Under state law, procedures can be performed in a doctor’s office only when they involve the skin or the tissues just underneath and require only local anesthesia and a mild tranquilizer. Otherwise, the office must be licensed as an outpatient surgery center.

Although Perry’s Artistic Surgical Center had advertised widely, health officials did not know the extent of the surgeries being performed there until a patient complained, said Dr. Robert S. Crausman, chief administrative officer of the state Board of Medical Licensure and Discipline.

Health Department inspectors visited Perry’s office in 2001. At the time, according to Crausman, Perry said he was only doing minor procedures that did not require licensure. Then this year the board received a complaint from a patient who required hospitalization and physical therapy after being treated by Perry. That prompted the investigation that led to the closing of his practice on Sept. 26. Since then, the board has received six additional complaints about Perry, which are under investigation.

Crausman said the board’s biggest concern, and the main reason why the Health Department shut down his office, was Perry’s approach to anesthesia, which Crausman called “dangerous.”

“He was using terrifically potent medications,” Crausman said, including Versed, a fast-acting tranquilizer, Ketamine, an anesthetic that separates mind from body, and Propofol, a fast-acting anesthetic. Unlicensed workers were mixing and administering the medications. There were no medical personnel -- such as a nurse anesthetist, physician assistant or anesthesiologist -- to monitor the patients while Perry performed surgery. The procedures required his full attention, and any of the drugs could have caused a person to stop breathing, Crausman said.

“He’s very fortunate that there haven’t been any tragic outcomes of that type,” he said.

The board also faulted Perry for not having hospital privileges that would allow him to perform the same procedures in a hospital, and for not arranging to have another physician cover for him if patients need help while he is away.

Also Perry’s advertising “had the tendency to be misleading,” Crausman said, because it implied that he was board-certified in plastic surgery.

Perry is board-certified in otolaryngology, and he also has certification from the American Board of Facial Plastic and Reconstructive Surgery, which was formed to recognize ear-nose-and-throat doctors who obtained additional training in plastic surgery.

How could Perry have operated with impunity for so long? Crausman said that other doctors were probably aware that Perry was doing surgery, but not that his office was unlicensed -- because “he was so open and blatant about this,” Crausman said. Also, patients paid out of pocket for his services, so no insurance company was involved to check on his credentials and licensure.

It’s a cautionary tale for cosmetic-surgery patients, Crausman said. He offered this advice to people contemplating cosmetic surgery:

--Consult your primary care physician and ask for a referral to an appropriate surgeon.

--If your surgery is not being done in the hospital, make sure the place where it happens is licensed. The license should be posted, or you can check with the Health Department’s division of facilities regulation. In Rhode Island, any surgery center that is licensed must also be accredited.

--Check your doctor’s credentials. Ask how many times he or she has done the procedure before. Ask what happens if there are complications -- who will care for you, and where?