A Connecticut plastic surgeon has had her clinic closed for violations which cite mouse droppings on surgical equipment and resealed one-use instruments with blood on them.
The state suspended the license for the Connecticut Plastic Surgery Center, run by plastic surgeon Dr. Teresita Mascardo, on Dec. 4.
According to a report from ABC News affiliate WTNH in New Haven, the state found nine violations, including the animal droppings, resealed instruments with human fluids on them, dust and blood on the floor and machines, and an unlicensed anesthesiologist.
Mascardo surrendered her license voluntarily on Dec. 11, according to a sworn statement sent to ABCNews.com by the Connecticut Department of Public Health.
A message left by ABCNews.com with a receptionist at Mascardo's Connecticut office was not returned. A number listed on her Web site for a New York office was not in operation.
With 17 million plastic or reconstructive procedures performed in 2008, according to the American Society for Plastic Surgery, many may be wondering what they need to look for to avoid having their operation performed at a clinic like Mascardo's, where risks for infection can run high.
Visible problems, obviously, are a red flag.
"If you see contamination and soiled items that are visible to the naked eye, you can pretty much guarantee there are microscopic things that are harmful as well," said Dr. Mark Abdelmalek, chief of the division of laser and dermatologic surgery at Drexel University and an ABC News contributor. "A lot of the things that are harmful, you can't even see, unfortunately."
There are some things patients can do -- though the possibility of infection, however minor a risk, will be present with any cosmetic surgery.
Asking the right questions "doesn't guarantee everything will be perfect," said Dr. Michael McGuire, president of the American Society of Plastic Surgeons. But, "It's the best precautionary approach."
Given varying standards by state, there are a number of steps patients can take to minimize risks when undergoing a cosmetic or reconstructive operation.
The ABCs of Plastic Surgery Safety
McGuire said patients can take steps before entering the operating room to ensure that the place they are having the surgery. He called it the ABCs -- for accreditation, board certification and credentials.
First, he said, the facility itself needs to be accredited by a national agency, the state it is operating in or Medicare.
"You can have the world's best surgeon, and if he or she is operating in a garage, you're not going to have a safe surgery," he said.
Next, he said, the doctor should be board certified in the specialty you are having treatment in. For plastic surgery, he said, that means "it's board certification by the American Board of Plastic Surgery."
Finally, he said, doctors should be credentialed by a hospital, meaning that the hospital would grant the doctor credentials to perform the operation there.
"At an acute care hospital, you have the peer-review process," McGuire said.
After ensuring that the big things are in place, McGuire, like Abdelmalek, recommended taking a look at the surgery site itself, adding that it often they can be well-judged on appearances.
If the place looks shabby and has paint chipping off the walls or otherwise doesn't look professional, he said, it likely has deeper problems.
But, McGuire added, only 15 states require all surgery sites to be accredited (Connecticut is among them) and so patients may need to take some extra steps.
"You cannot assume that a place has been inspected. As a result, you have to ask the right questions," he said. "Frankly, they should be happy to show you their certificate. If you don't see these, it's really just common sense that you ask.
"Certainly, if these things are not in place, I would recommend going someplace else," he added. "It's the best evidence you can get that at least it's safe."
Also, he explained, all of the certifications need to be renewed at some point, with accreditation done at three-year intervals, board certification done at 10-year intervals, and credentialing done by hospitals every two years.
Picking Up on the Details
While it may be difficult to spot any and all violations, patients' observations can make a difference. The Connecticut Department of Public Health investigated Mascardo after complaints from patients, according to department spokesman William Gerrish.
While some of the violations Mascardo's office was cited for involve very visible problems, Abdelmalek said there are some things patients can watch for during preparations for surgery -- although part of being able to do so reliably depends upon knowing more about the surgery the patient is receiving.
The primary issue is sterility, because in some operations, instruments must be completely sterile, while in others the area needs to be clean but cannot be completely sterilized, such as oral and skin surgeries.
"If you're having a procedure, you should be mindful as a patient and look at the instruments," said Abdelmalek. "If those instruments are not coming out of a sealed package, then those instruments are not sterile."
He noted that other problems are apparent if sterile instruments are handled without gloves or are handled by someone wearing gloves who is touching the chart and computer keyboard and then the surgical instrument.
Labeling is also an important sign that a clinic is organized, said Abdelmalek.
He said many items are single use, such as scalpel blades, needles, IV tubing, suture equipment and gauze, and patients should be aware that those items are new.
Unfortunately, violations do take place.
"It happens, probably more than people think," he said, explaining that he has seen some doctors take gauze that was on the tray but not used in a procedure and use that gauze for another patient.
Unfortunately, it can be difficult to complain when you see that happening, he said.
"How are you going to prove something like that? Are you going to send in a hidden camera?" he said. "If it isn't documented, it didn't happen."
In the end, most people still possess the best tool to avoid surgical complications. While some patients have immune system problems, those with healthier immune systems have perhaps the best tool for preventing complications -- and that may be the reason why unsafe clinics don't always yield a flood of infections.
"Your body's job is to fight off infections," said Abdelmalek, "so there are a lot of times you will have bacteria introduced when you won't get an infection."