Sunday 17 December 2017

Private clinic wins legal challenge over day-long masterclass in live breast implant surgery

A breast implant
A breast implant

Ray Managh

A private medical clinic has succeeded in a Court of Appeal challenge to the refusal of the Royal College of Surgeons of Ireland to accredit a day-long masterclass in live breast implant surgery

The College had refused to give its blessing to the specialist event planned in July 2013 by RAS Medical Ltd., which trades as Parkwest Clinic, and the clinic failed in a High Court application last year for leave to judicially review that decision.

The Court of Appeal in a judgment delivered by its president, Mr Justice Sean Ryan, has overturned the High Court ruling against the clinic.

RAS Medical had asked the College, as part of continuing professional development, to provide accreditation of the one-day event that would have featured live surgery demonstrations on implanting polyurethane breast enhancements and breast reduction.

The courts had heard that the RCSI’s refusal had been based on the fact that none of the surgeons who were to have been involved in the event were registered on the specialist register of the Irish Medical Council, although such registration is not a legal requirement for practising cosmetic surgery in Ireland.

The surgeons engaged to participate in the demo-day procedures were on specialist registers in their own countries but not here.  The clinic argued that the Irish Medical Council’s specialist register requirement had been set out in guidelines recommended and published only days before its planned event.

Judge Ryan said the medical director of the clinic is Dr Ahmed Salman who performs the surgery and who, although not a specialist plastic surgeon and not on the Medical Council’s register, claimed to be highly experienced and competent in the field with a large number of successful operations to his credit.

The judge said the RCSI was the body approved by the Medical Council for the purpose of certifying continuing professional development courses for doctors in the specific area of breast implant cosmetic surgery.

He said RAS Medical planned to run the “One-Dlay Master Class on the Polyurethane Breast Implants and Cosmetic Surgery” on 27 July 2013 during which three live surgeries would be performed.  Dr Salman had sent in his application for accreditation on June 20 and had made his application in accordance with Guidelines issued by the College.

Judge Ryan said Dr Salman had organised a similar event previously in 2011 and had obtained College approval for continuing professional development purposes for attendance at that event.

The Professional Development and Practice Committee of the College, through its secretary, Ms Marie O’Boyle, had sought additional information details on sponsors, speakers, facilitators and the name of a consultant on the Medical Council Specialist Division of the Register in Plastic Surgery who supported the course.

“In relation to the latter there was no such consultant although Dr Salman was satisfied that all the experts involved in the event were distinguished in their field,” Judge Ryan said.

Only three weeks before the event Professor Sean Tierney, Dean of Professional Development and Practice of the College, emailed RAS saying the event could not be approved as it was a requirement of the Professional Development Committee that the chief organiser should be on the Specialist Register in Plastic Surgery and that this was not the case.

Queries had been raised by Dr Salman and Professor Tierney had sent him a copy of “the latest version” of the Guidelines which had been approved at a recent meeting of the Committee.  The new Guidelines had been uploaded to the College website on July 15, only 12 days before the planned event.

Judge Ryan said the clinic’s primary complaint was that the College had changed the rules contained in the Guidelines for the purpose of refusing its application.  While there was room for appeal it would have been to the same committee and which was not scheduled to meet before the date of the event.

The judge said the committee was evidently of the view it needed to change the guidelines in order to impose a new requirement and indeed to refuse the application.

“Patient safety is a legitimate concern for any medical body that is asked to certify an event in which surgical techniques are going to be taught using live demonstrations of procedures being carried out…but there was no suggestion here of any lack of patient protection,” Judge Ryan said.

He said it was fair to acknowledge that the College in this judicial review application had not suggested that Dr Salman had any lack of surgical expertise in carrying out the particular procedures that he did and that a similar event had previously been approved by the College.

Judge Ryan said that having reviewed the evidence and, particularly, emails between the parties he felt the College seemed to have sought to find a reason to refuse Dr Salman’s application.  In his view the High Court was in error in rejecting the judicial review application and he allowed the clinic’s appeal.

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