Writing in his column in The Irish Times this week, Dr. Muiris Houston raised valid questions regarding the lack of regulation of cosmetic surgery clinics. He asked why, for some inexplicable reason, the Minister for Health and Children established the Health Information and Quality Authority without giving it responsibility for private clinics. He also asked why a situation is allowed to exist whereby people who choose to pay for cosmetic surgery are left in a regulatory vacuum. He pointed out that in the absence of any clear-cut role for the HIQA, passing the buck from the Department of Health and Children to the HSE to the Medical Council is a poor substitute for proper regulation, a point with which I agree. He concluded his column by remarking “those choosing this option need to be aware that availing of unregulated private facilities may also result in substandard care and a potentially fatal outcome”.
Earlier this year, a woman died in a cosmetic surgery after a failed gastric-binding surgery. This tragic incident has clearly highlighted the need for proper regulation of cosmetic surgery clinics and cosmetic surgeons. The French surgeon involved in the surgery which led to the death of this woman has since been removed from the Irish Medical Council's register by High Court order pending a full fitness to practise inquiry.
This inquiry was prompted by the Royal College of Surgeons in Ireland expressing concerns about the lack of sufficient aftercare being provided by this surgeon who was flying in and out of the country to perform surgeries. This is not the first time the Irish Medical Council has expressed concern over this practice. In 2004 it issued a warning and found a surgeon guilty of professional misconduct for failing to provide continuity of care for his patient by leaving the country after the surgery. As far back as 2005 the consultant plastic surgeon, Dr. Michael Earley, called for regulation of cosmetic surgeons in clinics. He warned that this was essentially in the interests of patient welfare. In recent times the Minister for Health and Children has recognised the need for accreditation of both public and private health clinics. Many people are surprised this accreditation does not apply to private health facilities at the moment. It is now time for the Minister to legislate on this issue to prevent any further deaths.
The difficulties caused by lack of regulation are clear to see. For example, on the website of the cosmetic clinic where the woman died in surgery, the successes of the surgery are listed as well as the dangers of obesity, but the risks associated are not emphasised and neither is the ongoing aftercare required. Furthermore, when I looked at the site last week it still listed the French doctor as a specialist surgeon, ignoring the fact that he has been suspended from the register. The Irish Association of Plastic Surgeons has voiced its concern over cosmetic surgery clinics. Surprisingly, it is pointed out that the industry is unregulated, advertising can be misleading, patients should be referred by their general practitioners, clinics should provide continuity of care for patients who undergo procedures, best practice indicates there should be a cooling off period between consultation and procedure, and clinics should be open and honest about complications. Procedures should be carried out in appropriate surroundings and those operating in cosmetic surgery clinics should be properly qualified and registered with the Irish Medical Council.
At present there are no restrictions on practising cosmetic surgery in Ireland. Under the law a GP or anyone trained as a doctor is permitted to carry out cosmetic surgery even though he or she has not undergone specialist training. The RCSI recommends that specialist registration should be a minimum requirement for those working in the plastic surgery industry.
In view of the increase in demand for such surgical procedures and calls by senior people in the Irish medical profession for regulation, I urge the Minister for Health and Children to examine this cosmetic surgery industry with a view to introducing regulation. The industry is apparently worth €20 million per annum in this country alone. It clearly generates significant profits and there is significant demand for such procedures. It is now crucial that patients should undertake such procedures, if they so desire, in the knowledge that the industry is regulated, the surgeon is registered and that any potential risks or complications of surgery have been explained in full to them. They must have the assurance that the clinic is obliged to provide the necessary and comprehensive level of aftercare for which the Irish Medical Council has highlighted the need.
