Maryland is moving to toughen regulations on the fast-growing medspa industry — a move designed to narrow a "loophole" and prevent deaths such as one last year following a liposuction treatment at a Timonium facility.
Regulations being discussed by state officials would bar plastic surgeons from performing liposuction and other procedures in medspas and medical offices unless the facilities are inspected by the government or third-party accrediting bodies, Maryland Secretary of Health Joshua Sharfstein said.
The changes would bring greater scrutiny to an industry where patients typically pay out of pocket for procedures — making the consumer the main oversight authority, instead of private or government insurers who demand safeguards, Sharfstein said.
"The goal is to make sure the riskier procedures are happening in the safer places," he said.
Maryland is among a growing number of states seeking to regulate where liposuction and other procedures can be performed. Twenty-seven states have passed laws or imposed rules regarding where surgeries can take place, according to the American Association for Accreditation of Ambulatory Surgery Facilities.
Florida, for example, passed a law last year requiring annual inspection of any facility that removes more than 1,000 cubic centimeters of fat during liposuction. In New York, accreditation is required for any office-based surgery that removes more than 500 cubic centimeters of fat during liposuction or uses anything more than minimal anesthesia.
"A lot of states are figuring out these issues with medspas," said Dr. Doug Forman, a plastic surgeon in North Bethesda who serves on the American Society of Plastic Surgeons' government affairs committee. "Nationally, medspas are falling into this gray zone."
While there were about 800 medspas across the country five years ago, there are nearly 5,000 now registered with the International Medical Spa Association, said executive director Allan Share.
But there is no definition for what qualifies as a medspa, and they include facilities that offer a range of services from Botox to complex surgeries, Share said. The industry as growing as centers seek to capture demand from cash-paying customers, he said.
"Minimally invasive" procedures such as laser skin treatments and Botox injections have increased 6 percent since 2000, according to the plastic surgeons society. Surgical procedures, meanwhile, have declined 16 percent over the same period.
Health officials encourage patients to verify that licensed physicians are performing their cosmetic surgery procedures and that the operations are taking place in accredited facilities that are either equipped to handle emergencies or have relationships with nearby hospitals.
Doctors and other health care workers have been charged with a range of infractions in recent years, sometimes with serious results, Maryland Board of Physicians records show.
Maryland lawmakers were pressed into action last year after a Lochearn woman died of an infection contracted during liposuction at Monarch Medspa in Timonium.
But earlier cases show similar risks. A doctor at another Timonium plastic surgery center lost his medical license in 2011 after two of his patients died of complications from complex cosmetic surgeries. Officials reprimanded that doctor and others for performing procedures in inappropriate settings.
Other people have been disciplined for providing procedures such as laser hair removal without a medical license at all.
The state Department of Health and Mental Hygiene elevated plastic surgery regulation to a top legislative priority in the days after regulators shut down Monarch Medspa in September over "probable deviations from standard infection control practices." Three patients contracted aggressive infections after undergoing liposuction; one of them, 59-year-old Eula Witherspoon, died less than a week after the procedure.
Monarch officials had pledged to work with authorities and extended their sympathies when the infections came to light. They could not be reached for further comment.
At the time, Sharfstein noted "an unevenness" in regulation over liposuction and other cosmetic procedures. While the Board of Physicians licenses doctors who work in medspas or other private practices, the facilities where they work are not always subject to oversight.
The 2013 General Assembly approved a bill authorizing the health department to develop regulations that address the loophole. Health officials expect Gov. Martin O'Malley to sign the bill next month, though Raquel Guillory, a spokeswoman for the governor, said it's not clear when that will be.
The process of developing and imposing regulations could take a year, Sharfstein said.
Regulators plan to start by seeking public input on procedures that should be covered by the requirements, Sharfstein said. That could include liposuction and other surgical procedures that require anesthesia, he said.