An example of a major deviation relates to the rate of
deaths of patients undergoing liposuction in Florida.18 In
office-based practice, the rate was one death in 5000 cases
compared with a rate of one death in 200 000 cases in
hospital-based practice. The deaths were due to local anaesthetic
toxicity. The BTCUs were an increasing disregard for
the accepted amount of drug administered to patients. As
these limits were breached, the operators initially ‘got away
with it’ and so may have become more tempted to try
even more extensive procedures in their own office settings.
Although financial profit may have been a motive, the desire
to provide treatment at a more convenient setting and even
lower cost for the patient may also have been factors. The
same disregard to maximum dosages may have taken
place in hospital but at least the backup resuscitation expertise
would be more readily available. This leads onto latent
conditions.