Province investigates physicians

Ontario’s medical watchdog is investigating 16 physicians who perform cosmetic surgery after the death of a 32-year-old Toronto liposuction patient two months ago prompted the group to accelerate a crackdown on the field.

The College of Physicians and Surgeons of Ontario sent out questionnaires last month to physicians in the province who conduct cosmetic procedures, asking what operations they perform and what their qualifications are.

Sixteen physicians, who have not been named, fall into what the college calls high- or moderate-risk categories. A high-risk doctor would be someone who is not a surgeon and is performing surgical procedures in an unaccredited facility, while moderate-risk physicians would include those with some surgical training who are performing procedures on parts of the body for which they have not been trained, said Dan Faulkner, director of research and quality management with the college.

“There is a concern for public safety,” Mr. Faulkner said.

The investigations are part of a series of steps to clamp down on the booming practice of cosmetic surgery in the province. The college voted on new measures yesterday at a public meeting of its governing body.

As part of the broader overhaul, the college voted to ban physicians from advertising as surgeons unless they have been trained as such.

Many family physicians in Ontario advertise as cosmetic surgeons even though they haven’t completed the five years of study it takes to become a plastic surgeon. That is alleged to have been the case with Behnaz Yazdanfar, who performed liposuction on Toronto real-estate agent Krista Stryland before she died in September.

The college also voted to inspect all cosmetic surgery clinics and to require all physicians to report their qualifications. Doctors also would have to specify which of the more than 70 recognized cosmetic procedures they perform.

Currently, all assessments of non-hospital clinics are conducted on a voluntary basis by an independent third party, and the scope of practice a physician reports to the college may differ sharply from what he or she advertises on the web and in newspaper classifieds.

Until the college investigations are completed – a process that could take several months, according to college president Jeffrey Turnbull – the 16 doctors being scrutinized will continue to practise.

“If in such time we determine that those individuals are not appropriately trained or are putting individuals at risk, we will act immediately,” Dr. Turnbull said.

The college also sent suspension notices to 20 doctors because they failed to return the questionnaire. Those doctors have 60 days to respond before their licences are suspended.

Growing public concern over the dangers of cosmetic surgery as well as pressure from doctors sparked the overhaul of Ontario’s cosmetic surgery regulations. Among the biggest complaints were murky doctor qualifications, vague public warnings about the risks of surgery, shoddy oversight of cosmetic clinics and inadequate physician training, according to Mr. Faulkner.

Recent regulatory overhauls in western provinces also helped trigger the changes. In British Columbia, for example, family physicians are barred from practising cosmetic surgery and all cosmetic clinics must undergo regular inspections.

Dr. Turnbull suggested the B.C. changes were too drastic.

“I’m aware of many circumstances where individuals who are not surgeons in fact have had training that exceeds that of a plastic surgeon in this discipline,” he said. “So I don’t think it would be fair to characterize all family practitioners as unable to practice high-risk cosmetic procedures. It’s all about the training.”

Until investigations into the 16 physicians are completed, Dr. Turnbull advised patients to call the college or consult its website for advice on the qualifications a physician should have to conduct cosmetic procedures.

In all, the college expects to receive questionnaires from 568 doctors, 150 more names than the college had originally cobbled together from a combination of Internet sites, advertisements and internal records.

The college has been conducting a review of cosmetic surgery in the province since April, but its special Cosmetic Procedures Project only became a high priority after the death of Ms. Stryland.

Dr. Turnbull denied that the college has taken too long to clamp down on cosmetic surgery in the wake of Ms. Stryland’s death and that of Toni Sullivan, 44, of Toronto after liposuction in 1989.

“I don’t think we’ve dropped the ball,” Dr. Turnbull said. “We’ve responded dramatically to the changes that are taking place around us and we’re very pleased with this. We’re working very quickly.”

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