Cosmetic Surgery Regulation and Regulation Enforcement in Ontario

Abstract

In September 2007, 32-year-old Krista Stryland died from complications suffered after undergoing a liposuction procedure performed by a general practitioner without any surgical designation. This death brought the dearth of regulation in Ontario's private cosmetic surgery market to the public's attention. In response to the death, the College of Physicians and Surgeons of Ontario (CPSO) implemented reforms to provide oversight of private cosmetic surgery clinics. However, the nature and scope of the self-regulatory apparatus established in the wake of this fatality remains distinct from, and in the authors' opinion inferior to, the governmental oversight typical of facilities that dispense "medically-necessary" health services through the public healthcare system.

It remains to be seen how rigorous the CPSO's self-regulatory regime will be. While numerous initiatives have been undertaken between 2008 and 2010, the authors discuss several institutional and professional disparities between the new self-regulatory regime for private cosmetic surgery and the existing regime for publicly funded cosmetic surgery. Inspections of private clinics through the "Out-of-Hospital Premises Inspection Program", for example, are only required once every five years. If minimally adhered to, this regime will not approximate the licensing requirements that would have resulted from the direct government oversight of private clinics. The authors also highlight that from a professional perspective, self-regulatory regimes in jurisdictions such as British Columbia and Alberta have required surgical specializations, either explicitly or implicitly, before licensing health professionals to perform invasive surgeries. The CPSO has been unwilling to follow suit, and consequently its standards of care remain below those of its institutional contemporaries and provincial equivalents. The authors propose further regulatory options such as promoting informed patient choice, creating a licensing requirement for private sector clinics, and requiring accreditation for physicians performing invasive surgeries