found that shell casing before everything caught up with him and now he is in his orange prison jacket paying for his crime. it will catch up with you sooner or later. a series of medical mixups left one woman dead and her doctor in prison for negligent homicide. but that wasn't the entire story. in a single strand of hair, a forensic toxicologist found evidence of another medical mystery, one that made headlines around the world. >> hi. say "happy halloween." >> happy halloween. >> happy halloween. >> who is that guy? >> 1997 looked like it would be

a banner year for the pignataro family. dr. anthony pignataro had a thriving medical practice, a wife, two children and social standing. >> that's great, ralph. >> dr. pignataro was also an entrepreneur. he invented and wore the snap-on toupee held in place by four bolts drilled into the skull. >> he's always been different and he just came up with this idea, i could say off the top of his head, but -- >> i remember laughing about it. it was the subject of many, many, many jokes around the family and even when he was around, but he was dead serious about it. >> his medical practice consisted primarily of cosmetic surgery, which he performed in his office. one of his patients was 26-year-old sarah smith, a young mother of two scheduled to have breast augmentation. dr. pignataro had no anesthesiologist or registered nurse present.

his only assistants were his wife and a licensed practical nurse. >> sarah smith was feeling pain, so dr. pignataro ordered a little more sodium phenethanol to dull the pain. when he did that, her system started shutting down and she was losing oxygen. >> at that point, he broke scrub, and i remember him tapping her on the chest and calling out her name, but there was no answer. and then all hell broke loose. >> sarah smith was dead, the result of too much anesthesia with no anesthesiologist to monitor her, and there was no ventilator to help her breathe. >> i knew that things would never be the same once this happened. >> when local prosecutors learned about the incident, they

conducted an investigation. they learned that dr. pignataro was not a board-certified plastic surgeon. in fact, he wasn't a plastic surgeon at all. >> he did train for ear, nose and throat but did not finish. so, technically, it did not make him an ear, nose and throat doctor. he didn't finish all of the things necessary to become one. >> medical experts told investigators that sarah smith would have survived if dr. pignataro had the proper resuscitation equipment. >> the procedure that sarah smith was undergoing was a transumbilical breast augmentation. it was a very invasive procedure and should have been done in a hospital setting or at least a certified surgical area. >> dr. pignataro claimed that deaths from anesthesia do occasionally happen. nevertheless, prosecutors charged him with manslaughter. to avoid a trial, he pled guilty to criminally negligent homicide. he was fined $5,000, sentenced to six months in prison and 250 hours of community service. he also lost his medical license.

although it seems hard to imagine, the pignataros' problems were far from over. when tony pignataro was released from prison, he had difficulty finding a job since his medical license was revoked and the terms of his parole . you found your way. on a personal note, as i was counseling the two of you...

when tony pignataro was released from prison, he had difficulty finding a job since his medical license was revoked and the terms of his parole prevented him from leaving the area. >> for years he had, you know, went to school, done residencies. he had gone quite a few years to do this, and that was taken away from all of us. >> to make matters worse, vandals spray-painted the word "killer" on the side of the pignataros' home. >> he claimed to have received death threats, but he didn't know where they were coming from, other than, you're going to pay for sarah smith's death. >> tony realized he would never get his medical license back. the stress took its toll and the pignataros separated. a few months later, the couple reconciled. tony pignataro's mother

supported them financially, or their situation would have been far worse. >> anthony pignataro came from a good family. his father was a well-respected and excellent surgeon in buffalo. his mother was a fine person. >> after the pignataros' reconciliation, debbie started to feel ill. >> i had thought i had the flu for months, just maybe a little case of the flu, because i would get nauseous and vomit and just not be myself. >> initially, neither her husband nor her doctors knew what to make of it. >> i was having trouble walking where i couldn't lift my legs. there was numbness in my legs and hands. >> i diagnosed myodisplastic state, and the neurologist diagnosed other things, the gastroenterologist diagnosed pancreatitis. we didn't know how to put it all together, so we were all puzzled. >> tony thought debbie's

gallbladder should have been surgically removed, but her doctors disagreed. >> i was so weak and my condition was so grave that i probably would have died on the table, i was told. >> but she got better. and when she got better we relaxed and thought, well, this isn't going to happen again. >> but debbie's symptoms returned again and again. the pain was getting worse. even more disturbing, her daughter started to experience the same symptoms but not nearly as severe. throughout that summer, debbie's condition deteriorated. she had severe memory loss and was relegated to a wheelchair because she was no longer able to walk. once again, she was admitted to the hospital. this time, dr. snyderman analyzed a sample of debbie's bone marrow under a microscope. >> i looked once, i looked twice, and i couldn't believe my eyes.

it looked like something that i remember reading about in medical school. >> debbie's red blood cells had degenerated, a condition known as karyorrhexis. >> i ran down to the library and i got out a book on toxicology and i also went on to something called medline on the computer. >> the medical literature described some possible causes. when her doctor factored in her other symptoms -- numbness of her hands and legs, disorientation and nausea, the answer became clear. >> i was able to complete the description of arsenic in my mind, and it fit her perfectly. >> arsenic is a heavy metal poison and not one you normally encounter. further testing indicated debbie had an arsenic level of 29,580 micrograms per liter, one of the highest ever recorded in a living person. >> almost sounded like a mistake in the lab reading, but it

wasn't. >> the amount i had, i shouldn't be here. >> she was immediately put under 24-hour security protection. but the question remained, how was she poisoned, and who wanted her dead? dad: so who's going to do what? boy: i'll pack the dead batteries. dad: great. girl: i'll only put what i don't need into a duffle bag. perfect. that's totally unhelpful. no problem. meanwhile, i will try to comfort everyone by speaking in a calm voice. and who is going to handle supplies? i can forget to do a list for us. thanks, pal. dad: we couldn't be any less prepared. i'm proud of you guys. announcer: talk to your kids about who to call, where to meet, what to pack. visit ready.gov/kids for tips and information.

when debbie pignataro was diagnosed with arsenic poisoning, doctors also tested her husband, tony, and their two children. their daughter had higher than normal levels of arsenic in her system, but her son and husband were normal. >> well, our first thoughts were we needed to look at the source of water for that area of west seneca. >> prior to 1900, arsenic was the primary ingredient in embalming fluid and had caused groundwater contamination near several older cemeteries. tests showed no such problem in the water supply near the

pignataros' home. investigators began to suspect that debbie may have intentionally poisoned herself. >> it made me very angry. i mean, if anybody knew me, they would know that i would never do this to myself. i mean, first of all, i wouldn't do it to my children. second of all, it's just, if i wanted to hurt myself, i wouldn't do it this slow, torturous, painful way. >> tony suspected sarah smith's family may have had something to do with the poisoning. sarah smith was tony's patient who had died during surgery. >> anthony thought that dan smith was trying to get even with him for taking his wife away from him, and he thought enough to say, well, maybe dan was trying to take my wife away from me. >> investigators searched for arsenic throughout the pignataros' home. >> we searched the house from

top to bottom looking for arsenic, pesticides and insecticides, anything that may contain arsenic. anything that looked suspicious, powdery was taken to be analyzed at the lab and came back negative. >> detectives interviewed debbie's daughter, since she, too, had some of the same symptoms as her mother. they asked her what she ate on the day she became ill. >> there was soup left on the kitchen table, and she ate some of it. that night she was vomiting. >> debbie then remembered an important detail, that tony made the soup that day. >> he brought me the bowl. and i remember saying, i can't eat all this. he's like, no, eat it, it's good for you. >> their daughter found some of that soup left over on the stove and took some.

to find out exactly how long debbie had been ingesting arsenic, doctors decided to study her hair. >> an arsenic combined to keratin, which is the major protein in hair. so, as the blood circulates through the body and it circulates to the root of the hair follicle, some of the arsenic will become incorporated in the hair follicle. >> when poison circulates in the body, it comes into contact with the hair follicles. so, traces of the poison will remain in the hair as it grows. since hair grows approximately 1 centimeter per month, a strand of hair can identify exactly when a person was poisoned. first, debbie's hair was divided into pieces, each 1 centimeter long. using atomic absorption spectrophotometry, a beam of light is passed through each hair sample. >> when the light is absorbed,

the amount of light that is hitting the detector on the other end decreases. the change of intensity of light that's reaching the detector is directly proportional to the amount of arsenic in the sample. >> the computer-generated results were startling. >> debbie started receiving small doses of arsenic in may of 1999, and towards the end of july of 1999, she received a large dose, which was approximately 80 times what a normal human being should have in their system of arsenic. >> this timeline excluded members of sarah smith's family as possible suspects because they had moved to the midwest after sarah's death. investigators had only one other suspect with a possible motive. [announcer] play close- good and close. help keep teeth clean and breath fresh. with beneful healthy smile food and snacks.

he'll love the crunch of the healthy smile kibbles. you'll love how they help clean. with soft meaty centers and teeth cleaning texture, healthy smile snacks help keep a shine on his smile. it's dental that tastes so good. beneful healthy smile food and snacks. it's about getting to the finish line. in life, it's how you get there that matters most. it's important to know the difference. like when i found out i had a blood clot in my leg. my doctor said that it could travel to my lungs and become an even bigger problem. and that i had to take action. so he talked to me about xarelto®. [ male announcer ] xarelto® is the first oral prescription blood thinner proven to treat and help prevent dvt and pe that doesn't require regular blood monitoring or changes to your diet. [ brian ] for a prior dvt i took warfarin, which required routine blood testing

and dietary restrictions. not this time. ♪ while i was taking xarelto®, i still had to stop racing, but i didn't have to deal with that blood monitoring routine. ♪ you made great time. i found another way. [ male announcer ] don't stop taking xarelto®, rivaroxaban, unless your doctor tells you to. while taking xarelto®, you may bruise more easily and it may take longer for bleeding to stop. xarelto® may increase your risk of bleeding if you take certain medicines. xarelto® can cause serious bleeding, and in rare cases, may be fatal. get help right away if you develop unexpected bleeding, unusual bruising, or tingling. if you have had spinal anesthesia while on xarelto®, watch for back pain or any nerve or muscle related signs or symptoms. do not take xarelto® if you have an artificial heart valve or abnormal bleeding. tell your doctor before all planned medical or dental procedures. before starting xarelto®, tell your doctor about any conditions such as kidney, liver, or bleeding problems. xarelto® is proven to reduce the risk of dvt and pe.

with xarelto® there is no regular blood monitoring and no known dietary restrictions. treatment with xarelto® was the right move for me. [ male announcer ] ask your doctor about xarelto® today. for more information including savings options, download the xarelto® patient center app, call 1-888-xarelto, or visit teamxarelto.com.

the scientific analysis of debbie pignataro's hair told a horrific story. >> the people who did the hair analysis asked when the funeral was. they just couldn't believe that someone with this level was still alive. >> debbie's hair established a timeline of the poisonings.

in march of 1999, when tony and debbie were living separately, debbie had no poison in her system. the couple reconciled in may, and in debbie's hair grown that month were the first signs of arsenic poisoning. the largest dose of arsenic was administered in july. this coincided with debbie's hospital visit in which tony recommended removing his wife's gallbladder, a procedure medical experts say debbie would not have survived. when questioned by police, the couple's daughter, lauren, remembered something. around this time, she saw her father setting small traps around their home. >> when we asked her, can you tell us what that bait was, she said she didn't know what it was, except for it was little, round tins that he set out on

the floor. >> only one manufacturer made insect repellent in small, round tins. the president of the company revealed their product contained arsenic. >> he told me that two of those hand stacks, which would contain four tins, would be enough to be fatally toxic to a 150-pound man. >> investigators found this brand of insecticide in a store not far from the pignataros' home. >> you don't want to believe it. you don't want to believe that someone you loved and lived with could actually do this to you. there's no, there's no answer. i don't know. >> a check into tony's background provided a possible motive. >> he became associated with a few cons in prison and was able to get involved with heroin. and he kept in contact with one particular person who would supply him with his narcotics

after he got released from prison. >> and investigators discovered tony was having an affair with another woman after he was released from prison. friends say tony feared his mother's reaction. >> his mother was against divorce, and if he had divorced debbie, he would have been cut out of any will with his family. >> but money wasn't the only motive. in the pignataros' home, detectives found a manuscript tony had written entitled "md: mass destruction." it was about tony losing his medical license and what was described as the conspiracy against him. >> it was a story about how he was wronged by the medical community and by the judicial system and, you know, by everyone on earth, the great wrong that they did to anthony pignataro. >> investigators believe this entire episode might have been a ploy for pignataro to get his medical license back. he gave debbie poison.

she developed gastric symptoms. he then tried to convince her doctors to perform gallbladder surgery that she wouldn't survive. had debbie died during surgery, tony could argue, as he did in sarah smith's case, that people occasionally die in surgery and that he shouldn't have been singled out. >> and in tony's eyes, that would have vindicated him. see, my own wife died under a doctor's care in a hospital while having surgery, and that's what we felt was his prime motivation. >> but why didn't she die from the massive dose of arsenic? medical experts say this was miscalculation. when tony gave his wife smaller

doses of poison, she developed a tolerance for it, so the higher doses later had less of an effect. >> i'm sure he was thinking, i can't believe she's still alive. i can't believe i gave her so much and she's still here. i think he just got panicky, and it wasn't working, so i think that's when he just figured, i'm just going to give her a massive dose and be over with. >> apparently, his daughter's ingestion of the arsenic was unintentional. investigators believe tony vandalized his own home to make debbie's illness appear to be retaliation for sarah smith's death. >> when i asked tony if he tried to kill his wife, he looked down at the table and told me, i can understand why some people might think that. but he never said yes and he never said no. >> when faced with the scientific evidence, tony pignataro confessed.

he pled guilty to attempted first-degree assault and was sentenced to 15 years in prison. pignataro promised to tell where he obtained the arsenic and how he administered it, but he never honored that part of the plea agreement. although debbie survived massive doses of arsenic, she will continue to suffer side effects for the rest of her life. the nerve damage and lack of fine motor skills are permanent. >> i can't believe any human being would do this to someone that they even cared about. i mean, maybe he didn't love me anymore, but there's other alternatives. you don't, you know, do this to someone, the mother of your kids. >> there on her head was the key evidence that pointed to, again, only one person could have done it. >> in the long run, his arrogance is what got him convicted.

you know, thinking he had outsmarted everyone, he outsmarted himself california police had several suspects in the robbery and murder of a retired couple. unfortunately, the forensic evidence was inconclusive. ten years later, a determined forensic scientist with materials used by dentists found evidence that had previously been overlooked, and in so doing, made scientific history. bakersfield, california, known for its oil fields, wide open spaces and an aggressive crime investigation unit.