Loophole in Law

Posted on February 26, 2015

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Hello. I have been away too long from this blog and have experimented with a local radio show that was interesting but I’ve tired of that and will now try to be a better blogger!
There is a loophole in the law that allows doctors with only an MD but perhaps no surgical training to do facelift, liposuction, breast augmentation and lifts and tummy tucks, etc. in the privacy of their own clinic operating facility…and there is no one judging their competence. You see a doctor of medicine has a legal license to practice Medicine and Surgery… so if an Ear Nose and Throat doctor [Otolaryngologist] performs a breast augmentation which is not part of their residency training, they are not breaking any laws although they are breaking a Hippocratic oath to be ethical.

Recently an Obstetrician/Gynecologist practicing in Rocklin California had his license taken away because he had been doing very poor quality tummy tucks and facelift and even paralyzed the arm of a young woman doing a breast augmentation. You are probably wondering; “How can a doctor only officially trained in doing surgery on the female reproductive organs be allowed to perform sophisticated operations on the face and breasts?” You might also be further perplexed to know that he had lost his license in Puerto Rico where the medical board determined he was doing cosmetic surgery beyond the scope of his OB/GYN specialty…by the way, one of his patients in Puerto Rico died. Nonetheless, he was allowed to move to Rocklin, CA and open a slick med spa and the plastic surgeons of the Sacramento area had to revise many of his botched cosmetic over the past 6 years until the medical board finally were able to act.

It’s hard to believe isn’t it? How can a society allow a general practitioner without a day of surgery training to do liposuction on your body which is a procedure that in the good hands of a plastic surgeon is quite safe but in untrained hands could lead to a perforation of the abdomen or fluid overload and pulmonary edema and death? Well there are these aforementioned doctors advertising with bill boards in Sacramento and doing procedures in their office that no hospital would ever allow them to do at the hospital. In fact a large percentage of doctors advertising as plastic surgeons and doing cosmetic breast and face and body contour surgery in their office could never get privileges to do those operations at Mercy or Sutter or Kaiser or Methodist or UC Davis hospitals. And that’s the crux of the problem: These cosmetic procedures don’t have to be done at a hospital and the under trained doctor can avoid scrutiny of peer review.

If you had to have [and I hope you don’t] a back surgery or your gall bladder removed or most operations for disease or trauma, insurance companies would be involved and they would not pay someone who was not a specialist in the field. The procedure would have to be done by a bona fide hospital or outpatient surgery center where it’s very arduous to get operating privileges. The doctor must first send all his or her records of training to the credential committee and if approved by that committee the application goes to the surgery committee and then to the executive committee and even after all those steps to make sure the doctor is adequately trained, a senior surgeon in the specialty for which privileges are requested must observe the new surgeon operate six times before privileges go from temporary to active. Now compare all that scrutiny to a quack just advertising that they are a plastic surgeon and opening an operating facility in their office and cutting on you…without having to prove any competency to any doctor committee anywhere other than passing a medical licence test which is the same for any MD and requires no knowledge of performing surgery.

So I’m not saying that office surgery is unsafe and I do most of my cosmetic surgery in my very well credentialed operating room because it is more convenient for the patient and less expensive. Most real plastic surgeons do the same. I am, just saying that I have also obtained privileges to do all my surgeries at most the hospitals in Sacramento and I [like my fellow legit surgeons] have gone through all the committees and I could do my surgery at Sutter hospital…it is just too expensive for the patient. So an astute patient must make sure the surgeon who is operating in their own clinic has actual hospital privileges or has in the past had hospital privileges to do the actual procedure you want. If the doctor had hospital privileges to do a hysterectomy that does not count if you want a facelift. So be exacting. =in what you ask. Also it is hard to go wrong by following this guide listing the type of cosmetic surgery to the specialty board certification:

1. Facial cosmetic surgery;  a. American Board of Plastic Surgery  or  b  American Board of Otolaryngology [ENT]

2. Liposuction: a. American Board of Plastic Surgery  b. for small areas only include dermatology and ent

3. Body contour like tummy tucks:   a. American Board of Plastic Surgery

4. Breast augmentation, lift, reduction:  a. American Board of Plastic Surgery

5. Skin Resurfacing and Restylane fillers and Botox: a. American Board of Plastic Surgery  b. American Board of Otolaryngology [ENT]   c.American Board of Dermatology

So, until there is some legislation requiring anyone doing surgery regardless of where they are doing it be evaluated by some credential commitee…there is no Sherrif in town and the bad guys [at least unprincipled and possibly dangerous guys] know it. Be wise and don’t try to be cheap about your body.

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