Naturopaths in Arizona have the widest scope of practice in the country. But does that scope allow for cosmetic surgeries?
PHOENIX — Bruce Tucker was scrolling through Groupon looking at the discounts and deals the greater Phoenix area had to offer. One particular offer caught his eye – an advertisement for liposuction surgery.
“It popped up and it looks like a great deal,” Tucker said.
The surgery would cost about $3,000, a significantly lower price than plastic surgeons in Scottsdale were quoting him, he said.
In the summer of 2019, Tucker contacted the office directly and booked it.
But during the surgery, Tucker said he realized the deal may have been too good to be true.
‘I was feeling every jab that they made.’
Among the many issues Tucker would eventually lay out in a malpractice lawsuit, he said he could feel the surgery.
“And it was starting to really hurt to where I was kind of grunting,” Tucker said. “Telling him to re-numb me because I was feeling every jab that they made.”
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Following the surgery, Tucker said he was never given a compression garment which is typically used to assist in the healing process, reducing swelling and bruising.
“That’s, like, very important for post-liposuction,” Tucker said. “No textbook I’ve ever seen says it’s an option. It’s mandatory. All the websites say it’s mandatory. He didn’t get it for me.”
Tucker said the surgery healed lopsided and has left him scarred with hardened fluid around his abdomen. The effects remain to this day.
“I have like ribbons of hardened flesh underneath,” Tucker described. “I’m a stomach sleeper. I have not been able to sleep on my stomach since, because it hurts to put pressure on that.”
The questionable side effects prompted Tucker to take a second look at the man who did the surgery. That’s when Tucker found he wasn’t a surgeon at all.
The doctor who cut open Tucker’s body was actually a licensed naturopath.
“I actually blamed myself. I felt really stupid,” Tucker said.
Naturopathic medicine is a form of alternative medicine traditionally involving natural, drugless remedies.
According to Arizona law, the practice of naturopathic medicine involves “nonsurgical methods” though Arizona’s naturopathic license does allow for minor surgeries.
However, neither the law nor the license explains or defines what a minor surgery is. This has left a gaping legal loophole for liposuction and other cosmetic surgeries.
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12 News has learned some naturopaths in Arizona are performing Brazilian butt lifts, a surgery which has a mortality rate as high as 3 to 4 percent and is considered one of the most dangerous cosmetic procedures that exists.
“Even if it’s done correctly you could still have complications that are serious,” said Dr. Sean Lille, a Scottsdale-based plastic surgeon certified by the American Board of Plastic Surgery.
Dr. Lille performs liposuction and Brazilian butt lift surgeries. To become qualified to perform the procedures he does, Dr. Lille describes a 16-year education which includes three to five years of general surgery training followed by a two to three-year residency program specifically focused on plastic surgery.
“You have to have the education, you have to have the background, you have to have the experience, you have to have the knowledge of having various options that if you encounter a problem, how are you going to get that patient safely out of that issue?” Dr. Lille said.
Dr. Lille says it is clear that cosmetic surgeries like liposuction and Brazilian butt lifts are not minor surgeries.
“Both liposuction and the Brazilian butt lift are major surgical procedures and can have significant impact on patients if it’s done incorrectly,” Dr. Lille said. “I don’t think it benefits our patients’ welfare if people are doing these types of surgeries that don’t have the adequate training and background to do them.”
State and national experts agree.
Local and national medical experts say liposuction is a ‘major surgery’
Naturopaths in Arizona have the widest scope of practice in the country and were granted even more protections in a law signed by Governor Ducey in March of 2022.
The new bill makes naturopathic physicians qualified healthcare providers to remove or provide clearance to someone after sustaining a concussion or head injury. Naturopaths are also now able to test blood alcohol concentration of a person who has died in a car crash. Naturopaths are additionally permitted to perform services outside of their scope of practice to someone in a life or death situation.
Already, naturopaths in Arizona have an expanded scope when it comes to prescribing medications. Naturopaths here can prescribe controlled substances and are issued DEA numbers.
In some states, naturopaths are prohibited from practicing medicine at all. In fact, only 23 states allow for naturopathic medicine, according to the Association of Accredited Naturopathic Medical Colleges.
Arizona’s wide scope of practice and loose regulation has been criticized by local and national medical experts.
“ANMA represents real naturopathic practitioners and real naturopathy never includes any of those procedures,” the American Naturopathic Medical Association said in an email to 12 News when responding to questions about liposuction and other cosmetic surgeries.
“Legislators in AZ, through regulation that continuously expands the naturopathic scope of practice, have allowed licensed naturopaths to practice medicine in the state of AZ without going to a medical school.”
Rebecca Mitchell, executive director of the California Naturopathic Medicine Committee, said in California, the only minor office procedures naturopaths can perform are “repairing superficial lacerations and abrasions” and they can “remove foreign bodies located in superficial tissues.” Naturopaths in California are not allowed to suture.
Mitchell noted California has no plans to allow traditional liposuction or any other procedure that would not normally be performed in a family practice setting.
The Maricopa County Medical Society released the following statement, also stating cosmetic surgeries like liposuction are major surgeries:
“Such procedures are major surgeries and should not be performed by unqualified health professionals. There is a big difference in training between naturopaths and licensed, board-certified plastic surgeons. For example, allopathic (MD) and osteopathic (DO) surgeons must complete residency and fellowship training, which may take 3-7 years and consists of 12,000-16,000 total patient care hours. Naturopaths, however, are not required to complete residency or fellowship training. Their total patient hours may be as few as 720-1,200 hours. That has an impact on patient safety and quality of care.”
The Arizona Medical Association also does not classify liposuction and Brazilian butt lifts as minor surgeries.
That’s what Tucker thought, too. He tried taking action and brought his case to the Phoenix Police Department, the attorney general, and the Arizona Naturopathic Physicians Medical Board, which is tasked with regulating the profession.
“So I figured they would take care of everything,” Tucker said. “That’s not exactly what happened.”
Board declines to take action against naturopaths performing surgeries
Tucker’s case from the fall of 2019 is spelled out in Arizona Naturopathic Physicians Medical Board meeting minutes and recordings. They show the board decided not to discipline the naturopath for performing the liposuction surgery. They did write a non-disciplinary letter telling that naturopath to keep better records.
12 News has learned this was not the first time an incident involving a naturopath performing liposuction went before the board.
“Arizona, by far, has the largest scope of practice for a naturopath than any other state in the country,” said attorney Mark Ryan.
Ryan does not represent Bruce Tucker, but he worked on another civil case filed against a different naturopath who performed liposuction on another Arizona patient. That patient ended up hospitalized for several days due to complications with the surgery.
According to naturopathic board meeting minutes, Ryan’s case eventually settled for more than $200,000. But when the case came before the board, members decided the naturopath had already “learned a hard lesson” with the large court settlement so they opted not to discipline her.
12 News is not naming the naturopaths in this story because they were not disciplined by the board.
“Liposuction is a major medical procedure that should be performed by a licensed allopathic or osteopathic doctor, period,” Ryan said. “When is enough enough, you know? Is it gonna take the death of a patient for the board to take action?”
Gail Anthony, the naturopathic board’s executive director, declined multiple requests for an interview so 12 News showed up to a board meeting to speak with her before the meeting began.
Only Anthony and an attorney from the attorney general’s office arrived in person. All other board members called in, so 12 News was not able to speak with board members directly.
12 News asked Anthony, “Would the board effectively be saying it is okay for naturopaths to perform liposuction surgery?”
“Well you can come to that determination yourself,” Anthony said. “What I can tell you is that the board did not in any of those cases make the determination that the physician was outside of the scope.”
Board fails to define “minor surgery”
12 News has learned the liposuction loophole is no secret to Anthony and the board. Defining “minor surgery” has appeared on its agenda repeatedly and at least four times since January of 2021. Members continue to avoid making a decision.
12 News asked Anthony where she and the board stand in defining the term “minor surgery” and eliminating the gray area that exists because of the lack of a definition.
“The board has taken it under consideration,” Anthony said. “We haven’t made a determination yet.”
The issue is still playing out before the court in Tucker’s case. He’s concerned if the loophole isn’t closed, someone else is going to get hurt.
“I guess we have to wait, but how many more people are going to get hurt or die while this goes to trial?” Tucker said. “I do feel like I’m kind of a crusader for everybody else.”
The Arizona Naturopathic Medical Association, the Southwest College of Naturopathic Medicine in Tempe, and the American Association of Naturopathic Physicians all declined to comment for this story.