SACRAMENTO — Though he is not a plastic surgeon, Dr. Peter Scheer has repaired some of Palm Springs' most grisly visages.
There was the jet skier whose face was sliced up when he roared into a water-ski towrope. There was the suicidal man whose jittery trigger finger skewed his aim, sparing his life but blowing off the front of his face. There were the two victims of a machete-wielding bar patron: the unintended recipient, whose skull was in the way of the blade's backswing, and the actual target, who literally got scalped.
For The Record
Los Angeles Times Saturday May 29, 2004 Home Edition Main News Part A Page 2 National Desk 1 inches; 62 words Type of Material: Correction
Podiatric surgeries -- An article Thursday in Section A about doctors seeking legislative permission to do operations not commonly thought to be within their expertise said that California podiatrists were asking to perform surgery as far up as the ankle. Podiatrists certified by the state in 1984 or later already have that permission. They currently seek authorization to amputate parts of feet.
Scheer is an oral surgeon, a dentist with extensive operating room training. In the forced moments of emergencies, he and his fellow oral surgeons have frequently mended facial features beyond the mouth. Now they want permission to perform nose jobs, eyelifts and other types of elective plastic surgery that are among the most lucrative of operations. The effort is firmly opposed, however, by physicians with medical school degrees.
This clash over cosmetic surgery is anything but pretty. Following the course taken by eye doctors, medical assistants and holistic healers, the oral surgeons are making their case before the California Legislature, where the operating tools of choice are commonly the campaign donation and the lobbyist rather than the scalpel and the sponge.
Doctors, nurses, dentists and other practitioners together make up one of Sacramento's best-endowed lobbies.
Their political action committees have already injected more than $2 million into campaign kitties for this fall's races, state records show. They also have spent $14 million on lobbyists since 2003.
Their rhetoric can be as blunt as their deployment of cash; they often diagnose their adversaries as suffering from greed, sloth, hypocrisy, incompetence and inflamed egos.
"I've been doing rhinoplastics for thirty years and it's one of the most delicate procedures you can do. There's no way on God's Earth these people can go in and do nose jobs," said Dr. Harvey Zarem, a Santa Monica physician who is president of the California Society of Plastic Surgeons. "The exclusive reason [oral surgeons] want to do this is money. They want to make more money."
Oral surgeons offer equally uncharitable assessments in return.
"The plastics people want you to believe these are difficult surgeries. They are not," said Dr. Larry Moore, former chief of oral surgery at Long Beach Memorial Medical Center. "No one is standing up and saying, 'We've got to get these dentists out of the emergency room,' because if we left the emergency room they'd have to go back. In many hospitals, you can't get a [plastic] surgeon for trauma cases, and the reason is, it doesn't pay."
The cosmetic surgery proposal is just one among many so-called "scope of practice" debates pending in Sacramento. Podiatrists are asking for authorization to amputate parts of feet and perform surgery as far up as the ankle.
Physical therapists want to be permitted to treat healthy as well as injured people, a move that would allow them to tap into the burgeoning fitness industry.
Social workers are seeking to be eligible for Medicare reimbursement for diagnosing patients with mental problems, an effort psychologists view as an incursion onto their turf. In the last four years, at least 48 of these kinds of measures have been proposed.
"Because healthcare funding is limited, we have more and more people scrambling for titles and legitimacy," said Liz Figueroa (D-Fremont), the chairwoman of the Senate Business and Professions Committee, which referees these disputes. "People seem to get ownership over certain titles and certain words. The word 'manipulations' -- chiropractors think they own that word. So when the physical therapists mention it, they go crazy."
Ophthalmologists spent more than a decade blocking optometrists from prescribing drugs to treat glaucoma and other diseases of the eye. The optometrists finally won in 2000. The following year, lawmakers made it easier for medical assistants -- unlicensed aides in physicians' offices -- to perform basic procedures without a doctor's supervision. The idea was unpopular among nurses, who feared that their tasks were being usurped by people with far less training.
Last year, a proposal to allow any appropriately trained holistic healer to identify him or herself as a "doctor of naturopathy" was opposed not only by physicians and acupuncturists but also by some herbal healers who lacked formal training. They feared they would be driven out of business. The measure was ultimately enacted.
A recent analysis by California Common Cause of gifts during the 2001-02 election cycle found that the California Dental Assn. contributed $1.5 million, more than any other single group, including state employees, Realtors, teachers and prison guards. The California Medical Assn., which represents physicians, ranked fifth. Both groups have placed in Common Cause's top 10 list since the group began tracking contributions in 1983.
