"Uncorrectable" liposuction disaster: board-certification matters

A. Foley on 14 Nov 2008 at 12:52pm

Despite our guidelines for identifying board certification, there isn't a week that goes by where we aren't challenged by a doctor who demands to be listed as a plastic surgeon in the RealSelf.com doctor directory.

Our position is that a "plastic surgeon" is a medical doctor who is certified in plastic surgery by the American Board of Plastic Surgery (ABPS).

A recent lawsuit illustrates why we take board certification so seriously and, consequentially, make some doctors unhappy.

The Oregon Supreme Court just affirmed the lower court decision in Knepper v. Brown, in which a liposuction patient sued her physician and Dex (a yellow pages vendor) for injuries arising from the surgery.  The doctor administering the tumescent liposuction was a dermatologist, not a board certified plastic surgeon as referenced in Dex advertising.

While the doctor settled the injury case out of court, Dex decided to go to litigation to fight the charge that it had committed fraud by advertising the doctor as "board certified" in plastic and reconstructive surgery. 

The plantiff alleged:

1) Dex knew that Brown was not board certified in plastic and reconstructive surgery; 

(2) Dex and Brown together designed and developed an advertisement that falsely implied that Brown was a board-certified plastic surgeon;

(3) Knepper wanted a board-certified plastic surgeon to perform liposuction surgery on her;

(4) Knepper relied in part on the misleading Dex advertisement and retained Brown to perform liposuction surgery;

(5) if Knepper had known the truth about Brown's credentials, she would not have consented to surgery by him; and

(6) Brown performed the liposuction negligently, causing injury to plaintiffs. 

Dr. Lloyd Hale, a Portland plastic surgeon, testified about the qualifications of dermatologists, as opposed to those of plastic surgeons, to perform surgical procedures.

He observed that dermatologists usually do not receive formalized surgical training, while plastic surgeons receive extensive surgical training over a period of many years.  Hale further observed that surgical knowledge, training, and experience are important for obtaining good results from liposuction.  Hale acknowledged that plastic surgeons do not always meet the standard of care for liposuction or other surgical procedures, but he stated that he had never seen an injury like Knepper's -- which he described as an "uncorrectable disaster" -- at the hands of a doctor who had gone through formalized surgical training.

The bottom line is that many consumers trust that a board certified plastic surgeon is qualified to conduct aesthetic surgery.  Anyone or any service that purposely attempts to obfuscate the true qualifications of a medical professional is putting consumers in harms way.

Comments (7)

Ohis post is rubbish and the referenced news story of an outlier event is propagandist sensationalism. Notwithstanding this particular isolated event, almost any generally competent physician - and certainly a dermatologist who despite Dr. Hale's characterization are quite knowledgeable of surgical anatomy of the skin and underlying tissues - can learn to perform liposuction successfully with a modest amount of time and effort. It does not require a full plastic surgery residency to do this safely and well. And, as Dr. Law points out, such training is not a de facto guarantee of good practice or outcome. Certified plastic surgeons belittle and demean other physicians and attempt to carve this procedure - along with many others - out for themselves for the same reason the author of this post claims other specialists seek to perform it: greed. The repeatedly well documented fact in numerous studies is that plastic surgeons have a higher rate of malpractice claims than do other specialists performing cosmetic surgeries and, despite aggressive and biased efforts to prove otherwise, other specialists do not have a higher rate of adverse events. This is specifically true for physicians performing office based procedures with no matching hospital privileges. As for the lawsuit reported in this post: I don't know the details and maybe the doc and Dex screwed up, but given that plastic surgeons are sued at a prodigious rate I imagine Dr. Law and his ilk often change their tune regarding the wisdom of jurors when on sitting at the defendant's table.
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Really, Dr. Law?? Just ask if they have hospital privileges?? My surgeon,an oral/max DDS MD, is somehow privileged at 3 hospitals to perform full body cosmetic surgeries, i.e.abdominoplasty, breast aug/reductions, etc. No ABMS certs or ABMS recognized certs. Stricly ABOMS. Not even a general surgery residency. So much for that rule!
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And the specific problem is....?
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Unfortunately, government agencies, such as state medical boards, don't impose practice restrictions on doctors based on their medical specialty. Any MD or DO with an active medical license can perform any medical procedure they choose, which makes it all the more important for us to educate ourselves about a doctor's educational background, specialty certification, hospital privileges and experience before undergoing a procedure.
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Exellent Blog Post. Thank you for sharing I'd like to also pint out the importance of finding a plastic surgeon with hospital priveleges for the procedure you are interested in having perfomed. Liposuction, as you may have heard in the popular media, is the most commonly performed surgical procedure each year in the United States. Here's a statistic that you may not have heard: the majority of physicians performing liposuction in the United States are not plastic surgeons; in fact, many do not have any formal surgical training whatsoever. It seems hard to believe, but many physicians performing liposuction have had no more training in liposuction than a 'weekend course'. One way to determine whether or not a physician has had appropriate training in a particular surgery is to confirm that they have hospital privileges for that procedure. I fear that some practitioners view liposuction as a 'simple' surgery, since it does not involve making large incisions, and it requires little, if any, suturing. Nothing could be further from the truth. Liposuction, in my mind, is a very challenging operation that requires careful planning and preparation, and a great deal of care and finesse when it is actually performed. It requires a three-dimensional understanding of the layers of human anatomy, an understanding that is second nature to a surgeon alone. I think that it is often an inadequate understanding of anatomy (and, perhaps, of the body's response to surgery) which leads to the poor results in liposuction and body contouring that unfortunately are so often seen. It is important that your physician has hospital priveleges for the procedure you are interested in having performed. A hospital has access to information and records that the general public does not. Hospitals also have tremendous exposure to liability for cosmetic surgery procedures performed within them. They therefore will only grant surgical privileges to physicians that can demonstrate appropriate training and experience. Although many aesthetic cosmetic surgery procedures are not performed in hospital operating rooms, the fact that a hospital has granted a surgeon privileges for a given procedure ensures that the surgeon has met an accepted standard of competence. It also means that your surgeon will be able to take care of you at a hospital should any complications from cosmetic surgery arise. If you are planning to have cosmetic surgery performed, you should do your due diligence to determine if your surgeon has the appropriate credentials. This issue can be settled by the following simple question: Does my surgeon have hospital privileges to perform my cosmetic surgery? Michael Law MD Board-Certified Plastic Surgeon Raleigh, North Carolina
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How can this be legal? I only learned this AFTER I had my dermatologist do lipo on me awake in his office. It was a horrible experience. Where are the laws to protect patients for this? It should be board certified plastic surgeons only. Will this ever change?
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Sorry for your experience Lexx, however, it is not uncommon for "board certified plastic surgeons" to perform liposuction with conscious sedation (you're awake) for more extensive procedures or even no sedation if the area is small. You may also find it interesting to note that it was a *DERMATOLOGIST* (Dr. Jeffrey Klein) who is credited with developing the tumescent anesthesia techniques used by virtually all physicians, including plastic surgeons, to perform liposuction. Dermatologists, and other non-plastic surgery physicians, can and do perform liposuction competently. Your bad experience is more reflective of that particular physician - or possibly just an unfortunate event that wasn't physician dependent - than any specialty as a whole.
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