We continue to try to actively seek ways to proscribe the surgical activities of physicians trained at weekend courses to perform cosmetic surgery. Progress is slow. Many parties have different viewpoints. The Board of Medicine has a laissez faire attitude to the practices carried out in physician’s offices, but they have limited individual physicians after being stimulated to investigate by patient complaints. Such complaints resulted in a sanction for a physician who practiced in the western part of our state. A review of this particular physicians behavior and comments should strengthen our resolve as a surgical specialty to continue to encourage changes that will make Virginia a safer place to undergo elective surgery. Recently, the physician who was sanctioned by the Board of Medicine in 2009 saw fit to dispatch a letter to some of his previous patients soliciting them to write to the Board of Medicine to support his effort to reverse the sanctions.
He was trained in a Family Practice residency and had initially provided nonsurgical cosmetic treatments. He then began to offer surgery to patients after attending meetings. A copy of this letter was delivered to one of our members by a not-so-happy previous patient. The Family Physician explains in his letter that “The Plastic Surgeons have united and planned a viscous (I think he meant vicious) and strategic attack” and that “the Plastic Surgeons unethically convinced the Virginia Board of Medicine that I was not trained or educated”. He goes on to note that he has (2) board certifications in Cosmetic Surgery. He lists board certification from World Board of Cosmetic Surgery and International Board of Cosmetic Surgery. I was not able to find a website for the World Board of Cosmetic Surgery. A website for the International Board of Cosmetic Surgery exists. It lists as a requirement for eligibility for taking their exam “Board certification in a surgical specialty or the equivalent”.
The physician in question does not have board certification in a surgical specialty. He ends his letter with a plea to end the restrictions so he can return to performing tummy tucks, facelifts, brow lifts or breast augmentations with “a perfect safety record”. The audacity of the letter is better appreciated by reviewing the order from the Virginia Board of Medicine. Several patient complaints were detailed in the Board of Medicine report. One involved a patient who was unhappy with the results after liposuction of her abdomen. The physician carried out liposuction of the abdomen on this heavy patient, even when his own office notes state that an abdominoplasty would be required to resect the large pannus. Another weekend training course presumably prepared him for conducting facelift surgery. On one occasion his 7 plus hour facelift that started in the morning required a call to a Plastic Surgeon at 3:00pm for advice on what to do about the “uncontrollable bleeding”. He was also criticized in the same Board of Medicine report for “false, misleading or deceptive statements” on his website.
“Dr. !@#$%’s website asserted that “most individuals have seen liposuction on TV displaying a very violent procedure while the patient is under general anesthesia….We are pleased to inform the public that these fears are not warranted due to the safe and much more effective style of liposuction performed at !@#$% Aesthetics.” The Virginia Board of Medicine judged that this characterization of liposuction performed under general anesthesia as a violent procedure is inaccurate and misleading and the claim to a much more effective style of liposuction performed at !@#$% Aesthetics constitutes an unsubstantiated claim of superiority. Additional outlandish statements found on his website follow. “Some surgeons rely on general anesthesia because they do not have the skill to achieve complete anesthesia with tumescent liposuction. Others recommend general anesthesia just because they prefer patients to be unconscious. Still others use general anesthesia because it permits liposuction to be completed more rapidly. However, the use of general anesthesia should not be based on what is most convenient for the surgeon, but rather what is best for the patient.”
“Dr. !@#$%’s website claimed that “with tumescent liposuction the areas being treated are injected with lidocaine, the local anesthetic, which kills bacteria. Therefore, using the tumescent technique reduces the risk of infection”, assertions which are unsupported and inaccurate.
Virginia is reluctant to apply broad rules to groups restricting their activity. It is easy to become complacent and adopt the attitude that you “can’t” change City Hall. The hubris of a family practice physician to morph himself into a surgeon should reinvigorate all of us to keep trying to protect patients in Virginia. Currently we are working to produce limits on the use of large doses of lidocaine to carry out these procedures. Limitation of general and moderate sedation anesthesia in the office setting already exists. Hopefully, constraining the use of lidocaine due to its potential toxicity will limit the activity of similar inadequately trained physicians. Limitations on the length of procedures conducted in an office setting, proximity to a hospital setting, and clear identification of the physicians ABMS board certification or the lack thereof would be required to be included on the surgical consent form.
A more effective restraint on the practice of office based surgery by inadequately trained physicians will require legislative action. Legislative action will require that our perspective receives the attention of the state legislators. Supporting the PAC with your contribution will allow us to support the election of representatives who will recognize the positive contribution to safety and quality for the patients of Virginia.
John Alspaugh, M.D., F.A.C.S.