For the Sake Of Appearances

<v Narrator>The following program contains graphic scenes of surgical operations. <v Preacher (Home Video)>Love is not happy with evil, but is happy with the truth and love never gives up. Its faith, hope and patience never fail. Love is eternal. Let's bow our heads in a moment of prayer. <v Tom Thompson>This was the start of a new life for Gail and Carmen ?Albom?. A second marriage that both hoped would last forever. <v Preacher (Home Video)>So long as you both shall live. <v Tom Thompson>Shortly after the wedding, Carmen decided to have cosmetic surgery to correct a cesarean scar. <v Gail>She wanted to have it done, uh, so she would be prettier. She was beautiful enough without, with the scar I mean. <v Tom Thompson>Gail says the morning of surgery, the doctor offered Carmen a bargain on liposuction, a procedure that vacuums fat out of the body. <v Gail>Turned out that the procedures that were done was thigh, the flank, the knees and the upper arms, and the scar tissue on her stomach was never touched. <v Tom Thompson>After the operation, Carmen was wrapped in a body stocking from her neck to her ankles and sent home. Two days later, Carmen was in excruciating pain. Gail took her to the emergency room where doctors removed the body stocking.

<v Gail>Her whole complete body was taken over by infection. It reached her brain. She went into a coma. <v Tom Thompson>10 days later. Carmen was pronounced dead. <v Gail>They convince you that this thing is a piece of cake, it's a very simple thing to have done. We can have you in and out in a couple of days. No risk. No risk involved, and uh, we believe 'em. <v Tom Thompson>Each year a growing number of Americans like Carmen ?Albom? give in to the seductive promises of cosmetic surgery. Many have dramatic positive results. But for some, it is the picture of irony when healthy people die for the sake of appearances. An estimated 3 million Americans will undergo surgery this year to improve their looks. That's a nine hundred percent increase since 1981. Baby boomers approaching middle age and already obsessed with youth and fitness are now turning their hopes and disposable incomes to cosmetic surgery. <v Plastic Surgeon (1)>Make a fist, please. You see all the fat spreads.

<v Tom Thompson>Just last year, Americans spent a billion dollars to surgically redesign their bodies. But this industry, steeped in glamor, youth and beauty, is also fraught with dangers. <v Plastic Surgeon (1)>Extend your fingers, please. Extend, open. <v Tom Thompson>Hello, I'm Tom Thompson. According to investigators for the state board of Medical Quality Assurance in California, there are more unqualified doctors practicing in cosmetic surgery than in any other field of medicine. In fact, some investigators and even doctors are warning that the field has become a public health menace. In this program, will examine how the lack of regulations by the state of California and the medical profession have left the consumer dangerously unprotected. <v Tom Thompson>This is where plastic surgery began: in the trenches of World War One. As army medics reassembled the bodies of wounded soldiers. In the process, they created a new medical specialty dedicated to reconstruction. <v Plastic Surgeon (2)>Could you do right in that area there?

<v Plastic Surgeon (3)>You could, uh - <v Tom Thompson>Today, plastic surgeons still heroically restore victims of burns and birth defects. Only now the specialty is better known for sculpting torsos, adding cleavage, changing profiles and erasing wrinkles. Plastic surgery is the new frontier in America's quest for physical perfection. <v Mark Gorney>America is crazy in love with young and beautiful, young and beautiful. It doesn't swing in this country. <v Female Patient (1)>Dr. Brennan is going to remove fat from a certain part of my body and put it in my hands. <v Female Patient (2)>Before I had my tummy tuck. I had considered having a couple of ribs removed to maximize the narrowing at my waist. <v Male Patient (1)>I've had uh upper eyelid surgery, I've had lower eyelid surgery, I've had liposuction on my chin. <v Female Patient (3)>I'm having my lips made a little larger. <v Speaker>We can make a lip larger today and make it smaller tomorrow. <v Tom Thompson>Ninety five percent of cosmetic surgery is now performed in doctors' offices. In some cases, people walk out of the office with a new face and under three hours. This arrangement costs about half as much as having the procedures done in a hospital. However, with the added convenience and affordability of outpatient surgery centers, there are additional risks. There's no one watching over what a doctor does in his private office. Dr. Mark Gorney is a past president of the American Society of Plastic and Reconstructive Surgery. He operates in both hospitals and outpatient surgery centers.

<v Mark Gorney>A lot of these offices are as well-qualified or as well equipped as hospitals. On the other hand, there's no checks and balances. No one controls who is doing what in that office. Many individuals are not cannot get hospital privileges, so they'll open up their own office or their own surgery center and have at it. <v Tom Thompson>Traditionally, operations have been performed in hospitals where high standards of care are assumed. Before doctors can perform surgery, their qualifications are reviewed by other doctors. Anesthesia is administered by specialists and life-saving support systems are nearby. However, these safeguards are not required by law. Consequently, they are not always applied by doctors operating in their private offices. Dorothy Dick learned about this lack of regulation after a tragedy that shattered her life. <v Dorothy Dick>I received a call from Dr. Lipton's office and it was the doctor telling me I had better get to his office immediately. And I started to shake and he said, just get here right away. Something has gone wrong with little operation we were doing on Denise.

<v Tom Thompson>Denise ?Fulbear?, Dorothy',s daughter, went in for a chemical face peel, a relatively simple procedure to soften wrinkles. At 9 a.m., she entered a surgical suite in this Brentwood building and had these pictures taken by noon. Denise was dead. Complications from anesthesia. <v Dorothy Dick>And the doctor put his hand on my shoulder and just shook his head. And I said, You don't mean she's gone? And he said yes, and I immediately slumped into a chair. <v Tom Thompson>Dorothy blames Dr. James Lipton for not having an anesthesiologist present. <v Dorothy Dick>The consent form Denise signed said a physician anesthetists would be in attendance. And one did not show up. And yet he went ahead with the procedure, assuming that he could take care of it should any emergency arise? And he couldn't. He obviously couldn't.

<v Tom Thompson>Even though administering anesthesia is one of the trickiest parts of any operation, there are no laws requiring anesthesiologists to be present. Some doctors operating in their private offices try to perform the surgery and administer the anesthesia at the same time instead of paying for a licensed anesthetist. This is Dr. Lipton, as he testified at a deposition in the lawsuit filed by Denise's mother. He had his office manager, Carol ?Lemos?, assist him with Denise ?Fulbear's?, anesthesia. <v Carol ?Lemos?>He inserted the IV, he started the procedure. And as directed by instructed by Dr. Lipton, I did the ?CCs?, yes. <v Tom Thompson>At times, Dr. Lipton also put ?Lemos? In charge of monitoring Denise's vital signs while she was under the anesthesia.

<v Lawyer>And the patient always appeared to have a normal respiratory rate? <v Carol ?Lemos?>Yes. <v Lawyer>You know what is a normal respiratory rate? <v Carol ?Lemos?>120 over 80. <v Lawyer>No that's blood pressure. <v Tom Thompson>According to paramedics, when they arrived, Denise lay lifeless on the operating table. No emergency life support systems were being used to save her. <v Dorothy Dick>The only genuine attempt was to revive her when the paramedics, and they were called at 11:23 and apparently she was in trouble long before that. <v Tom Thompson>There are also no state requirements for lifesaving equipment. By the time Denise was rushed to UCLA, his emergency room, it was too late. <v Carol ?Lemos?>Before we started the procedure, she was saying how happy I go. I go Denise, you don't even need the chemical fill, I was telling her, because you're so beautiful! And, and she goes, are you kidding, Carol? She goes, I would lay my hands in Dr. Lipton's, I would lay my life in Dr. Lipton's hands. I go God, what a, what a thing to say, you know? <v Lawyer>Where did she say this?

<v Carol ?Lemos?>She said that right on the surgery table. <v Tom Thompson>Dr. Harvey Zarem, former chief of plastic surgery at UCLA, is critical of the state's failure to establish standards where equipment and personnel in doctors private offices. <v Dr. Harvey Zarem>The dangers are simply that, that we don't have any regulations that control over what a doctor does in his office. If he wanted to, he could do brain surgery in his garage and that would not be illegal. <v Tom Thompson>Another danger is that private offices like this one are especially attractive to unqualified doctors who want to practice plastic surgery. Consider the case of Joyce Palso, an Orange County businesswoman who had a tummy tuck operation in this building in Santa Ana. Palso noted in this ad that her doctor, James Dean, called his practice The Institute of Cosmetic Surgery Medical Group. He advertised breast surgery, eye surgery, facelifts and tummy tucks. However, what Palso did not find out until it was too late was that Dr. Dean was actually a general practitioner who had never attended a residency program in plastic surgery or any other kind of surgery. After the operation, an infection developed that the doctor failed to treat. <v Joyce Palso>I became short of breath. My coloring was turning gray, edema in my left ankle, and I kept complaining about this every time I was in, and he'd just say, don't worry about it, it's gonna be OK.

<v Tom Thompson>Palso ended up in the emergency room. <v Joyce Palso>They discovered that the infection from the wound had gotten into the bloodstream, into the lungs and into the heart. There was vegetation on the mitral valve in the heart. <v Tom Thompson>She had to undergo open-heart surgery. <v Joyce Palso>I have an artificial mitral valve in my heart. And so I'm on Coumadin, which is a blood thinner, and I am on that for life. So I have to be very careful about bleeding. So no, my cardiologist not all- or, yeah, cardiologist will not allow me to have reconstructive surgery. So I live with the scarring for my life. <v Tom Thompson>In California, once a person is licensed as a medical doctor, he or she can practice in any specialty with no additional training. Most hospitals require physicians to complete a residency program before they are given privileges to practice in a specialty. However, there is no one setting such standards for doctors in their private offices. Dr. Zarem explains. <v Dr. Harvey Zarem>The only regulations that go on are within the hospitals themselves. In other words, if I have an operating room in my office, I can tell somebody I'm a neurosurgeon or I'm a plastic surgeon or an orthopedist and I can perform these on the individual without any specialty training or any credentials or expertise.

<v Female Interviewer>And that's legal? <v Dr. Harvey Zarem>It is 100 percent legal. It's stupid that it's legal and it's being done. <v Tom Thompson>This means that even though the American Medical Association requires a five year residency to become board certified in plastic surgery, doctors without this training can legally advertise themselves as plastic surgeons. In fact, our study of the 1988 Beverly Hills Yellow Pages revealed that of 133 doctors listing themselves as plastic surgeons, only 62 were A.M.A. board certified plastic surgeons. 31 are ear, nose and throat specialists. 7 or ophthalmologists, 3 are dermatologists, 2 are general surgeons. 28 are not board certified in any specialty. Plastic surgeon Mark Gorney believes the reason so many doctors are eager to move into plastic surgery is simple: money. <v Mark Gorney>They see plastic surgery as the last refuge of the pirate or the free ?booter? because you can charge what the traffic will bear because most of the aesthetic procedures are not covered by insurance. They're not covered by Medicare, and they can charge what they please or so they think. And so all kinds of people are pouring in to what they see as a very lucrative specialty where they can maintain their standard of living without necessarily getting involved in insurers in that kind of thing.

<v Tom Thompson>Some of the movement by doctors into plastic surgery poses no problems. For example, ear, nose and throat specialists have extensive training in facial surgery. They are experts in cosmetic surgery procedures such as facelifts, eyelids and nose surgery. However, some ear, nose and throat specialists are moving into areas not covered in their residency program. Dr. Donald Weissman, for example, is an ear, nose and throat specialist who advertises breast operations and tummy tucks. This is his office in Beverly Hills. "Donald Weissman, plastic and reconstructive surgery." DB ?Barone?, a professional model, went to Dr. Weissman for breast surgery. <v DB ?Barone?>Of course I thought he was a plastic surgeon. I'm talking to him about breast augmentation and he's telling me it's gonna be a piece of cake and he does it all the time.

<v Tom Thompson>Barone regrets not checking further. <v DB ?Barone?>I had been through three operations, one side being lopsided, then a reversal, the other side being lopsided, grossly scarred. Also, um, I lost, um, full use of my arm after the second operation. It doesn't go up all the way. <v Tom Thompson>Last February, the attorney general's office filed an accusation recommending that Dr. Weissman's license be revoked. The accusation contains numerous allegations of gross negligence and incompetence dating back to 1984. Deputy Attorney Generals defend. <v Speaker>Uh one of the allegations alleges that Dr. Weissman is advertising the availability of medical services for which he, in our judgment, is not qualified either by training or experience to perform. <v Tom Thompson>Dr. Weissman is still practicing cosmetic surgery. A hearing on his case is set for early next year. He declined to be interviewed for this story. Some dermatologists are also advertising plastic surgery. This one offers breast enlargement and this one, liposuction. At this office in Irvine, dermatologist Jeffrey Klein has set up practice in plastic surgery.

<v Dr. Jeffrey Klein>In my office, we mostly do liposuction surgery, chemical peels, dermabrasions, some eyelid surgery, and the occasional facelift. <v Tom Thompson>Although he did not go through a plastic surgery residency, Dr. Klein feels qualified to perform these procedures. He learned liposuction, surgery to vacuum fat out of the body at weekend seminars like this one last spring. Klein attended four such seminars before trying the technique on his own. <v Dr. Jeffrey Klein>There are lectures and obviously you're standing right in the operating room, being able to talk to the surgeon and ask questions. And after three or four days of this, you've seen basically all of the routine techniques. <v Dr. Harvey Zarem>For people to go to a course or listen to a video or read a book is a farce, and to pretend that that is a course in surgery. Why would we want an individual to train for five years to become certified in general surgery or seven years to become certified in plastic surgery or five years and otolaryngology if we can take a weekend quickie course and do the same thing? I think that it is rather naive of anyone who would think that this kind of um pseudo training would have any meaning whatsoever.

<v Dr. Jeffrey Klein>I think it's pure arrogance for someone to say simply because they spent four years in general surgery and then four years or three years in general plastic surgery, that they should be better at dealing with skin than a dermatologist who has spent many years studying studying skin. <v Mark Gorney>And what if he gets a pulmonary embolism? Will he know what to do with it? What if he gets a massive infection? Will he know what to do with it? What if he gets a large hematoma? Will he know what to do with it? You've got to have the core knowledge that comes with general surgery training. <v Tom Thompson>The lack of uniform training in the field of cosmetic surgery makes it difficult for consumers to know whether a doctor is qualified. Joyce Palso called UC Davis Medical Center before deciding on Dr. Dean.

<v Joyce Palso>UC Davis said, be sure you get a board-qualified surgeon. I looked at his credentials and it said he was a member of the board of Cosmetic Surgeons. And so I set up another appointment and then we made it the date for the surgery. <v Tom Thompson>Again, what Palso did not know is that not only are doctors not always what they appear to be, neither is board certification. For instance, the American Board of Cosmetic Surgery, listed on Dr. Dean's resumé, is not recognized by the A.M.A. certifying board, the American Board of Medical Specialties. Instead, it was started five years ago by Dr. Richard Aaronson, an ear, nose and throat specialist and other doctors who simply decided there was a need for a new specialty in cosmetic surgery. <v Dr. Richard ?Aaronson?>I would be having interviews with patients and they would say, well, Dr. Aaronson, you're going to do my nose. Are you certified, board certified in plastic surgery? And I'm very honest fellow. I said, no, I'm not. So I just wanted to establish something that when people ask me if I'm certified I can say yes I am certified. I didn't know why no one else had done it before. I just decided to incept a board and I did.

<v Tom Thompson>Its members include dermatologists and gynecologists who advertise themselves as board certified and board certified cosmetic surgeons. The new board angers many A.M.A. board certified plastic surgeons. <v Dr. Harvey Zarem>To create a board that is not recognized by the American Board of Medical Specialties is clearly an effort to create chaos and confusion in the minds of the public and the profession. These are people whose standards are low, whose integrity is questionable, and who are simply out for their own personal gain and economic purposes. <v Dr. Richard ?Aaronson?>It's, uh, dollars and cents, although they will claim that they're trying to protect the public for not getting harmed by these specialties, these so-called bogus specialties or for any cosmetic surgery. What they're really doing, they're not protecting the patient, they're protecting their pocketbook. <v Tom Thompson>Traditionally, the AMA has set the standards for board certification. It recognizes the American Board of Plastic and Reconstructive Surgery, which requires a three year residency in general surgery and a two year residency in plastic surgery. The cosmetic board, which is not recognized by the AMA, does not require a surgical residency. Its members must simply perform a thousand cosmetic operations.

<v Dr. Harvey Zarem>The number of cases that a person do is absolutely meaningless. You know, I've hit a golf ball a thousand times, but I don't qualify for the Masters. Um, numbers means zero and not not a little bit, zero. If you're not doing something right, what difference how many times you do it? <v Tom Thompson>There is a growing number of other credentials being advertised, a confusing situation for consumers. DB Barone was impressed by the certificates on her doctor's wall. <v DB ?Barone?>There were a lot of papers that look like diplomas. You know, everything is framed. I just didn't realize how easy those papers are to get. <v Tom Thompson>Barone's doctor advertises membership in four associations, one of which requires attendance at a weekend seminar. The other three can be joined simply by paying annual fees.

<v Dr. Harvey Zarem>We say to people, you know, check people's credentials. Well, that's meaningless now because I can you and I can form the American Board of Cosmetic Plastic Surgery. We want to form a board. We can form a board. We can sell certificates, if you like. And who is gonna know the difference? <v Tom Thompson>Although most cosmetic surgeries are successful, the stories we have described represent only a small fraction of the abuses taking place in this field. <v Speaker>Here's one that's got a -. <v Tom Thompson>Sooner or later, the most serious violations end up here in the archives of the State Board of Medical Quality Assurance in Sacramento. Consumers can call this office to verify whether the board has ever taken action against a particular doctor. Joyce Palso tried this. She called before her surgery to ask about Dr. Dean. <v Joyce Palso>They told me that they had nothing on him. And this is a direct quote. Later, the California board came to interview me and told me that they had 14 cases against this doctor when I had called Sacramento.

<v Tom Thompson>At the time, Kathy Schmidt, a medical investigator for the board, was investigating complaints about Dr. Dean. She says when Palso called, there were eleven cases on file against Dean, including allegations of gross negligence and incompetence. But because these charges had not yet officially been filed with the attorney general, the board could not give this information to Palso. <v Kathy Schmidt>I felt terrible when I found out what happened to Joyce. I knew it wasn't my fault or even anyone's fault except the system's. And yet this terrible thing had happened to her. She almost died. And, you know, we had all this information, but we were not allowed to tell anyone by law. <v Tom Thompson>Schmidt admits that because the board is understaffed, investigations can take up to two and a half years to resolve. During this time, a doctor may continue to practice. <v Kathy Schmidt>We have a backlog of two or three hundred cases that are sitting in my supervisor's office waiting to be assigned. Things have changed a lot from years ago when consumers felt they could trust their physician and didn't need to be aware. But in today's society in Southern California, with a number of unscrupulous doctors, it's up to all of us to ask questions and and to be aware.

<v Tom Thompson>But asking questions is not always enough. Checking out doctors qualifications and the standards of their operating rooms is a formidable task for most people. Many believe that protection is only possible through legislation. However, so far, all attempts by the state legislature to regulate doctors' private offices have been unsuccessful. Last spring, Assemblyman Bruce Bronson introduced a bill that would require doctors performing surgery in their offices to have either hospital privileges or peer review or certification of their clinic. But like many bills proposed on this issue, Bronson's was killed in committee. He feels this was due to opposition from the medical profession. <v Bruce Bronson>Most would welcome that as a matter of professionalism. But many, unfortunately, did not. And uh, a portion of the organization of doctors in this state were the ones that really put the pressure to stop the bill.

<v Tom Thompson>That organization is the California Medical Association. It is the largest campaign contributor to state legislators and it actively lobbies against regulation of doctors. Dr. William Wyle is chairman of the CMA's Commission on Quality Care Review. <v Dr. William Wyle>Doctors are paranoid right now with a variety of regulations coming down on them through the board of Medical Quality Assurance, through Max Medicare, through that the Medi-Cal regulations so we're, we're always scared of being overregulated and and anything that mandates something, I find, I think you find the medical associations would shy away from. <v Tom Thompson>However, not all doctors agree with the CMA's position. <v Dr. Harvey Zarem>It upsets me that if I go to a soda fountain and ask for a Coca-Cola and they give me a Pepsi, they can close down the soda fountain, but that a physician can say that he's anything he wants and nobody seems to care.

<v Tom Thompson>Bronson hopes to overcome the CMA, his opposition next session when he reintroduces his bill. <v Bruce Bronson>The problem is that they are very can be a very powerful lobbying organization. And if they are against something, it becomes very difficult to get it through the legislature. <v Tom Thompson>So if history is a lesson, the prognosis for Bronson's bill becoming law does not look good. In the meantime, people considering cosmetic surgery should remember that there are no regulations in the doctor's private office beyond the laws of supply and demand. Consumers should do research before surgery and should not be afraid to ask tough questions. Check whether the operating room is equipped with life support equipment. Ask about the credentials of the person administering the anesthesia, and most importantly, ask about the qualifications of the doctor performing the surgery. As with Denise ?Fulbear?, who died on the operating table, your life could depend on it.