The Maryland State Board of Physicians, which is responsible for physician discipline in Maryland, has issued a Final Decision and Order against a Board-certified Maryland plastic surgeon after two of his patients died following long multiple cosmetic surgeries he performed at his unapproved in-office surgery facility that he solely owned and operated. The outpatient surgery center had never been licensed as an ambulatory surgery facility by the State of Maryland.
One continuous surgery lasted almost 10 hours and the other lasted over 12 continuous hours. Both otherwise healthy patients died of cardiac arrhythmias.
The plastic surgeon who had his medical license revoked by the Board gave up his hospital admitting privileges in 2003 because he decided to “stop carrying medical malpractice insurance then.” And without having medical malpractice insurance, he could not have hospital admitting privileges. He claimed that he had a “verbal agreement” with another doctor to have his patients admitted to a specified hospital if they experienced medical complications due to the outpatient surgeries he performed. However, in actual emergency circumstances, the plastic surgeon did not use his handshake-agreement with the other doctor but called an ambulance to transfer his patients to another acute care hospital where he did not have admitting privileges or a written transfer agreement.
The Board found that the plastic surgeon’s failure to have hospital admitting privileges limited his ability to safely perform certain outpatient surgeries at the outpatient surgery center that he solely owned and that by failing to limit the surgeries he performed at his outpatient surgery center he compromised patient safety. Adding to the safety concerns was the lack of immediately available blood products at his outpatient surgery center if the anticipated blood loss during surgery would be greater than 500 cc (the plastic surgeon had arranged for needed blood products to be delivered within one and a half hours, but the Board found that arrangement to be inadequate for patient safety).
The Board found that the multiple procedures performed on his two patients who died during continuous surgeries, which were performed because of the patients’ desire to have the multiple procedures performed during single surgeries to fit the procedures into their personal schedules and for the best aesthetic outcomes, resulted in the duration of the surgeries exceeding acceptable safety standards for outpatient surgeries.
The Board concluded in its Final Decision and Order that the plastic surgeon violated standards of quality care by performing multiple plastic surgery procedures on each patient as one continuous lengthy operation in an outpatient surgical setting lacking adequate resources to deal with complications that could reasonably be expected to arise.
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