or

FLORIDA

90-day ban on cosmetic procedure
A moratorium on an in-office combination surgery starts Wednesday. Tummy tucks and liposuctions must now be done at least 14 days apart.

BY DANIELA LAMAS
dlamas@herald.com

A statewide 90-day ban on combination liposuction and tummy tuck procedures in doctors' offices will go into effect Wednesday, an emergency rule unanimously approved by medical regulators this weekend.

Since July 2002, eight people died after surgeries were performed in Florida doctors' offices. Three of the cases involved combination liposuction and tummy tucks. The others included a dental extraction, a pregnancy termination, a breast augmentation, a face-lift and a liposuction with a fat transfer.

Two of the deaths stemmed from the Florida Center for Cosmetic Surgery in Fort Lauderdale. One was a tummy tuck and breast reduction; the other was a face-lift, according to state records.

Dr. Jeffrey Hamm, the center's medical director, said Monday he couldn't comment about the cases because of medical disclosure laws.

''We welcome any inquiry, any investigation, any oversight, which the Board of Medicine feels will help increase the safety of cosmetic surgery in the state of Florida,'' he added.

Statewide, the greatest number of deaths have come from the combination tummy tucks and liposuctions. The Florida Board of Medicine, which issued the moratorium, said the two procedures must be separated at least 14 days under the new rules.

Together, the two procedures might increase the likelihood of a fatal blood clot traveling to the lungs, said Larry McPherson, the board's executive director.

''Is it as ideal to do the procedure in the office as it is in the hospital? Probably not quite,'' said Dr. Joel Levin, chief of plastic surgery at Baptist Hospital.

The board's rule also requires doctors who perform surgery in their offices to submit their surgical logs from June 1, 2003 to Jan. 1, 2004, McPherson said. This includes information on anesthesia, procedure length and errors. The board voted to work toward passing a state law requiring doctors to submit logs regularly.

POPULARITY GROWS

Office surgeries have become increasingly popular in recent years, doctors say, fueled by advances in technology and anesthesia and cost-cutting. But the board is concerned about their safety, as offices don't have the range of services that a hospital would in an emergency. The board has seen cases where patients suffered a cardiac arrest during an X-ray, McPherson said, or died during dialysis, a colonoscopy or chemotherapy -- all done within offices.

The ban is expected to affect 427 doctors working in 294 offices, McPherson said. ``This rule is very limited -- it doesn't close down anybody.''

The board did not know the number of combination liposuction and tummy tuck procedures performed in Florida. Nationally, doctors performed 83,043 tummy tucks and 372,831 liposuctions in 2002, said the American Society for Aesthetic Plastic Surgery. Some plastic surgeons criticized the ban, even as they waited for notification from the state.

''From a purely surgical standpoint, I think the ruling is unreasonable,'' said plastic surgeon Howell Tiller, who operates out of a surgical suite in his South Beach offices. ``But for the appearance of public safety, it's not surprising.''

And the surgery itself might not be the problem, said Dr. Yoav Barnavon, president of the Florida Society of Plastic Surgeons.

''It is unclear whether the problem is the type of procedure, the training of the surgeon, the type of facility, the type of anesthesia or the anesthesia provider,'' said Barnavon, a Hollywood plastic surgeon. ``All of these factors need to be considered.''

MORE LIKELY TO DIE

Hector Vila, chief of anesthesiology at Tampa's H. Lee Moffitt Cancer Center and Research Institute, co-authored an article in the 2003 Archives of Surgery that found patients undergoing surgery in doctors' offices were 10 times more likely to die than their counterparts in ambulatory surgery centers.

Vila analyzed 13 deaths from April 2000 to April 2002, which included a cardiac arrest during a colonoscopy and a hemorrhage during a liver biopsy.

Vila said patients should be able to expect the same safety in office surgery as they do when they go to a hospital -- just as they expect the same safety record on a cheaper airline.

In Florida, a spate of deaths in 2000 spurred regulators to impose a 90-day moratorium on all office surgery that required general or spinal anesthesia.

When the ban was lifted, doctors faced new rules, including mandatory reporting of errors and a ceiling on the amount of fat that can be removed during liposuction with a tummy tuck

http://www.miami.com/mld/miamiherald/living/health/7915815.htm
HOW PROCEDURES ARE PERFORMED

A tummy tuck, on average, is a three-hour procedure of tightening loose stomach muscles and cutting out excess skin and fat from the lower part of the stomach.

While the patient is still under anesthesia, doctors will recontour the area, using a device to suck out some of the remaining fat. This is called liposuction.

The two are generally performed together, although there are limits on how much fat can be removed.