On September 20, Krista Stryland,
a 32-year old Toronto real estate agent, died suddenly
of a heart attack, after having liposuction in a private
clinic. The procedure was done by Dr Behnaz Yazdanfar,
an FP who got into the cosmetic surgery business several
years ago. Plastic surgeons have renewed their calls
for better regulation of invasive cosmetic treatments.
The College of Physicians and Surgeons of Ontario (CPSO)
says it's in the process of doing just that.
COSMETIC
SURGERY DISASTER
Ontario's coroner's office has done an autopsy on Ms
Stryland and said it would decide some time in October
whether to hold an inquest. According to friends, Ms
Stryland chose liposuction for its relative safety.
They say she might have thought twice if she'd known
her cosmetic surgeon wasn't really a surgeon. Unlike
plastic surgeons, in most of Canada doctors calling
themselves cosmetic surgeons need no special licence
to ply their trade.
Dr Yazdanfar's clinic didn't respond
to NRM's request for an interview, but released
a statement saying it wasn't operating out of bounds,
but followed College guidelines on what treatments it
was allowed to offer.
That claim seems to be true —
and that's exactly the problem, say plastic surgeons.
"The public may think that there's a universal level
of education, training and experience, but in the area
of cosmetic surgery there's no program or licence,"
says Dr David Kester, president of the Canadian Society
for Aesthetic Plastic Surgery (CSAPS) and a BC plastic
surgeon. "Anyone can do it if they can get into a clinic."
"A variety of names are used by
cosmetic practitioners. It's confusing," agrees Dr Jeffrey
Turnbull, president of the College of Physicians and
Surgeons of Ontario. "When someone calls themselves
a surgeon, people think they're a surgeon."
Dr Kester thinks GPs-cum-surgeons
aren't always trained for what they're doing. "Liposuction's
a two out of 10 on degree of difficulty, but problems
come up," he says. But he doesn't think plastic surgeons
should have a monopoly on cosmetic work. "We wouldn't
object to, say, an ENT doing some cosmetic work if properly
trained, but not going to a weekend course and saying
'now I can do liposuction.'"
But the draw for docs wanting to
pull in some quick cash is strong. "Because it's well-remunerated
outside the public system, there's a burgeoning field,"
says Dr Turnbull.
FOUR
POINT PLAN
"There are two main concerns," says Dr Kester. "The
evaluation and monitoring of quality of care in private
clinics, and the credentials of individuals — what
they call themselves, what their training is and how
they're advertised."
Dr Turnbull says that the rapid
expansion of the field of cosmetic surgery and associated
increased complaints have been commanding more attention
from the College, including a spate of botched lipos
done by Toronto general surgeon Dr Alvin Anderson.
Yet critics say it's too little,
too late for Ms Stryland. A 1989 Ontario liposuction
death prompted the coroner to make recommendations for
stricter College regulation of cosmetic surgeons. Little
has changed since. There was a policy shift in 2000,
with a call for voluntary self-reporting from physicians
intending to change the scope of their practice.
But most doctors who've changed
their scope haven't bothered to let the College know,
admits Dr Turnbull. "That's why we started this whole
process back at the beginning of the year," he says,
referring to the College's Four Point Plan. Announced
in April, the plan includes steps to assess the training
of docs who do cosmetic surgical work. This would mean
an audit of the many different treatments and their
required training, says Dr Turnbull. Change-of-scope
reporting would also become mandatory. "Right now, what's
a significant change is open to interpretation. We want
it to be perfectly clear. And we want to raise public
awareness."
The College also intends to push
for possible cosmetic facility accreditation. Keeping
tabs on cosmetic surgeons isn't easy, because they often
work in private clinics. "Normal processes like OHIP
and hospital reporting systems don't apply here," says
Dr Turnbull. "It might require legislative changes and
take time, but would give us the power to assess facilities."
So when will we see the plan in
action? "We'd like to act quickly on some of the changes,"
says Dr Turnbull. "Much of the plan could be in place
within a year - the components characterizing cosmetic
procedures and the training required for them."
But the CSAPS isn't holding their
breath. They've long been lobbying the College to deal
with the lack of an adequate plastic/cosmetic distinction.
"We've objected to it for years," says Dr Kester. "But
it's seen by colleges as a turf war, a monetary concern
— we've never been able to make the point."
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