Legislators target renegade plastic surgeons.

Plastic surgeons in California may soon be getting a little nip and tuck of their own - from the state Legislature.

After several deaths and disfigurements in L.A. and Orange counties, lawmakers want to tighten the rules on doctors who perform cosmetic procedures.

The field of plastic surgery is relatively unregulated and free from the bookkeeping minutiae of managed care. Usually elective, the procedures are rarely covered by insurers and thus guarantee better profits for physicians.

As a result, more and more doctors are getting into the trade. Anyone with a medical degree can legally perform cosmetic surgery in California. No special training is required - and that has many at the Medical Board of California and in the Legislature alarmed.

"We are going to weed out bad doctors in the field and institute patient protections," said Democratic Assemblyman Martin Gallegos of Baldwin Park, chairman of the Assembly Health Committee, who is drafting a measure to tighten the rules. "Indeed, this has been a long time coming. It is unfortunate that people had to lose their lives before anything could change."

Plastic surgery might not seem like a life-or-death procedure, but there have been fatalities. In 1997, a Lynwood physician was accused of contributing to the death of one patient and seriously harming two others during a liposuction procedure. Patrick Chavis, an obstetrician-gynecologist, had only taken a four-day course at the Liposuction Institute of Beverly Hills and failed to complete the second part of the program. Chavis had his medical license revoked and is under investigation by the District Attorney's Office.

In the same year, another patient in La Habra died after more than 10 hours of plastic surgery, including large-volume liposuction. The doctor, Earl W. Matory Jr., and the anesthesiologist, William Hoo, were also stripped of their medical licenses.

After the deaths, the Medical Board set up a committee that has been meeting for more than a year to investigate the problem. Gallegos and Sen. Liz Figueroa, D-Alameda, are both working on legislative remedies. Figueroa, who chairs the Senate Committee on Business and Professions, is holding a heating to investigate the matter on Feb. 17.

Gallegos has already drafted a measure, but it has not been formally numbered. The bill will cover three areas:

Physicians who engage in outpatient plastic surgery procedures will be required to have medical malpractice insurance.

They must have proper equipment and use licensed health care professionals to assist, and must have a plan to transfer patients to a hospital if there are complications.

The office or outpatient clinic must be licensed by the state, and deaths or complications must be reported to regulators.

Currently, the state does not track deaths or complications that result from cosmetic surgery.

"This is going to revolutionize the plastic surgery industry," said Ron Joseph, executive director of the Medical Board of California. "The ability of any licensed physician to perform surgery will be limited. We're charged with protecting patients, that is the aim of this legislation."

Though physicians can normally be counted on to rally against legislation that increases regulation of doctors, there is widespread support for Gallegos' bill among medical organizations.

"People who cannot qualify with medical malpractice insurers will not be able to get approval (to practice plastic surgery)," said Dr. Michael F. McGuire, chief of plastic surgery at St. Johns Hospitals and president-elect of the California Society of Plastic Surgeons. "The basis for all of this is patient safety. Doctors should only be performing surgery they were trained to perform. I would not attempt to do heart surgery."

The requirement under Gallegos' bill that all plastic surgeons have malpractice insurance will likely mean they will have to be board certified as well, because few insurers would be willing to cover a non-certified surgeon.

Board certification is done by the American Board of Plastic Surgery. The certification requires five years of general surgery residency, two years of plastic surgery residency, plus another one-and-a-half to two years to meet the board certification requirements.

The profession's current lack of regulation or requirements for board certification stem from the fact that, in the past, the procedures were nearly always performed inside hospitals. But as cost cutting and inroads in technology moved more procedures to outpatient facilities, there was less monitoring. Hospitals require physicians to be formally trained and board certified; clinics do not.

"(Gallegos' proposed legislation) elevates consumer protection," said Scott Syphax, associate director of government relations for the California Medical Association. "This is a phenomenon that has been developing over the years and it needs to be rectified."