Many of us have been shocked by reports of how badly cosmetic surgery patients have been let down in Australia, reports we only know about thanks to courageous whistle-blowers.
Sadly, these are just the latest in a number of high-profile cases that show both regulation and the systems designed to protect and support patients remain insufficient when it comes to the cosmetic surgery industry.
It is well past time to clean up the industry with meaningful regulatory and legislative reform, and to stop tinkering around the edges. As part of this, it is also timely to review the compensation available to patients who suffer from botched cosmetic procedures, and to make sure that proper checks are in place to help patients weigh the risks attached to cosmetic surgery, including with their GP.
While the most recent cosmetic surgery review outlined a range of welcome recommendations, one area that has not yet been properly looked at are the gaps in compensation for those who suffer adverse consequences as a result of negligent cosmetic procedures.
In our common law system, damages are available to compensate patients who suffer injury or loss as a result of negligent medical treatment, including damages for pain and suffering.
However even where an injury can be shown to be the result of negligent care such damages may be limited, either because a rating system limits claimable amounts to largely modest sums or because permanent impairment thresholds must be met in order to qualify for compensation, as occurs in Victoria.
While this system works effectively for most serious injuries whilst also helping to manage overall compensation costs, for some injuries such as those from cosmetic procedures, this can be a barrier to justice as disfigurement injuries in particular may not always reach such a threshold, despite the devastating and long-lasting impacts these injuries can have.
This poses significant challenges for those patients impacted to seek fair compensation for harm caused and it also means that much-needed accountability and scrutiny that can come with pursuing a claim is lost, including highlighting poor practices that can help to drive safety improvements and better manage risks.
Another area where reforms have not gone far enough is around proper oversight when it comes to ensuring patients are properly aware of their options when considering cosmetic surgery, including making sure this is first discussed with their GP.
Unlike other specialist medical professions, cosmetic surgeons at present are able to solely assess patient suitability for a cosmetic surgery procedure. This can all be done without a patient having to seek a GP referral first, which is at odds with any other patient seeking specialist treatment.
While the recent review did recommend a strengthening of pre-procedure guidelines, including around psychological screening, the concern is that this will not be enough and it’s crucial that AHPRA now also look at the requirement for a GP referral prior to a cosmetic surgery procedure.
Such a measure is vital to add a much-needed layer of protection for patients as well as working to ‘slow down’ the process, affording crucial time for a patient to reflect and discuss their intentions with a health practitioner familiar with them and their medical history, whilst also ideally better ensuring procedures don’t happen without further checks and balances – something particularly important in the cosmetic surgery industry, where some specialists have too often prioritised profits over patient safety.
That oversight is also vital given that both AHPRA and the Medical Board lack the legislative power to check practitioner compliance with the guidelines. The AHPRA guidelines also recommend cosmetic surgeons offer a range of alternative options to patients – especially if a procedure is not in their interests – but the current expose of cases makes clear that this is not happening and shows that a further level of protection, including having a discussion with a GP, is warranted.
Meaningful reform must also come from legislative change to ban doctors who perform cosmetic surgery from calling themselves ‘surgeons’, regardless of their surgical training or qualifications. Specialist surgeons, such as plastic or orthopaedic surgeons, cannot use this title without undertaking accredited surgical training and it defies belief that doctors can call themselves ‘cosmetic surgeons’ without a similar level of training, with many patients unlikely to be aware of the distinction.
Indeed, the term ‘surgeon’ carries enormous weight in the community and assumptions are clearly made about the expertise of a person using it. Allowing the term to be used by those who have not undergone specific training creates confusion and is misleading, undermining both the consent process and patient safety. It is therefore welcome that Health Ministers have now also agreed that ‘surgeon’ must become a protected title.
After everything we have learned through repeated media exposes, keeping patients safe from injury must now be the number one priority for all governments and regulators when it comes to the future of our cosmetic surgery industry.
As a medical negligence lawyer, I’ve seen too often patients who have not appreciated the enormity of cosmetic surgery or been left forever debilitated and traumatised by the permanent disfigurement they have been left with.
We can and must do better.