13 December 2012

Dermatologists testify against proposed bill on surgery provisions

WASHINGTON, D.C. (Dec. 13, 2012) —Dermatologists representing the American Academy of Dermatology Association (AADA), Dermatological Society of New Jersey (DSNJ), the American Society for Dermatologic Surgery Association (ASDSA), and the American College of Mohs Surgery (ACMS) testified today before the New Jersey Assembly Health and Senior Services Committee against changes to statutes that would limit the setting where certain minimally invasive procedures can be performed.

According to Assembly Bill (AB) 1824, physicians can perform any of the following procedures only in an office or facility that is accredited by the American Association for Accreditation of Ambulatory Surgery Facilities, the Accreditation Association for Ambulatory Health Care, or The Joint Commission:

  1. Liposuction procedures that involve more than 750 cubic centimeters of aspirate.
  2. Procedures that utilize a breast implant.
  3. Aesthetic truncal contouring procedures that involve the excision of skin.
“Although we appreciate the committee’s interest in ensuring patient safety, such legislation could in fact hinder patient safety, access to dermatological procedures, and lead to even higher health care costs in New Jersey,” said board-certified dermatologist Brett M. Coldiron, MD, FAAD, 2013 AADA president-elect.

During the testimony, the physicians maintained that patients frequently choose to have these minimally invasive procedures performed in outpatient settings rather than hospital settings because they are able to avoid high hospital overhead costs while avoiding the risk of hospital-acquired infections such as antibiotic-resistant staph infections.

Additionally, the passage of this bill could set a precedent for legislation that does not aim to ensure patient safety, but rather negatively affects patient access to minor surgeries, which are safely performed in physician offices.

“This legislation may have the unintended consequences of requiring accreditation for the offices of physicians who perform minor surgery, such as the excision of moles, warts, cysts, lipomas, skin biopsies, the repair of simple lacerations, or other surgery limited to the skin and subcutaneous tissue, all of which could arguably be considered ‘body contouring’,” said board-certified dermatologist Robert Paull, MD, FAAD, DSNJ board member.

The organizations called on the Committee to require mandatory adverse-incident reporting so the root cause of adverse events can be identified and addressed.

Additionally, the groups encouraged the committee to consider truth-in-advertising legislation that would enable patients to make informed decisions about who provides their medical care. Such legislation should include disclosure of level of licensure, disclosure of the full name of the board in which a physician is certified, and a requirement that the board be legitimized by the American Board of Medical Specialties, American Osteopathic Association, or the American College of Graduate Medical Education.

Drs. Coldiron and Paull also recommended that the Committee initiate standards to ensure that physicians providing surgical and procedural services using anesthesia — that significantly impairs the patient's protective reflexes — should have demonstrated competencies in moderate and deep sedation and airway management. However, the use of minimal to moderate sedation with local, dilute local, oral, or intramuscular analgesia should be specifically omitted from such requirements.

“Without knowing the cause of adverse events, this legislation is premature,” said Dr. Coldiron. “Once data from mandatory adverse-incident reporting is available, the appropriate decisions can be made to address any problems and ensure patient safety.”

Following the hearing, the bill passed out of committee and will go on to the full assembly for a vote.

The AADA commends the Committee for offering the specialty the opportunity to testify on behalf of these important patient-safety issues, and will continue to work with the New Jersey state legislature to ensure that the necessary amendments to this bill are made.

Like plastic surgeons, facial plastic surgeons, and occuloplastic surgeons, dermatologists have the medical education, training and experience to perform surgery. It is essential that states establish or strengthen laws that govern the performance of these services because they are critical to ensuring patient health and safety.