Entries categorized as ‘Cosmetic Medicine’
Governor Arnold Schwarzengger has unexpectedly vetoed Assembly Bill 2968, the Donda West Law, which had easily passed the California Legislature roughly six weeks ago. The governor cited the state budget crisis and the limited ability to attend to other matters as the reasons for the veto, which was one of 131 bills vetoed on the same day (along with 64 signatures).
In light of the veto, California physicians (and dentists) are not required by law to obtain physical examinations of patients and clearance prior to performing cosmetic procedures. Nonetheless, such exams are asserted by the Medical Board of California to be standard of care (whether performed by the operating physician, nurse practitioner, or physician assistant, or, alternatively, by a primary care doctor).
Recommended Action: Irrespective of the veto, physicians (and dentists) should ensure that the documentation of a physical exam, including a complete medical history, is part of every patient chart prior to performing any cosmetic procedure. Although the passage of the law would have increased the potential penalty, in the absence of a new law, the Medical Board of California will nonetheless continue to initiate disciplinary actions routinely for violation of this standard.
Harry Nelson is a partner in Fenton & Nelson, LLP. Harry conducts audits and training programs for plastic surgeons and cosmetic healthcare providers to ensure effective risk management and compliance in medical practice. For additional information, please contact him at harry@fentonnelson.com
©Harry Nelson 2008
Categories: Cosmetic Medicine · Medical Board
Tagged: cosmetic dermatology, donda west, liposuction, plastic surgery
Camille Sweeney reports in the New York Times on on plastic surgeons’ growing attention to the art of identifying problem patients in advance. (“Skin Deep: A Face Not Even a Plastic Surgeon Could Love.”) Varieties of problem patients include:
- litigious patients
- plastic surgery junkies
- patients with unrealistic expectations
- patients who badmouth physicians online
The various categories of “problem patients” each carry their own hidden danger. Among other challenges are the risk of having to do extensive post-operative care and revisions to try to satisy people who ultimately are not capable of being satisfied. Physician staff who have preliminary contact with patients should be trained to spot and report red flags. Worst of all are the disgruntled patients who turn to the Internet to vent their fury, whether on ready-made ratings websites like RateMDs.com and MakeMeHeal.com or through the patient’s own personalized blog. Barring contractual limitations agreed to in advance by patients, it is nearly impossible to prevent angry patients from causing reputational harm online.
Recommended Action: Providers need to become more adept at spotting and steering clear of potential problem patients. Although there is no substitute for identification and avoidance of patients who will waste providers’ time and, worse, harm their businesses, Fenton & Nelson recommends that providers adopt intake agreement forms that condition the rendering of services on patients’ agreement not to participate in online defamation and other reasonable behavior. Requiring patients to sign such documentation will help identify reluctant future patient bloggers.
Harry Nelson is a partner in Fenton & Nelson, LLP. Fenton & Nelson review and counsels providers on practice management, including drafting of patient forms. In addition, Fenton & Nelson conducts audits and training programs for health care providers to
ensure effective risk management and compliance in medical practice. For additional information, please contact him at harry@fentonnelson.com
©Harry Nelson 2008
Categories: Cosmetic Medicine
TheNew York Times reports on the trend of plastic and cosmetic surgeons refusing to operate on patients who smoke based on reduced blood supply to the skin and related complications. According to the article, the trend has accelerated over the past five to ten years to the extent that Dr. Patrick McMenamin, the president-elect of the American Academy of Cosmetic Surgery, claims that, although it may have been acceptable 25 years ago, today many surgeons would deem it malpractice to perform flap surgery on a known smoker. The article describes how some physicians are even going to the extreme of obtaining urine tests to verify cessation, rather than relying on checking skin condition and smell to detect nicotine.
Recommended Action: The trend of refusing to operate on smokers raises a question of how standard of care is defined and how it evolves. The question is relevant both for malpractice purposes (where plaintiffs must establish that the standard of care has been breached in a particular case) and disciplinary licensing actions (where, in California, a single gross departure from standard of care or repeated simple departures will support a disciplinary action by a licensing board).
Generally, standard of care is defined as the prevailing understanding among similarly qualified, reasonably prudent practitioners in a given community as to how patients in similar circumstances should be treated. It can be difficult to ascertain what the standard of care is without identifying how practitioners in a particular community are treating patients. In many cases, there may be a range of acceptable options from which to choose that are within the standard of care. Applying this standard to the issue of smoking cessation, plastic and cosmetic surgeons should consider whether and, if so, how the standard of care on this issue may have evolved or be evolving.
Harry Nelson is a partner in Fenton & Nelson, LLP. Fenton & Nelson counsels healthcare providers on regulatory compliance and business matters. For additional information, please contact him at harry@fentonnelson.com
©Harry Nelson 2008
Categories: Cosmetic Medicine · Medical Board
Tagged: Cosmetic Medicine, plastic, smoking, standard of care
Assembly Bill 2968, known as the Donda West Law, passed the California Legislature on August 14, 2008 by wide margins (37-1 in the Senate and 73-0 in the Assembly). The new law, which applies to both dentists (Business & Professions Code §1638.2) and physicians (Business & Professions Code §2259.8), awaits signature by Governor Schwarzenegger.
Until now, most plastic surgeons and cosmetic dermatologists required their patients to obtain physical exams and clearance as a prerequisite to performing a procedure. Under the Donda West Law, the law now reflects this standard. The law permits the physician performing the procedure to perform the exam, although many plastic surgeons and other cosmetic doctors opt to have the patient’s primary care physician or another doctor perform the exam. The law was amended in the Senate to permit the physical exam to be conducted by a certified nurse practitioner or licensed physician assistant.
Recommended Action: Physicians (and dentists) should take care to ensure that the documentation of a physical exam, including a complete medical history, is part of every patient’s file prior to performing any cosmetic procedure. .
Harry Nelson is a partner in Fenton & Nelson, LLP. Harry conducts audits and training programs for plastic surgeons and cosmetic healthcare providers to ensure effective risk management and compliance in medical practice. For additional information, please contact him at harry@fentonnelson.com
©Harry Nelson 2008
Categories: Cosmetic Medicine
Tagged: Cosmetic Medicine, plastic
