What a wonderful meeting we experienced in Washington! I would like to publicly thank, and to offer my sincere congratulations to Dr. Paul Cotterill and his committee for their hard work in making it such a success.
In Washington, significantly more than at ANY other meeting, I was asked my opinion on how I would handle various alleged ethical improprieties by colleagues. Virtually all of these problems had a common theme, which was that patients were being misled. They are being told that ONE large transplant procedure would be all that they would require; patients are still not being educated about the progressive course of androgenetic alopecia. Patients are given “firm” fee amounts, not estimated costs, that are UNREALISTICALLY low. After an initial transplant, they then are told that more surgery with accompanying additional fees, would be needed.
Just this week in my own office I saw a young man of 26 years, with Norwood Class V hair loss. His family history was very significant for severe pattern baldness, maternally and paternally. He had been told in a consultation 2 weeks before that he would require one 1,500 graft session to get a FULL HEAD OF HAIR. I asked him specifically then how many sessions he was counselled he would require in the future. He answered that he was told that he would need no future surgeries!
If you are practicing in this manner or are having your staff doing so, just stop!
Other issues surrounded professional misrepresentation. One Virginia doctor told me of a colleague who advertised that he had 11 years of transplant surgery experience when, in fact, he had only 4. Another doctor tells patients that he performed hair restoration surgery on a full-time basis, when indeed he worked in another practice setting several hours per week.
Remember, the main reasons for legal action against hair surgeons are fraud and misrepresentation. Be honest with your patients!
The following is a letter from Dr. James Arnold of California:
Dear Dr. Leonard:
Many follicular unit transplant surgeons have their medical assistants create the recipient sites. The assistants generally use the “stick and place” method. A hypodermic needle is used in this technique to create an opening in the scalp. As the needle is withdrawn, a graft is inserted. This cycle is repeated over and over by the assistants until all the units are transplanted.
Is it legal for assistants to create recipient sites in this manner? Here in California it has been suggested that this state would take a dim view of an assistant actively cutting recipient sites. The assistants, along with the surgeon, could possibly be charged with “practicing surgery without a license.” Do you know of any ruling or opinion from a state medical board on this subject? Do you think surgeons and their assistants using the “stick and place” technique have overstepped the boundary between assisting and surgery?
Sincerely,
James Arnold, MD
Well, I am not an attorney, nor do I play one on TV, but I have spoken to a few about this particular situation. Each of them told me in no uncertain terms that they felt this practice was, indeed, practicing medicine without the benefit of a medical license by the assistants, as well as aiding and abetting the practice of medicine by an unlicensed individual on the part of the surgeon.
I also contacted by telephone five medical boards and described the technique to either their legal department or to their consumer affairs office. Every one of them indicated exactly what my attorney friends had indicated.
Thus far, I personally know of no medical authority that has offered an official opinion on this matter. But do we want such a declaration? My personal opinion of this practice is that I frankly cannot see how anyone can call this anything BUT the practice of surgery by a non-physician. When an assistant is creating recipient sites (making incisions), how can this NOT be performing surgery on that patient's body? If the surgeon has excised the donor strips, does he or he not have an obligation to his/her patient to create the surgical sites into which the excised tissue will be returned to that person? I honestly feel that this practice WILL bring extremely harsh and severe negative exposure to our specialty. We are not only bombarding our own colleagues from within our field with unethical practices and denigration, but do we need to open ourselves to unnecessarily severe criticism from those outside our field? This is something that can only bring us very negative press.
Letters like Dr. Arnold's are important, thought-provoking, and anxiety-provoking. This issue is indeed extremely volatile. There are respected and honorable gentlemen in our Society who utilize and promote this technique. I am very concerned, however, that its practice not only will negatively impact the individual surgeons, but it will expose our entire profession to ethical and legal scrutiny that could lead to governmental authorities limiting the scope of our practices.
I hope that you will send me your thoughts as well as any information you may have from your individual state or country addressing this issue. I would also be interested in learning what opinions the surgeons using this technique have obtained from their own state medical boards on this issue.
- Copyright © 1999 by The International Society of Hair Restoration Surgery