Physicians Weigh In for Fight Over Who May Do Fat Reduction Surgery

HOUSTON — Housewife Patsy Howell wanted to look slimmer in a bathing suit. Lawyer Lannis Temple wanted to get rid of fat deposits around his waist.

After undergoing liposuction, or fat removal surgery, Temple was pleased with the result. Howell was dead of a massive infection.

Temple now is representing Howell’s family in a lawsuit filed against the doctor who performed her surgery.

“It is a safe operation if you follow safe procedures and have been treated properly,” said Temple, who had the operation done in a plastic surgeon’s office.

Booming in popularity, liposuction has prompted debate over how much training doctors should have before offering the expensive surgery to an appearance-conscious society. The American Medical Assn. has not taken a position.

Liposuction is now being performed on nearly 100,000 people a year in the United States, making it by far the most widely sought form of cosmetic surgery available, according to the American Society of Plastic and Reconstructive Surgeons Inc. The technique was offered for the first time in this country just five years ago.

With a tube inserted through an incision in the skin, bulbous whitish fat literally is sucked from the body.

The cost of the procedure ranges from about $500 to as high as $4,000, depending on the type of surgery undertaken.

After Howell died and another patient developed a massive infection, Dr. Hugo Ramirez, the suburban Pasadena, Tex., obstetrician-gynecologist who performed both operations, was ordered by the Texas Board of Medical Examiners to refrain from performing the procedure.

The board revoked his license to practice on July 24 after hearing evidence of substandard hygiene in Ramirez’s clinic and wide deviations from commonly accepted liposuction procedures. Among the allegations were that Ramirez sometimes removed too much fat and that patients were not adequately monitored after the procedure.

On Aug. 14, a federal judge allowed Ramirez to resume his primary obstetrics and gynecology practice, but barred him from performing surgery pending the outcome of a Dec. 1 trial over legal objections Ramirez raised in his license revocation.

Ramirez has described himself as “a scapegoat” in the case.

Dr. Julius Newman, chairman of the department of cosmetic surgery at Graduate Hospital in Philadelphia and founder of the American Society of Liposuction Surgery, says thousands of doctors, including Ramirez, have been trained through his 2 1/2-day workshops, which result in society certificates.

Newman says almost any doctor with a surgical specialty, such as dermatology, gynecology, orthopedics or general surgery, can learn to perform liposuction.

“Liposuction is not a specialty, it’s just a procedure,” said Newman. “Since it is only a procedure, it transcends many specialty groups.”

Dr. Simon Fredericks of Houston disagrees.

Fredericks chaired an American Society of Plastic and Reconstructive Surgeons study committee in 1982 that concluded liposuction is safe only when performed by trained plastic surgeons in a hospital or supervised outpatient facility.

“This is not a turf battle, this is a battle for the protection of the American people,” Fredericks said. “The only people who call it a turf battle are those who want to get their nose in under the tent.”

Newman and Fredericks agree, however, that there are limits on how much fat can be removed from the body without risking major complications, making liposuction an inappropriate treatment for general obesity.

“Liposuction is to contour the body, not for those who want to lose weight,” Temple said. “It’s lost on some doctors.”

He said Howell’s family is asking punitive damages of $1 million and unspecified general damages from Ramirez in order to send a message to doctors and alert the public about the need to choose physicians carefully and be informed about what the operation can and cannot do.

“The public has come to realize that appearance is important for both romantic and economic success,” Fredericks said. “But the public has been deluded by things they read in slick magazines that they can have anything they want as long as they are willing to pay for it.”