Court upholds tighter rules on office surgery

The appeals court action largely affects cosmetic surgeons, who often operate in the office to keep costs down.

By WES ALLISON, Times Staff Writer
© St. Petersburg Times
published January 26, 2002

A Florida appeals court says the state Board of Medicine can require an anesthesiologist to be present during major office surgeries, validating sweeping changes the board passed last year aimed at making cosmetic surgery safer.

The ruling, issued by the First District Court of Appeal in Tallahassee, mostly affects Florida's cosmetic surgeons, who frequently perform nose operations, breast augmentations, liposuction and other procedures in their offices -- rather than hospitals -- to keep costs down.

The court upheld a board rule requiring an anesthesiologist to be on hand when a patient is heavily sedated or put to sleep. Certified nurse anesthetists typically provide the anesthesia during office surgeries.

The court also upheld a new Board of Medicine rule requiring surgeons to have a transfer agreement with a nearby hospital so patients can be quickly admitted if a problem occurs.

"The board's primary concern is the welfare and safety of patients in the state of Florida, and they believed when they implemented this rule it would ensure patient safety," board spokesman Bill Parizek said Friday.

The losers threatened to appeal. Frank Mirabella, who represents the Florida Academy of Cosmetic Surgeons, which opposed the rules, said requiring the transfer agreement essentially gives the hospital the power to drive out competitors.

It's unnecessary, he said, because hospitals must take any patient brought to their doors. "This actually allows the hospital to license who their competition will be."

The two rules were among several the Board of Medicine adopted in February 2000 aimed at making office surgery safer. Most have been implemented, but these were successfully challenged by a coalition of cosmetic surgeons and nurse anesthetists on grounds the board lacked the authority and the cause to require them.

The opponents argued nurse anesthetists have a strong safety record, and state law allows them to practice under the supervision of any physician.

Requiring an anesthesiologist to attend an office surgery will add thousands of dollars to the cost of many procedures, Mirabella said.

The surgeons and nurses now have two weeks to appeal this latest ruling, and Mirabella said it is likely they will. If they don't, the rules would go into effect 20 days later.

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