”Fly in, fly out” cosmetic surgeons – do they leave patients stranded?

Posted: 30/05/2014

The British Association of Aesthetic Plastic Surgeons (BAAPS) has called for changes to the law to help combat problems that can arise when cosmetic clinics in the UK use so-called “fly in, fly out, surgeons”. We support their concerns, having seen the problems first hand that can arise for patients when they suffer complications from surgery done in these circumstances.

“Fly in, fly out” surgeons are foreign surgeons who fly in to the UK, carry out a list of operations in a condensed period of time on a private basis and then fly out again leaving the patient under the care of the clinic with no follow up from the surgeon who performed the operation. The clinics encourage the surgeons to complete as many operations as possible in one day – rather like a factory production line. Surgeons are often paid according to the number of procedures they perform and, as the clinic’s income is clearly determined by the number of patients, there is pressure to obtain patients’ consent and process them through surgery as quickly as possible.

Potential risks from ‘production line’ surgery

There are a number of potential problem areas with ‘production line’ surgery. The first is that of pre-operative preparation and consent. One of the issues with cosmetic surgery procedures is that patients may have unrealistic expectations about the outcome and, if sufficient time is not taken to understand the patient’s history and expectations, there is a risk that the outcome may not be as the patient hoped.

The second potential area of risk is if complications arise during surgery. For a surgeon with a production line of patients and an expectation of flying home at the end of the day, the care of a patient who suffers complications may be left to nursing staff and not monitored or managed in the same way  as in a ‘normal’ hospital environment. The lack of facilities to deal with critical patients can also cause problems and, in situations involving bleeding or other progressive complications where the patient deteriorates significantly, the only recourse will be to transfer them as an emergency to a hospital elsewhere.

We are currently dealing with just such a claim for a client who suffered bleeding following a gastric banding operation. Her condition deteriorated to the point where she was in danger of losing her life before she was transferred elsewhere as an emergency for life-saving surgery. Even if the surgery itself goes to plan, patients can then struggle to obtain good consultant aftercare as their surgeon may not be back in the UK for some time.

Difficulties in pursuing a claim – some case examples If things do go wrong, it can prove difficult to pursue a clinical negligence claim for damages against a foreign surgeon whose professional indemnity insurer may or may not cover his or her practice abroad. Tracking down the surgeon and any medical defence organisation or insurer can be tremendously difficult particularly if there are complex issues involving jurisdiction and multiple defendants. All in all, patients can be left in a very difficult position if things do not go to plan.

We have recently settled two cases that are good examples of the problems that can arise. In the first case, we represented a client who had received very poor care from a French plastic surgeon operating in the UK. Our client’s facial fat injections migrated from their intended position leaving her with a cosmetic deformity and causing her considerable distress. She had met the surgeon only a  few days before the fat injections were given because he was only in the UK for a short period of time and did not have time to offer the minimum two week “cooling off’ decision period before her procedure. If our client had been given longer to think things over and to weigh up the risks associated with the treatment, she would not have rushed into having her procedure - and may not have proceeded at all. There were, in fact, less invasive options open to her and, had she known about them, she was likely to have tried them first.

The French plastic surgeon was very reluctant to disclose her medical records and, when he did, we strongly suspected that they had been falsified to some extent. The records suggested that there had been a much earlier initial consultation, which our client denied and provided evidence that it had never happened. The claim settled with our client receiving damages of £28,000.

In the second case, we successfully settled a claim for a client who had a very poor result from surgery undertaken by an Austrian plastic surgeon arranged through one of the leading national cosmetic surgery clinics in the UK. Tracking down and liaising with the surgeon was very difficult as he repeatedly ignored our correspondence and tried to stall our investigations.

Our perseverance paid off and we eventually discovered the details of his professional indemnity insurers. They were a foreign company but, once we established contact with them, they co-operated and we were able to open negotiations and settle a claim for £20,000 plus costs. Considerable time and legal costs would have been avoided had the defendant surgeon been UK based or had insurance cover with a UK insurer who understood the legal process.

The BAAPS three point plan

BAAPS has come up with a three point plan to help avoid these difficulties:

• Informed consent – the consultation must be with the surgeon and not a nurse or any sales person for the clinic involved. The surgeon must consider the patient’s suitability for the intended procedure and discuss the treatment thoroughly in order to take informed consent.
• Indemnity insurance – all surgeons operating in the UK should have adequate insurance cover, either from companies based in the UK or policies that provide equivalent cover, so that their work here is covered and they can meet claims for damages and legal costs if necessary.
• Equivalent standards – all foreign surgeons should undergo the equivalent of the revalidation with the General Medical Council (GMC) as UK surgeons are required to do.

BAAPS has said that its recommendations would be a “costs-neutral way of establishing proper informed consent, a proper insurance cover and proper standards for the benefit of all patients” and we agree.

Penningtons Manches LLP has a leading clinical negligence practice that deals with clients nationwide. Within that practice, we have a specialist team dealing with cosmetic surgery claims relating to treatment performed in the UK and abroad. Members of the team can advise on issues arising from such treatment and the options in relation to any claim.

For more details click here or call 0800 328 9545.

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