Cosmetic Surgery: the end of an unregulated medical specialty?
19th Oct 2016
In recent years, there has been a dramatic increase in the amount of cosmetic surgery being performed in Australia. Cosmetic surgery is no longer only for the rich and famous; it is becoming more popular and accepted within the community at large. The increase in the availability of cosmetic surgery has led to stiff competition between providers, driving down prices.
With this increase in use, there have been a number of recently reported incidents where patients have suffered adverse reactions during cosmetic surgery procedures or from patients unhappy with the results of their surgery, which highlights the lack of regulation of the industry.
Alarmingly, a British survey last year titled ‘Think Over Before You Make Over’ revealed that one in four people considering undergoing cosmetic surgery did not check their doctor’s qualifications before having the procedure. Dr Tony Kane, president of the Australian Society of Plastic Surgeons, commented that he believes if the same research was undertaken in Australia the statistic would be similar to the British results.
These concerns have been partially addressed by the introduction of guidelines by the Medical Board of Australia that came into effect on 1 October 2016. NSW has gone further still, introducing regulations in June 2016 which deal with the licensing of clinics carrying out cosmetic surgery procedures.
In Australia, anybody with a medical degree can call themselves a cosmetic surgeon and perform surgeries such as breast augmentation, unlike most specialities in the medical field which require numerous years of additional specific training. It is also important to note that in Australia, the term ‘cosmetic surgeon’ differs from ‘plastic surgeon’, as specialist plastic surgeons are required to have extensive surgical education and training including a minimum of 12 years medical and surgical education, with at least 5 years of specialist postgraduate training.
One way some cosmetic surgeons have reduced the cost of certain procedures is by placing patients under conscious sedation, rather than using general anaesthetic. With conscious sedation, the patient is administered medicine to help them relax and to block pain during the procedure, but with the intention that they stay awake. By performing a procedure under conscious sedation, rather than general anaesthetic, doctors are able to perform the surgery in their office, rather than a private hospital or day surgery clinic. Additionally, this service does not have to be provided by a specialist anaesthetic practitioner. The danger with conscious sedation is that the clinic may not be set up or have the expertise to deal with complications and is not subject to the stringent regulations that are required for private hospitals and day surgery facilities.
In March 2016 the NSW Health Care Complaints Commission prepared a report, which detailed their investigation into 33 incidents where patients were given questionable levels of sedation during procedures that were carried out under conscious sedation. Six of these patients suffered potentially life-threatening complications including rapid heartbeat, seizures and cardiac arrest, thought to be due to high doses of anaesthetics.
Following this investigation and report, NSW introduced amendments to the Private Health Facilities Regulations 2010 that now require facilities carrying out certain cosmetic procedures —including breast augmentation, tummy tucks, liposuction and facial implants—to comply with the licensing standards that already apply to private hospitals. The facilities have until 3 March 2017 to comply with the standards.
The guidelines that were recently introduced by the Medical Board of Australia are intended to be used by the Board as evidence of what constitutes appropriate professional conduct or practice for the profession. It will also make it easier for people considering cosmetic surgery to determine whether their doctor is complying with accepted practice.
These guidelines do not go as far as the NSW regulations in relation to licensing of facilities. They do however state that in facilities where sedation, anaesthesia and/or analgesia is required, the medical practitioner must ensure there are trained staff, facilities and equipment available to deal with any emergencies, including resuscitation of the patient.
The guidelines also explain what is required for informed consent, outlines additional responsibilities relating to patients under the age of 18, states the requirement for appropriate training, expertise and experience and deals with expectations for advertising and marketing.
The hope is that the guidelines will have a positive impact upon the industry and ensure not only that consumers are better protected, but that they are also able to make well-informed decisions about any procedures they undergo.
It will be interesting to see whether any other states will follow NSW’s lead by regulating to ensure major procedures are performed in licenced facilities, but for now, it is clear that any regulation of the lucrative cosmetic surgery industry should provide for a better and safer patient experience.
Sarah Vinall is a Senior Associate at Mellor Olsson Lawyers in their Adelaide office, where she has worked for the last ten years. She specialises in personal injury law, in particular medical negligence, motor vehicle accidents and public liability claims. Sarah is a committee member of the South Australian branch of ALA.
The ALA would like to acknowledge that the image for this article is creative commons and was originally sourced from Flickr and can be accessed here.
The views and opinions expressed in these articles are the authors' and do not necessarily represent the views and opinions of the Australian Lawyers Alliance (ALA).