The Donda West Law protects patients.

On Oct. 11, 2009, California Gov. Arnold Schwarzenegger signed into law a bill requiring a health check and a written clearance before patients can undergo plastic surgery. Assembly bill 1116, the Donda West Law, was inspired by the death of entertainer Kanye West's mother, Donda West, who was the former chairwoman of the Chicago State University English department. She died on Nov. 10, 2007, because of complications from cosmetic surgery. A physical was not performed before she underwent surgery.

There are a growing number of people opting to have elective cosmetic surgery who may not be aware of the risks involved. Sometimes patients may think they are well enough for surgery, but they are not. Prior to the bill's approval, patients could undergo elective cosmetic surgery in California without having a physical. If the law would have been in effect before Donda West's surgery, she might still be alive.

Yolanda Anderson, the niece of Kanye West's late mother and one of my constituents, joined me in helping to pass this bill, and she is now working with legislators in other states to pass similar measures in her aunt's memory.

The law, which went into effect on Jan. 1, will protect citizens from unnecessary bodily trauma that could result from elective cosmetic surgery. Specifically, the law requires physicians and surgeons to complete a physical examination, including a complete medical history on their patients, prior to performing elective cosmetic surgery.

As the price comes down for cosmetic surgery and the stigma of undergoing elective procedures disappears, cosmetic surgery is becoming more accessible. Aggressive marketing of procedures has led people to believe that they are safe and makes the risks seem almost nonexistent. This measure will make people more aware that there is an element of risk and that a medical clearance is critical.

The Donda West Law strikes an appropriate balance between the patient and the surgeon. It will protect both from harm: the patient from unnecessary bodily trauma, and the surgeon from having to deal with the injury or loss of a patient if he or she is not physically fit at the initial scheduled time of the elective cosmetic surgery.

By Wilmer Amina Carter (D-Rialto), a member of the California State Assembly and the sponsor of the Donda West Law.

The new law is 'feel good' legislation.

The Donda West Law smacks of good politics. A popular musician on the heels of a tragedy jumps into action to fix the system and to make sense of the senseless death of his mother. Politicians love the play. This is reelection gold. A movie plot could be no better. The real question is: Will it make a difference?

Sadly, the answer is probably not.

The law requires a history and physical examination of a potential cosmetic patient before surgery. I have been doing this routinely for over a decade. Will this make cosmetic surgery safer? If a physician needs to look at the law before doing the right thing, the patient is probably better off going to someone else. You cannot use legislation to make a better doctor.

An important issue not addressed by the law is that of medical clearance. Patients with multiple medical problems, or those who are in questionable health, should have medical clearance in addition to a history and physical examination. Knowing when to obtain this takes good judgment on the part of the physician. In the actual Donda West case, a prior consultant plastic surgeon reportedly wanted to have such an evaluation, which might have saved her life.

The new law allows the required history and physical to be performed by a physician, nurse practitioner, or a physician's assistant. The assumption is made that such an individual will know what to do with the results of the examination and, more importantly, when to go further in a preoperative evaluation.

Maybe the legislature will be kind enough to use their vast experience in clinical medicine to provide physicians with a flow chart to tell us what we need to do. Suffice it to say, I do not believe they understand clinical medicine well enough to produce effective law.

Medicine is already over-regulated, so what good does it do to add more regulation? It would be better to give physicians the tools to weed the incompetent out of health care. Our malpractice tort system just lines the pockets of the legal profession at a high price. Doctors know who the good and the bad in medicine are, but they are really unable to effect change. Instead of creating “feel good” legislation, how about addressing medicine's problems by means of real change?

By Dr. John Di Saia, a board-certified plastic surgeon in Orange County, Calif., and author of the “Truth in Cosmetic Surgery” blog at www.cosmeticsurgerytruth.com

Point/Counterpoint: Will California's mandate for health checks before elective cosmetic surgery save lives?