The deadly risks to patients who choose to have cheap cosmetic surgery in Miami became painfully evident following the recent death of a 29-year-old woman from West Virginia from a fat transfer procedure at a Hialeah clinic.
The clinic, Encore Plastic Surgery, is registered with the state as an office surgery center, which requires that it either be accredited by a recognized medical board or submit to inspections from the Florida Department of Health.
A health department spokesman said Encore was last inspected on Jan. 27, though the related report was not immediately available. But because Encore is not wholly owned by a physician, the Florida Board of Medicine cannot take emergency action to restrict surgeries or close the center after a patient’s death, said Christopher Nuland, general counsel for the Florida Society of Plastic Surgeons.
“That’s a glitch in the law,” said Nuland, whose group supports stronger state oversight of office surgery centers. “It’s a loophole we’re trying to close. When you're fully physician-owned, the Board of Medicine can shut you down.”
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And because the clinic does not submit claims for payment from third parties, such as a health insurance company — it’s cash, personal check or credit only — Florida law does not require Encore to be vetted by the state’s other healthcare regulatory department, the Agency for Health Care Administration or AHCA, which oversees the licensing of hospitals, nursing homes and other medical facilities.
In the absence of strict state oversight for office surgery centers, said Florida state Sen. Eleanor Sobel, a Broward Democrat, consumers must be aware of the dangers they face when choosing to have cosmetic surgery at South Florida clinics such as Encore.
Research published in Dermatologic Surgery Journal concluded that the elective procedure liposuction, when performed under general anesthesia, required further investigation because deaths from this procedure continue to occur.
The Miami-Dade Medical Examiner’s office said Monday that Heather Meadows, a West Virginia mother of two young children, died from fat clots that entered her bloodstream during a fat transfer procedure, causing her heart and lungs to fail.
“There’s no state law with oversight. So you’re at risk,” said Sobel, who sponsored a bill this year to tighten state regulation of office surgery centers but failed to win approval. “Any woman who goes to a clinic and doesn't check their credentials is at risk of not coming out of that clinic.”
Up until about 2007, Florida strictly regulated outpatient surgery centers, requiring them to meet standards such as accreditation from the Joint Commission, a nationally recognized nonprofit that certifies hospitals and other medical facilities, said Linda Quick, a South Florida healthcare consultant.
But over the years, the Florida Legislature has chipped away at regulations governing office surgeries by physicians and also stripped away many consumer protections.
“If you do it in your office, the only rule or requirement is your own personal [medical] license,” Quick said, “and what's particularly scary is that in the state of Florida, physicians aren't even required to have malpractice insurance.
“Our Legislature,” she said, “has been enamored with deregulation.”
Quick said that even if tighter government regulations were in place requiring more facility inspections, Florida Gov. Rick Scott has reduced the budget and staff of the health department and its ability to effectively monitor office surgery centers and their physicians.
Our Legislature has been enamored with deregulation.
Linda Quick, healthcare consultant
Since 2014, according to Scott’s budget, the Florida Department of Health has cut about 1,500 positions, mostly in the areas of children’s special health care and county health agencies. The health department also has seen its annual budget reduced by about $57 million during the same time period.
“They don't have the workforce to go running around to all these offices,” Quick said.
With no rigorous regulation from the state, consumers are forced to fend for themselves, said Nuland of the Florida Society of Plastic Surgeons.
“One of the things that’s very difficult to regulate,” he said, “is a culture of safety. ... But that is what the consumer really needs to try and obtain a knowledge of.”
Sobel, the state senator, said consumers’ choices are often driven by price or societal pressures, and not healthy outcomes.
“The consumer often doesn’t know what the right questions are to ask, and it's unfortunate,” she said. “In the name of vanity, people are looking for a bargain and they often choose the cheapest and it's not quality. This is not quality care.”
In Florida, though, an educated consumer can find out a lot about his or her physician through the health department’s Medical Quality Assurance online search service, which can be used to verify a doctor’s medical license, educational background, professional certifications and disciplinary history.
AHCA, which regulates facilities, maintains FloridaHealthFinder.gov, an online search service where consumers can learn more about licensed surgery centers and hospitals.
Even with consumer tools provided by the state, though, it can be difficult for consumers to decipher the truth about a clinic and its physicians.
46 Office surgery deaths in Florida from 2000-2010
Encore, the Hialeah clinic where Meadows underwent an undisclosed procedure on May 12, is registered with the state as an office surgery center.
The registration names four “supervising physicians,” including Carlos Reydell Medina, a board-certified plastic surgeon who carries medical malpractice insurance, unlike the other doctors affiliated with Encore.
But Medina said in an email to the Herald that he never worked at Encore, and that he has contacted the health department to have his name removed from the clinic’s registration. The other three physicians registered as supervising physicians are Orlando Llorente, James McAdoo and Osakatukei “Osak” Omulepu.
Llorente declined comment through an attorney. McAdoo and Omulepu did not respond to interview requests placed through Encore’s call center and submitted on the clinic’s website.
Hialeah police and health department officials have not identified the physician who operated on Meadows. Brad Dalton, a health department spokesman, said supervising physicians listed on Encore’s registration do not necessarily have medical oversight at the center.
“It’s just a way for us to link these physician licenses with that address,” he said.
Many patients are lured from out-of-state by offers of cheap cosmetic surgery and personal testimonials posted on industry-oriented websites, such as RealSelf.com, where one Miami physician received rave reviews even though the health department has charged him with repeated medical malpractice.
One woman who asked not to be identified but produced receipts, contracts and other documents establishing that she had received a liposuction procedure in May 2015 at Vanity Cosmetic Surgery, an office-based clinic affiliated with Encore, said she traveled to Miami from Tampa after finding her doctor online.
There’s no state law with oversight. So you’re at risk
Florida Sen. Eleanor Sobel
“I was Googling Miami because you see all these beautiful people in Miami,” she said, “and I came up on Vanity. ... I found a video of a lady who was saying how happy she was. I went on RealSelf and found a bunch of good reviews on [the doctor].”
The woman said what she thought would be a simple liposuction procedure turned into a gruesome ordeal — with the physician, Omulepu, discharging her to a hotel room, where she awoke the next morning in a pool of her own blood.
After being rushed to Hialeah Hospital in intense pain, the woman said, she received blood transfusions and later went to Tampa General Hospital before moving to Kentucky so her parents could care for her. The woman, who manages retirement accounts, said she still feels pain in her stomach and that a psychiatrist diagnosed her with Post Traumatic Stress Disorder.
She also lost her job as a retirement account manager — the same job where she had been awarded a $2,500 bonus that she used to pay for the liposuction procedure.
”Coming in, you expect that you will be, if not a lot happier, at least a little happier with the way you look, and that wasn’t it,” she said. “It was quite the contrary. I have scars. My stomach is kind of deformed. … It’s just been an emotionally draining roller coaster.”
Cosmetic surgery is still surgery and carries medical risks for patients. But consumers can take steps to learn more about their physicians and the facilities where they will undergo surgical procedures, said Christopher Nuland, general counsel for the Florida Society of Plastic Surgeons. He offered the following tips for consumers considering cosmetic surgery in an office setting.
- 1. Don't believe everything you read in advertisements, and don't be seduced by seemingly impossibly low rates. If the rates are impossibly low, you need to ask yourself: What are they not providing?
- 2. Always check the physician’s profile, which is available online from the Florida Department of Health’s Medical Quality Assurance search service. The profiles list disciplinary actions against a physician.
- 3. Verify a physician’s medical specialty certification from the American Board of Plastic Surgery, or to some extent, the American Board of Dermatology.
- 4. Never go into surgery without having a prior consultation. “I'm not talking the day of surgery,” he said, “and make sure it’s with the surgeon — not with the sales person, not with a nurse.”
- 5. You should be asked to sign an informed consent agreement. The informed consent should be very specific as to what procedures will be performed, down to the exact body part.