RISKY BUSINESS? : The Increasing Rate of In-office Surgery Prompts a Need for Closer Controls

With more cosmetic surgeons practicing here than in any other region in the United States, Southern California is the focus of what many doctors are calling a chaotic and potentially dangerous situation. They caution that the dramatic increase in the number of surgeries requiring anaesthesia performed in doctors’ offices can leave patients at risk from substandard operating environments.

Surgical procedures performed in doctors’ offices cost 60 to 75% percent less than hospital surgeries. To offer even lower prices, however, some doctors cut corners by working with fewer trained personnel, and by eliminating emergency equipment such as cardiac resuscitation machines and back-up electrical generators. In other cases, sanitation needs go unmonitored.

Doctors who do in-patient surgery can choose to have their office operating rooms inspected and accredited, but they are not required to do so. In fact, as Dr. Robert Grazer, an associate clinical professor of plastic surgery at UC Irvine, points out, “At least the Public Health Dept. checks soda fountains--nobody polices in-office surgical facilities.”

There are several voluntary systems for accrediting office facilities, however. The American Assoc.for Accreditation of Ambulatory Plastic Surgery Facilities (AAAAPSF) is the largest. The Accreditation Assoc.for Ambulatory Health Care, Joint Commission on Accreditation of Health Organizations, and Medicare also offer rigid screening programs. “The goal of these organizations is to bring up the standards of office facilities,” Grazer says. “When more than half of the plastic surgeons in California are performing surgery in their offices, some controls are necessary.”

Another cause for concern is that many doctors perform cosmetic procedures in their offices even though they are not credentialed to perform the same operation in a hospital. Dr. Robert Singer, vice-chairman of surgery at Scripps Memorial Hospital in La Jolla, calls the doctor’s office “a haven from outside scrutiny.” In hospital settings, surgeons are evaluated by other doctors; in most office-surgery situations, there is no form of peer review.

“More than half the people who list themselves as cosmetic surgeons in the Beverly Hills phone book don’t have the proper training to be doing the work, and yet no one is overseeing what they do,” says Singer, who recently testified before the House Subcommittee on Regulation, Business Opportunities and Energy in Washington D.C.

Rep. Ron Wyden (D-Ore.), chairman of the subcommittee, is leading an investigation into several phases of the cosmetic surgery field, including misleading advertising, unqualified practitioners and substandard facilities. Singer and other plastic surgeons representing the AAAAPSF have asked for government standards defining who can perform plastic surgery and in what types of facilities, and calling for mandatory peer review.

Until guidelines are established, consumers should ask to see certificates of accreditation for office facilities, or call the AAAAPSF (312-949-6058) for a referral to a board-certified plastic surgeon with an accredited in-office operating room. “We’re not trying to stop office surgery,” says Dr. Gustavo Colon, vice president of the AAAAPSF and a clinical professor of plastic surgery at Tulane University. ‘But we do want some form of guidelines for these facilities. The patient must be protected.”