This discussion was of course brought about by the recent events in the Phoenix area, where a local ER doctor was accused, indicted, and then convicted of second degree murder and manslaughter after 3 of his patients died while undergoing (or shortly thereafter) liposuction.
The case is noteworthy not just because of the fact that 3 human beings unfortunately lost their lives during procedures that should have been very safe for healthy people like them, but because the doctor was found guilty of MURDER, and not just of malpractice.
To review, the prosecutors successfully argued that as Dr. Peter Normann was intelligent enough to complete medical school and training in Emergency Medicine, he should also have been intelligent enough to understand that his complete lack of legitimate training in plastic surgery and liposuction (he took a weekend course) constituted an untoward risk for his patients. In other words, Duh! You're an ER doctor- probably shouldn't be doing liposuction on people.
Furthermore, they reasoned that he should also have had the wherewithal to know that his advertising a level of expertise in these procedures that he clearly did not have, along with his lack of training, and the fact that he performed the procedures in a facility without appropriate accreditation was fundamentally wrong...
Therefore, they concluded that he clearly showed more regard for his income than for his patient's safety, and displayed what they (the prosecutors) called an "extreme indifference" to human life, which met the guidelines for murder in the second degree.
Scary.
So- what should we all take away from this?
Well first of all, as a plastic surgeon, clearly it would be wrong for me to offer to do heart surgery on a patient- as cool as it would be to be able to say I do heart surgery AND plastic surgery, I know it would be wrong.
The amazing thing is that it would NOT be illegal.... At least not if I could talk someone into letting me do it on them in my office under local anesthesia.
And that's a big part of how so many unfortunate patients wind up injured or dead after cosmetic surgery.
Historically, what kept doctors "honest" and prevented them from trying to do procedures on people that they were incompetent to perform, was the hospital credentialing system.
We'll use myself as an example... If I (as a trained Plastic Surgeon certified by The American Board of Plastic Surgery) wanted to obtain privileges at a hospital for the performance of liposuction, I would need to submit a great deal of paperwork to the hospital's Credentialing Committee proving that I had received legitimate, ACGME approved training in plastic surgery and liposuction.
The ACGME, or Accreditation Council for Graduate Medical Education, is the body that judges whether residency training a doctor receives is adequate and appropriate before letting them say they are trained in the discipline. From their website:
- The Accreditation Council for Graduate Medical Education is a private, nonprofit council that evaluates and accredits medical residency programs in the United States.
- The ACGME was established in 1981 from a consensus in the academic medical community for an independent accrediting organization. Its forerunner was the Liaison Committee for Graduate Medical Education, established in 1972.
- The mission of the ACGME is to improve health care by assessing and advancing the quality of resident physicians’ education through exemplary accreditation.
If I, on the other hand, asked for privileges performing heart surgery in the same hospital, my request would be quickly denied (and I would probably even be denied privileges in procedures I can prove competence in- just for asking to do something so far outside my area of training) because I would be unable to provide proof of ACGME accredited training in this discipline.
But here's the thing.... What if I could convince people to let me try doing heart surgery on them in my office under local anesthesia?
By avoiding the hospital, I've also avoided the Credentialing Committee.
And there is no law to stop me from doing whatever I want to patients in my office, as long as I have their (the patient's) permission to do it.
It's true- if you were dumb enough to let me charm you into having heart surgery under local anesthesia in my office, I could legally do it. The outcome may not be so good, but I could do it.
And that's why I always tell people that if you could only ask your provider one question, the most important one would be, "Do you have privileges to perform the operation you are proposing for me in a hospital?" (but don't take their word for it- call the hospital and check).
Now heart surgery in an office setting is so obviously ridiculous that there are probably very few people alive who would consent to it (although someone probably would).
But what about if we were talking about liposuction? How hard would it be to distract you from the fact that I might not have the proper training in the procedure and fool you into letting me do it on you?
What if I were able to convince you that the machine I use in my office makes it so easy that you're not really having surgery at all, but rather a "minimally invasive" fat removal?
What if I convinced you that I'm the only one in town who knows how to do it- by giving my procedure a cute name?
What if I (fraudulently) advertised that my procedure was fundamentally different and better than liposuction, and that there was minimal or no downtime?
What if I (falsely) told you that having it done under local anesthesia was "safer" because you don't need general anesthesia?
Now it's not so hard to understand how otherwise intelligent people might put their happiness and safety in the wrong hands, is it?
And believe it or not, there are ER doctors, gynecologists, and an eye doctor here in Central Florida making all of these claims.
So let's all realize the following:
- All liposuction is surgery. It doesn't matter what machine is being used, or how you're anesthetized. If someone is removing fat from your body through an incision, however small, you're having surgery.
- All surgery has risks (just ask the families of the 3 patients who died in Dr. Normann's OR)
- You can minimize your risks by choosing the right surgeon, the right facility, and the right anesthesia provider- and all 3 are important.
- Conversely, your risks of a bad outcome are much greater if you let yourself be fooled into having plastic surgery performed by someone who does not have legitimate, ACGME training in plastic surgery.
And with regard to the last point- make no mistake about it, Dr. Normann was not an isolated numbskull. Every large community in America now has ER doctors, gynecologists, family doctors, and even an eye doctor (here in Orlando) calling themselves liposuction experts, despite a lack of ACGME accredited training in the procedure.
How do you protect yourself and those you love?
- Do as much research as you can
- Research the surgeon
- What was his training in?
- Is he Board Certified- and just as important- by WHICH BOARD?
- Where was his training?
- Research the facility in which the procedure is to be performed
- Is it accredited? Ask to see the certificate
- By whom? Make sure the facility is accredited by The AAAASF or JCAHO
- Research the anesthesia provider
- Who is taking care of you while you are having surgery is just as important as who is doing the surgery!
- Is it an anesthesiologist (a doctor of anesthesia)? PREFERRED
- A certified nurse anesthetist? LESS IDEAL
- The surgeon himself or a nurse?? BE VERY CONCERNED
Finally, where can you look for these important answers? Here you go...
- Check the website for the State Medical Board in the state in which you live. You can learn about the doctor's training (or lack thereof) and much more. For Florida, the link is: http://ww2.doh.state.fl.us/IRM00profiling/searchform.asp
- You can also check reputable doctor review sites. The word reputable is critical here... more on that later. The very best is www.RealSelf.com
- What makes it the best? Quite simply:
- It is complete- there is a wealth of information about doctors, their training, and their outcomes
- It is fair- Realself balances doctor's legitimate concerns against patient's in the most fair fashion of the sites out there right now. As I will write about in the near future, there is no perfect site, but this is as good as there is at the present time.
- Realself requires doctors market honestly, and only in the specialty in which they actually are trained. Critical.
And finally, if you are still uncertain about a doctor you have seen, email me and I can help you figure out what their training was all about-
And for those cynics out there-- this is not about me feeling competitive. As long as you are in the hands of a Board Certified Plastic Surgeon, I'm good.
It's the damage done to the reputation of ALL plastic surgeons and plastic surgery itself by injuries and deaths caused by non-plastic surgeons that I'm trying to prevent here.
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