Taxpayers Foot Bill for Navy Cosmetic Surgeries

Navy doctors are performing hundreds of free cosmetic surgeries at taxpayer expense to Navy personnel and their families--a benefit rarely provided by private health insurance and specifically prohibited by Veterans Administration hospitals.

In San Diego alone, 544 free cosmetic operations were performed during the past two years. From 1986 to 1988, Navy doctors nationwide performed more than 1,300 breast augmentations, face lifts, nose jobs, liposuctions and hair transplants--operations that usually cost thousands of dollars apiece.

Navy officials say these surgical procedures allow doctors to hone their skills and practice their craft in readiness for wartime.

But critics contend that taxpayers should not foot the bill for military personnel to fine-tune their faces and physiques, especially when the government is trying to reduce military spending. If the doctors need practice, they say, they could help out the many indigent patients who need but cannot afford reconstructive surgery.

“It’s inappropriate to spend taxpayers’ dollars on medical operations that essentially are designed to allow people to be more stylish rather than to provide real substantive medical benefits,” said Rep. Duncan Hunter (R-Coronado). “The ability to do a tummy tuck or nose bob is of relatively little medical benefit to a surgeon who really does intend to spend time working on military-related cases and combat-related cases.”

If Navy doctors need practice, Hunter said, they should operate on wounded refugees.

“We have literally tens of thousands of people, mostly refugees wounded in Afghanistan. And we can provide those wounded people for any surgeon who feels a compulsion to rush off and do a tummy tuck,” said Hunter, usually a military proponent on the House Armed Services Committee.

The surgery has been available to active-duty personnel, their spouses and children as well as retired members of the military at San Diego’s Naval Hospital and three other facilities across the nation.

Donna Baden, a San Diego Navy dental assistant, had her jaw surgically moved forward 6.5 millimeters. Still unhappy with her face, she underwent two nose jobs. And finally, in February, 39-year-old Baden, who joined the Navy five years ago, had her breasts enlarged. Soon after the last operation, Baden left the Navy.

All of Baden’s operations were performed at the Navy Hospital in Balboa Park. They were performed free of charge, except for the breast implants Baden had to provide for the last surgery. Those cost $565, she said.

In San Diego, cosmetic surgeries represent 12% of all plastic surgeries performed; they also represent almost 6% of all surgeries performed by the hospital’s ophthalmologists and ear, nose and throat doctors, according to statistics obtained by The Times.

“The issue isn’t whether or not we should be doing cosmetic surgery; my position is how much is reasonable. I suggest that 6% is reasonable and 12% is appropriate,” said Rear Adm. Robert Halder, the commanding officer of the Navy Hospital, which has no plastic surgery residency program but does have three plastic surgeons.

“We need to maintain our skills and do surgery on non-distorted tissue. When our surgeons do cosmetic operations, they are operating on non-distorted tissue. . . . If they have had the experience of working with normal anatomy, they can appreciate better the distorted anatomy,” Halder said. “We certainly have educational reasons for wanting to do it.”

The Army’s 22 plastic surgeons and the Air Force’s eight also do “aesthetic operations.”

“Why in the world is an army doctor doing a nose job? Because it’s really critical for skills--an army doctor can’t just sit there and do nothing for two years,” said Viginia Stephanakis, a spokeswoman for the U.S. Army surgeon general. “They really have to keep their skills up. We can’t keep doctors on hold, waiting for a war to come.”

In the civilian world, face lifts can cost as much as $6,000; hair replacements and tummy tucks usually go for no more than $5,000, breast augmentation for $2,500, according to the American Society of Plastic and Reconstructive Surgeons.

Critics say taxpayers should not have to pay for these surgeries, performed solely for vanity.

“Even at charity hospitals or county hospitals, low-income patients . . . do pay something,” said Dr. Merrel Olesen, a plastic surgeon with the La Jolla Cosmetic Surgery Center. “I understand that the hospital and residents’ programs want to give young doctors experience, but it’s absolutely unconscionable that I am paying for it.” And some in the military say performing cosmetic surgery tarnishes the Navy’s image.

“It sends a bad signal to the American public: Here’s the military skimming off the cream again,” said retired Rear Adm. Gene R. La Rocque, director of the Center for Defense Information, an independent research organization that analzyes military spending and policies. “I am shocked and disappointed that we are spending resources for that when there’s a dire need for medical attention to military active forces and retired personnel, which is not actually being met.”

Eleven plastic surgeons are assigned to Navy hospitals in Bethesda, Md.; Portsmouth, Vir.; Oakland and San Diego. Three work in San Diego. In 1988, the most recent year for which national figures are available, doctors at the four facilities performed 131 breast augmentations, 158 face lifts, 167 liposuctions and one hair transplant.

To help facilitate the Navy Hospital’s fat-removing surgeries, the hospital bought two liposuction machines, which cost $3,200 each. One was purchased in 1988, the other in 1986, said Halder, who added that the hospital would have purchased the machines even if doctors did not perform cosmetic surgeries.

In about 98% of the operations, the liposuction machine is used for cosmetic procedures, said Cmdr. Scott Barttelbort, chief of the plastic surgery division at the Navy Hospital.

In San Diego, the plastic surgeons are deluged by about 100 requests monthly, mostly from women who desire bigger breasts, wrinkle-free faces and smaller noses--in that order, said Barttelbort. About 12% of the 1,138 plastic surgery procedures performed in two years beginning March, 1988, were performed for aesthetic reasons, said Halder.

Two other departments at the Navy Hospital--ophthalmology and the ear, nose, throat--also conduct some cosmetic surgeries. During the two years beginning in March, 1988, ophthalmologists performed 189 operations to reduce wrinkles around the eyes. In the same period, ear, nose and throat physicians performed 217 cosmetic surgeries, which make up about 5% of their total number of operations.

In all three departments, these operations are conducted when doctors have taken care of more pressing cases, Barttelbort said.

“If I see a reasonable candidate, I sit down and tell her, ‘Ma’am, from my clinical standpoint, you are my last priority. I am happy if I can help you,’ ” he said. “But our system is set up to take care of other problems first.”

Navy patients who undergo cosmetic surgery usually wait about 6 to 12 months, Barttelbort said. Baden, however, said that for each of her four operations, she waited from 2 to 4 months.

Doctors and officials at other medical facilities agree that plastic surgery is popular. But the Veterans Administration issued regulations prohibiting such surgeries, which are considered elective and non-essential, local spokesman Bob Stevens said.

A number of civilian health maintenance organizations, including Kaiser Permanente Medical Care Program and CIGNA Healthplans of California, do not cover the cost of cosmetic surgery unless it is medically indicated.

At the Navy Hospital, doctors give priority to active duty, rather than retired, personnel, said hospital spokeswoman Pat Kelly. Among the categories, patients undergo surgery on a first-come, first-served basis, she said.

“Our physicians like to maintain their skills,” Halder said. “What is a reasonable person out there going to conclude?”