CAMBRIDGE, Mass. (AP) – The death of a woman who underwent liposuction on a massage table in the blood-stained basement of a condominium, allegedly at the hands of a couple not licensed to practice medicine in Massachusetts, may indicate a much more widespread problem, prosecutors said Monday.

Luiz Carlos Ribeiro, 49, and his wife, Ana Maria Miranda Ribeiro, 49, both Brazilian nationals, pleaded not guilty when they were arraigned in Framingham District Court on Monday on charges of unauthorized practice of medicine and drug charges. Luiz Ribeiro was held on $250,000 cash bail while his wife’s bail was set at $50,000.

The death of Fabiola DePaula, 24, of Framingham on Sunday raises health concerns for people in the Brazilian immigrant community, District Attorney Martha Coakley said.

Two other women have already come forward to say they underwent medical procedures at the hands of the same couple, Coakley said, including one woman who is currently hospitalized with an infection.

Because the Ribeiros ran a cash-only business with no record keeping, there may be many more people who were operated on by the couple.

“We think the number may be quite large,” Coakley said.

The Ribeiros had apparently been traveling between Brazil and Massachusetts on a regular basis for two or three years, Coakley said. The defendants charged from $1,800 to $3,000 per procedure and relied on word-of-mouth referrals for business, she said.

Prosecutor Lee Hettinger said in court the couple had 30-day work visas “for the sole purpose of coming up here to perform plastic surgery in the basement of a local condominium.”

The surgeries were performed on a massage table, he said.

“There was a tremendous amount of blood protein on the floor in the basement in that location,” Hettinger said.

The victim was unconscious when she was brought to MetroWest Medical Center in Framingham late Sunday afternoon and pronounced dead shortly after arrival. Autopsy results will not be known for several days, and charges could be upgraded to manslaughter or even murder, Coakley said.

Neither Ribeiro nor his wife is licensed to practice medicine in Massachusetts, but Coakley believes Luiz Ribeiro may be a licensed doctor in Brazil. The couple was ordered to surrender their passports. They are due back in Framingham District Court on Aug. 25.

A spokeswoman for the district attorney’s office said the Ribeiros were temporarily represented at their arraignment by a bar advocate, and did not yet have an attorney of record.

Framingham, a town of about 67,000 about 20 miles west of Boston, is home to an estimated 14,000 Brazilian immigrants.

Neighbors said they had long known about the couple doing plastic surgeries.

“They were going around offering people cheap surgery for $2,000,” Alex Jordan told WHDH-TV.

Just last week, Ribeiro taped an interview for a local cable-access television show to warn against seeking medical care from unlicensed professionals or outside of a medical facility, said Ilma Paixao, who conducted the interview.

Paixao, the former president of the Brazilian American Association in Framingham, said she has been working on raising awareness about health care issues in the Brazilian community, where some families have inadequate or no health insurance.

When she heard Ribeiro was in town, she moved quickly to get an interview because he has such a good reputation in Brazil. She said he spoke of the need for “not only professional equipment but a professional clinic and always get a second opinion.”

She was shocked when she heard of his arrest.

“That would be the last person that I would think would do something like that,” she said.

Appearance is important to Brazilian women, Paixao said.

“They’re very aware of beauty, to keep healthy, attractive, lean and well-dressed. Appearance is important to us, and sometimes with a cost,” she said.

AP-ES-07-31-06 1821EDT

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