One more death re-ignites the discussion: Should the general practitioners practice plastic surgeries, even though they did not specialize for it? In Costa Rica, this is allowed. However, associations and the same College of Physicians and Surgeons recommend looking for specialized professionals when submitting to these procedures.

Since last October 31st, the Public Ministry investigates another death related to aesthetic processes. It is the death of a 41-year-old woman who lost her life after undergoing liposuction in a private clinic in Rohrmoser. The procedure was performed by a friend of the deceased, a general practitioner who, according to the complaint, would have given her a higher dose of anesthesia than that was appropriate.

A woman who is being given anesthesia

“Supposedly, she put more anesthesia on her than she should have and she gave her a stoppage. He stopped breathing and -to what they tell us- they did not have the tools to bring it back to life. A doctor arrived about 10 minutes and the ambulance lasted about 20 minutes”, explained Gerardo Soto, a friend of the victim. Now the authorities are investigating the possible commission of the alleged crime of negligent injuries in the form of malpractice, to the detriment of the woman who died, surnamed Méndez.

Cases of recognized women who have been serious, such as the journalist Maricruz Leiva or the model Linda Díaz, have turned the gaze towards the safety of patients when they undergo these surgeries. However, the fatal consequences of these operations are not a new issue.

A thesis from the University of Costa Rica (UCR) revealed that, between 2006 and 2015, 13 people died related to aesthetic surgical procedures. In 2 of these cases, there was professional responsibility on the part of the doctors: one was general and another plastic surgeon. In the realization of this thesis, by Marcela Balmaceda, the Office of the Prosecutor of the College of Physicians and Surgeons of Costa Rica was consulted on which medical specialties can perform aesthetic procedures in Costa Rica.

According to the document, the answer was that “aesthetic procedures do not have specialty exclusivity because there are no professional profiles that limit it. That said, these procedures can be performed by any registered physician and surgeon active in our school, according to their criteria of freedom of medical act “.

Hands tied

Mauricio Guardia, attorney general of the College of Physicians, told that they are “tied hands” when it comes to controlling who practices these interventions: whether general practitioners, plastic surgeons or both. The truth is that the law empowers any doctor and any surgeon to perform this type of procedure, although they do not have a specialty in plastic surgery.

“One of the things we are doing is the professional profiles, we are saying as a school what each doctor can do according to their learning range (…) The position of the school and of this office is that there are procedures that are a very high risk and we are living consequences where aesthetic surgeries have proliferated (…) Please call the school and ask if the doctor is a specialist or not”, said Guardia. Currently, the College of Physicians and Surgeons has opened 8 research processes for cosmetic surgery performed in the country.

For Guardia, it is necessary to create a professional profile to define functions, but the regulation will not be completed until there is a legal reform that specifies who is authorized to practice these processes: all doctors or those who specialized. He recalled that there was an attempt to reform the Law of the College of Physicians, “which gave them more power” for this type of controls, however, the Government of Luis Guillermo Solis vetoed the proposal. Until now, he said, as a school, they have had a rapprochement with the new deputies, without there being any concrete result.

The tax reform, he added, has impeded achieving greater rapprochement with the assembly members to talk about the necessary reforms. Meanwhile, each time a patient dies the discussion is reopened, without taking concrete measures that allow users to know that those who perform the procedures specialized for it.

Emptiness in the regulation

Mario Alvarenga, a plastic surgeon, said he does not imagine a general practitioner, a gynecologist or a dermatologist doing plastic surgery. “It is just as I cannot imagine treating skin problems, because I am not a dermatologist. Then the first thing is that each patient should worry and find who is who is going to operate”, he commented.

Víctor Urzola, president of the Costa Rican Association of Plastic, Reconstructive and Aesthetic Surgery, affirmed on this medium, on September 25th, in a note entitled “Vacuum in regulations allows any doctor to become a Plastic Surgeon”, which is not that they want “Block anyone”, but things are done as they should be.

“This is not about blocking anyone and it is something very important, we are not trying to block someone from working or that can be accredited, because the last 7 people who have come from abroad have been properly incorporated, but all have a program that It was comparable and satisfactorily passed the exams with the appropriate level”, he explained. According to the specialist, what is sought is that doctors are trained, but there are people who try to do it “taking shortcuts”.

Ileana Balmaceda, director of the San Juan de Dios Hospital, said that there are many cases that arrive at the hospital and that it is very frequent. “There are patients who start a private therapeutic process and end up in the Caja”, he said. Balmaceda said that in aesthetic matters it would be up to the College of Physicians to investigate. “The Office of the Public Prosecutor of the College must investigate and establish the responsibilities”. The director of the medical center indicated that from the institutional point of view, they document the patient because the processes end in judicial cases.

An attempt was made to obtain the position of the Ministry of Health, but at the close of the edition, they had not replied.