Overstepping boundaries and lack of information

Cosmetic surgery

Allegations made against the performance and conduct of a cosmetic surgeon who principally performed breast augmentation surgery on several patients were wide ranging in relation to unprofessional conduct, among them the issue of informed consent.  

A summary of the circumstances: 

  • Patients mostly lived interstate and had discussions with the practitioner and/or practice staff previously but only saw the practitioner immediately prior to their surgery. 
  • In most cases a broad consent form was provided and signed covering general aspects of breast augmentation surgery in a reasonable time before the surgery.  
  • Some patients who wanted breast augmentation surgery were referred by the practice to XYZ Financial Services to provide finance if they went to this practitioner, (a director of the finance company, a fact unknown to patients). One patient was called by the practitioner, quoted $6,000 and asked to send measurements and photographs of her breasts. 
  • Health records show that virtually no physical assessment was conducted by the practitioner save drawing on their breasts, and little if any medical history was taken. 
  • During procedures some patients were consulted as to the size and location of implants whilst under twilight sedation. 

The practitioner asserted it was “usual practice” that patients: 

  • watched an educative online video (this was never produced) 
  • had an opportunity to have a consultation with a nurse, free of charge, to go over the procedure and ask questions 
  • if the patient decided to proceed, they would have a consultation with him, and he would go through the detailed consent documentation as well as making a medical assessment of the patient 
  • on the day of the procedure he would undertake a further assessment of the patient. 

Reason for complaint, claim or investigation 

Patients made various allegations of unsatisfactory professional conduct and professional misconduct in respect of this cosmetic surgery, including specific allegations of lack of informed consent. 

Questions to ponder 

  1. Has the practitioner discussed the risks material to the circumstances of each of his patients?
  2. Has the practitioner met the regulatory and legal requirements for an informed consent?
  3. What elements relevant to regulatory code and or legal principles around informed consent may have failed in this case? 

Relevant MBA code of conduct skills and competencies 

3.2 Good patient care 

3.3 Shared decision-making 

4.5 Informed Consent 

10.5 Medical records