Going ‘bare’ may no longer be an option for physicians who perform Brazilian butt lifts

Physicians who perform Brazilian butt lifts in an office surgery setting would be required to carry medical malpractice insurance under a bill being considered by the Legislature.

They would be the only physicians in Florida required to carry medical malpractice insurance if the bill (HB 1561) sponsored by Rep. Demi Busatta Cabrera were to become law.

SB 1188 is the companion measure filed by Sen. Ileana Garcia. It does not have the financial responsibility mandate, but has other provisions that are problematic for physician lobbyists.

With just days left before the 2024 Session ends, it’s not clear what proposal, if any, will pass.

The bills are an effort by legislators to delve into physician regulation surrounding gluteal fat grafting, commonly called Brazilian butt lifts, or BBLs. BBLs involve two steps: the liposuction of fat from the abdomen or back, and the injection of the purified fat into the subcutaneous layer of the buttocks, which is below the skin but above the gluteal muscle.

“Both bills have a couple of really good components,” said Jacksonville health lawyer and lobbyist Christopher Nuland. The bills both close what Nuland called a “loophole” in the 2023 law that required office surgery sites to register with the state if procedures were performed where 1,000 cubic centimeters of fat were removed.

“Evidently, some people were saying, ‘We aren’t removing 1,000 CCs of fat because we are just borrowing it,’” Nuland said. “That’s just ludicrous.”

To that end, bills close the loophole by requiring offices to register whether the fat is temporarily or permanently removed.

If passed, the financial responsibility mandate is a leviathan policy change. Florida law currently allows physicians to practice without medical malpractice or irrevocable letters of credit, often referred to as going “bare.”

Doctors who go bare must post a sign in their waiting room indicating their decision to go bare and that they will satisfy a judgement of $100,000 (or $250,000 if they have hospital privileges).

“They would be the only physicians in the state who could not go bare. That is my understanding,” Nuland said of physicians who perform BBLs in office surgery settings, should the provision pass.

The requirement, he said, could prevent some surgeons from entering the BBL market and force other larger physician groups that currently go bare to purchase medical malpractice policies.

SB 1188 does not have the insurance mandate that is troublesome to physicians. That’s not to say the Senate bill is supported by physicians, though. SB 1188 places into law the current office surgery rules and beefs up some of those standards.

While there are concerns with both bills, Nuland said they are better than the original bills that were filed in the House and Senate.

Those bills would have required all surgery centers to re-register with the state according to a yet-to-be-published Department of Health (DOH) timeline. The bills, which were opposed by the Florida Medical Association, would have effectively closed down the 724 surgery centers currently registered with DOH. That’s because the 2023 law required state surgery center inspections to be done in person by DOH medical quality assurance (MQA) staff.

Moreover, the original bills required MQA staff to refer to the state Agency for Health Care Administration office surgery centers that staff determined would cause significant risk to the safety and health of patients.

“Both pieces of legislation are drastic improvements on the original bill and they both close some loopholes that needed to be closed,” Nuland said. The bill sponsors “fixed all of our problems (with the original bills). And then came up with something brand new — each completely, obviously, independent of each other — that were meant to address the problems.”

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