Sunday, July 20, 2008

Plastic Surgery News from HADCORP ... Thanks to Pamela!

HADCORP NEWS: July 20, 2008

Leading Story

Top TV surgeon pays six-figure damages to woman who had a stroke during facelift

Daily Mail
By Chris Brooke
Last updated at 7:52 AM on 18th July 2008

A plastic surgeon has agreed a six-figure compensation payout to a woman who suffered a stroke during a facelift operation.

Diane Newbould, 53, sued Jan Stanek for negligence after she was left severely disabled, unable to speak properly and in need of lifetime care.

Mr Stanek, well-known through his role on a reality TV series, is also being sued by BBC newsreader Kate Silverton after laser treatment forced her to stay off work with an allegedly bloated face.

Mrs Newbould will never recover from the facelift and liposculpture operation at a private London hospital in January 2002.

Mr Stanek was accused of failing to take properly into account her medical history and health by going ahead with the surgery.

Yesterday Mrs Newbould's counsel, Simeon Maskrey QC, told London's High Court that Mr Stanek and the anaesthetist, who was also being sued, had agreed to a substantial settlement.

Although the payout amount was kept confidential, her solicitor, Janet Baker, revealed outside court it is 'a significant, six-figure sum'. The settlement was agreed without any admission of liability.

Based in Wimpole Street, London, Mr Stanek is considered to be a leading surgeon and has a high public profile after appearing in the Five series Plastic Fantastic, and the Channel 4 programme 10 Years Younger.

In documents before the court, Mrs Newbould's lawyers alleged not enough account was taken of her 'poor medical history'.
She was obese, a heavy smoker and her medical problems included bronchitis and hypertension.

They claimed she should have been told to 'undergo significant lifestyle changes' - particularly to lose weight and cut down on cigarettes - before surgery.

Mr Maskrey told the court that Mrs Newbould, formerly from Sheffield, was cared for after surgery by her husband, until that became impossible when he suffered two strokes.

The couple recently moved to southern Spain, where Mrs Newbould is cared for by her daughter and son-in-law.

Mr Justice Cranston approved the settlement after a brief hearing today. The family was not in court.

Miss Baker said after the hearing that the family were 'very happy' that the matter had been settled and the payout would be used to cover the costs of future care.

In January Miss Silverton reportedly instructed lawyers to begin legal action after she had treatment at Mr Stanek's clinic.

She said: 'I was told it would be a routine procedure and I'd be back to work in days.

'The treatment, however, caused a massive skin reaction.'
Mr Stanek, an Oxford-educated fellow of the Royal College of Surgeons, is a frequent lecturer on 'aesthetic surgery' and has published journal articles and books.

His practice's website refers to operations on more than 10,000 patients in the past 20 years and treatments offered include tummy tucks and breast and cheek implants.

Cosmetic doc fired for 'impairment'

Two other Beth Israel allegations date to '01

Boston Herald
United States
By Jessica Fargen
Sunday, July 20, 2008

Beth Israel Deaconess Medical Center has fired a high-profile plastic surgeon - who once criticized third-rate cosmetic doctors during a "Dateline NBC" expose - after an "impairment" issue during a surgery he conducted last month.

Dr. Loren J. Borud, 44, was fired effective Friday, the hospital said in a statement. The firing came two days after the Herald began inquiries into two previous allegations of impairment involving Borud that date to 2001. Two medical sources said Borud had been disciplined internally by the hospital twice in the past seven years.

The Board of Registration in Medicine, which investigates complaints against Massachusetts doctors, has been notified, the hospital said.

Borud was suspended June 30 following a June 27 incident at the hospital, said Kenneth Sands, the facility's senior vice president of health care quality. He would not say when the decision was made to fire Borud.

He also would not specify the nature of Borud's "impairment."

"This is a timely action related to timely events," Sands said.

The Borud incident occurred three days before an unrelated wrong-site surgery was performed at the Harvard-affiliated hospital, prompting a state investigation.

Borud runs Loren J. Borud Plastic Surgery, which operates out of Beth Israel and offers Botox, breast implants, liposuction and other cosmetic procedures.

According to his business Web site, Borud is certified by the American Board of Plastic Surgery and is a full-time faculty member at Harvard Medical School, teaching in the Plastic Surgery Residency Program.
"We pride ourselves on providing the individual care and attention of a private practice setting with the impeccable safety standards and resources of a top-tier Harvard hospital," the site says of Borud, who appeared in a 2005 "Dateline NBC" report on third-rate cosmetic surgery abroad.

Telephone and e-mail messages left for Borud on Friday and yesterday were not returned. He did not answer the door at the home in Newton listed as his address.

Borud is on medical leave "at the moment," according to an automatic e-mail reply generated from Borud's hospital account yesterday. His attorney, Bruce Singal, declined to comment.

In an interview Thursday, Sands declined to comment on Borud's work history. Asked if the hospital knew of alleged impairment issues prior to June 27, Sands replied:

"We followed all required and recommended processes, making use of the Physician Health Services in Massachusetts," a program of the Massachusetts Medical Society. "That is considered the best option in these cases."

Physician Health Services is a nonprofit corporation that provides confidential consultation and support to physicians, residents and medical students facing health concerns related to alcoholism, substance abuse and behavioral or mental-health issues.

Borud's "physician profile" on the Web site for the Board of Registration in Medicine lists no record of reportable hospital disciplinary action in the past 10 years.

By law, hospitals are required to notify the Board of Registration of suspension of privileges imposed on a physician, said Russell Aims, a spokesman for the board.

Dr. Sidney Wolfe, who directs the Health Research Group at Public Citizen, the consumer safety group founded by Ralph Nader, said what's made known to the public about physician behavior can sometimes differ from reality.

"Why should a patient not know that a physician in whose hands they are placing themselves has a substance-abuse problem, particularly when they are allowed to continue operating?" he said, speaking generally and not about this particular case.

"Wouldn't you as a patient like to know whether this doctor has a substance-abuse problem? There is a strong argument from a patient perspective that once someone has problems serious enough to go into a treatment program and they are practicing medicine it should be made public," Wolfe said.

Cowboy clinics 'will scar thousands'

Plans to end inspections of cosmetic surgeries is likely to lead to many more patients being burnt or seriously scarred, admits government report
Denis Campbell and Rowan Walker
The Observer, Sunday July 20, 2008

Thousands of people undergoing laser treatment could be left with burns and scars as a result of government plans to end inspections of clinics, the Department of Health has admitted.

Up to 3,400 more patients could be harmed by cosmetic procedures to remove a mole, tattoo or unwanted hair, according to a consultation paper on the move drawn up by Whitehall officials themselves. The change, which critics claim will allow cowboy operators to open premises that have poor safety standards because they would no longer need to apply for a licence, comes into effect on 1 October.

A two-page appendix to the paper, headed 'Deregulation of lasers and lights - possible effect on the number of adverse incidents', said that harmful outcomes may double. It reads: 'Laser and light treatments ... are potentially harmful and they will generate adverse incidents ... Deregulation would generate an extra 1,700-3,400 adverse incidents per year.' There are already an estimated 3,400 each year.

'It's shocking that the government is prepared to countenance thousands more people being injured as a result of this deregulation - and it's an astonishing thing to admit,' said David Gault, a consultant plastic surgeon who specialises in laser treatments. 'While some of these "adverse incidents" involve only minor scarring or pigmentation, people's sight can also be damaged by a powerful laser being shone into their eyes. The psychological harm from these things happening is, in my view, harsher than the physical damage people suffer,' added Gault, the British Association of Aesthetic Plastic Surgeons' spokesman on the issue.

Skin laser treatments are a booming area of the cosmetic surgery industry, with an estimated 340,000 performed in England alone annually. They are also used to remove wrinkles, freckles and unsightly 'spider veins'. Previously only found in specialist hospitals, laser machines are increasingly used in beauty salons and hairdressers. Ministers have been criticised for scrapping the existing system whereby the Healthcare Commission, the NHS watchdog for England, inspects and monitors the safety of the 900-plus laser clinics.

Critics have argued that the change, designed to lighten the commission's workload, will end up costing more money than is saved.

The paper said: 'Based on the estimate of increasing the number of adverse incidents by between 1,700 and 3,400 cases, this represents a yearly extra cost of treating these cases of between £900,000 and £1.8m.' The costs, it added, were likely to fall on the NHS.

That compares with £1.4m a year spent by the watchdog conducting initial inspections of laser surgery premises when they first register, monitoring annual self-assessment forms submitted by clinics and carrying out a further safety visit to all 922 licensed premises every five years.

Health campaigner Jenny Driscoll of the consumer organisation Which?, which has exposed malpractice in the cosmetic surgery industry, said: 'It's shameful and absolutely inexplicable that the government is introducing a policy that it admits will ultimately lead to more people being harmed. It's shocking that it could do this, especially when so many people have said "don't do this because more people will be harmed if you do".'

Even the Independent Healthcare Advisory Services, which represents cosmetic surgery operators, is opposed. 'The government's proposal means that anyone could purchase low-cost, low-quality non-approved equipment and operate it anywhere without any training or safety considerations on vulnerable adults as well as children,' said spokesman Paul Stapleton.

In a letter last week to Which? the health minister Ben Bradshaw defended the plan as 'the right way to proceed'.

A department spokeswoman said the planned deregulation of laser treatment clinics was part of wider moves to 'ensure regulation [of independent healthcare facilities] remains proportionate to the risks'.

'I felt burning ... it looked like a disease'

Danielle Brown, a 31-year-old PA, tells of the after-effects of laser treatment.

'A friend of mine had her hair removed by laser at a clinic on the south coast and she looked amazing, I wanted the same. On arrival at the clinic, they gave me a patch test. I was supposed to wait 24 hours, but within an hour I was receiving treatment, which lasted five hours.
'I had a bit of tingling, but the laser was only set at a low frequency.

The second time I went I felt burning almost straight away. The power on the laser had been increased and I got badly burnt on my arms, under arms, bikini line, on the back of my legs. I was told it was normal and I would need eight sessions. The next day the burns started to blister up , my skin was popping. I rang the clinic to explain but they weren't interested. I looked like I had a disease and everybody asked me what had happened.

'It wasn't until I went to another clinic two years later, that I realised the machine that they had used on my Sudanese skin was meant for white skin only. I think I will be scarred for life.'

Dying patient left alone for 30 minutes

Court documents detail death of realtor; college had concerns about risks at cosmetic clinic

Hamilton Spectator
July 19, 2008

The young real-estate agent who died last year after a liposuction procedure at a Toronto doctor's office was lying in a recovery room for 30 minutes with no vital signs before anyone called 911, according to allegations filed in court.

Documents detailing the death of realtor Krista Stryland also show that the College of Physicians and Surgeons of Ontario had concerns about risks to patients being treated at Dr. Behnaz Yazdanfar's busy cosmetic clinic as far back as 2002.

And just over two months before Stryland's death, another patient had serious complications after five litres of fat were liposuctioned from three body parts in a single session, according to court documents. The college alleges that Yazdanfar previously told the college that she only removes under two litres of fat at a time, and only performs liposuction on one body area per procedure. That patient survived and her family has complained to the college as well.

Stryland, 32, died on Sept. 20, 2007. The young mother had gone to the Toronto Cosmetic Clinic for liposuction. Both the hospital doctor who later tried to revive her and the coroner suggest the delay could have contributed to her death.

The college is seeking a court order to compel Yazdanfar's co-operation in its investigation of her medical practice. The court hearing is Tuesday. In support of the application, the college has filed hundreds of pages of documents. Some remain subject to a publication ban or have portions blacked out. This story is based on documents in the public domain.

Yazdanfar is not accredited as a plastic surgeon and holds no surgical designation. A Star investigation last fall documented the college's dithering around regulation of the rapidly expanding field of cosmetic surgery.

Today, hundreds of MDs without recognized surgical training continue to perform cosmetic procedures in private offices over which the college has limited oversight.

The court documents reveal a lengthy history of college involvement in Yazdanfar's practice.

Tracey Tremayne-Lloyd, a Toronto lawyer representing Yazdanfar, said each of the issues raised by the college over the past six years was "addressed and rectified."

"(Stryland) suffered her unfortunate complication in the recovery room. The surgery went perfectly fine. It was in recovery that something happened to the patient. The patient took a very sudden downturn that had to be dealt with as an emergency," Tremayne-Lloyd said.

Back in 2002, the college looked into a complaint about her lack of formal training. Yazdanfar told investigators she had taken "a course in liposuction in Colorado the previous spring and had been performing the procedure since then," court records show. Because the college had no specific standards for cosmetic surgery, the investigator concluded the doctor's training was "adequate but not extensive."

The next year, a college-appointed plastic surgeon was asked to assess Yazdanfar's practice. He concluded she had the "skill, knowledge and judgment to safely practice liposuction," but found several areas where her practice fell "below an acceptable standard of care."

For example, the assessment report said Yazdanfar's assistant, an Iranian nurse, "is not actually a registered nurse in Ontario and has not taken the College of Nurses Licensing exams." The report called Yazdanfar's practice of delegating duties such as infusions (giving fluids by intravenous) to the nurse "an unacceptable standard of practice."

Documents filed in court by Yazdanfar indicate those problems were subsequently remedied.

Other documents in the file raise alarm bells about patient safety in the years leading up to Stryland's death.

A college letter to Yazdanfar in April, 2004, stated the college was "quite troubled by the lengthy list of deficiencies at your facility, relating to sterilization and infection control practices, lack of appropriate equipment and room allocation."

A follow-up assessment last year found the cleanliness issues had been dealt with.

Throughout the documents, the college raises issues common to its general concern about unregulated surgeries.

For example, in 2006, a college-appointed assessor raised concerns about the use of anesthesia in a private clinic where the normal "protective envelope" of a hospital is missing.

"Dr. Yazdanfar does not have hospital privileges," the assessment report says. "She should therefore have at the very least, a standing relationship with the surgical department of a hospital that would guarantee the efficient, speedy and safe transportation of her patient to that hospital for ongoing surgical care in the event that it would be necessary. Instead, Dr. Yazdanfar would refer her patients to the Emergency department and depend on the medical personnel in that department to make appropriate decisions about the management of her surgical patients. When surgical complications arise requiring transfer and admission the process should be as seamless and efficient as possible."

Two months before Stryland's death, a 66-year-old patient had complications after liposuction surgery performed by Yazdanfar, the court records allege.

In a complaint to the college filed by Francine Mendelson's daughter, she alleges her mother's "fluid loss was staggering, and the fact that she was sent home in that condition was truly unbelievable," states the complaint by daughter Dr. Stacey Mendelson, a veterinarian.

The Mendelsons allege that when Francine visited her family doctor 12 days later, he immediately sent her to emergency at North York General Hospital where staff performed an ECG that indicated serious cardiac abnormalities. She was admitted and spent five days under the care of a cardiologist. The college records allege that five litres (5,050 ml) of fat was taken from the woman's abdomen, lower back and upper back in a single session. The college alleges that Yazdanfar previously told college officials she only operates on one body area per session, and only removes one to two litres of fat at a time.

Yazdanfar lawyer Tremayne-Lloyd said the Mendelson complaint has been answered in full, including an expert report that indicates "the woman was treated entirely appropriately," and said Yazdanfar "has never breached her undertakings to the college and would never do so."

Two months after Mendelson's procedure, Krista Stryland went to the clinic for liposuction surgery. Following the birth of her only child, she wanted to lose weight. When problems emerged during her operation "the patient deteriorated in the recovery room and there was allegedly some delay in calling 911," according to a memo from a college investigator.

Based on information supplied by a doctor who attempted to resuscitate Stryland, the investigator said the doctor's understanding was that "Mrs. Stryland's vital signs were absent for 30 minutes and then an ambulance was called and Mrs. Stryland was transferred to North York General Hospital. Resuscitation efforts were ongoing for two hours."

The college investigator notes that neither Yazdanfar nor the anaesthetist accompanied Stryland in the ambulance. A nurse from the clinic did come but she was "not present during the case," the investigator's memo said.

In answer to the alleged 30 minute delay in calling 911, Tremayne-Lloyd said both her client and the anaesthetist were still at the clinic after Stryland was moved into the recovery room and "it's my understanding that (the anaesthetist) checked his patient ... I think it's highly improbable that that state of facts will be proven to be true." According to her lawyer, Yazdanfar was in the middle of another surgery, so she sent her most senior registered nurse with Stryland, who had complete knowledge of Stryland's case. "They did the best they could. There is no requirement in law that a physician accompany their patient to hospital."

At the hospital, Stryland was in cardiac arrest. Doctors tried to resuscitate her, and called in Dr. Sean Rice, a certified plastic surgeon.

Rice, in a letter to the college, describes how he called Yazdanfar at her clinic to find out what happened. Yazdanfar "stated that she was a cosmetic surgeon and had performed the operation numerous times in the past." Rice asked her if there was "the potential for a possible puncture to an internal organ" but Yazdanfar said this was not possible. "Dr. Yazdanfar then asked how the patient was doing, I stated it appeared that Mrs. Stryland was not going to survive," Rice's letter to the college says.

Another memo from a college investigator says coroner Dr. James Edwards also raised a concern about a delay in calling 911.

The college's "broad investigation" into Yazdanfar intends to determine whether she has committed "an act of professional misconduct or is incompetent," court records show.

College investigators have asked to observe her performing surgery and interview her about her "knowledge, skill and judgment in cosmetic surgery" and ask questions about "specific cases under review." The college has also requested documents from Yazdanfar including her surgical schedule and information related to two patient testimonials on her website.

Yazdanfar has declined all such requests. Her nursing staff has also declined requests from the college to be interviewed.

When the college issued the summons requiring her to meet with them and produce documents, she also refused, arguing that she is not legally obligated to co-operate with the investigation.

Tremayne-Lloyd said that while Yazdanfar has provided the college with numerous charts, appointment books and other records, she will not submit to an interview or allow a college assessor to watch her practise surgery.

"It is our position that the college wish to go way beyond their legal jurisdiction and way beyond what would be considered legally appropriate. They want to force her to allow a college inspector to stand and watch her and that expert will then become the college expert in a prosecution against her ... The whole thing strains credulity that she should be forced to do that."