Phoenix — In the wake of several recent patient deaths during and after in-office surgeries — most of them cosmetic procedures — the state of Arizona has issued new rules for physicians who perform such surgeries, reports the Arizona Daily Star.
One of the deaths occurred a year ago, when 53-year-old Tucson attorney Kimberley Taylor suffered cardiac arrest during cosmetic surgery in the office of plastic surgeon Armando Alfaro, M.D. Ms. Taylor suffered profound brain damage and died 10 days later.
Among the new rules for office-based surgeons using sedation:
- The office must have the equipment necessary to safely perform the procedure, to safely administer the sedation, to monitor the use of the sedation, and to rescue a patient who enters a deeper state of sedation than intended by the physician.
- Informed consent must be obtained from the patient authorizing the office-based surgery.
- A physician cannot perform office surgery using sedation if the patient has a medical condition that indicates it should not be done there or will require inpatient services at a hospital.
- From the time sedation is administered, a licensed and qualified healthcare professional, other than the physician performing the surgery, must be present whose sole responsibility is attending to the patient throughout the surgery.
- A minimum of equipment for resuscitation must be available for use in an emergency, and the physician must have a policy and procedure for getting the patient to emergency care.
- While the patient is sedated, the doctor must be able to measure the patient’s oxygenation levels and circulatory function, and must check blood pressure and heart rate at least every five minutes.
Some physicians and others have criticize the new rules — drafted by the Arizona Medical Board last year and recently approved by the governor’s office — claiming they aren’t specific enough to be truly effective. For example, critics say the state fails to specify exactly what “licensed and qualified healthcare professional” other than the doctor should attend to the patient during surgery, noting that a licensed practical nurse would not be adequate for that duty while a registered nurse would be.
Critics also note the rules include no requirement that a doctor disclose to patients the specialties for which the doctor is board-certified — thus making possible a scenario in which an ophthalmologist or dentist, for example, could perform a cosmetic procedure though inadequately trained to do so.
The new oversight rules, critics say, also do not include inspections to verify that the rules themselves are being followed. They do, however, lay out guidelines for disciplining a physician who’s found to have violated one or more of the rules.
