She recalls one day there were two identical procedures booked with quite similar body shapes, one patient paid $16,500 and the other paid $30,000.
The national regulator AHPRA is under the spotlight in a parliamentary inquiry headed by Greens senator Janet Rice, who earlier this week announced a four-month extension to the inquiry to accommodate hearings and investigate allegations about cosmetic surgery following a media exposé by The Sydney Morning Herald, The Age and ABC’s Four Corners.
“Following the Four Corners and Age revelations, we decided we needed more time to further consider AHPRA’s regulation of cosmetic surgery; whether there was more that they could and should have done to have prevented these appalling outcomes,” Senator Rice said.
“Given AHPRA are responsible for regulating our health system, it’s clear something needs to change to ensure these disastrous outcomes won’t happen in the future. Our inquiry is an important oversight of AHPRA, especially considering they aren’t required to appear at Senate Estimates.“
AHPRA is largely funded by the medical industry through fees and according to many experts, it needs more teeth and far more public accountability. Put simply, it is a national scheme, but it is run by each state, which means the Federal Government has little control over it. The state governments also have limited control, as one expert said, as a lot of its operations occur outside their respective borders.
That goes a long way to explain how the cosmetic surgery industry has been able to grow unchecked into a multi-billion dollar sector.
Experts, including consumer research advocates Michael Fraser and Maddison Johnstone, say the use of social media by certain practitioners has been a big driver of the growth. In a submission to Parliament they wrote they had been researching the industry for months. Of the accounts they viewed, the use of social media by cosmetic surgeons couldn’t be defined as educational. “Many of the videos are graphic with both gore and almost naked, or in some cases, fully naked and uncensored female patients. The doctors are all men, and they are doing thousands of procedures.”
Even the title cosmetic surgeon is problematic as it can be used by doctors without them being registered as a specialist surgeon and without them completing Australian Medical Council-accredited surgical training.
This anomaly means doctors with a basic medical degree, or GPs or dermatologists, can call themselves cosmetic surgeons, even though they aren’t registered specialist surgeons, who receive at least eight to 12 years of postgraduate surgical training.
Adding to this is the lack of oversight of outpatient facilities or registered day surgeries. In Australia, state health departments are in charge of checking whether cosmetic surgery clinics are complying with regulations. In Victoria, the Department of Health gives registered day procedure hospitals six to eight weeks’ advance warning of an audit.
Registered day procedure hospitals must also comply with safety and quality standards, with inspections booked weeks in advance. This gives clinics plenty of time to get things in order.
In the US, physicians operating in a day facility must be able to show they have held unrestricted hospital privileges in their specialty at an accredited and/or licensed acute care hospital. Only surgical procedures included in those hospital privileges may be performed within the accredited facility.
David Gardner, a lawyer who specialises in medical regulation after spending years at AHPRA as a senior manager of teams of investigators, highlighted serious flaws in the regulatory system, in a submission to parliament.
Gardner left AHPRA in 2018 and sued for constructive dismissal believing he was managed out for raising too many concerns. His action is resolved but his quest for reform remains.
Issues he raises include the slow pace of dealing with complaints. “Relatively simple matters stretch into years with no apparent reason,” he said. “There is no significant reason or motivation for AHPRA or the boards to resolve matters quickly. It is not required by the law and there is no penalty for taking a long time (or reward for timely completion).”
Gardner also raises the issue of “splintering” between the various state and national regulators, which results in systemic issues falling between the cracks.
The submissions made to the inquiry make one thing clear, the cosmetic surgery sector has exploited the weak regulation, hurting patients along the way.
Patients were given a general anaesthetic then abandoned halfway through a procedure, Nixon wrote in his submission.
“The doctors would commence operating and would often leave the patient still ventilated on the operating table mid-procedure to run off upstairs to consult and chase fame. Creating low-brow content on TikTok, under the guise of education.”
The patients would become hypothermic and their vital signs would drop. Some would be transported to a nearby private hospital, managed by friends of the doctor, he says. Others would stay overnight in a day hospital with no formal records showing that such an event took place.
For Hewish the fear that harm was falling on unsuspecting patients became so much she decided to speak out. But until politicians step up and push to change the laws and regulations and more doctors, nurses and hospitals start lodging complaints, little will change.
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