as a result of cosmetic surgery malpractice in Washington State or in another U.S. state, you should promptly find a Washington medical malpractice lawyer, or a medical malpractice lawyer in your state, who may investigate your cosmetic surgery medical malpractice claim for you and represent you or your loved one in a cosmetic surgery malpractice case, if appropriate.
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