Members of Florida’s medical boards want to change the state’s office surgery regulations to cap at five the number of Brazilian butt lifts (BBL) a physician can perform in their office daily, and also require surgeons to use ultrasound equipment when performing the procedures.
Members of the Board of Medicine and Board of Osteopathic Medicine’s Joint Committee on Surgical Care and Quality Assurance agreed that while the proposed changes to the office surgery regulations should increase patient safety, the changes would increase the cost of doing business for Florida surgeons by more than $200,000 in the first year.
That acknowledgment will slow down approval of the proposed rule, meant to supplant an emergency rule that expired earlier this year. The emergency rule limited surgeons from performing more than three surgeries a day.
The $200,000 price tag for the first year means the Florida Department of Health will have to prepare what’s called a “statement of estimated regulatory costs” (SERC). If the SERC indicates that the proposed rule will increase costs by $1 million or more over a five-year period, the proposed rule will require legislative approval.
Meanwhile, members of the Board of Medicine and Osteopathic Medicine’s Joint Committee on Surgical Care and Quality Assurance discussed the proposed regulation for about three hours Thursday before agreeing to give it preliminary approval.
Miami plastic surgeon Constantino Mendieta told members of the joint committee Thursday that he supports the goal of increased patient safety, but expressed concerns the proposed regulation may go too far.
While he said he has “no problems” with the five-procedure daily limit, he questioned whether the medical boards were “setting a historic precedent of controlling surgeons.”
As written, the proposed rule bans a “consented” surgeon from “delegating” any portion of the procedure to another health care professional other than another surgeon.
But Mendieta, president of a group called Surgeons for Safety, told the board he uses assistants, including advanced practice nurses, during procedures where a lot of liposuction is required, such as “mommy makeovers.”
Using assistants, he said, gets the patients off the operating table quicker, which means they aren’t under anesthesia as long, which is good for the patients. He also said the use of assistants is common because liposuction can be exhausting, he said.
“It takes a lot of force, it takes a lot of action … and to do this for hours and hours on end, standing up,” he said, adding that researchers currently are tracking the amount of exertion the BBL procedures require and that some surgeons are wearing physical activity monitors to help in the research.
“The amount of activity it takes to do one BBL is the amount of activity it takes to do a spin class,” he said.
In a Brazilian butt lift, a surgeon augments the size and shape of the buttocks without implants. In lieu of implants, a surgeon injects excess fat that has been removed from the patient with liposuction.
After newspaper reports highlighted the substantial number of deaths occurring in Florida from Brazilian butt lifts, the Boards of Medicine and Osteopathic Medicine passed rules in 2019 stating that doctors could no longer inject fat into the muscle. In addition to new rules, the Legislature passed a law later that year requiring the medical boards to better regulate and discipline doctors when patients die.
In 2021, eight women died from BBL in Florida, which pushed the boards to initially implement emergency rules earlier this spring. While the rules have subsequently expired, they limited the number of BBL procedures that could be performed to three a day and required physicians to use ultrasound equipment while conducting the procedure.
The medical boards are working on permanent rules to replace the expired ones. To that end, the medical boards are proposing to amend their office surgery rules, which only apply to physicians and the surgeries they conduct in their offices. That means the boards cannot address rules that apply to other licensed health care professionals, such as nurses.
Chief Assistant Attorney General and Board of Medicine Counsel Ed Tellelchea said one way to improve patient safety is to only allow the procedures to be conducted in hospitals, though he conceded it would be controversial.
“The problem is the hospitals don’t want us,” Mendieta said. “The problem is people are going to have this procedure no matter what. They are going to go anywhere. All you are doing is sending these people to places that are probably going to create more problems and more issues here.”
He added: “They are going to get ‘Fix a Flat’ and go to hotel rooms to get this done. So it’s not about regulating so tightly to exclude the good actors from the bad actors.”
Tampa General Hospital Chief of Plastic Surgery David E. Halpern told members of the joint committee that no hospital or ambulatory surgical center in Florida would grant hospital privileges to an advanced practice nurse or any other health professional other than a surgeon to assist in liposuction.
“PAs (physician assistants), nurses, nurse practitioners — under no circumstance — will have this privilege to do this type of procedure or any procedure in an ASC (ambulatory surgical center) or hospital setting. There’s no doubt,” said Halpern, who also is the current president of the Florida Society of Plastic Surgeons.
“The fact we are even considering this to be allowed in an office setting, under who knows what kind of supervision, is the reason why we are here today. The No. 1 reason we are here is for patient safety.”