A high-ranking Pentagon lawyer has concluded that military hospitals that perform elective cosmetic surgeries are violating a 1979 law prohibiting operations that are medically unnecessary.
The Times reported last month that military doctors worldwide were performing hundreds of cosmetic surgeries at taxpayer's expense, even though such surgeries are rarely covered by private health insurance or military health insurance, called CHAMPUS.
Military officials say they expect regulations will be tightened as a result of the Pentagon legal review, significantly reducing the numbers of cosmetic surgeries, including liposuctions and nose jobs, that are performed.
Although acknowledging that the language of a 1979 law is not entirely clear, Department of Defense Assistant General Counsel Robert L. Gilliat said, "The law prohibits the general provision of elective cosmetic surgery--there is some interpretation."
In a memo dated July 5, Gilliat wrote that the "better interpretation of the current statutory restriction would exclude many of the cosmetic surgeries now being performed."
This memo, prompted by newspaper reports of the cosmetic surgeries, is being reviewed by the Department of Defense's Health Affairs Office, which will determine whether to change existing regulations. Another Washington official, who declined to be named, said a decision was expected this week.
In San Diego alone, 544 cosmetic surgeries were performed at the Naval Hospital during the past two years. Hospital officials have defended these operations, saying that they enable plastic surgeons to hone and maintain their skills. And they say, such surgeries allow young doctors to pass their certification examinations and are conducted only when more pressing medical cases have been tended.
In San Diego, cosmetic surgeries represent 12% of all plastic surgeries performed and 6% of all surgeries performed by the hospital's ophthalmologist and ear, nose and throat doctors.
Nationwide, 2,354 breast augmentations, nose jobs, tummy tucks and other surgeries were performed in 1989, according to statistics recently released from the Navy. But spokeswoman Liz Noland said only 210 were conducted for purely cosmetic reasons.
"I still feel cosmetic surgery has a valid role to play in our teaching hospital," said Rear Adm. Robert Halder, commanding officer of the hospital, which has three plastic surgeons on its staff. Halder said he was unaware of any new policy but added: "I will await further guidance. I don't want to speculate on what they are going to say. When my boss gives me orders, I follow it."
The Army's 22 plastic surgeons and the Air Force's eight also do aesthetic operations. In an effort to evaluate the cosmetic surgery programs, Dr. Enrique Mendez, assistant defense secretary for health affairs, recently held meetings with top-ranking medical officers from the Army, Navy and Air Force, sources said.
The surgeries are performed on active duty and retired military personnel and their families. In San Diego, active duty personnel are given priority over other individuals, Halder said. These surgeries, however, are specifically prohibited by Department of Veterans Affairs hospitals.
In the civilian world, face lifts can cost as much as $6,000; hair replacements and tummy tucks can cost up to $5,000; and breast augmentation goes for about $2,500, according to the American Society of Plastic and Reconstructive Surgeons.
Some military personnel say cost is a factor when they opt for surgery. One San Diego banker, whose husband is in the Navy, said she had her breasts enlarged because the operation was free. "Otherwise, I wouldn't have done it," said the 30-year-old woman, who requested anonymity.
Critics of the elective cosmetic surgery say taxpayers should not pay for military personnel to improve their faces and physiques at a time when the government is trying to decrease military spending.
"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," Rep. Duncan Hunter (R-Coronado) had told The Times.
And some in the military said they are angry that active-duty personnel sometimes stay out of work from several days to several weeks as they recuperate from beauty-enhancing surgery.
"Is this truly a valid reason to miss work? I don't think so," said one official, who requested anonymity and added that he had lost a staff member for seven weeks while the woman recuperated from an aesthetic jaw surgery.
But patients who have undergone cosmetic surgery defend the practice, saying it is small compensation for the rigors and poor pay of military life.
Former Lt. Cmdr. Merlin Bitzer, who left the military in January after 15 years of service, had bags removed from his eyes. And, two years ago, his son, Chad, had his ears operated on so they would not stick out.
"You can't expect plastic surgeons to just be there for the real bad stuff. You are paying the guy to be there, but when they have extra time, they need to keep up their skills," Bitzer said. "The more work they do, the better they become."