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After years of rampant deaths in Florida's cosmetic surgery clinics, state lawmakers approved sweeping legislation Wednesday that calls for some of the nation's strictest controls of the industry.
If signed by the governor, the new law would allow the state for the first time to punish dangerous plastic surgery facilities and shut down the worst offenders.
The legislation passed after years of no regulation in Florida, where private investors opened high-volume, discount clinics that became magnets for women seeking cosmetic procedures.
"It's been long overdue," said Crystal Call, 34, of New York, whose mother found her in a locked recovery room nearly bleeding to death after her surgery in Miami. "[It's] sad that so many people had to die or have serious injuries to do so."
The effort to toughen the law began two months ago after an investigation by USA TODAY and the Naples Daily News that showed eight women died after procedures at a plastic surgery business owned by one doctor.
In April, a second story revealed the state tried unsuccessfully to pass legislation four times that would have cracked down on the centers, even as felony offenders opened their own facilities with no background screening by the state.
In those businesses, at least 13 women died after cosmetic surgeries and nearly a dozen others were critically injured, including two hospitalized in septic shock.
The majority of the patients who lost their lives were African American or Hispanic women – ethnic groups singled out in the clinics' advertising blitzes.
State Sen. Anitere Flores, a Miami Republican who led the drive, said it was time to close a dangerous loophole that allowed the state to regulate doctors who owned clinics but not the private entrepreneurs who began opening facilities more than a decade ago.
“People are dying and being horribly disfigured,” she told Senate colleagues before their vote on the bill. “We are going to take a step to make sure this doesn't happen to anyone else."
The House finalized the legislation Wednesday, passing it unanimously. It heads to Republican Gov. Ron DeSantis for his signature.
The legislation, which would take effect in January, would give the state the power to suspend a clinic's operations or even revoke its registration if the state found the facility posed an imminent threat to the public.
Each clinic owner would have to appoint a doctor to ensure a facility was safe for patients – a role now filled by anyone in charge of the center. If a surgery office was shut down, the state could ban the owner and the doctors from working in another center for five years.
The legislation is the most successful effort to regulate surgery centers since the late 1990s, when plastic surgery was a cottage industry in Florida dominated by traditional clinics and board-certified practitioners.
Shelia Powell, 35, a Mississippi mother of twin daughters whose lung was punctured during her tummy tuck surgery last year, said the measures could save lives.
"Lots of people came there and died there," Powell said. "It was like they could do whatever they wanted to do, and there were no consequences."
For patients who are injured, the regulations would require all clinics to carry at least $250,000 in malpractice coverage.
Patients have had to fend for themselves, at times losing their jobs and getting buried in medical debts, said Andres Beregovich, an Orlando lawyer who investigated the clinics on behalf of patients.
"How is that fair?" he asked.
Beregovich said his main concern with the new legislation is whether the state will require the clinics to show health authorities proof of that coverage.
Patient advocates applauded the changes but were harshly critical of the loss of one protection during negotiations over the bill: a requirement to screen owners for criminal records.
The background checks were pulled off the table after the Agency for Health Care Administration raised concerns about the costs, including the possibility of having to pay for seven new staff positions, records show.
Former state Sen. Eleanor Sobel, who tried unsuccessfully three times to get legislation passed, said removing the requirement was "crazy," citing USA TODAY's story exposing the state for allowing four people with felony convictions to open businesses where patients died.
Dave Aronberg, Palm Beach County's state attorney, questioned whether the state would have needed to hire seven new people.
"It just seems like an inflated number," he said. "The fact that [the background checks] are not being done because they are too expensive is not a legitimate reason to jeopardize public health."
Flores acknowledged she and other supporters of the bill had to strike some compromises. But she said the core of the plan remains, giving the state "the tools" to shut down problem centers.
Seven other states and the District of Columbia have laws that permit health departments to crack down on cosmetic surgery facilities with sanctions including suspensions and fines, according to the Policy Surveillance Program at Temple University.
Flores said that among the things that most disturbed her was that, even after highly publicized death cases, clinic owners remained open by simply removing a troubled doctor and substituting another dangerous surgeon.
"In these cases where someone dies in a clinic, the place will simply shut down for 24 hours and open up the next day," Flores said. "Not a big deal, not a problem."
Many doctors working in the clinics were not adequately trained in plastic surgery or had been disciplined by medical boards for charges including unethical conduct and malpractice in death cases, USA TODAY found.
During an impassioned speech last week to the Senate, Flores reminded her colleagues that the women traveling to Miami for their surgeries were not only from Florida.
“This is not a Miami problem. It’s not a South Florida problem. It’s a national problem,” she said. “There was a young woman from West Virginia. Her name was Heather Meadows, 29 years old, left behind two children. And her kids are never going to see her again because, quite frankly, we dropped the ball.”
Since filing her bill in February, Flores said she has been contacted by parents who lost their adult children and doctors who treated patients who suffered injuries in the cosmetic clinics.
“If there is a silver lining in there, it is that your family member’s … death was not in vain,” she said. “It was because of that tragedy, today we’re going to take a step to make sure that doesn’t have to happen to anybody else.”
This article originally appeared on USA TODAY: Florida plastic surgery center safety: New rules for dangerous clinics