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Nevada liposuction brings medical complaints

November 21, 2023

Liposuction live on the web? Two physician assistants and two supervising M.D.’s associated with a Nevada clinic showing liposuction videos on the web were named in complaints recently by the Nevada Board of Medical Examiners describing liposuction that went wrong, putting two women in the hospital in two separate cases.

Why are these two liposuction events worth noting? Nationwide, physician assistants and nurse practitioners and other “midlevel” clinicians are pressing to have broader ability to practice without supervision. Meanwhile, licensed doctors are pressing to have supervision be more effective and broader, saying this is in the interest of protecting patients.

The Nevada complaints are examples of the cosmetic and “medspa” industry, which appears in some places to be lightly regulated, and to have supervision that can be extremely lax. A doctor is listed as supervisor, for instance, but has no credentials for the specialty and has seldom, if ever, been on site. (We wrote about a recent Texas case here.)

These two cases are unusual also because the place where the complaints said they work, MyShapeLipo in Henderson, Nev., near Las Vegas, posted on its Instagram account a video of a liposuction procedure in which the patient is awake and waves and talks during the procedure. The person performing the procedure, who is not identified, notes that people who are watching “seem to know who you are,” and gives the name “Melissa.” Another video has a different angle and may be a different patient.

Disciplinary complaints

The investigative committee of the Nevada Board of Medical Examiners has several disciplinary complaints regarding MyShape Lipo. (See original documents below.)

In one, from Feb. 21, 2023, Trevor Andreas Schmidt, a physician assistant who is described as the owner of MyShapeLipo, was under supervision of John Bowman, an M.D. specializing in orthopedics and sports medicine, the complaint against Schmidt said.

According to that complaint and a complaint against Bowman, Bowman had two days of training in liposuction from the International Society of Cosmetogynecology. Bowman did not perform liposuction, but instead, as supervising physician, delegated liposuction to Schmidt, the complaint said. Schmidt had a two-day course in liposuction from the International Society of Cosmetogynecology, the complaint said.

The complaint added that Schmidt has had seven supervising physicians since May 12, 2010.

The complaint says a 36-year-old woman scheduled liposuction on her pubic area for Nov. 12, 2020. When she arrived, she also asked for liposuction on her abdomen.

The complaint says there was no discussion of the patient’s medical history or pre-operative appointments or lab work, and that no pre-operative antibiotics were prescribed. The complaint says Schmidt performed liposuction, and acted as both surgeon and anesthesiologist.

Patient hospitalized

After the surgery, the patient complained of pain and nausea and a foul odor from her lower abdomen, the complaint said, and she was admitted to a hospital Dec. 3, 2020, due to an infection.

The complaint accused Schmidt of malpractice, failure to maintain appropriate medical records, practicing beyond the scope of his license and violation of competence regulations.

Bowman was accused of failure to maintain appropriate medical records, practicing beyond the scope of his license, malpractice, practicing beyond the scope of his training, and failure to adequately supervise.

Schmidt also has a 2017 settlement agreement in a case with the Nevada State Board of Medical Examiners relating to inadequate records.

Another complaint

In another MyShape Lipo complaint, filed on May 30, 2023, Schon Colby Roberts is listed as the supervising physician in a complaint against him and another against David Kayle McCleve, a physician assistant.

The complaint says Roberts, listed as an emergency medicine physician, has two days of liposuction training with Inspiring Physicians Worldwide, and a certificate from a master class offered by Elite Medical, which the complaint says no longer exists. He did not perform liposuction, instead delegating to McCleve, who has the same liposuction credentials. McCleve has had eight supervising physicians since Aug. 14, 2014, the complaint says.

A patient came for liposuction at MyShape Lipo on March 4, 2022. Her medical records are “preprinted and highly templated,” and she did not get preoperative antibiotics, the complaint says. There is no documentation of postoperative medications, the complaint says. The postoperative medical record then notes that on March 7, McCleve spoke to an intensive care unit physician at Mountain View Hospital who said the patient was there, was in pain, and probably had necrotizing fasciitis, an aggressive bacterial infection that spreads quickly in the body. She then spent two weeks in the hospital, the complaint says.

The complaint accused McCleve of malpractice, failure to maintain appropriate medical records, practicing beyond the scope of his license, and violation of competence regulations.

Roberts was accused of failure to maintain appropriate medical records, practicing beyond the scope of his license, practicing beyond the scope of his training, malpractice and failure to adequately supervise.

In none of the four MyShape Lipo cases does the medical board have database records of a disposition of the complaint, only a record that the complaint was made.

After the complaint is issued by the Board of Medical Examiners, according to state statute, the next step is a hearing. Following that, the charges could be dismissed, or if a violation is found, a range of disciplinary actions including probation, fines, license revocation and other possibilities are listed.

A woman named Valerie at the Board of Medical Examiners said by phone on Nov. 21 that she could see no records indicating that a hearing had been held on any of the four cases, and no records that any action had been taken.

In Schmidt’s 2017 case, the board does document that he fulfilled the requirements.

The Nevada Board of Medical Examiners also reported that Roberts had a $250,000 settlement in a 2019 case involving “alleged failure to obtain consent prior to performing catheter placement, and further allegations of improper technique during the catheter placement resulting in bowel and bladder injury.”

Video narration

In the MyShape Lipo video, for about 15 minutes, a person wearing a mask uses a needle-type wand and semi-narrates and answers questions, to audiences said to be both on Instagram and Facebook. Another person attends the procedure, and also a camera person who also takes questions. The narration explains that the procedure is done with Lidocaine but no spinal block, and that he is going to “break up the fat manually and then suck it out” of the patient’s abdominal region. “You can see it here so you know it’s real,” he said, and then stops the live feed after explaining that no tummy tuck is needed.

For MyShapeLipo, the Linktree link on the Instagram page gives an “Instant $$ quick quote” option, among others. The “Why us” page lists Trevor Schmidt, a physician assistant, as the owner, and Dr. Schon C. Roberts as an “emergency medicine physician” whose role at the clinic is not specified.

Schmidt’s profile has links to a personal webpage, which no longer appears on the web, and to places where his certifications can be checked — NCCPA, Pharmacy Board and Osteopathic Medicine board license. None of the links work.

Many financing options are available, the site says.

McCleve is not listed on the “why us” page on the site.

Schmidt is featured on the site in this Youtube video, apparently an infomercial, about the dangers of “backroom” liposuction providers.

In 2015, in response to news reports that a Tucson woman was imprisoned for doing liposuction without a license, Schmidt was quoted as a “liposuction expert” in a press release from MyShape Lipo saying that his group “had zero liposuction deaths and 84% of our patients return to work within 3 days. With good techniques it is possible to get high quality results safely and consistently.”

Violations of sterile technique

“There appear to be multiple violations of sterile technique here,” wrote Dr. Phil Shaffer, a retired M.D. radiologist from Ohio who is a board member of Physicians for Patient Protection, after viewing the Instagram video. P.P.P. is a 501(c)3 that says its “mission is to ensure physician-led care for all patients and to advocate for truth and transparency regarding healthcare practitioners.”

“Schmidt was censured by the Board of Nursing in 2015 for poor records, in multiple cases not documenting antibiotic coverage, and in multiple cases failing to monitor vital signs during the procedure,” Shaffer wrote in an email.

“He has had 7 supervising physicians since 2010. He has had 2 days of training in the procedure. His supervising physicians have been ER docs who also have had 2 days of training. This is out of scope, I believe. He has a current case of a patient who developed a serious, life threatening infection after her surgery. He had a partner who has since left, who also had a life threatening infection.

“I will point out that the two cases of infection we are aware of would be expected to occur as a result of poor sterile technique. More importantly, these two only came to our attention because they were the subject of reports to the Board of Medicine. This is very unusual, simply having a complication of surgery like infection is not a situation for a board report – which is to say – I suspect there are many more cases of infection that were not reported to the board.“

Other videos

There are a startling number of live liposuction videos online. One is online here at “Midlevel Care” on Twitter.

Here’s another one, on Facebook. And another on Reddit. The Health and Wellness Center in St. Louis, Mo., which posted these, has an interesting collection of Google reviews.

(Some of these videos seemed to be taken down as we were reporting this article.)

A number of online sites seem to be acting as watchdogs for the practice of lower-qualified people doing medical procedures without full supervision — including the subreddit r/Noctor and also Midlevel.WTF. They trade notes about how to report malfeasance — as in this thread about how to report a physician assistant representing himself as a physician, or this one about how the Noctor group seems to constantly criticize midlevel clinicians, while they clearly fill a need in medicine (though some practice beyond their scope of training).

Cosmetic practices nationwide seem to particularly frequently skirt the laws on qualifications of the practitioner and also supervision by a medical doctor. (Regulations vary from state to state.) We wrote recently about a case in which a Texas woman died in a “medspa” after receiving an infusion. The person who gave the infusion has not been charged, but the doctor who was named as supervising her had his license suspended.

The MidlevelWTF site was started by an emergency medicine doctor in the Midwest who is retraining to be a family medicine doctor. He spoke in a Zoom conversation on condition of anonymity to keep his professional identity separate from the MidlevelWTF site, which does not name the founder or contributors. It is often in attack mode, and the language used is sometimes not what would be found in a professional environment.

The site defines midlevels as “non-physician midlevel providers nurse practitioners (NPs), physician assistants (PAs), and nurse anesthetists (CRNAs, or Certified Registered Nurse Anesthetists).”

The site says it “aims to aggregate and publish content that documents and exposes real-world, concrete examples of midlevel malpractice, misconduct, and clinical ignorance in order to show why allowing midlevels to practice independently without physician leadership and close oversight is bad patients and doctors alike. Don’t get us wrong — our goal is not to indiscriminately attack midlevel providers. On the contrary, we support the use of properly-supervised, well-educated midlevel providers as a part of physician-led healthcare teams.”

Like Shaffer and other doctors, the site emphasizes that the use of well-supervised midlevel providers to do some medical work is not a problem — it’s the ones who are not well supervised, and not well trained.

Dr. MidlevelWTF said he founded the site in 2021 because of “some personal experiences clinically, working with medical providers, as well as at the time there was certainly a growing fervor online of similar reactions among physician colleagues” who think that midlevel providers should be effectively regulated.

He has several contributors, he said, and they collect information for the site from various places, including Facebook groups where midlevels congregate and share their stories. They then follow up reports and research them, and post things like “Puzzled nurse practitioner consults Facebook for a patient with critical hyperkalemia” and “Get some testosterone at the library from your friendly neighborhood NP.”

In an email after our Zoom, he wrote: “One thing I’d like to proactively address (since this is something we get criticized for sometimes) is the tone and frequent use of profanity on MidlevelWTF. Admittedly, this comes at the risk of not being taken seriously by outsiders and other press, but this is more or less by design, intended to express the egregiousness and ridiculousness of the cases and examples we come across and genuinely capture the emotional reactions and feelings of most physicians to the content.”

What can you do?

Concerned that you might be seen by an underqualified clinician? Here are some things you can do.

Patients should be sure to check the credentials of any medical practitioner — do they have a license to practice? — with the relevant medical board.

Along with records of licensing, many states have a public record of disciplinary actions from an oversight organization. This is one for Texas; here is one for Nevada. Here is one for Nebraska.

A state board of nursing is likely to have a different set of disciplinary records; here is one for Texas nurses and here is one for Nevada nurses.

These listings may be klunky or hard to navigate. It’s also well-known that most states do not list a mere complaint against a doctor or other practitioner; only formally investigated cases or completed disciplinary actions are listed in most states. The Nevada complaints have been issued by the Board of Medical Examiners, though a response is not documented.

As basic as it seems, the recommendations of friends and neighbors can be very valuable. Ask around, but don’t take everything you learn at face value.

Online reviews like those on Google or Yelp should be taken with a grain of salt, or rather a barrel of salt, but they can be informative. Here’s MyShape Lipo’s Yelp page. Notice that Yelp’s average of the reviews can be less useful than reading the actual reviews. In this case, there is also a large number of “not currently recommended” reviews; Yelp doesn’t explain what that means, but it’s sometimes worthwhile to look. Also a large number of reviews were “removed for violating our terms of service.”

A huge number of online reviews are fraudulent, typically the positive ones. Here’s our story about that.

Check the online presence and web documentation for a provider. If the site looks seedy and is full of misspellings, you might want to move on.

Check the physical setting; if the building looks seedy and dirty, move on.

If you don’t want to see a physician assistant or a nurse practitioner, say so. For example, your doctor’s office might say “Dr. Smith is booked through the end of the month — but I can get you in with our PA.” You can say no.

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