Another piece of news from Almaty is shocking in its ordinariness: a 53-year-old patient died during liposuction. And this is not the first case. Similar tragedies occur periodically in private clinics around the city, and in between these high-profile deaths, stories of sepsis, tissue necrosis, and resuscitations following "beauty injections" keep surfacing here and there.

When a person dies from cancer or a severe injury, it is a tragedy that medicine cannot always prevent. But when a woman lies down on an operating table to lose some excess weight, and it ends in tragedy, this is evidence of a systemic failure.

WHAT DO THESE ALARMING FACTS TELL US?

The first thing that comes to mind: why do many of these fatal outcomes occur not in the setting of a multidisciplinary hospital, but in small rented offices on the ground floors of residential buildings?

Essentially, liposuction is a full-fledged surgical operation under general anesthesia. During the procedure, blood vessels are damaged, fluid volume is lost, and blood pressure changes dramatically. This is a stressor on the heart, kidneys, and lungs.

Performing such an operation without a resuscitation room, without a defibrillator, and without a 24/7 anesthesiologist on duty is short-sighted and irresponsible on the part of the doctors – it is criminal negligence.

Such cases indicate that the aesthetic medicine market in Kazakhstan still resembles a game of chance, relying on "maybe." Plastic surgeons with dubious certifications, anesthesiologists working with no oversight of potent drug circulation.

The question arises: why do people go to questionable clinics? Because in an official, large clinic, liposuction costs significantly more, while "a trusted master from Instagram" charges much less. Deadly economy. Society has cultivated a dangerous illusion: "If a cosmetologist has 100,000 followers, he must be a god." But a beautiful Instagram feed will not suction a fat embolism out of the pulmonary artery.

These tragedies cry out about the fact that we have developed a consumerist attitude towards our own bodies, evaluating them emotionally rather than rationally, without a real assessment of risks. You cannot fool nature, and the path to past beauty can sometimes be your last.

ON THE INACTION OF THE STATE REGULATOR

If one death occurs, it is an accident. If there is a second and a third, that is a statistic. After each such death, the following usually happens. An investigation begins, during which the clinic closes for a week, changes its sign, and reopens – for example, under the founder's relative. The Medical Control Committee issues a fine "for violation of sanitary norms." And that's it. Whether the clinic owner will receive a real prison sentence for causing death by negligence due to improper medical care is also a big question. As long as punishment is expressed in money and compensation to the family, the business will thrive.

Yet, it is long overdue for the regulator to introduce an indispensable rule: any operation under anesthesia (even "light" anesthesia) must only be performed in an inpatient facility with appropriate accreditation and a resuscitation unit.

WHAT NEEDS TO BE DONE RIGHT NOW?

First and foremost, criminal liability must be introduced for owners of such clinics for patient deaths if the operation was performed without a resuscitation department or a surgical license. Fines must be replaced with real prison sentences.

There is a need to create a registry of anesthesiologists, considering that in Kazakhstan there are many "specialists" who work in several places at once. A national registry is needed to track their workload and the number of anesthetics administered per day. A ban should be imposed on targeted advertising of liposuction and blepharoplasty on social media without warnings about the risks of death. People must see not only the "before and after" but also the possible consequences – which are currently omitted. The patient should document that they have been explained the risks of fat embolism, thrombosis, and death. This psychologically sobering measure targets those who view surgery as a trip to a beauty salon.

Death from liposuction in Almaty is not a verdict on modern medicine. It is a verdict on ignorance, greed, and lawlessness. As long as we buy surgeries like socks at a bazaar, as long as a plastic surgeon seems to us like just a cosmetologist with scissors, and as long as the state waves away the problem with inspection protocols, these cases will repeat.

The pursuit of aesthetics must not become a fad. Saving lives must start not with the surgery but with the patient's mindset and the strictness of the law. After all, in recent years, numerous centers and beauty salons have sprung up, temptingly offering rejuvenation and enhanced attractiveness. These quasi-medical organizations make enormous sums of money from this desire. And it would be one thing if the effect simply failed to meet expectations – that is the lesser evil – but in some cases, one can lose their health, or even their life.

SURGERY WITHOUT A DIAGNOSIS

The desire to make substantial amounts of money drives employees of such establishments to neglect the generally accepted canons of medicine and common sense. Yuridicheskaya Gazeta has already written about a legal case involving a tragic incident that occurred several years ago in one such center, which offered a "full range of services in the field of plastic surgery, facial and body aesthetics, and reconstructive microsurgery."

Back in 2016, a citizen of Ukraine, D.A., born in 1982, entered into a contract for a one-time paid service with an Almaty LLP. According to the contract, the clinic's plastic surgeon, D.P., was to perform an operation on her – liposuction of the abdomen and back, and a skin lift of the shoulders.

However, the patient had a complication: in 2011, doctors had found viral hepatitis C. This diagnosis should have alerted the surgeon, prompted a postponement of non-urgent cosmetic procedures until after comprehensive examinations, and, following diagnostics, the selection of the most optimal method of providing the medical service. The surgeon did not order an important enzyme immunoassay to diagnose hepatitis C, nor did he refer the patient for consultations with a therapist, an infectious disease specialist, and a hepatologist.

As a result of non-compliance with the procedures and standards of medical care, the surgeon did not ensure an examination by an anesthesiologist-resuscitator before the operation to select the anesthetic management. Instead, he personally performed the function of an anesthesiologist-resuscitator, which led to an incorrect choice of anesthesia. This also constituted one of the diagnostic defects, which subsequently affected the outcome of the operation.

On January 29, 2016, surgeon D.P. performed the operation at the LLP clinic in a dressing room – an unsuitable room not equipped with appropriate equipment, using uncertified equipment not intended for such operations.

Furthermore, it turned out that the operation was performed by one clinic, while the inpatient facility was located elsewhere. When the victim was transferred to the inpatient facility, there was only one doctor on duty, although it should have been a resuscitator.

In court, questions arose regarding the equipment of the medical center. The operation used a suction device from the 1970s, and experts determined that there were no documents for it, and it could not be classified as medical equipment.

Overall, all experts agreed that this case was fundamentally wrong from start to finish. As a result, a patient who came for what seemed like a simple cosmetic procedure lost her life. Relatives lost a loved one, a daughter lost her mother.

The court found surgeon D.P. guilty of committing a criminal offense under Part 3 of Article 317 of the Criminal Code of the Republic of Kazakhstan. However, due to the expiration of the statute of limitations, he was released from criminal liability and punishment on the basis of paragraph 2 of part 1 of Article 71 of the Criminal Code of the Republic of Kazakhstan. The court ordered D.P. to pay D.A.'s relatives compensation for moral damages in the amount of 3,000,000 tenge.

THE STORY CONTINUES

And another recent case, recently reported by our colleagues from Tengrinews.kz citing the publication Stan.kz. A 49-year-old deputy of the Mangistau Regional Maslikhat, E.A., died after plastic surgery – mentoplasty – performed in a private clinic in Aktau.

He went to the private clinic to remove excess fat from the chin area and was operated on April 4 of this year after undergoing tests. Later, it turned out that the examination was incomplete, and his blood sugar level exceeded the norm at which surgery is considered inadvisable.

As the deputy's wife reported, his condition sharply deteriorated during the operation: his blood pressure and blood sugar levels rose, after which he suffered a stroke and fell into a coma. He remained in this state for about a month and never regained consciousness.

It turned out that the clinic where the deputy was operated on had been operating with violations. The Department of the Medical and Pharmaceutical Control Committee of the Ministry of Health for the Mangistau Region reported that an inspection of the private clinic revealed a number of violations.

In particular, it was established that the operating department was insufficiently equipped, some equipment had expired service life, and there were no emergency supplies for anaphylactic shock. Additionally, the clinic did not meet the requirements for providing inpatient care and did not have a license for anesthesiology and resuscitation for adults.

The reaction is the same as always. A criminal case has been opened. Inspections are underway... Perhaps those responsible will be named. In short, we are witnessing a process resembling firefighting.

But radical, real measures are needed. Otherwise, how many more lives must be lost before the responsible agencies finally restore order?

By Akmaral ABDULOVA

Zanmedia.kz