Amid an avalanche of bills that Governor Schwarzenegger had to consider this week, two will directly effect every cosmetic plastic surgery patient in California.
AB 1116, the Donda West Law, requires that all patients undergoing elective cosmetic surgery have a medical history, physical exam and signed clearance for surgery. and these are to be completed within the 30 days before surgery is performed.
Now this is nothing new for Board Certified Plastic Surgeons, American Society of Plastic Surgery members and American Society for Aesthetic Plastic Surgery members. I would not consider doing surgery without these safe guards in place. It is a simple way to identify patients who are more likely to get into trouble, and well worth the effort to complete.
Every patient I have operated since I opened my practice in 1997 has had a medical history, physical exam and a signed written clearance for surgery. Not because it was the law, but because it was part of my responsibility to my patients as a professional. It is how I was trained to operate.
Cosmetic surgery is elective. This means there is no emergency, and no harm is done by waiting. While at times the need may seem urgent, and I always try to accommodate your schedule, there is also the time to be safe — to review your medical history; to perform a focussed physical examination; and to obtain pertinent labs and test. This may take a little longer, and may cost a little more, but dotting all the i’s and crossing all the t’s is the best way to have a safe and predictable cosmetic surgery. Moreover, paying attention to details is exactly what I want my Plastic Surgeon to do.
This law is more the result of a doctor not doing what he was trained to do, than an indictment of how the vast majority of doctors practice. Most doctors care about their patients, and their results, so for most doctors, and their patients, this law will have no effect. We are already taking these precautions in our daily practice.
All Active American Society of Plastic Surgery members, myself included, are required to use accredited hospitals and surgery centers. Accredited hospitals and surgery centers already require a current history and physical examination be present and signed, in your patient chart, prior to surgery.
Another bill, AB 832, addresses oversight and monitoring of ambulatory surgical clinics. My hope is that this will also lead to improvement or elimination of those centers that are not up on patient safety, and that it will not become a costly burden on an important vehicle for patient care. Ambulatory surgery centers provide state of the art surgical care for patients who are healthy. Because these facilities limit the types of procedures they perform, they can be focused and more efficient than hospitals which have much higher overhead, and much sicker patients.
I respect and depend on our excellent local hospitals. Without them, I could not care for those patients who are really sick. The unfortunate victims of trauma, those who are critically ill, or those who have multiple medical problems, are not candidates for ambulatory care centers. They require the additional resources, and teams of doctors, nurses and technicians, that are only available in large institutions.
I maintain admitting and operating privileges at John Muir Medical Center in Walnut Creek, CA, across the street from my Walnut Creek office; John Muir Medical Center in Concord, CA (formerly Mt. Diablo Medical Center); and San Ramon Regional Medical Center in San Ramon, California. All are top notch, and we are lucky to have three such facilities in the Tri-Valley. But the vast majority of my cases are done in neighboring ambulatory surgery centers.
The down side to hospitals, they have sick people in them. This may seem obvious, but when you are a healthy patient having elective plastic surgery, you don’t want to be around sick people. Major hospitals also have major emergencies, and these emergencies have to have priority. For emergencies there is harm in waiting, so elective surgeries get bumped, and carefully planned schedules get delayed and sometimes cancelled.
These are just two of the reasons that ambulatory surgery center were born. Since only elective surgery is performed, few surprises arise. You are screened with a medical history, physical exam and pertinent test, so few surgeries are cancelled. The procedures are predictable, so schedules tend to be kept on time. It makes for a safe secure and very predicatable environment for elective surgery.
Without ambulatory surgery centers, doctors and surgeons could not provide the cost efficient, high level of care, to the large numbers of people needing that care, in the state of California. Our hospitals are crowded and frequently full. Every flu season, elective surgery is cancelled in hospitals because there are not enough hospital beds. If no bed, or nurse is available to care for you after surgery, you can’t have surgery. This decision is frequently made at 5:00 PM the night before and elective case, and no one is happy about it – you, your doctor or the hospital. Ambulatory surgery centers do not have this problem.
AB 832 requires the State to convene a workgroup no later than February 1, 2010, to consider and develop recommendations for state oversight and monitoring of ambulatory surgical clinics. Surgical clinics are defined as a place owned, leased or operated as a clinic or office by one or more physicians or dentists, which provide ambulatory surgical care.
My hope is that AB 832 will result in legislation similar in spirit to the Donda West law, in that, the Donda West law requires actions be taken that all good doctors would do as part of their normal practice. While it is unfortunate that some doctors need to have a law to do what is best for their patients, the Donda West law is not restrictive for those thoughtful surgeons who practice safely. The documentation required by the Donda West law is not just for site inspectors to review, but is directly useful to all those caring for the safety of my patients. The Donda West law did not require theoretical rationalizations to justify it’s passage, because it does require that all doctors do the proper preparation for elective surgery, like we were taught in our training.
The third bill, SB 630, will impact the lives of children in California born with cleft palates. It was sponsored by a group in which I am an active member, the California Society of Plastic Surgeons. This law clarifies existing law to require dental coverage needed for medical reasons for patients with cleft palates. Most California Plastic Surgeons do not do dental procedures, but most our young patients benefit from dental procedures as part of the multidisciplinary approach to repairing cleft palates. I am proud to be a member of a group that is willing to fight for the complete care of our patients, not just for the care we provide.