Robert Cribb
Staff Reporters
Ontario's self-regulating medical watchdog is cracking down on family doctors who conduct cosmetic surgical procedures, demanding they prove their skills and come clean with patients about their credentials.
The College of Physicians and Surgeons of Ontario is investigating 16 doctors performing high-risk cosmetic procedures in private clinics that could be a danger to the public because of concerns about their qualifications and training.
A second group of 20 doctors have been put on notice that, if they do not answer mandatory questions about their qualifications, their licences will be suspended in 60 days.
For the first time in Ontario, the college is taking action against family doctors who call themselves "cosmetic surgeons" without having proper qualifications.
Under proposed new rules announced yesterday, the title "surgeon" will be reserved for physicians certified as surgical specialists by recognized medical bodies. Specialties such as plastic surgery take years of post-graduate medical training.
Currently, hundreds of family physicians in Ontario advertise themselves as cosmetic surgeons without any specialty designation or training.
"The regulation is to ensure people are appropriately using their title," said college spokesperson Kathryn Clarke. The change will be discussed by council again in February and, if passed, sent to the Ontario government for approval.
The death of 32-year-old Toronto real estate agent Krista Stryland prompted the college to move swiftly after years of poor policing in this area. On Sept. 20, Stryland died after Dr. Behnaz Yazdanfar performed liposuction at her Toronto Cosmetic Clinic to remove "pregnancy fat." Yazdanfar declined repeated requests for an interview.
The Ontario coroner's office is still investigating the Stryland case. No decision has been made on whether there will be an inquiry into her death. Yazdanfar continues to practise in her Toronto clinic.
Yazdanfar's website pitches her as a "premier Toronto cosmetic surgeon" with an "impressive résumé" featuring "extensive" experience, medical credentials and professional affiliations. She is not a certified surgeon.
In September, a Star investigation documented years of dithering by the medical watchdog about whether to crack down on unqualified cosmetic surgeons.
College council briefing notes and discussion papers dating back to the early 1990s, obtained by the Star, revealed years of lax standards and unenforced regulations even as college officials were quietly raising concerns about family physicians conducting cosmetic procedures without oversight or training.
Three weeks after the Star story was published, the college sent mandatory surveys to 406 physicians requesting details about their cosmetic procedures practices to determine whether they should receive "a practice assessment" by the college.
College officials yesterday refused to name the 16 doctors who are the subject of "immediate" action.
"The 16 we know to be practising in a high-risk circumstance where they are doing relatively invasive procedures out of a hospital setting by individuals who may not be adequately trained," said Dr. Jeffrey Turnbull, the college president.
The 16 will be evaluated by trained physician assessors as soon as possible, officials say. But those doctors have the right to continue practising until that time.
"We won't release the names until we can do due diligence and ensure these people are appropriately trained. But I can reassure you we will be reassessing them properly," said Turnbull.
If patients have questions about their doctor, they should look at the college website at cpso.on.ca, said Turnbull. The college recently posted tips for the public on what questions they should ask about a physician's qualifications before they undergo a cosmetic procedure.
Beyond the doctors, when the procedures are performed outside of a hospital at "independent health facilities," the college wants to inspect the premises and equipment used.
Every physician who performs cosmetic procedures at one of these facilities must inform the college in writing of what services they intend on providing and they must submit to an inspection that could include direct observation of the performance of procedures. The inspection will take place at least once every four years.
The council is making "significant steps forward" to protect the public, Turnbull said.
"We are going to start moving quickly. You'll see in the next several months we'll be out assessing many of the different practices where there are cosmetic procedures taking place in what we consider higher risk circumstances," he said.
Turnbull said the college was not bowing to pressure from the government to better police its members. He said the college was responding to the public and other doctors who are concerned.
Toronto lawyer Alan Rachlin applauded the college's changes but also said there is nothing in place to protect the public today.
"It doesn't address what do you do in the meantime? There is no protection in place for the public right now," Rachlin said. The patient questionnaire on the college website doesn't cut it for Rachlin.
"How the hell will they get that in the hands of a consumer and ensure the consumers look at it?" he asked.
"Again, if you walk into a clinic office and see 30 diplomas on the wall, are you qualified to know if those diplomas mean anything or not?"
In 1989, Toni Sullivan, a 44-year-old Unionville mother and real estate agent, died after cosmetic surgery. Her death prompted a 1990 inquest that recommended the college establish standards for quality of care at private clinics and the credentials of the doctors performing surgery there. But mandatory oversight of cosmetic doctors and their facilities hasn't been pursued in Ontario until now.
In Alberta and B.C., all surgeons and their surgical facilities must be licensed for each procedure they perform. They cannot advertise themselves as cosmetic surgeons without holding a surgical specialty. Doctors who call themselves cosmetic surgeons are not required to meet any of the strict training and oversight rules that govern plastic surgeons. In addition to five years of specialized surgical training, plastic surgeons must pass a national exam and be certified as members of the Royal College.
"I was a general practitioner before I became a specialist," says Dr. Brian Peterson, a plastic surgeon in Kelowna, B.C., and president of the Canadian Society for Aesthetic Plastic Surgery, which represents plastic surgeons.
"As a GP, you have medical school and an internship. You have no experience doing surgery and no appreciation for all those things that can go wrong. Five years of surgical training teaches you how to select patients properly and what to do when things go wrong."
Peterson recently wrote all of the provincial college registrars urging more rigour when it comes to monitoring medical advertising claims.
"Advertising should not be misleading," he wrote. "Any physician stating they are a surgeon, should hold a specialist certification in surgery from the Royal College (of Physicians and Surgeons) and hold similar privileges at their regional hospital to provide comprehensive care of patients. Anything less than this is misleading to patients and allows the potential for harm."
Karyn Wagner, executive director of the Canadian Society of Plastic Surgeons, said the public "should be made aware that there is a difference between a certified plastic surgeon and a general practitioner conducting cosmetic surgery."
The victims
Krista Stryland, 32, was a successful Toronto real estate agent and mom to a 3-year-old son. Her father, Don Tabacoff, remembered her as always smartly dressed, with flowing hair and a cheerful smile. She didn't tell anyone about her liposuction surgery. She died on Sept. 20.
Toni Sullivan, 44,, also a realtor and mother, died from a blood clot two days after liposuction surgery on June, 30, 1989. An inquest was held and the coroner's jury found her medical care suffered and her death could have been prevented.
The practitioners
The college's crackdown is aimed at family doctors who perform invasive cosmetic surgeries such as face lifts, liposuction and tummy tucks.
Regulators say these procedures should be performed by licensed plastic surgeons, who are medical doctors with five years of specialized training in surgical procedures and have hospital operating privileges.
They pass national exams and are certified as specialists in plastic surgery by the Royal College of Physicians and Surgeons of Canada.
Plastic surgeon fellows hold the designation FRCSC (Fellow Royal College Surgeons Canada), which mandates ongoing professional development. There are 441 active plastic surgeon fellows in Canada.
They also perform highly complex procedures such as face reconstruction for accident victims and skin grafts for burn victims. OHIP will pay for medically necessary plastic surgery but not procedures deemed strictly cosmetic.
The numbers
150% increase, between 2002 and 2006, in number of physicians who reported doing cosmetic surgery
6th Toronto's ranking in North America for number of cosmetic surgeries performed
17 number of years since an inquest into the liposuction death of Toni Sullivan recommended quality of care standards at private clinics and proper credentials for doctors performing surgery there
85.5% of all cosmetic procedures are sought by women
$2,500 lowest price charged for liposuction at the Toronto Cosmetic Clinic
$6,000 lowest price charged for breast augmentation at the Toronto Cosmetic Clinic
$210M amount spent on cosmetic surgical procedures in Ontario in 2003
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