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Commentary: Politics and patient safety; lawmakers 'white hat' response seen as 'grandstanding'


I recently read a short newspaper story (USA Today, May 27, 2008) from California, where it was reported that "two lawmakers want greater protection for cosmetic surgery patients."

Key Points

I recently read a short newspaper story (USA Today, May 27, 2008) from California, where it was reported that "two lawmakers want greater protection for cosmetic surgery patients."

Their proposed legislation comes six months after the unfortunate death of a prominent entertainer's mother following liposuction and breast surgery.

The solution proposed by these two California Assembly members is to seek "stricter review of the outpatient clinics where such surgeries are increasingly occurring."

However, without knowing the facts in this case - and I doubt these members of the Assembly know them very well, either - I'm left with a certain amount of indignation that elected political representatives seem to react to any tragic news story like this one with the belief that they can propose hastily developed solutions to solve a patient safety problem that may not even exist.

This whole opportunistic, "white-hat" response by some lawmakers to any high-profile medical incident such as this one provides evidence of politics at its worst. For what would be better-perceived by the electorate than having their elected representatives propose legislation that will supposedly improve patient safety?

After all, improved patient safety is as wholesome as Mom and apple pie, isn't it? Yet, it doesn't seem to matter that there may not really be a problem after all.

Certainly, a bad outcome can be indication of a problem, but without further evidence that risky procedures, inadequate training or lack of supervision impaired patient safety or even reflected bad medical practice, how can one leap to the conclusion that some corrective action must be taken?

Yet with elected representatives, the same thing happens over and over again.

How ludicrous is it for legislators - many of whom are trained as lawyers and not as physicians or nurses - to decide for themselves that a problem exists, and then have the incredible ego to believe they can - without the benefit of medical training - solve the supposed problem from their seats in the state capitol?

There are pre-existing mechanisms to develop standards and monitor the quality of medical care. The medical board of each state is given the responsibility of monitoring the quality of physicians' medical practices and taking action when that quality falls below the standard of care.

State initiatives

Many state legislatures, besides California's, have also proposed legislation they believe will somehow improve the quality or safety of patients undergoing cosmetic surgical procedures. For example, in Virginia, House Bill 1399 would create the entity of "Laser Light Technician," who would report not to the state medical board but rather to the Board for Barbers and Cosmetology. This bill would permit the "Laser Light Technician" to use lasers or light therapy devices for laser hair removal and photorejuvenation.

Arizona Senate Bill 1419 would allow aestheticians to use lasers and intense pulsed light (IPL) devices for hair removal without direct physician supervision.

Incredibly, Illinois House Bill 4667 would restrict the injection of Botox (Allergan) and the administration of chemical peels only to board-certified plastic surgeons. Both procedures developed and perfected by dermatologists!

Exceptions to the rule

To be fair, I have to admit that some legislation potentially does seem to improve patient safety.

Georgia Senate Bill 498 would require the consulting physician to examine each patient prior to any cosmetic laser service being performed.

California Assembly Bill 2398 would provide for fines of $25,000 or sentences up to six months in jail for each violation in which a corporate entity fails to have on-site physician supervision for cosmetic medical procedures.

However, the bulk of these legislative activities, in my opinion, are nothing more than political grandstanding and pandering to the voters so that legislators will get re-elected.

What is really required is to define the problem. Rather than reacting in a knee-jerk fashion to the tragic injury or death of a high-profile individual by rapidly assembling rules and regulations that may not correct the perceived problem, or even improve the quality or safety of healthcare, wouldn't it be better to first ascertain if there was a problem that needed fixing?

For some time, there has been a call from concerned physicians around the country to develop a comprehensive mandatory reporting system for all adverse events that might occur in any setting in which medical or cosmetic problems are treated. Without proof that a problem exists, it is impossible to correct it.

However, if the simple act of requiring the reporting and collection of adverse event data - with some built-in protection from litigation, from physicians, nurse practitioners, physician assistants, medical assistants, aestheticians, directors of medical spas and even "laser light technicians" - it would be possible to determine if a problem does exist, and then appropriate action can be taken by the development of prudent and effective rules and regulations that can truly improve patient safety, while ensuring that a high quality of patient care is being uniformly provided in all settings where medical or cosmetic services of this type are being delivered.

In the meantime, we must all continue to practice with our patients' best interests in mind. Politics and politicians should not interfere with that basic principal.

The piecemeal approach taken by many of our elected representatives in an incident-by-incident and state-by-state fashion is doomed to fail. Rather, politicians should work together with physicians and other providers of cosmetic and medical services to first determine if there is a problem, and then develop the best plan to solve it. In this way, the public will be best served, and those legislators responsible for taking appropriate action will be rewarded by a grateful electorate.

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