Sixteen minutes into the surgery the medical team realized that he was still awake. The inhalational anesthesia, along with another drug intended to induce amnesia were given at that point, but Mr. Sizemore experienced nearly a half hour of surgery, complete with pain, while fully conscious. He was never told what happened. But although he was unable to point to a concrete memory of the incident, something was clearly wrong. With no prior history of psychiatric or psychological conditions, Sizemore was suddenly panicked. He thought that people were trying to bury him alive, and suffered from insomnia and nightmares. He committed suicide just weeks after the surgery, but his family didn’t fully make the connection between the surgery and his psychological struggles until a doctor mentioned the possibility while offering his condolences, prompting a closer look at his medical records.

Upon returning to school following her treatment, the girl was informed that many people at the school, including students and teachers, knew of her hospitalization. The girl became distraught and was eventually readmitted to the hospital on suicide watch. During this time, another release of information form was signed that indicated that the school should not be notified of the repeat hospitalization. Once again, the hospital sent two letters to the school, both of which were satisfaction surveys sent by the hospital's CEO. After being released, the girl refused continued treatment from the hospital and moved to another city with her family seeking a fresh start.

   The emergency room personnel asked for a psychiatric consultation. A physician interviewed the man and prepared a certification that a basis existed for involuntary mental health commitment on grounds of grave danger to others. The plan was to transfer him to another facility that had an inpatient psych unit. The patient agreed to be admitted to the first hospital until his cardiac signs being monitored there were stabilized, then to go to the second hospital voluntarily.

   When he got to the second hospital the patient balked at voluntary psychiatric admission. The emergency room nurse ordered him kept against his will, based on her interview with him and his signs of anxiety and agitation, and based on the physician’s certification from the first hospital, which stated valid grounds for involuntary admission, but which was more than seventy-two hours old by this time.

   The psychiatrist from the first hospital was called to the second hospital. She decided to let the man leave when he said the threats he had voiced were just a joke.

   The Appellate Court of Illinois ruled that if a physician’s certification is too old, the patient must be seen and a "fresh" certification must be prepared. State law must be followed to the letter when a citizen’s liberty is at stake, and if not, the citizen can sue for false imprisonment.

Because he was going to be fully anesthetized, the man decided to turn on his cellphone’s audio recorder before the procedure so it would capture the doctor’s post-operation instructions, the suit states. But the man’s phone, in his pants, was placed beneath him under the operating table and inadvertently recorded the audio of the entire procedure, court records show. The doctors’ attorneys argued that the recording was illegal, but the man’s attorneys noted that Virginia is a "one-party consent" state, meaning that only one person involved in a conversation need agree to the recording.

The recording captured Ingham mocking the amount of anesthetic needed to sedate the man, the lawsuit states, and Shah then commented that another doctor they both knew “would eat him for lunch.”

The discussion soon turned to the rash on the man’s penis, followed by the comments implying that the man had syphilis or tuberculosis. The doctors then discussed “misleading and avoiding” the man after he awoke, and Shah reportedly told an assistant to convince the man that he had spoken with Shah and “you just don’t remember it.” Ingham suggested Shah receive an urgent “fake page” and said, “I’ve done the fake page before,” the complaint states. “Round and round we go. Wheel of annoying patients we go. Where it’ll land, nobody knows,” Ingham reportedly said.

Ingham then mocked the man for attending Mary Washington College, once an all-women’s school, and wondered aloud whether her patient was gay, the suit states. Then the anesthesiologist said, “I’m going to mark ‘hemorrhoids’ even though we don’t see them and probably won’t,” and did write a diagnosis of hemorrhoids on the man’s chart, which the lawsuit said was a falsification of medical records.

After declaring the patient a “big wimp,” Ingham reportedly said: “People are into their medical problems. They need to have medical problems.”

Shah replied, “I call it the Northern Virginia syndrome,” according to the suit.

The doctors argued that the Vienna man did not suffer any physical injury or miss any days of work. The man’s complaint said that he was “verbally brutalized” and suffered anxiety, embarrassment and loss of sleep for several months.