Six months after the mother of Kanye West died following liposuction and breast implant surgery, the reverberations of the tragedy continue to be felt. Now lawmakers and physicians are urging greater protections for patients undergoing cosmetic surgery.
Across the country, such surgeries are increasingly done outside hospital settings in outpatient clinics, where a doctor can avoid the rigorous review that, say, a heart surgeon would face at a traditional hospital. Those lobbying for greater surveillance say attempts to regulate the fast-growing industry have faltered.
"These [clinics] are not hospitals. You have to raise the standards," said state Sen. Mark Ridley-Thomas (D-Los Angeles), chairman of the senate Committee on Business, Professions and Economic Development.
California is not alone in looking to tighten oversight of doctors performing cosmetic surgery. Two years ago, Florida passed a law designed to educate patients about their doctor's credentials. And in the Canadian province of Ontario, officials are increasing scrutiny after the death of a Toronto woman who received liposuction from a general practitioner.
More than a decade ago, California pushed to regulate outpatient surgical centers amid high-profile reports that patients were critically injured or dying during procedures. Legislators passed a law that said such centers must be accredited by an agency recognized by the state, which requires a clinic to have resuscitation equipment and procedures to transfer a patient to a hospital. But Ridley-Thomas says the law has not been effective; he has proposed legislation requiring regular inspections.
In addition, across-the-board budget cuts forced the Medical Board of California about five years ago to disband a five-person investigative team designed to ferret out unlicensed doctors, said board spokeswoman Candis Cohen.
The budget cuts came as cosmetic procedures overall were booming in popularity. In 2007, there were 11.7 million cosmetic procedures performed in the United States, a 59% increase over 2000.
In California, the death of Donda West, 58, in November prompted two lawmakers to push for additional patient safety protections.
A bill, AB 2968, by Assemblywoman Wilmer Amina Carter (D-Rialto) calls for a patient to receive a physical examination before undergoing cosmetic surgery.
Yolanda Anderson, West's niece, said her aunt did not receive a physical exam by her surgeon, Dr. Jan Adams, before undergoing surgery. A spokesman for Adams has previously said it was his understanding that both Adams and the anesthesiologist thoroughly questioned West before her surgery.
"It's not like she was 90 or terminally ill with cancer," Anderson said. "It was something that did not have to happen."
Another doctor whom West had previously seen declined to operate on her, saying that she was at risk of having a heart attack if she were to undergo the cosmetic surgery.
A coroner's report cited West's heart disease and clogged coronary arteries as a factor in her death. According to the coroner, there was no evidence that her death was caused by a mistake in surgery.
West, who was 5 feet 2 and weighed 188 pounds, had part of her right breast removed, both breasts enlarged and her abdominal muscles tightened. She had significant liposuction as well as a "belt lipectomy," which excises fat around the abdominal area and tightens the surrounding skin.
West was sent home after her 5 1/2 -hour surgery. She was not hooked up to medical equipment to monitor her recovery, something experts now say should have been required, given her extensive surgery and her pre-existing heart disease.
Ridley-Thomas' legislation, known as SB 1454, would require that outpatient facilities be inspected at least once every three years. There now is no state requirement for how often the facilities must be inspected. New advertising requirements would go into effect, such as banning statements or photos "likely to create false or unjustified expectations."
But some doctors say that some of the additional regulations being proposed won't fix what will affect the patients most.
"There's no way to control surgical judgment," said Dr. Michael F. McGuire, vice president of the American Society of Plastic Surgeons and an associate clinical professor at UCLA.
A solution, McGuire said, is for patients to know how qualified their surgeons are.
McGuire said he wants all healthcare providers, including cosmetic surgeons, to disclose their educational background and specialty training before treating patients, an idea he has pressed with lawmakers. The idea would be a more robust version of a "Truth in Medical Education" law passed in Florida in 2006.
In this scenario, a patient would receive a document detailing the practitioner's license, identifying the provider's schooling, residency training program, what boards had certified the physician -- and what boards the doctor failed to complete, McGuire said.
State law permits medical doctors to practice whatever medicine they want, which "goes back to the old general practitioner days where a doctor delivered you, fixed your broken bones and took care of your heart attack," McGuire said.
McGuire said he would favor laws allowing only doctors who are board certified in plastic surgery to perform cosmetic procedures. West's doctor, Adams, who has promoted himself as an expert on cosmetic surgery in books and on TV shows, is not board certified in plastic surgery or any other specialty overseen by the American Board of Medical Specialties. But McGuire said "any legislation that tries to limit in any way a doctor's ability to practice" would face tremendous political opposition from other doctors.
One province in Canada, however, does precisely that.
In British Columbia, doctors must be recognized as plastic surgeons or otherwise certified by the Royal College of Physicians and Surgeons of Canada to perform major cosmetic surgical procedures, such as liposuction or anything involving a scalpel.
And in Ontario, officials are considering barring doctors from calling themselves "surgeons" unless they are certified as such by the Royal College.
In September, a 32-year-old real estate agent who lived in Toronto died after receiving liposuction from a general practitioner.
The California Medical Assn. would oppose Canadian-style restrictions, said its president, Dr. Richard Frankenstein.
Physicians must be vetted by an independent medical staff and malpractice insurers before they can pick up a scalpel in California, Frankenstein said in a prepared statement.
"The Canadian model wouldn't enhance these protections and would risk depriving people who live in underserved areas of access to physicians," he said.
Certification is not a guarantee of competence. There have been cases where board-certified plastic surgeons are involved in cases of gross negligence, said Janie Cordray, research director for the Medical Board of California.
In Florida, the state increased oversight over non-hospital surgeries after at least 12 people who underwent surgery in office-based settings died in 1998, said Chris Nuland, general counsel to the Florida Society of Plastic Surgeons.
The number of reported deaths has decreased, but a couple of patients still die each year, Nuland said. He said that a significant problem is doctors who inappropriately clear patients who are too ill to have the surgery.
For example, he said, "a 55-year-old obese person with diabetes, there is no reason that person should have been selected for an office surgery," Nuland said. "You can't legislate good medical judgment."