Four years ago, a patient died after an unqualified physician botched a tummy tuck operation late at night at a Portland doctor’s office.
According to The Oregonian, Dr. Soraya Abbassian, an internal medicine physician, was doing the plastic surgery procedure as a favor for an employee, whom she often bartered services with such as babysitting. The surgery took place at 10 p.m. while the two of them were alone in the office. Abbassian had to leave the patient, who experienced a bad reaction to Abbassian’s anesthesia, and run downstairs to let the paramedics in the building.
Abbassian’s case was so horrendous that no medical board rules would likely have stopped her from trying the procedure, but the tragedy served as a wake-up call for the Oregon Medical Board, which set about crafting rules in 2011 to govern procedures that its licensed physicians perform in office settings.
“There are rules that cover hospitals; there are rules that cover ambulatory surgical centers,” said medical board director Kathleen Haley. “There were no rules for procedures in the office.”
Abbassian was found guilty last October of criminally negligent homicide after pleading no contest, and given the proverbial slap-on-the-wrist as a sentence: 300 hours of community service, three years probation, no prison time. A plea deal for the former Lake Oswego physician dropped charges of manslaughter, which carries a mandatory minimum sentence in Oregon of at least six years, depending on the severity.
The medical board finalized its rules that same month and more recently discussed them with the Legislature’s House Health Committee.
Nicole Krishnaswami, an operations and policy analyst at the medical board, said the rules are classified according to the degree of anesthesia. Those requiring only a topical anesthesia have the fewest restrictions, while those with general anesthesia require the most vigorous accreditation. There are also requirements for safety equipment and safety procedures in case of emergencies, something that was strikingly absent in the Abbassian case.
Nevertheless, the rules have received some pushback from plastic surgeons who feel they don’t go far enough.
Dr. Tim Connall of Tualatin notes that the medical board did nothing to limit scope of practice in lower level procedures. Proper credentialing is optional for all but the most serious procedures, which require general anesthesia. “With these rules a psychiatrist can perform tummy tucks, a pediatrician can perform breast cancer surgery, and an anesthesiologist can perform face lifts,” Connall said.
Connall, the current president of the Oregon Society of Plastic Surgeons, also thinks that physicians should be required to have hospital privileges for the procedures they perform in the office, but that as well is only required for level 3 procedures.
Hospitals and ambulatory surgery centers require extensive credentialing, which provides an additional layer of patient safety and ensures physicians are qualified to perform a procedure, Connall said.
“I think there are severe limitations with the final result,” he told The Lund Report. “I don’t think it really protects Oregonians.”
Krishnaswami said the board had discussed these issues with Connall and other stakeholders for two years before making their ruling. She said the board had to balance patient safety with patient access. The board also did not want to unnecessarily inhibit physicians from practicing.
Many hospitals won’t credential providers if that procedure is never performed in their facilities, she said, giving the example of laser surgery.
“No other state in the country restricts physicians according to what their specialty is,” she said. “It gets really difficult limiting anything by scope when you’ve got such a broad range of procedures.” She added that most other states do not go as far as Oregon in other points of contention as well.
For level 2 procedures, which are generally those with local anesthesia, physicians and physician assistants must show proof of continuing education classes if they are not board-certified.
Chris can be reached at [email protected].
