Dr Chan: Surgeon under the knife

By JAN CORBETT

Of all the hallways you might walk along to give evidence of suffering a wretched assault, the warmly toned passage to the Stamford Plaza's function rooms must be the most elegant.

Some of the beautiful people who routinely grace this venue might have had their features chiselled or their thighs toned by something more than Mother Nature or a gym subscription. They may have quietly slipped off for a spot of remodelling, a discrete nip and tuck or maybe had the nozzle poked under their skin to hoover up those stubborn fatty deposits.

Never would they have imagined a visit to the cosmetic surgeon could result not only in disfigurement or near death, but in having to shuffle anonymously into the plush hotel to give evidence against a doctor whose former patients have been testifying against him for the best part of a decade.

The eight complainants who made that trip to the Stamford Plaza this week to testify before the Medical Practitioners Disciplinary Tribunal angrily recounted the horror of waking up during painful liposuction procedures, passing out in agony, begging the doctor to stop but being ignored.

They detailed being sent home in pain, still bleeding and phoning the clinic only to be told this was normal.

At least one went into post-operative shock and was on the verge of renal failure. Several went through liposuction or breast reduction surgery only to wake up looking the same as before, except for savage scarring. One who wanted the size of his nose reduced, unwrapped the bandages to find it bent. Some of their injuries are irreparable.

And some might wonder how Dr Warren Wing Nin Chan had been able to stay in practice for so long.

In a stern letter written in October 2000, then president of the New Zealand Foundation for Cosmetic Plastic Surgery, Dr Julian Lofts seemed to be wondering the same thing when he asked Medical Council chairman Dr Tony Baird whether "it will take an unfortunate patient's death to finally tell the New Zealand public and the Medical Council that Dr Chan is not properly trained to practise any form of cosmetic surgery".

Simply, the law governing medical discipline never envisaged an unrepentant repeat offender such as Chan. Just as juries never get to hear of the accused's criminal past, the tribunal can consider only the charges brought before it at any one time.

In isolation, Chan's misdemeanours have never reached the threshold of seriousness required for the only type of finding that can get a doctor struck off the medical register - disgraceful conduct. With the recent exception of Dr Graham Parry, disgraceful conduct is usually reserved for cases of sexual impropriety as opposed to poor clinical practice.

Only when they are deciding the penalty on lesser charges for which a doctor cannot be struck off, can the tribunal consider his sorry history. And with Chan there is a lot of that to consider.

Born in China and trained as a doctor in Sydney, Chan arrived here in the early 1990s as a circuit doctor moving between the two countries. He set up nationwide clinics under the name the Australasia Cosmetic Surgery Centre and was fond of displaying qualifications on his wall and business card that, apart from his bona fide medical degree, were as pumped up as this bodybuilding fanatic's biceps.

It wasn't long before he was into the first of what now amounts to five disciplinary hearings, including this week's.

The accusations are always depressingly familiar: failing to provide proper information; being underqualified for the procedures he was undertaking but misleading patients about his qualifications; botching the anaesthetic and failing to provide the proper post-operative care. Even his patient record-keeping is woeful.

Lately he has not bothered defending the charges, but has been able to negate earlier suspension orders by lodging lengthy appeals. The District Court overturned the most recent order that he practise only under supervision because although he tried, he was unable to find a plastic surgeon here or on Australia willing to supervise him.

The fines and costs awarded against him now total close to $140,000. According to tribunal secretary Gay Fraser, not all that money has been paid. Instead he has claimed $1 million in damages from the tribunal because its findings against him have prevented him practising in Australia to where he retreated, declaring himself a victim of a medical mafia trying to drive him out of business because it resented the competition.

A reciprocal suspension by Australian medical authorities banned him from operating in Queensland or New South Wales. But he was already in trouble over there anyway.

This year a Brisbane woman sued him, claiming a breast enlargement left her looking like a "freak" and "very promiscuous."

Chan worked closely with Australia's self-styled "Queen of Cosmetic Surgery", Pamela Noon, whose company, Clinical Beauty, acted as an agent for a range of practitioners, including Chan.

Anne Edwards was one woman who went under Chan's knife on Clinical Beauty's recommendation.

But the 35-year-old mother of two was unhappy with the result of the 1998 operation and sued both parties for A$250,000.

She claimed Chan made her breasts too large. She felt uncomfortable and men found her unnattractive.

While Judge Neil McLauchlan QC dismissed the case against Clinical Beauty on the grounds it had not breached the terms of its contact, he ruled that Chan failed to advise Edwards that the operation may not produce her desired results. Judge McLauchlan agreed the implants were "riding too high".

The majority of Edwards' compensation was awarded for having to undergo two operations that didn't achieve the required result, forcing her to endure "very unattractive breasts", which caused embarrassment and emotional distress.

The list of cosmetic surgeons Noon represents no longer includes Chan, whom she continues to staunchly defend as the victim of a run of bad luck.

"He certainly was the master of liposuction," says Noon. "He had such interesting techniques on things like face and nose and breasts.

"No one has been maimed, seriously injured and certainly not died. I was a patient of his and I thought he was a very, very good surgeon. A lot of other surgeons feel the same way."

Noon says she hasn't spoken to Chan for more than six months. A friend told her he has gone to China to pursue business interests that have nothing to do with cosmetic surgery.

"The last conversation I had with him, he said he was not going to reregister.

He said he did not think he would practise medicine again," she says.

Practical matters are likely to restrict Chan from making a comeback in Australia.

In March the Queensland Medical Practitioners Act was amended to stop practitioners such as Chan who don't have proper qualifications from touting themselves as surgeons. To do so risks a heavy fine.

New Zealand GPs, or specialists in other fields such as dermatology, can call themselves cosmetic surgeons with as little as a weekend's worth of training in the field. If you want a true specialist redesigning your nose or dealing to those crows' feet, flabby abdomen or flat chest, you need to ensure your chosen doctor is a vocationally registered plastic or reconstructive surgeon.

Unfortunately the terms cosmetic surgeon and plastic surgeon get used synonymously, when in reality years of study and experience separate them. Confusingly Telecom lists plastic surgeons under cosmetic surgeons in the Yellow Pages.

Even with the limitations of New Zealand law, our medical authorities finally got tough with Chan this year.

With details of the most recent five complainants piling up, the Medical Council suspended him from practising until the charges had been heard, a ban that came into effect even before his previous suspension had expired.

Hearing rumours that he might still be practising, the Medical Council took the unprecedented step of warning the public against Chan.

The council's assistant registrar, Tania Turfrey, says that although she fielded a couple of inquiries from prospective patients, she never had enough evidence to notify the Ministry of Health that a doctor was still practising while suspended, which is an offence.

Yet one of this week's complainants, an immigrant, had his nose operated on by Chan while he was suspended.

When lawyer Kate Davenport looked at the latest batch of complaints against Chan she was determined to find a way to have him stopped - even though no one is sure where he is.

Digging back through medical case law, she found a precedent for laying a cumulative charge of disgraceful conduct, in case none of the individual complaints cleared that hurdle on their own.

The tribunal and the Medical Council discussed the issue of serial medical offenders with Helen Cull QC, who reviewed medical disciplinary procedures for the Government.

The resulting Health Professionals Competency Assurance Bill, tabled in the House in its final week, flattens the old hierarchy of charges into one of professional misconduct with all the penalties, such as striking off, available.

Turfrey predicts there will be considerable debate at select committee stage about reinstating the three levels of charges.

If they are returned, she says, the case on what to do about low-level repeat offenders will have to be reopened.

- Additional reporting by Billy Adams.