The RACS NSW Committee has been a strong proponent for safe cosmetic surgery practice in New South Wales for some time now and previously advocated to the Minister for Health, to the Agency for Clinical Innovation, to the Clinical Excellence Commission and to the previous Health Care Complaints (HCCC) Inquiry into unsafe and illegal practices. RACS is supportive of collaboration between agencies, organisations and government to improve quality and safety for the consumer, and believes that this is the only way to bring about change and promote patient safety.

Key points made by RACS:

  • We feel that further protections need to be put in place, particularly around confusing naming.
  • The title "surgeon" should be protected for use by Fellows of recognised organisations such as RACS, or equivalent in other fields.
  • There needs to be further protections in place in regards to the registration and practices of beauty salons. With all injectable procedures prescribed by a medical practitioner.
  • We also feel that the HCCC has influence over registered practitioners and organisations; however increased visibility over the practitioners and organisations, qualifications, experience and scope would potentially speed up process and also protect the consumer more. 
  • Collaboration is essential to continual development of safe practice.

Initially, the RACS NSW Committee sought the public recognition for our highly qualified surgeons who were well trained and skilled to be recognised separately by protecting the use of the word "surgeon" for our Fellows, rather than only by the post-nominal "FRACS" which is not well recognised in consumer circles. Many medical practitioners in NSW have not undertaken FRACS accredited training, but are performing surgery under local anaesthetic or conscious sedation in private clinics. In our view surgical operations should only be performed by practitioners who are registered surgical specialists. Although this has value, implementation would have unintended far reaching implications for other professionals, both inside and outside of the health sphere, due to other areas that use the term "surgeon" e.g. dental surgeons, ophthalmologists and tree surgeons.

RACS works closely with the professional societies representing its surgical specialties, including the Australian Society of Plastic Surgeons (ASPS). RACS and ASPS share the mutual goal of protecting the integrity of plastic surgery as a specialty, and to providing the highest quality care possible. ASPS partners with RACS to deliver the Australian Medical Council (AMC) accredited training program to become a recognised specialist plastic surgeon. By the time they are accredited, registered plastic and reconstructive surgeons have undertaken a minimum of 12 years medical and surgical education, including at least five years of specialist postgraduate training. Due to the status quo there is the opportunity for under trained under qualified individuals to practice and call themselves cosmetic surgeons. As an example a cosmetic surgery clinic can call their medical specialists "Cosmetic surgeons", although they may be doctors of other medical specialties, we feel that this may be misleading to the consumer. However these medical practitioners do meet the requirements set down by the HCCC where the consumer must have a consultation undertaken by a registered medical practitioner.

Cosmetic surgery is not recognised as a surgical specialty, nor is the title of "Cosmetic surgeon". The training of cosmetic surgery is overseen by the Australian Society of Plastic Surgeons (ASPS) through the auspices of RACS. Only Specialist Plastic Surgeons are accredited by the Commonwealth Government of Australia, through the Australian Medical Council, to perform all reconstructive and cosmetic plastic surgery.

We support the need for the HCCC to address complaints with regards to cosmetic procedures and also the review of the sector as it becomes ever more popular. We would like to see greater visibility of responsibilities of practitioners and facilities and also greater protection for the consumer who purchases a procedure in good faith, particularly as augmentation becomes more popular. It was highlighted in 2017 that one in ten Australians aim to have plastic surgery in the next three years with the "main procedures undertaken were facial contouring (37 per cent); facial (31 per cent) and breast/chest enhancement (27 per cent)." 

Previously the Health Minister initiated a discussion paper of the "Cosmetic Surgery and The Private Health Facilities Act 2007"  in 2016 and consequent tighter regulation that came into effect in October of 2016 in New South Wales, whereby clinics administering anaesthetic resulting in more than conscious sedation had to meet standards, further to this the implementation of cooling off periods under legislation offered increased protection to the consumer, but could have gone further. This also addressed the need for all invasive procedures, namely breast augmentation and liposuction, to be performed in facilities equipped and accredited for general anaesthetic.

Unfortunately, in September 2017 the death still occurred of a manager of a Sydney beauty salon where an international tourist administered anaesthetic and breast filler resulting in death. Although this was already outside the law implemented in 2016 the manager was the consumer in this case and the law was not adhered to. This could easily have been another consumer purchasing the service from this, or another beauty salon.

Following this death the New South Wales Health Minister, Mr Brad Hazzard queried whether beauty salons not directly undertaking surgery who were not required to have registration previously should now be obligated to do so. Under the Public Health Amendment (review) Act 2017 beauty treatment operators who carry out skin penetration procedures, including waxing, must be registered with the local council. However the registration form 6 contains only contact details, rather than qualification and experience, so does not protect the consumer any more from a practice perspective. Indeed in the Parliament of New South Wales Media release for this review opens with "Unsafe and illegal cosmetic procedures are being performed at some cosmetic and beauty clinics by unregistered and unqualified health practitioners." We are now more than a year later since the death in NSW and although legislation has been implemented the risks to the consumer are still apparent.

There have also been national attempts to standardise titles to protect the public, and the Health Practitioner Regulation National Law 8 was introduced in an attempt to standardise medical practitioners under the same regime. However it is not completely uniformed. In NSW this is covered by the Health Practitioner Regulation National Law (NSW) No 86a.  The restrictions on the use of protected titles is legislated under s113. This provision explains that a person should "not knowingly or recklessly" take of use a title to induce the belief in another person that they are a registered health professional if they are not. Penalties of up to $30,000 for an individual may apply.

Another risk that we see is the lack of awareness of the consumer as to their rights, the HCCC have promoted the changes well, but the public when making choices may go on a recommendation of an associate or website, rather than undertaking research to ensure safe positive results. We are aware that this cannot be controlled by the HCCC, but we would encourage clearer paths for the consumer to follow to get best practice and best outcomes.

Read the complete submission at the link below.