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Why the cosmetic surgery industry needs reform

A Victorian Coroner’s investigation into the death of a young woman, Lauren James, after liposuction has been in the headlines recently.

Kathryn Booth, principal of Maurice Blackburn (which represented Lauren James’ partner), and her colleague, lawyer Laura Vines, say the case has wider implications – for cosmetic surgery in particular, and quality and safety in health care more broadly.

They write:

“Lauren James was a healthy and beautiful 26-year-old who, for reasons that only she could have known, underwent liposuction by a plastic surgeon at a day surgery clinic.

Three days later she was dead.

Following a ten day inquest, Victorian Coroner Paresa Spanos found that Lauren died from post-operative complications including sepsis, decreased respiratory function and central nervous system depression.

The Coroner also found that the clinic and the treating surgeon failed in their duty to provide Lauren with adequate post-operative care; Lauren’s complications were treatable and her death could easily have been prevented.

This case is undoubtedly a tragedy.  It was clearly devastating for Lauren, for her family, for her loved ones, and for the medical and nursing staff involved with the procedure and its aftermath.  But it also provides vital warnings for the cosmetic surgery industry and for the provision of patient care generally.

Lauren’s death was preventable.  Her surgery was optional, it was expensive, it took place at an apparently reputable clinic with experienced surgeons, but she still died.

Every single day in our legal practice we see heart-breaking cases caused by medical negligence and mismanagement.  One of the most alarming features of our work is how many of these cases result from a simple lack of communication (between medical staff or between doctor and patient) or a failure to value patient safety above commercial interests.

Cosmetic surgery is a peculiar beast.  It is not about healing.  Most doctors are involved in treating illness and, to a greater or lesser degree, saving lives. Cosmetic surgeons providing elective procedures are paid to perfect the perceived physical flaws of ostensibly healthy people.  There is an uncomfortable and at times blurry line between entrepreneurial and commercial interests, and the provision of medical care.

This article isn’t about begrudging surgeons a decent living, or saying that all cosmetic surgery is bad, it is about demanding that patient safety and well-being come first, not commercial interests.

Cosmetic surgery clinics advertise fiercely for patients and provide comfortable, user-friendly services which can trivialise the seriousness of the surgery and give patient’s unrealistic expectations about the outcome and the risks involved.    It is elective surgery based entirely on the patient’s choice and in this context providing detailed information to allow the patient to make a fully informed choice is all the more important.  No matter how simple the procedure, all surgery carries risks.

Cosmetic surgeons are used to treating healthy people in a lower risk environment than most surgeons and this can mean that when complications arise, these surgeons are less attuned to the signs and symptoms.  It is an unfortunate human tendency to fail to see what we are not expecting.

On the morning of Lauren’s death, she attended the Clinic complaining of severe pain three days post-operatively.  She was examined, injected with an opioid and discharged within approximately 30 minutes with the management plan effectively being to “wait and see”.  No investigations into the cause of Lauren’s pain were ordered.  She was not seen by the surgeon who operated on her.  She was not kept for observations following the injection of a strong narcotic and she was not admitted to hospital for further investigation and/or monitoring.  She was simply sent home.

As Lauren’s condition worsened that afternoon and evening, she experienced continuing strong pain, swelling, blistering and bleeding from her incision sites.  Her partner made a total of six telephone calls to the Clinic asking for help, but he got only a farcical series of administrative and communication breakdowns.  Messages were not passed on, no sense of urgency was communicated to the treating surgeon who put off calling back for hours, and no doctor ever suggested speaking directly to Lauren about how she was feeling.

These failures by the medical staff charged with Lauren’s care meant that the opportunity to save her life was lost.

The Coroner found that the weight of expert evidence presented at inquest was:  “not only that the deceased may have survived with optimum treatment but that she would probably have survived.”

One expert medical witness put the time for effective intervention as late as mere moments before Lauren fell unconscious, never to re-awake.

The take home message for doctors and all health professionals is that the value of good old fashioned clinical examination – and taking the time to actually see or speak to the patient – cannot be underestimated.  Sloppy communication endangers patients and leads to unmet expectations.  It does not matter how reputable the clinic is, how experienced the surgeons seem or how glossy their pamphlets are, if medical staff do not prioritise patient safety, communication and thorough clinical examination the results can be deadly.”


• Maurice Blackburn Lawyers are the legal representatives for Lauren James’ partner Simon Dal Zotto.  The firm represents people injured as a result of medical negligence through Coronial investigations and civil compensation claims.

Comments 14

  1. William says:

    This piece is entitled ‘Why the cosmetic industry needs reform’….Am I missing the point here. There is no mention of reform or even the word ‘reform’ in the whole article. It just seems to be the recounting of a tragic death of a healthy young person following cosmetic surgery, relating to poor postoperative communication and care.

    This looks an awful lot like self promotion by Maurice Blackburn and it’s lawyers…

    So now Croakey publishes pieces by medical negligence lawyer’s expounding their most recent triumph? and dressing it up as a constructive piece on how the system needs ‘reform’?!!! Please!

    How does this sit with your views on conflict of interest Croakey?

  2. Croakey says:

    Hi William
    If you can read that piece and not see that it is about the need for change – whether of individual behaviour, systems of care or service delivery – then I suggest you read it again.
    Cheers
    Melissa

  3. William says:

    Hi Melissa,

    If you can read that piece and not see that it is an advert by a legal firm specialising in personal injury and medical negligence work – then I suggest you read it again.

    Cheers
    William

    PS Might I respectfully suggest that the piece would have some credibility had it been from someone with no pecuniary interest in the case, it’s outcome and it’s relevance to regulation of the cosmetic surgery sector.

  4. marilyndramsay says:

    Does it really matter if Melissa made this post with some kind of professional interest? Who cares? At least she mentioned it! Why is it so often the case that when women draw attention to matters that support other women, someone comes out and focusses on the messenger rather than the message. I don’t care if Melissa has some connection with Maurice Blackburn. It does not make her post less credible. The events shown on 60 minutes were clearly based on fact, and if Melissa wants to draw attention to the need for health reform via the piece, her motive doesn’t really matter. At least she’s DOING IT !! Where are our current health regulation authorities? Kerry Mullins mentioned the name of her plastic surgeon; Dr. [Edited] from [Edited] and [Edited]. Dr [Edited] was not so long ago on A Current Affair, flogging a potion called Macrolane, which enables women to have a boob job via injection! Marvellous isn’t it? This insanely expensive procedure has not yet been passed by The Theraputic Goods Administration in Australia, but that didn’t stop Dr. [Edited] from making sure that eveyrone knew HE was the one doing the “Tiralls”. In this crass peice of marketingm Dr. [Edited] did not mention any “risks”, he underplayed the real extent of pain that women are often in afterwards and he didn’t mention the fact that the jury is not out on the safety of Macrolane, with many doctors believing it to be potentially dangerous and others who are very concerned that women cannot feel lumps in their breasts while this “stuff” is inside them. The “advertorial” went against all the advertising guidelines laid down by the Medical Practitioners Board of Victoria and the ACCC, but despite this, the health commissioner, Beth Wilson, went on the show to warn women not to believe that all things are safe simply because they are said to be so. I want to know why our Health Commissioner was wasting time with this narcissistic plastic surgeon, rather than pulling his segment, which would have been in line with the regulations. This flogging of macrolane came after Dr. [Edited] massacre of Kerry Mullins via his suggested mum’s make-over. Yeah – wow – what a mum’s makeover. Dr. [Edited] even told Kerry Mullins to stop breast feeding her baby so that she could have the breast implants. It’s hard to believe that such a mentaililyt exists in “health care”. And that’s the real issue here. These kinds of doctors should not be registered as “health care professionals”. The real push for change should come via definition. Plastic/cosmetic surgery is here to stay. It’s not going away. In some cases, it is justified perhaps. However, Dr. [Edited] is not a health care professional as much as he is the owner of a seriously big business with an income closer to an oil sheek than a surgeon. So- Why not push for “surgeons” like him to be registerd as “BEAUTY THERAPISTS WITH MEDICAL AND SURGICAL TRAINING”. Then we would approach them with the same buyer beware attitude that we might apply to a house renovator or a plumber- except that these tradies are far more honest. Women should join forces to stop this shocking level of disregard for the female body and write about it, whenever and however they like.
    Moderator: this comment has been edited.

  5. Melissa Sweet says:

    Just for the record, I have no professional connection with Maurice Blackburn whatsoever. I was approached by them asking if I’d be interested in a post on this case and I thought it worth posting because of the public interest issues involved. Clearly Maurice Blackburn has an interest in talking about this case and related issues, but their authorship is clearly disclosed, and I’d assume most Croakey readers would be sensible enough to draw their own conclusions about the merits of the issues raised here.

  6. Stanley-Clarke Helen says:

    I have my own case happening at the moment which involves an Australian cosmetic surgeon, HQCC, AHPRA, the Medical Board of Aust, legal representation for the Board and QCAT.

    My dealings with all of these entities and people have shown there is a lack of integrity in the Medical field and I have created a petition to the Ministerial Council for appointments to the Medical Board of Australia to update legislation to include a mandatory oath of impartiality for members appointed to the Board and they be made accountable for the decisions they are making.

    PLEASE – anyone who also believes legislation needs to be updated to account basically for the lack of integrity within this profession and the agencies engaged to deal with complaints from the public regarding any medical practitioner – whatever field they operate in – SIGN the PETITION. Link Below.

    http://www.gopetition.com/petitions/medical-board-of-australia-oath-of-impartiality.html

    I found this website when I googled ‘advertising laws cosmetic surgery’ but see the last comment was in Sept 2010. Obviously things have gotten worse since that time
    and I am looking into what I can do to update the advertising laws as well. The Law is way too lax in both of these areas.

    Where it fails is back when the original National Scheme was set up by COAG. The Ministerial Council is responsible for appointments to the Board but the only requirement is that they are professionally qualified for the position. It failed to take into account that the very success of the Scheme depended on the integrity of each member of the Board and person engaged in the process;

    Health Practitioner Regulation National Law Act 2009 states this:

    4 How functions to be exercised

    An entity that has functions under this Law is to exercise its functions having regard to the objectives and guiding principles of the national registration and accreditation scheme set out in section 3.

    The Ministerial Council are not empowered to insert themselves into the day to day business of the entities concerned, they appoint the members and must abide by legislation in this regard though. Board members are not responsible for the decisions they are making regarding public complaints about medical practitioners. A public petition to this body is the first step (I know of & am capable of doing) in presenting a Bill to parliament to update legislation.

    The success of the Scheme then depends on whether each of the people involved in the scheme are PERSONALLY abiding by the objectives and guiding principles of the national registration and accreditation scheme. (The Scheme)

    I have presented Affidavit proof to QCAT that my allegations against the surgeon involved are true and requested a review of the Medical Board decision in my case. The Board has taken legal action against me to prevent it.

    On the petition is a link to my website where relevant documents and records can be viewed along with photos and details of the event (sans names of course). Anyone who does not have their own reasons for deciding to sign the petition is welcome to view this information – everything is under menu option Medical Board only – the rest of the website is not related to the Board, its just my website.

    I would really appreciate any feed-back from people – even opposing views are welcome, I believe in this petition and the need for it but these Laws affect every person in Australia as it is a National Scheme and each of us need to decide for ourselves. Here is the link again.

    http://www.gopetition.com/petitions/medical-board-of-australia-oath-of-impartiality.html

    Cheers

    Helen

  7. Stanley-Clarke Helen says:

    Website http://WWW.theenchantedgardenau/cosmetic surgery. A MUST SEE FOR ANYONE CONTEMPLATING COSMETIC SURGERY IN AUSTRALIA.

    Helen Stanley-Clarke

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