Family physician jailed for assault after botched cosmetic procedures.
Editor’s note: Media reports of non-ABPS-certified physicians who have left patients injured after going beyond their core training to perform cosmetic surgery procedures, have unfortunately, become all too common. However, recent weeks have seen an encouraging uptick in courts cracking down on those who have reached beyond their skills and subsequently put the public at risk.
Two of the following cases present instances in which physicians without core training in plastic surgery performed cosmetic procedures with disastrous results. In one, a family physician whose license had already been restricted to disallow facial surgery continued to perform several facial procedures that went awry, leading to his eventual guilty plea to an assault charge. Another details the case of a radiologist accused of substandard and damaging liposuction resulting in a lawful search of his home and office by his state’s medical board.
The third case outlines a court ruling holding a publisher responsible for fraud after a deceptive Yellow Pages® ad led to a patients disfigurement after a liposuction procedure.
A Canadian family physician who ignored a College of Physicians and Surgeons of Ontario (CPSO) – imposed restriction prohibiting him from performing facial surgery was sentenced to nine months in jail late last year.
Vincent Cheng, 43, Ameliasburg, Ontario, pled guilty to two counts each of aggravated assault and assault causing bodily harm for performing facial cosmetic procedures on two women that resulted in complications.
Cheng received a restriction against performing facial surgery by the CPSO in 2004, after several patient complaints were lodged against him beginning in 2000.
The criminal charges of aggravated assault and assault causing bodily harm resulted after two patients confirmed to police that they never would have consented to surgery by Cheng in 2005 had they known his license was under restriction, according to Ontario Police Detective Sgt. Mark Allison.
“In Ontario, you actually can ‘consent’ to an assault, which involves the use of force,” Allison says. “For instance, two guys in a fight give their implicit consent. But these two women would not have consented to the surgical activities had they known about Cheng’s restriction; therefore, they couldn’t consent to the ‘assault’ – the use of force. It becomes ‘aggravated’ because the assault resulted in maiming, a wound or disfigurement.”
Police launched their investigation after the two patients complained that Cheng- whose medical license was permanently revoked by CPSO in October 2006- performed a blepharoplasty and breast augmentation, respectively, in his office-based facility that left them with complications requiring correction by plastic surgeons.
“He knew he wasn’t suppose to be doing these (procedures) because the CPSO was clear in its intent when it handed down his license restrictions,” Allison syas.
While serving as plastic surgery division chief at the University of Toronto, PSEF President Peter Neligan, MD, Seattle ( who was recently named director of the Center for Reconstructive Surgery at the University of Washington Medical Center) was asked by the CPSO review the case. Dr.Neligan also served as a witness for the prosecution during sentencing.
To fulfill the CPSO roel, he requested 25 random charts that he pored over before a face-to-face meeting with Cheng.
“I found from the charts that his documentation was completely inadequate, and that’s dangerous,” Dr. Neligan says. “For example, in liposuction cases he didn’t document the amount of aspirate and how much fluid he had administered-and these were but the tip of the iceberg.”
“During our meeting I asked him about training, but the only plastic surgery training he had was as a medical student rotating on the plastic surgery service. I said, ’In other words, you’ve had no training in cosmetic surgery?’ He agreed that was the case. And his lack of knowledge of basic anatomy was frightening.”
During sentencing, Canadian Justice Richard Byers criticized Cheng for “becoming so greedy he became an outlaw,” according to an article by the Osprey News Network, owned by the Sun Media Network, Ontario. The article noted that Byers also criticized the CPSO for what he called its lack of oversight of Cheng: “I get the sense that the people in charge-the College- knows about this problem [of rogue physicians], but they can’t get their act together to deal with it,” Byers said.
CPSO spokesperson Kathryn Clarke says the College is working to strengthen patient safety in part by submitting proposals to the Legislative Authority of Ontario-similar in function to U.S. state legislatures-to give the College the ability to accredit office-based surgical facilities, as well as disallow physicians from advertising services for which they are not formally trained.
“We would like the ability to go into facilities to see how physicians are performing, look at their equipment and the personnel they work with and see how the facility is set up,” Clarke Says.
“We also would like the authority to prohibit physicians from using the title ‘surgeon’ or the word ‘surgery’ in their advertising if they aren’t board-certified as such,” she adds.
“Patients need to have the right information.”
In December, the Legislative Assembly of Ontario introduced the legislation as an amendment to the Regulated Health Professions Act of 1991.
Clarke says these proposals would have been introduced regardless of the Cheng case.
“He wasn’t specifically linked to this,” she says. “His behavior certainly was in the background, but it wasn’t the sole reason for moving forward with our initiatives.”
Dr. Neligan agrees with the College’s approach of submitting its own legislative proposals to better protect patients.
“It needs to do this if it’s going to prevent regulation from government-meaning having its oversight functions controlled by people other than physicians,” Dr. Neligan says. “Physicians should be making sure that they are protecting their patients.”
Radiologist ‘liposuclptor’ leaves county after home, office searched.
A Beverly Hills-based radiologist who performed liposuction procedures and used the modified aspirate to per his diesel fuel SUVs has reportedly left the country after the Medical Board of California conducted a search of his home and office on Nov. 14.
Search warrants targeting Alan Bittner, MD, were executed following several patient complaints, according to the Canyon News (Beverly Hills, Calif.). the Medial Board declined to release details of the case.
The Los Angeles Daily News reported Dec. 29 that several patients filed civil suit in 2008 against Dr. Bittner, medical director of Beverly Hills Liposculpture, for allegedly allowing his girlfriend-who does not hold a medical license-and an assistant to perform liposuction procedures that left the patients disfigured.
The Medical Board and San Francisco District Attorney filed suit against Dr.Bittner in 2003 for posting information on his website that was not based in truth, according to a Medical Board spokesperson, who declined to specify the alleged infraction. She added that Dr. Bittner corrected the information, and that no further action was taken against him at the time.
On his website (www.dralanbittner.com), Dr. Bittner’s website reports that he has left the United States for South America, in order to volunteer at a small clinic. “I am going back… to volunteer with a small clinic that is very similar to where my medical career began decades ago, where I can help those most in need,” according to the website.
Dr. Bittner gained attention last year for reportedly using liposuction-derived fat to power diesel vehicles although the practice of using human medical waste as fuel is against California law, according to Discover magazine’s online version (www.discovermagazine.com).
Misleading Yellow Pages ad leads to lipo ‘disaster,’ fraud ruling
An Oregon woman who underwent a liposuction procedure in 1997 by a dermatologist she believed was ABPS-certified-based on the physician’s deceptive Yellow Pages® advertisement-suffered a plastic surgery “disaster” that led to a $1.32 million fraud judgment against publisher Dex Media Inc. The decision was upheld by the Oregon State Supreme Court in late 2008.
At issue was Dex Media’s failure to properly consider “reasonable foresee ability” for consequences related to its printed material. The patient, M.M. Knepper, settled out of court in 2005 with the dermatologist Timothy Brown, MD for $175,000, according to the State Supreme Court decision obtained from the Oregon Judicial Department Appellate Court Decisions website (www.publicatoins.ojd.state.or.us).
Dr. Brown used a Yellow Pages advertisement to announce that he was “board certified” – but it did not refer to his certification in dermatology-which prompted Knepper to choose him for a tumescent liposuction procedure that resulted in chronic pain and misshapen skin. ASPS Life Member Lloyd Hale, MD, who testified as an expert witness on Knepper’s behalf in 2002, described her outcome as an “uncorrectable disaster”.
The State Supreme Court ruling affirmed the $1.32 million jury verdict against Dex for allegedly publishing the advertisement that misrepresented Brown’s qualifications with knowledge that the information contained within was inaccurate. In fact, the DEX sales representative convinced Dr. Brown to drop the reference to his dermatology certification in the ad, as well as place it under the heading, “Surgery, Plastic and Reconstructive,” the court document states.
However, Dr. Brown began performing liposuction only after receiving some limited informal training in how to perform that procedure,” according to the document.
Knepper testified that she never would have consented to the procedure by Dr. Brown had she known that he was ABPS-certified. Her pain and misshapen skin could not be corrected even after two follow-up procedures by Dr. Brown.
Dex attorneys argued that fraud was not present in this case, because there was no evidence the injury to Knepper was “a reasonably foreseeable consequence of the defendant’s conduct” – that there was no way to establish that by printing the ad, the publisher should have known that the adverse result was possible.
The state Supreme Court rejected that argument. “Dex had reason to expect that… and adverse result was more likely if Brown, rather than a board-certified plastic surgeon performed the liposuction,” it stated.
Dex also based its claim of innocence on the plaintiff’s failure to prove that it “acted maliciously, with the intention to harm another, or in reckless regard of consequence.” This, too, was rejected by the court: “This is not a case of the unwitting publications of an advertisement that turns out to be false. It is, instead, a case in which the publisher took a knowing and active part in the perpetration of the fraud.
“An advertisement that misrepresents a medical provider’s qualifications self-evidently creates a risk that a consumer who seeks treatment from the provider in reliance on that misrepresentation will suffer an adverse result that would not have occurred if the provider’s qualifications had been as represented,” the court stated.
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