Cosmetic Surgery Rules Tightened by Pentagon

The Department of Defense on Tuesday prohibited beauty-enhancing cosmetic surgeries at military hospitals, saying military hospitals will now follow a “better interpretation” of the law.

The Pentagon’s actions followed a legal review that found that many cosmetic surgeries skirted a federal law banning operations that weren’t medically indicated. The new regulations will permit plastic surgery for active-duty and retired military personnel--as well as their family members--when the operations are meant to correct congenital anomalies or repair injuries, said spokeswoman Susan Hansen. Military doctors will also continue to perform post-mastectomy breast reconstructions.

The Times reported last month that military doctors worldwide were performing liposuctions, tummy tucks, nose jobs and other cosmetic surgeries that are rarely covered by private or military health insurance.

Under the new regulations, “face lifts and other procedures relating to the aging process and any procedure performed for personal, non-therapeutic reasons to improve the appearance will not be provided . . . using appropriated funds,” Hansen said.

Critics, who had said taxpayers should not have to foot the bill on preenings, responded warmly to the new regulations.

“I am extremely pleased. . . . The law is clear that this kind of procedure is not to be done at taxpayer’s expense,” said Rep. Duncan Hunter (R-Coronado), a member of the House Armed Services Committee. “Military personnel, retirees, and their families have many other pressing medical needs that have a far greater priority on our resources.”

Retired Rear Adm. Gene R. La Roque, director of the Center for Defense Information said: “It was a wise and sensible move on the part of the Pentagon to proscribe that type of activity because it was sending the wrong signal to the American public.”

The new regulations were issued after the Defense Department Assistant General Counsel Robert L. Gilliat reviewed the existing legislation and concluded that military hospitals were misinterpreting a 1979 law in performing aesthetic cosmetic surgeries. In a July 5 memo, he wrote that the “better interpretation of the current statutory restriction would exclude many of the cosmetic surgeries now being performed.”

Dr. Enrique Mendez, assistant defense secretary for health affairs, hammered out the new regulations after meeting with the surgeons general of the Army, Navy and Air Force. Mendez also faced some tough questions from Rep. John Murtha (D-Pa.), defense subcommittee chairman for the House Appropriations Committee, who was apparently irritated by news reports of the surgeries. Murtha did not return repeated calls from The Times.

The Veterans Administration Hospitals prohibit cosmetic surgery; and military medical insurance, known as CHAMPUS, does not cover such operations unless they are medically indicated. Under the newly issued regulations, military hospitals will mirror the CHAMPUS policy covering cosmetic surgery.

Military officials had defended cosmetic surgeries, saying that the operations allow surgeons to perfect and practice their skills. The operations, conducted when more pressing cases have been tended, also help young surgeons pass their certification examinations, said Rear Adm. Robert Halder, commanding officer of San Diego’s Naval Hospital, where 544 cosmetic surgeries were performed in the last two years.

As the new regulations are implemented, officials will explore other options for allowing doctors to perform cosmetic surgeries--perhaps under a fee structure, said Liz Noland, spokeswoman for the Navy’s Bureau of Medicine and Surgery in Washington.

“The Navy still believes that aesthetic surgeries are necessary to provide Navy surgeons the opportunity to work with normal undistorted tissue and anatomy so they can meet specialty requirements and will have the knowledge, skill and experience to repair or rebuild that tissue or anatomy when necessary,” Noland said.

Worldwide, 2,354 breast augmentations, nose jobs, tummy tucks and other cosmetic surgeries were performed in 1989 at 33 Navy hospitals. Of these operations, 210 were performed for purely aesthetic reasons, Noland said.

“The bottom line here is these regulations are a minor policy change because we don’t do that many surgeries,” she said. “We don’t anticipate it’s going to impact the way we do business.”

The cosmetic surgeries, which can cost up to $6,000 in the civilian medical world, had been offered free to active-duty and retired military personnel--as well as to their families.

Ed Badrak, chairman of the United Veterans Council, said the Pentagon was simply caving in to pressure, and the new regulations are unfair.

“It is tragic because of all the negative publicity that military hospitals are getting right now that the Pentagon has a knee-jerk reaction and cuts out cosmetic surgery,” said Badrak, whose organization represents an alliance of 30 veteran groups in San Diego County. “They are punishing the whole community instead of putting this into perspective.”

Others expressed concern about how the new regulations will affect young doctors.

“I would feel it was unfortunate if it discourages doctors from coming into the military,” said Rosemary Locke, director of the Arlington-based civilian and military group called My Image After Breast Cancer. “Trying to get good doctors and keep them is difficult, and that’s particularly true with plastic surgeons.”