Tightening Restrictions on Plastic Surgery, California Leads the Charge

Two California lawmakers have introduced legislation on the state level that would require more protection for consumers who undergo plastic surgery. While Florida took some steps to tighten regulations in 2006, California is now leading the way in taking more significant strides to ensure the safety of cosmetic surgery procedures in the United States.

It is significant that there were 11.7 million cosmetic procedures in the U.S. in 2007, an increase of 50 percent from the year 2000. Generally, less than half of 1 percent of those result in death, but the frequency with which more people are going through with plastic surgery has caused concern over the possibility of those numbers rising.

In particular, however, it was the November 2006 death of Donda West, mother of music star Kanye West, who died at the age of 58 as a result of liposuction and breast implant surgery. The five-and-a-half hour operation was not preceded by a physical exam to determine her ability to withstand the procedure, and West was not hooked up to any medical equipment to monitor her recovery, even though her health indicated that she had a pre-existing heart condition. Her untimely death sent shockwaves through social, medical, and political circles, and California lawmakers took it upon themselves to put forth legislation to prevent this from happening again.

Senator Mark Ridley-Thomas (D-Los Angeles), chairman of the Senate Committee on Business, Professions, and Economic Development, proposed Assembly Bill 1454 would require that outpatient facilities be inspected once every three years. The regular inspections are needed, he feels, because a previously passed law that sought to regulate outpatient surgical centers has not been effective. The purpose of the law was to require that such centers be accredited, have resuscitation equipment, and be able to transfer patients to hospitals if necessary, but Ridley-Thomas feels this has been insufficient.

Assemblywoman Wilmer Amina Carter (D-Rialto) also introduced AB 2968 that would require patients to receive physical exams prior to undergoing cosmetic surgery. An additional regulation being pushed would ban statements or photos, such as "before" and "after" pictures, that create or raise false or unrealistic expectations, which lawmakers anticipate will reduce the number of surgeries in unnecessary and dangerous situations.

Some doctors have opposed the California bills, saying that the problem affecting most patients is the qualifications of the surgeons and their judgment regarding their patients' pre- and post-surgical care. For example, Dr. Michael McGuire, vice president of the American Society of Plastic Surgeons and an associate clinical professor at UCLA, has pushed for legislators to consider something that would require healthcare providers, including plastic surgeons, to disclose their educational background and training. Board certification would be part of that process, which would help weed out unqualified surgeons.

If California tightens its cosmetic surgery regulations, other states may be prompted to follow suit. Though Florida passed the "Truth in Medical Education" law in 2006 to educate patients about doctors' credentials, California may increase the stakes and attempt to put more actual controls on the industry.

Canada may provide the template for such regulations, as British Columbia recently ruled that plastic surgeons must be recognized as such and certified by the Royal College of Physicians and Surgeons of Canada to perform major cosmetic surgical procedures. Lawmakers in Ontario are looking to go even further by considering prohibiting uncertified doctors from calling themselves surgeons. The tight restrictions were prompted by a 2007 death of a 32-year old who received liposuction from a general practitioner.

The California Medical Association, headed up by President Dr. Richard Frankenstein, has noted that it would oppose such strict laws, as current regulations already require that physicians are approved by independent medical staffs and malpractice insurers.

Even so, it seems that many are concerned with the doctors' credentials and feel that stricter guidelines might do more to protect patients. In addition, the clinics in which procedures are conducted must be overseen more carefully to ensure their safety and ability to protect patients before and after surgery. California is in a position to lead the way in the United States for more patient protections, and time will tell if laws are passed to actually do so.