In 2015 I acted for a client who had been the victim of botched cosmetic surgery. What made this case particularly difficult was the fact that the surgery had been carried out by an Italian doctor, employed by a private clinic, who had flown in to perform the surgery before flying back to Italy. This month the Medical Practitioners Tribunal Service has just struck off another Italian doctor who had performed a number of cosmetic surgical procedures on the same ‘fly-in, fly-out’ (FIFO) basis. A common factor in both cases is that, despite both doctors being registered with the GMC, neither had adequate insurance to cover the work they were carrying out in the UK, leaving both women (and others who had been harmed) unable to claim compensation from them.
Lives ruined by FIFO doctors
In the most recent case, Dawn Knight from County Durham had eyelid surgery performed by Dr Arnaldo Paganelli, an Italian doctor, at a private hospital in Birmingham. After the operation, Mrs Knight discovered that he had removed too much skin, leaving her unable to shut her eyes properly and in considerable pain and discomfort. A number of other patients had also come forward to complain about the inadequate treatment they received from the same doctor, something that the hospital group tacitly acknowledged by the fact they withheld a proportion of his fee every month in order to compensate complainants. Throughout the tribunal, the hospital refused to accept liability, arguing that Dr. Paganelli’s ‘errors’ were within acceptable parameters.
In the case of my client, she suffered post-operative necrosis for which the surgeon who carried out the operation essentially refused to accept responsibility. Although we filed a medical negligence claim against the surgeon, including serving the papers on him personally, he singularly failed to communicate with us and, worse, he failed to tell his insurers that he was the subject of a negligence investigation preventing them from honouring the settlement. We notified the GMC about his unprofessional behaviour and, as a result, the GMC suspended his registration in the UK.
Lack of regulatory oversight
It was a lack of regulatory oversight that enabled these surgeons to practise privately in the UK without either being a specialist in a particular area of cosmetic surgery or having adequate insurance in place. At present, a doctor who comes to the UK to perform surgery and then returns home, only has to register with the GMC; they do not have to be registered as a specialist surgeon trained to operate on a specific part of the body. Inevitably this leaves patients vulnerable to rogue surgeons who are not competent to carry out, what are often, very delicate surgical procedures. Inevitably, it is the NHS that has to pick up the cost of repairing the botched surgery left behind by the ‘fly-in, fly-out’ doctors.
Woeful government response to tightening regulation
Despite much lobbying from the British Association of Aesthetic Plastic Surgeons (BAAPS) for much tighter regulation, not only of cosmetic surgeons specifically, but also of the cosmetic treatment industry generally, the government has been very slow to respond. It was in 2013 that the Health Secretary commissioned Sir Bruce Keogh to review the lack of regulation in the cosmetic treatment industry in his report ‘Review of the Regulation of Cosmetic Interventions’. Although he was primarily concerned with non-surgical intervention (in particular, dermal fillers) his report outlined a number of recommendations that would have applied equally to cosmetic surgery, not least, that all practitioners of both surgical and non-surgical treatments should receive specialist training, accreditation and registration. The then President of BAAPS was even moved to describe the whole area of cosmetic surgery as the ‘Wild West’.
Onus on patients to do their research
At the moment, the onus remains on individual patients to do their research into prospective surgeons thoroughly. To help with this process, the Royal College of Surgeons has a Cosmetic Surgery Certification Scheme; to be certified through this scheme, surgeons have to prove that they are adequately insured to carry out work in the UK. Unfortunately, this scheme is not mandatory leaving patients at risk that their operation will be carried out by someone who is not properly insured.
This is an area of practice most commonly undertaken in the private sector so inevitably cost is an important factor when deciding who to go to. Nonetheless, it is critical that all patients seek a face-to-face consultation with the surgeon who is due to operate, check that they are properly insured, and take full advantage of the ‘cooling off’ period between consultation and operation to ensure that they have made the right decision. There is no suggestion that doctors from other countries should be barred from performing cosmetic surgery (the fact that both doctors mentioned above are Italian is incidental) but that they should be properly qualified, accredited and insured. It is certainly the case that private clinics should be much more rigorous in their vetting procedures before allowing doctors to work through them – too many hide behind their role as ‘intermediary’, reluctant to take responsibility for those they do not directly employ.
Cosmetic surgery must be ‘de-commoditised’
There is no doubt that cosmetic surgery has been commoditised – most notoriously demonstrated by the now banned ‘two for one’ offers - and it is certainly not clear that a determined effort has been made to tame the ‘Wild West’ of the cosmetic procedures industry. Despite the best endeavours of BAAPS to raise awareness of the need for better regulation, where cost remains an important driver there will always be a temptation to cut corners. Standards in private practice must be brought in line with those of the NHS; unless proper safeguards are put in place as a matter of urgency, I will continue to make negligence claims on behalf of clients whose lives have been ruined by the handiwork of incompetent or unethical practitioners.
In the meantime, anyone who has suffered from a botched treatment may well have a medical negligence claim but, legally speaking, the lack of regulation does make this a grey area. We are always happy to have an initial chat to see whether or not we can help.