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SINGAPORE: Health professionals who perform liposuction without accreditation face “severe actions,” said the Ministry of Health (MINSA), but a doctor said that accreditation guidelines could be more stringent.
This comes after the Superior Court ruled in November last year that Surgeon General Dr. Edward Foo Chee Boon was responsible for the negligence in the death of his patient. He was ordered to pay around S $ 5.6 million in damages.
READ: Doctor ordered to pay around S $ 5.6 million in damages after patient died from failed liposuction procedure
“Liposuction and related procedures are generally considered the specialty of plastic and reconstructive surgeons, and Dr. Foo is a general surgeon who only attended several liposuction courses and internships abroad before practicing liposuction,” said the Judge Choo Han Teck.
File photo of Foo Chee Boon Edward. (Photo: TCS Aesthetics Central Clinic)
Dr. Foo delayed calling an ambulance even after his patient’s blood oxygen dropped to the emergency level, the court heard.
“The fact that it took 45 to 50 minutes for him to realize that he couldn’t understand what was going on forces me to infer that Dr. Foo was not adequately trained for such surgeries,” Judge Choo said.
The judge said that ultimately it is up to the health and medical authorities to define the limits as to whether a general surgeon should be able to perform liposuction surgeries.
In response to the CNA’s inquiries, the Health Ministry said that Dr. Foo was “negligent” in performing the liposuction procedure on his patient, as well as in managing her postoperative condition.
“To protect the interest and safety of consumers, the Ministry of Health will take severe measures against any licensee or health professional who performs liposuction without proper accreditation or without compliance with the conditions of the license,” said the ministry .
The Health Ministry added that it has not received “comments of this kind” on the performance of such invasive procedures in the last year. The Singapore Medical Council (SMC) is currently investigating Dr. Foo’s case and said its deliberations at this stage are confidential.
GUIDELINES FOR AESTHETIC SURGERY
Following news of the court case, questions were asked about guidelines for general surgeons who perform cosmetic surgery.
The demand for cosmetic procedures has been on the rise over the past 10 years, and the rate has dropped slightly in recent years, said Dr. Ivan Puah of Amaris B Clinic. Growth is stronger for minimally invasive or non-invasive procedures compared to invasive ones, he added.
The increase in demand is also partly related to the COVID-19 pandemic, as work-from-home arrangements allow patients to work and recover at the same time, said plastic surgeon Dr. Andrew Khoo of the Center for Aesthetics and Reconstructive at Mount Elizabeth Medical Center. .
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The Health Ministry told the CNA that invasive procedures, such as filler injections and cosmetic surgeries, should only be performed by trained doctors who must be registered with the SMC.
These physicians are also required to adhere to the SMC guidelines for performing cosmetic procedures, which were first published in July 2008 and updated in October 2008. They were last revised in 2016.
Under the guidelines, physicians who are not plastic surgeons or who do not practice other recognized specialties can still perform three types of invasive procedures: free fat grafting, hair transplantation, and mechanical dermabrasion.
They can do this as long as they have performed the specific type of procedure 10 times “to good effect” between October 1, 2006 and September 30, 2008, per the guidelines.
Doctors who do not meet that requirement can still perform the surgery if they receive a certificate of competence. As part of their application, they should include a certificate of training courses abroad or local, details of the course, the amount of practical experience and the duration of the course, among other details.
All physicians wishing to perform liposuction in medical clinics, except those employed by hospitals, must be accredited by the Liposuction Accreditation Committee (ACL), an independent committee appointed by the Ministry of Health.
They must follow the specific licensing conditions for liposuction that were implemented by the Ministry of Health and the ACL in 2015, which state that they must have received “proper and accredited surgical training”.
This means that doctors must have received one year of surgical training in a hospital after cleaning. Relevant positions are not limited to plastic and reconstructive surgery, but also include general surgery and orthopedic surgery, among other specialties.
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Doctors must also have observed at least 10 liposuction procedures under the tutelage of a qualified surgeon and have performed at least one liposuction procedure per month under the close supervision of a qualified surgeon for the past two years.
If a doctor decides to perform more than one type of liposuction, he or she must meet the same training criteria for each type of liposuction.
ROOM FOR IMPROVEMENT
The doctors CNA spoke with were divided on whether the guidelines are strong enough. There should be a minimum period of training for physicians before they begin to perform cosmetic procedures, Dr. Khoo said.
“In plastic and reconstructive surgery, for example, the training program is four years. The first years are dedicated to reconstructive surgery which is the basis of good cosmetic surgery. We are supervised, trained and audited by our superiors, ”said Dr. Khoo.
“At the other end of the spectrum, there are three- and six-month scholarships awarded by ‘certification bodies and institutions’ that will certify you in all kinds of procedures. You pay the money, you attend and you get a certificate and you put it on the wall. This can be improved. “
He suggested that specialist accreditation boards review the number of cases a surgeon has performed before allowing them to perform cosmetic procedures.
“This can be calibrated: less documented experience for less risky procedures and more documented experience for more risky and invasive procedures,” he said.
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Dr. Khoo also recognized the difficulty of regulating medical practice in individual clinics compared to hospitals, which have their own accreditation committees.
“The prohibition of procedures would affect the practice of many doctors who carry out a responsible and safe aesthetic practice. Too laissez faire an approach will lead to more mismanagement, ”he said.
Dr Puah said that Singapore’s guidelines on cosmetic procedures are “very comprehensive.”
“To ensure patient safety, Singapore (has) erred on the safe side and rightly imposed very strict guidelines on all cosmetic treatments, relative to most other countries,” he said.
The guidelines for liposuction, for example, are “one of the strictest in the world, to ensure patient safety and maintain the highest level of care for patients,” he said.
READ: Are complaints against doctors destroying the doctor-patient relationship? A comment
Going forward, regulators of cosmetic treatments will face a twofold challenge, Dr. Puah said.
“One is to keep up with the change and development in the field with flexible and progressive guidelines, to allow Singapore to keep up with the best and be a center of excellence for aesthetic procedures, as the demand of patients it’s big and it’s growing. ” added.
“The other is to guarantee the safety of the treatment and a high level of care, to eliminate the black sheep in the industry. It’s not easy to find a balance between the two, but I hope they (the authorities) can do it. “
Dr Khoo said that Singaporean doctors and specialists are generally well trained and regulated.
“Maintaining a good level of care depends on accredited training, the recognition of each professional of their own level of training and capacity and that all professionals, both general and specialist, practice at a level appropriate to their training,” he added. .
“As in all professions, there will be outliers, and regulatory bodies and the legal system can come into play here.”
Cosmetic surgery is a “completely optional” procedure, Dr. Khoo noted.
“Patient protection also comes from seeing the right surgeon, understanding the risks and benefits of the procedure you are embarking on, and being comfortable with the experience and results that surgeon offers,” he said.
“Even with this, one only minimizes the risk: properly trained doctors also have complications. The difference may be the recognition of the complication and the ability to rectify it. “
