Is my sister in-law being extorted by plastic surgeon?

[JHE1967]

I'll try and make this short--my SIL is having a mastopexy (breast lift). 2 weeks ago she went in for a test and they said she tested for 2nd hand smoke--she was advised not to smoke. She didn't. She *did* go in a bar where smoking was allowed.

Surgery was scheduled for today--she had to pay 90% upfront (8K). They did a lab test when she arrived and she tested for 2nd hand smoke again. They refused to do the surgery. Understandable but they said if she *didn't* reschedule she wouldn't get the 90% back (8K)-- if she does reschedule they charge her 35% for the anesthesiologist that showed up for surgery today (3K--increasing cost by a 1/3) + remaining 10% balance.

Does this sound right? She is out 3K even if she hasn't had a procedure done?
Seems like she is being strongarmed by the Dr. who has complete control in this situation. I don't really know anything about this so I thought I'd ask you guys.

Any advice is appreciated!
Chris

[CrazyCatLady]

I've never heard of testing for 2nd hand smoke (except for the people who claim their tox screens came back positive because of someone smoking pot or crack around them), and I can't imagine not doing surgery for 2nd hand smoke anyway, so that part seems rather odd.

The deposit thing seems fairly normal to me, although the percentage seems rather high. Service providers with a relatively high rate of people scheduling service and then backing out, like plastic surgeons and wedding vendors, have non-refundable deposits, so that they don't turn down other work to keep a slot open for you and then wind up with no job that day when you change your mind or find someone cheaper. Some places will let you transfer that deposit to another date/service if you reschedule, others won't. Some places will only let you transfer a portion of that deposit, especially if they have to hire a sub-contractor who typically has his own non-refundable payments.

And that's what it sounds like is going on here--the anesthesiologist in question has some sort of contract that he gets paid for showing up ready to work whether you wind up cutting or not, so that portion of her deposit can't be transferred to her rescheduling.

Can she fight this? I would guess probably not. Things like this are typically spelled out in pretty excruciating detail in your contract, and every doctor's office I've ever been in that charged late-cancellation or missed-appointment fees has not only had signs up but has had you sign a sheet of paper acknowledging that you know about the policy. So odds seem very high that somewhere in your sil's chart is a paper detailing all this with her signature on it, acknowledging that she knows the policy and agrees to abide by it.

[EvilTOJ]

What does smoking have to do with anything? Why are they testing for it? Get the money back, go to another surgeon this one sounds like bullshit.

[JHE1967]

I've never heard of testing for 2nd hand smoke (except for the people who claim their tox screens came back positive because of someone smoking pot or crack around them), and I can't imagine not doing surgery for 2nd hand smoke anyway, so that part seems rather odd.

The deposit thing seems fairly normal to me, although the percentage seems rather high. Service providers with a relatively high rate of people scheduling service and then backing out, like plastic surgeons and wedding vendors, have non-refundable deposits, so that they don't turn down other work to keep a slot open for you and then wind up with no job that day when you change your mind or find someone cheaper. Some places will let you transfer that deposit to another date/service if you reschedule, others won't. Some places will only let you transfer a portion of that deposit, especially if they have to hire a sub-contractor who typically has his own non-refundable payments.

And that's what it sounds like is going on here--the anesthesiologist in question has some sort of contract that he gets paid for showing up ready to work whether you wind up cutting or not, so that portion of her deposit can't be transferred to her rescheduling.

Can she fight this? I would guess probably not. Things like this are typically spelled out in pretty excruciating detail in your contract, and every doctor's office I've ever been in that charged late-cancellation or missed-appointment fees has not only had signs up but has had you sign a sheet of paper acknowledging that you know about the policy. So odds seem very high that somewhere in your sil's chart is a paper detailing all this with her signature on it, acknowledging that she knows the policy and agrees to abide by it.

Thanks much for this. Makes sense..

[voltaire]

Did she mention what method of testing they used?

I have a feeling that this is mostly a way for doctors to impose their view that all tobacco smoke, no matter how small the amount, is evil! That said, there is apparently some degree of legitimacy to the practice, and it seems it's fairly standard. I did a little google-fu, and this is the best I came up with:

some surgeon's website (http://www.omegahospital.com/breast-reconstruction-surgery.asp)Do Not Smoke. Avoid smoking for at least 6 months before and 6 weeks after surgery. This includes exposure to “second hand smoke”. Cigarette smoking causes blood vessel spasm and can diminish blood flow to your reconstruction. Tissue without blood supply heals poorly and can die completely.some other surgeon's site (http://www.drseballos.com/faq.html)• What about smoking?
Smoking adversely affects healing. You should not smoke for 6 weeks before any major cosmetic procedure. Some procedures involving skin flaps, muscle flaps and breast flaps are significantly affected by smoking. You may experience delayed healing or death of the surgical flaps. Please advise your doctor if you continued to smoke before surgery. Passive smoke or second hand smoke is also bad for healing. Please ask all loved ones or friends to not smoke in your presence before and after surgery.Relevant anecdotes on message boards:
http://www.breasthealthonline.org/cgi-bin/mwf/topic_show.pl?tid=92610
http://messageboards.makemeheal.com/rhinoplasty/second-hand-smoke-close-surgery-t50711.html

[JHE1967]

What does smoking have to do with anything? Why are they testing for it? Get the money back, go to another surgeon this one sounds like bullshit.

They said smoking can hinder recovery time, cause excess scar tissue, etc. That's the thing...she can't get her money back. If she does not reschedule with them they said they will not refund the 90% she was required to pay--around 8K.

[voltaire]

P.S. I forgot to mention that the first message board anecdote above mentions testing of nic level and possible rejection by the surgeon.

[Qadgop the Mercotan]

More and more surgeons are now refusing to do elective procedures on active smokers. Outcomes are poorer, healing times are longer, bad results are more common.

[pbbth]

Where does she live that people are still allowed to smoke in bars? I thought that had been banned pretty much nationwide.

[Moonlitherial]

So they can't do the surgery because your SIL didn't follow the directions she was given. That slot in the operating room couldn't be filled at the last minute, the surgical team is now(except for the anesthesiologist it seems) not getting paid. I don't think they're out of line at all.

I presume they gave her more information than "Don't smoke" however. If it was just one instruction in a list of preop directives I can see how she didn't take it seriously but based on my experience with presurgical checkups I suspect that the consequences of not following this direction was on a piece of paper that she signed saying she read and understood.

tl/dr - in this case the customer was wrong.

[Agent Foxtrot]

Did the pre-op directions specifically indicate to avoid second-hand smoke? Was she shown a policy beforehand that the surgeon reserves the right to not refund the deposit if the surgery is called off due to second-hand smoke? If the answer to both these questions is "yes", then your SIL is SOL.

[alice_in_wonderland]

Well, a couple of things:

1. I assume that your SIL signed some sort of contract detailing what she could and could not do before surgery, and what the consequences would be if she didn't follow those rules (e.g. surgery not being performed, her losing a portion of her deposit, etc)

2. I believe that nicotine does not stay in a person's system for that long usually - could she have been exposed to second hand smoke in the 2 weeks after the initial test? Does she have a spouse that smokes? Close friends? Honestly, it wouldn't be the first time that someone figured they could blow off directions because 'What's the surgeon going to do? Cancel my surgery? Ha!' Um, oops.

3. Many anesthetists tend to do things a bit differently than many other types of doctors - I know for many they're essentially contractors who get paid just for showing up, regardless if they work or not. Obviously, it's unfair for the anesthetist to not get paid for his or her time if they showed up ready to work. Similarly, it's unfair for the surgeon to have to pay for the anesthetist twice because your SIL didn't follow instructions.

So, to sum up, your SIL should check her contract. Assuming the rules are in it, and she signed it appropriately, she's either going to have to suck it up and have the procedure with this surgeon, and repay the anesthetist, take the loss and get someone else to do the surgery or not get the surgery done.

If the rules are NOT detailed in the contract she should try to negotiate with the surgeon.

[Bob Ducca]

So she tested positive for 2nd hand smoke 2 weeks ago.

They advise her to avoid smoke (which is probably also in various paperwork/instructions that she'd already been given and signed)

She then goes to a bar where people smoke.

Tests postitive again for 2nd hand smoke, and is baffled that this is a problem?

Sounds to me like your sister just learned a $3,000 lesson about following instructions.

[Zsofia]

Where does she live that people are still allowed to smoke in bars? I thought that had been banned pretty much nationwide.
Since when? You can't do it here, but that's just in the past couple years - when I go to visit my boyfriend in a smaller city an hour and a half away it takes me a minute to realize the hostess is asking me if we want a smoking or nonsmoking table. But that's just because my city banned it, plenty didn't.

[pbbth]

Since when? You can't do it here, but that's just in the past couple years - when I go to visit my boyfriend in a smaller city an hour and a half away it takes me a minute to realize the hostess is asking me if we want a smoking or nonsmoking table. But that's just because my city banned it, plenty didn't.

For some reason I had thought it had been banned in pretty much every state. Upon further research it looks like it is a city-by-city thing instead of by state.

[needscoffee]

This site (http://www.webmd.com/healthy-beauty/mastopexy-breast-lifting-procedures?page=3) explains Once the procedure is chosen, the patient will be scheduled for a preop appointment approximately ten days to two weeks prior to the surgery. At that time, I answer all questions, take pictures, and confirm that the patient is healthy. Smoking is contraindicated. There can be problems with blood supply to the nipple areolar complex, and this can occur when patients smoke or even are near secondhand smoke. Secondhand smoke is responsible for 50 percent of complications in patients who experience problems following surgery.

[TriPolar]

This site (http://www.webmd.com/healthy-beauty/mastopexy-breast-lifting-procedures?page=3) explains

That sounds like pure BS.

IANAL, but I've often heard that the law abhors a default. If the costs weren't incurred, she should get her money back.

[Qadgop the Mercotan]

That sounds like pure BS.
Science disagrees with you.
Effects of "second-hand" smoke on structure and function of fibroblasts, cells that are critical for tissue repair and remodeling (http://www.biomedcentral.com/1471-2121/5/13/)

Lots of other interesting articles on second-hand smoke and impaired healing are out there via Google Scholar too.

[TriPolar]

Science disagrees with you.
Effects of "second-hand" smoke on structure and function of fibroblasts, cells that are critical for tissue repair and remodeling (http://www.biomedcentral.com/1471-2121/5/13/)

Lots of other interesting articles on second-hand smoke and impaired healing are out there via Google Scholar too.

First of all, science does not disagree with me. Your cite doesn't address the previously cited article, which still sounds like BS.

Your cite provides some science, which is interesting. But I'm still skeptical. Human breasts aren't chicken embryos. That doesn't mean the conclusions in the cite are wrong. I am just a skeptic.

[Qadgop the Mercotan]

A good scientist is skeptical, but your approach (calling it BS) is cynical, not skeptical.

A skeptic says "I wonder if what they say is true. How can I find out?"

A cynic says "that's pure BS".

Here's a nicely referenced article about plastic surgery and smoking, including second-hand smoking.

Smoking and Plastic Surgery (http://westcountyplasticsurgeons.wustl.edu/westcountyplasticsurgeons/images/pdf/SmokingandPlastic%20Surgery.pdf) [note: pdf]

[Cat Whisperer]

So she tested positive for 2nd hand smoke 2 weeks ago.

They advise her to avoid smoke (which is probably also in various paperwork/instructions that she'd already been given and signed)

She then goes to a bar where people smoke.

Tests postitive again for 2nd hand smoke, and is baffled that this is a problem?

Sounds to me like your sister just learned a $3,000 lesson about following instructions.I agree with this. It is certainly nothing new in the medical field that patients pay when they miss appointments (or can't have a procedure done because they didn't follow instructions), and it wasn't the anesthesiologist's fault that the surgery couldn't be done.

[needscoffee]

I wouldn't call it BS, but the claim that "Secondhand smoke is responsible for 50 percent of complications in patients who experience problems following surgery" seems unverifiable. It wouldn't surprise me if it were true, though.

[Qadgop the Mercotan]

I wouldn't call it BS, but the claim that "Secondhand smoke is responsible for 50 percent of complications in patients who experience problems following surgery" seems unverifiable. It wouldn't surprise me if it were true, though.
Just off the top of my head, one could verify it by studying the rate of complications in matched patients whose chief difference is exposure to secondhand smoke. If the complication rate in the exposed group is significantly higher, one could posit that the difference in the complication rate is due to the smoke exposure, and thus figure out overall what percentage of complications is caused by secondhand smoke.

[kayaker]

It is certainly nothing new in the medical field that patients pay when they miss appointments (or can't have a procedure done because they didn't follow instructions), and it wasn't the anesthesiologist's fault that the surgery couldn't be done.

I agree. However, if I as a patient show up for my surgery and the surgeon is unable to perform that day (emergency, illness, etc) shouldn't I be reimbursed for time missed from work?

[Swallowed My Cellphone]

I agree. However, if I as a patient show up for my surgery and the surgeon is unable to perform that day (emergency, illness, etc) shouldn't I be reimbursed for time missed from work?If that was a clause written into the contract you signed than probably, yes. It's not however, typically in contract. Now I'm wondering what would happen if I had an elective surgery scheduled, and I had my lawyer draft in such a rider and insisted that the surgeon executed their copy too.

[cuauhtemoc]

How much secondhand smoke counts as "exposure" to secondhand smoke? Do you have to be breathing it in deeply for a certain amount of time? Are you "exposed" if you just walk by somebody smoking on the street and get a whiff? What if you're in a car and the driver's smoking? What if you open the window?

Should these questions go in a separate thread?

[JHE1967]

So she tested positive for 2nd hand smoke 2 weeks ago.

They advise her to avoid smoke (which is probably also in various paperwork/instructions that she'd already been given and signed)

She then goes to a bar where people smoke.

Tests postitive again for 2nd hand smoke, and is baffled that this is a problem?

I agree she clearly screwed up. No doubt she is at fault for not following instructions. I just thought the doctor's office claim that if she does not reschedule the operation she will not get the 8K deposit (90% of surgery cost) was odd. I don't see how they can keep her 8K when no procedure was done. The charge for the anesthesiologist seems high (3K) but I understand it--I don't see where the doctor keeps the remaining 5K she has already paid though.

[alphaboi867]

That sounds like pure BS.

IANAL, but I've often heard that the law abhors a default. If the costs weren't incurred, she should get her money back.

Except it sounds like costs were incurred if the anesthesiologist was an outside contractor (as opposed to someone onstaff).

If that was a clause written into the contract you signed than probably, yes. It's not however, typically in contract. Now I'm wondering what would happen if I had an elective surgery scheduled, and I had my lawyer draft in such a rider and insisted that the surgeon executed their copy too.

[alice_in_wonderland]

I agree she clearly screwed up. No doubt she is at fault for not following instructions. I just thought the doctor's office claim that if she does not reschedule the operation she will not get the 8K deposit (90% of surgery cost) was odd. I don't see how they can keep her 8K when no procedure was done. The charge for the anesthesiologist seems high (3K) but I understand it--I don't see where the doctor keeps the remaining 5K she has already paid though.

Same reason as the anesthetist - they couldn't schedule another surgery in there with no notice so the surgeon lost the opportunity to earn a living because your SiL couldn't follow instructions.

[Cat Whisperer]

I agree. However, if I as a patient show up for my surgery and the surgeon is unable to perform that day (emergency, illness, etc) shouldn't I be reimbursed for time missed from work?
You've probably noticed that respect in healthcare is a one-way street - we are to respect the healthcare workers and their time, but they make little effort to respect ours.

[Steophan]

She's paying for the surgery, they should have done it or refunded the money. In the unlikely event that a small amount of second-hand smoke could affect healing, she could sign a waiver if she tested positive for that. It's a pure money-making scheme.

I'll be off for a cigarette now.