Two Delaware residents have been hospitalized with infections believed linked to a Monarch location in Pennsylvania, said Jill Fredel, a spokeswoman for the Delaware Department of Health and Social Services.
Officials in Harrisburg said that because of patient confidentiality, they could not comment on any possible cases.
Although Monarch's website says liposuction is offered at all the sites, spokeswoman Laura Feragen said King of Prussia and Timonium were the only centers where the procedure was performed; the other locations make referrals. Feragen said that the company was cooperating with Maryland officials but that she did not have information about other investigations.
In theory, an infection from Maryland could have been carried to Pennsylvania by Monarch medical personnel who work in both states, officials said. Fredel said those personnel did not work at the Delaware location, which she said was closed Friday for unknown reasons.
The women in Maryland were infected with Group A streptococcus (GAS), a bacterium commonly found on the skin or throat that normally causes a mild illness similar to strep throat. In other parts of the body, however, such as the blood, muscles, or lungs, it can cause a more dangerous infection known as invasive GAS disease.
"It is pretty rare to hear about a death from infection from liposuction," said R. Barrett Noone, a plastic surgeon in Bryn Mawr, who said customers should always go to accredited facilities. It was unclear Friday night whether Monarch is accredited, and Feragen said she did not know.
Because they do not use intravenous anesthesia, the centers are not regulated or inspected as ambulatory surgical centers by the Pennsylvania Health Department. Maryland also does not regulate them, and Fredel said late Friday that she believed Delaware did not either.
A spokesman for Montgomery County, Frank X. Custer, said county Health Department inspectors were expected to accompany state health inspectors on a visit Monday to the King of Prussia location.
Stephen M. Ostroff, director of the state Health Department's Bureau of Epidemiology, said that he could not discuss plans but that the state's investigation would include "looking into their procedures" and "trying to identify people at risk."
Donald F. Schwarz, Philadelphia's health commissioner, said that the city had no authority over centers that do medical procedures, but that his department nevertheless went Friday morning to the center at the Shops at Liberty Place to inspect. He said inspectors at first were turned away but, after discussions with the company, were allowed in that afternoon.
At that visit, he said, the city learned that only cosmetic facial procedures - no liposuction, nothing invasive - were done at the Philadelphia center. He said no problems were found.
But the Maryland cases were a wake-up call, he said, about centers that are operating legally but are not regulated by the state, although the physicians who work in the centers must be licensed by the state.
"How many places like this do liposuction in Philadelphia? The answer is, I have no way to know," Schwarz said. "But, boy, we are going to be finding out."
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