We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Invited Commentary |

The Gap in Patient Protection for Outpatient Cosmetic Surgery

Daniel J. Morgan, MD, MS1,2; Anthony D. Harris, MD, MPH1
[+] Author Affiliations
1Department of Public Health and Epidemiology, University of Maryland School of Medicine, Baltimore
2Hospital Epidemiology, Veterans Affairs Maryland Healthcare System, Baltimore
JAMA Intern Med. 2014;174(7):1142-1143. doi:10.1001/jamainternmed.2014.441.
Text Size: A A A
Published online


In September 2012, a 59-year-old woman died in the hospital shortly after undergoing tumescent liposuction at a medical spa for cosmetic surgery in suburban Maryland. As her sister reported, “We never expected her to die from something…that’s so simple.”1 Astute physicians reported her case to the Maryland Department of Health and Mental Hygiene, Baltimore, prompting an investigation that identified 4 confirmed cases and 9 suspected cases of patients with severe invasive group A Streptococcus infections related to this outpatient facility and another owned by the same company in Pennsylvania. Each of the affected patients had surgery that was performed by a physician who was not board certified in plastic surgery and, as was later determined, was colonized with group A Streptococcus and likely experienced a Streptococcal hand cellulitis at the time procedures were performed on 3 patients. The technician working on each of the cases was also colonized with group A Streptococcus (both the surgeon and the technician harbored the identical genotype of the bacteria that had infected patients). Three other patients were hospitalized with necrotizing fasciitis. They required a median of 19 days in the hospital, with 2 to 6 surgical debridements per patient. This outbreak ended with the closure of the outpatient cosmetic surgery facility in Maryland and the temporary suspension of liposuction at the facility in Pennsylvania until infection prevention practices were improved.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Quick Reference

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Quick Reference