Part 2: "A total fraud"

Although every surgery comes with risks, some victim testimonies offer clear examples of medical negligence.

Liliana Fragozo, 40, from Bogota, was unhappy with her loose skin following two pregnancies and had an abdominal lipectomy, breast implants, fat-removing laser lipolysis, belly button reconstructive surgery and breast augmentation. She awoke from her ordeal on the operating table with unexpectedly large and asymmetric breasts.

During the surgery, her surgeon had placed one of the breast implants in backwards. He had also told Fragozo that the implants were of the highest quality and would last a lifetime, but her reconstructive surgeon, who discovered that the implant was put in upside-down, also found that the artificial breasts were actually the lowest grade products on the market.

Fragozo had the same surgeon as Lorena Beltrán, the journalist who publicized her case, and their doctor was exposed as having obtained an express degree from Brazil; he now faces multiple lawsuits for malpractice.

In Colombia, doctors can legally perform plastic surgeries without a four-year specialization — the minimum training required to become a member of the country’s professional society of plastic surgeons. But some surgeons who have only taken out-of-country crash courses in plastic surgery managed to obtain licences through government corruption, according to critics. These surgeons then market themselves as fully-fledged plastic surgeons.

Surgeons accused of malpractice such as Beltrán and Fragozo’s have seldom given comment to Colombian media, but in a written statement to Al Jazeera, Beltrán‘s doctor denied any illegal activity.  “I clarify that I was competent enough by the time I reached the last leg of my studies in Brazil, and I left the country still competent but having validated my previous knowledge. Therefore I am not nor have I ever been a social risk, I have not done anything illegal in my academic education,” wrote the doctor.

In October of 2017, Beltrán‘s doctor, along with five others that attended the express course in Brazil, was charged with procedural fraud and falsehood in private documentation.

In the worst of cases, complications from plastic surgery have led to the death of patients. The Instituto Nacional de Medicina Legal (Colombia’s National Institute of Legal Medicine) reported 13 deaths related to plastic surgery in 2015. In 2016, the number rose to 30, and in 2017, 14 deaths occurred, three of which resulted from surgeries performed on foreigners.

Bernardo Guerra, a former doctor and now city councillor in Medellin, has been working on improving medical standards and in assisting with the prosecution of negligent doctors for a decade. “In 2015, four women died in Medellin. In 2016 we (went from four) to 14 women. We’re talking about an increase of over 400 per cent” in the number of plastic surgery-related fatalities in a year, Guerra said during an interview in mid-2017.

“The complex situation in Colombia is lamentable,” added Guerra, who described a “white route” of plastic surgery as well as a “dark route”.

“We have a criminal gang of white coats with false titles obtained in Brazil, Peru and Argentina,” Guerra explained. “After obtaining these false titles, some managed to validate them in Colombia in an unusual manner through corruption in the Ministry of Education. They have promoted themselves through social media and Internet pages to attract patients from Europe, United States, Mexico, Central America, and the rest of the world.”

A Colombian investigative journalism unit found that an administrator from the Ministry of Education, Maria del Pilar Leiva Gutierrez, was married to one of the doctors who had obtained an express degree from Brazil. She allegedly signed off on paperwork certifying his credentials in Colombia, as well as other documents certifying other underqualified surgeons with similar degrees.

Another high-profile Colombian news source, El Espectador, also reported the case of Leonor Herreño, another Ministry of Education official who was charged with bribery, fraud and falsehood in public documentation. Herreño was accused of falsely validating plastic surgery licences for at least three surgeons, with 44 more under investigation.

Guerra said that clandestine clinics often put up a front as a hair salon while risky cosmetic surgeries take place in a back room. A black-market trend involves injecting silicone polymers to the glutes during buttock enhancement — a quick-and-dirty operation with immediate results. However, the silicone can then shift to other parts of the body and is nearly impossible to completely remove, creating severe health risks.

Plastic surgeons accused of malpractice have also been known to inject substances such as glue or cooking oil into patients’ bodies instead of silicone. Radio Ambulante, a Spanish-language podcast distributed by the American public radio service NPR, has documented the case of 21-year-old Ximena Lopez, who had gluteal injections. A vein was pinched during her operation, and the injected substance travelled to her lungs. Her breathing compromised, Lopez died of cardiac arrest.

More than 250 women have contacted Guerra to express their concerns about plastic surgery malpractice in Colombia. “As a medical specialist in public health, this subject interests me because it’s a total fraud,” said Guerra, a Medellin city councillor since 2008. “It’s not only national patients but international ones, as well. The subject threatens the good name of the city and mars its health.”

While Guerra and other politicians are trying to change legislation to more strictly regulate and monitor plastic surgery in Colombia, he said government corruption has made it difficult to make serious headway in reforming the industry.

“The increase in deaths is a reflection of the lack of control and vigilance in the authorities to prevent these people from setting up garage clinics,” he said.

Barbosa said he agrees that plastic surgery in the country needs legislation that would prevent underqualified surgeons from operating.

“The problem in Colombia is that there is no legislation about specialities,” said Barbosa. “Here, any general doctor can do anything.”

And Barbosa, whose Bogota clinic is frequented by people like Salgado — victims of botched surgeries seeking post-op medical treatment or corrective reconstruction — sees the fallout from Colombia’s poorly regulated yet highly popular plastic surgery industry.

Unlike many Western countries, he said, in Colombia any doctor with a general licence can practice any kind of surgery, with the exception of procedures in radiology and anesthesiology. Unspecialized and unethical doctors can take advantage of this glaring problem in the medical profession by turning a profit from plastic surgery.

In countries such as the United States and Canada, plastic surgeons operate under the watch of professional bodies governed by boards of directors, strict medical regulations and enforcement regimes. In Canada, the provincial colleges of physicians and surgeons oversee licensing of medical professionals, and the Canadian Society of Plastic Surgeons has a code of ethics that bars false advertising and any practices that mislead patients.  Misconduct can result in having medical licences and society membership revoked.

Medical professionalization isn’t so strongly enforced in Colombia. The most powerful guiding body for plastic surgery is the Sociedad Colombiana de Cirugia Plastica or SCCP, a longstanding private association of plastic surgeons that promotes best practices. SCCP members are required to have completed a four-year specialization in plastic surgery from a recognised program, followed by a two-year probation period before being able to join the society. Barbosa also said that since the SCCP is a private association, not all Colombian plastic surgeons with 4-year specializations are members.

Despite its strong reputation, the SCCP lacks the legal clout necessary to prevent bad operators from carrying out botched surgeries. Investigating and shutting down clandestine clinics fall on municipal departments of health, and malpractice cases are investigated by the National Institute of Legal Medicine. Licencing is overseen by the Ministry of Education.

According to Barbosa, the safety of plastic surgery, or any operation, rests on four pillars: a qualified surgeon, a well-equipped and hygienic clinic, a patient suitable for the operation, and proper post-operative care. Lacking in any of these four areas can result in medical complications ranging from minor to life-threatening.

Barbosa also said that many of the symptoms that victims of botched surgeries suffered, such as infections or necrosis, are easily preventable with proper surgical techniques, follow-up care and selecting healthy patients.

“If you are having an operation without a specialist, you’re at higher risk — or if you’re operated on in an inappropriate place,” said Barbosa. “If you are an inadequate patient — diabetic or with cardiorespiratory problems — that’s going to be a problem.”