Cosmetic surgery reforms need more than a nip and tuck

When you have been forced to watch hundreds of videos of barbaric, illegal and exploitative cosmetic surgery procedures, including facelifts done while awake and patients left butchered and in agony, the urgent need for a fundamental overhaul of this area is crystal clear.

Changes need to be strong, immediate and effective.

The 16 recommendations in a report commissioned by the Australian Health Practitioner Agency (AHPRA) and released on Thursday are more akin to a nip and tuck instead of the urgent reforms required to keep patients safe.

While some recommendations will theoretically help to protect vulnerable patients, their impact will depend on the regulator, which until now has been ineffectual.

The report, commissioned by AHPRA last November, was an admission that under its watch the booming $1.4 billion cosmetic surgery industry has been allowed to run amok.

Dr Daniel Lanzer (left) retired last year after a damning media expose, and Dr Ryan Wells (right) has been suspended.

The review comes a few days after an investigation by this masthead into some shocking practices at the biggest and most high-profile network of clinics run by celebrity doctor Daniel Lanzer and his associates including Dr Ryan Wells.

It showed videos of doctors dancing and laughing as they recklessly performed liposuction on an unconscious patient, pictures of human fat unhygienically stored in bar fridges, directives by a nurse to use expired medication on patients and sending patients to hotels instead of hospital when surgery went wrong.

At a media conference on Wednesday, the head of AHPRA Martin Fletcher and Anne Tonkin, the chair of the Medical Board – one of 15 boards that AHPRA oversees – conceded they needed to do better – much better.

But they stopped short of resigning, despite calls for them to go. “There’s work to be done and we’re not walking away from it,” they said in a statement.

The clock is ticking.

In an attempt to repair the damage, they accepted all recommendations of the review by former Queensland Health Ombudsman Andrew Brown and promised to set up a cosmetic surgery enforcement unit, a hotline for patients and proactively use software to monitor social media. They even agree that cosmetic surgeons should not be allowed to use patient testimonials in cosmetic advertising – something AHPRA had previously worked against.

But when it comes to the big decisions, they squibbed and pointed fingers.

For instance, they backed a new endorsement model, or accreditation pathway for cosmetic surgery, but this is something that will take two to three years.

Meanwhile, the lobbyists will be in full PR mode trying to protect their patch.

The reality is anyone with a basic medical degree can call themselves a cosmetic surgeon.

It begs the question of why the baseline can’t be if you call yourself a surgeon or do major cosmetic surgeries you must have done the six-year surgical training required of surgeons.

The title cosmetic surgeon is outside AHPRA’s remit, but there was nothing stopping the review panel making recommending only properly accredited surgeons can use the title. To do so would keep pressure on state and federal governments to change the law.

Last week Health Minister Mark Butler vowed to take urgent action to clean up the cosmetic surgery industry and clamp down on practitioners without proper surgical training. He will discuss the matter and this report with state and territory counterparts at a meeting on Friday.

The hope is action will come fast.

The report acknowledges a confusing regulatory system. But surprisingly, it found a lack of understanding from the regulator itself. Indeed, one of the recommendations says AHPRA should “identify and clearly map the roles, responsibilities and powers of each regulator in the cosmetic surgery sector and produce a corporate document available to relevant staff”.

That a regulator that has been operating for years has to be told to do this is breathtaking.

But the industry has also let itself down. Fundamental to public safety is a strong culture of reporting mistakes and rogue operators. It is a mandatory requirement for all health practitioners and employers to make notifications when things are bad or wrong. But the review found notifications were non-existent.

Between July 1, 2018 and December 2021, no mandatory reports were made by practitioners in cosmetic surgery. Whether the lack of reporting was due to doctor coercion and intimidation – something patients have experienced when they post negative reviews about their cosmetic surgeons – apathy, or a lack of confidence in AHPRA following through, is something that needs to be investigated.

A few recommendations, including allowing notifiers to be confidential or anonymous sources, will hopefully improve the situation, along with a mass letter campaign to remind them of their obligations.

But getting more names of potential cowboys will only be effective if state and federal regulators do their job. To date, their actions against doctors who have butchered patients, advised victims not to go to hospital when they are seriously wounded, or game the system has been underwhelming.

Australians deserve better.

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