Cosmetic surgery costs for Buffalo Public Schools employees have skyrocketed from less than $1 million in 2004 to nearly $9 million last year.

The vast majority of those procedures — nine out of 10 of them — were chemical peels, laser hair removal, skin rejuvenation and other skin treatments. All of them were elective procedures that required a doctor's approval.

The number of procedures tripled during the same period, with more than 8,000 of them performed for school employees in 2009. Because the district is self-insured for its cosmetic surgery rider, taxpayers cover the entire cost directly, district officials said.

Board of Education member Christopher Jacobs is alarmed by the increase in costs. "On the surface, it smacks of abuse," he said.

Jacobs' interest in the issue was piqued when Bryce Link, an official at the Buffalo Fiscal Stability Authority, began researching use of the cosmetic surgery rider by employees of the school district as well as the city, and found a significant increase in the district.

Jacobs is asking the district and the city comptroller to investigate.

In a letter to Superintendent James A. Williams, Jacobs wrote: "We are in the midst of a fiscal crisis and we were forced to lay off many employees this year. The millions spent on cosmetic surgery could have saved jobs. I want to make sure these are legitimate expenditures and that this benefit is not being abused."

A few unions in the district have a cosmetic surgery rider on their health insurance, but officials say that teachers or their dependents account for 90 percent of the people getting the procedures. Teachers can choose from four health insurance plans. One of them, a traditional plan with BlueCross BlueShield, includes the cosmetic surgery rider, according to Barbara J. Smith, the district's chief financial officer.

A relatively small number of people — about 500 — are getting the procedures, which is less than 2 percent of those covered by health insurance through the district, Smith said. That works out to an average of nearly $18,000 in elective procedures last year per employee who used the benefit.

Last year, the cosmetic surgery procedures accounted for 9 percent of the district's total spending on health benefits for employees and retirees.

Philip Rumore, president of the Buffalo Teachers Federation, said the union has agreed to give up the benefit.

"We've already told them we're going to give [it] up in these negotiations," he said. "We've told everybody it's going to be gone in the next contract."

Smith said the issue of the rider came up during the district's budget talks last spring.

"We asked the unions to forgo the cosmetic surgery rider for one year, so we could use the money to reduce the number of layoffs," she said. "They weren't interested."

Rumore emphasized that the benefit is a negotiated item — one that his union is willing to forgo, but only as part of contract negotiations.

He said he does not know what caused the dramatic increase in procedures over the past few years. "Maybe it's because everybody knows it's going to be gone," he said. "I would imagine that's probably the reason."

The last teachers contract in Buffalo expired in 2004. There are no active negotiations taking place right now to hammer out a new agreement, but Rumore said he expects "very serious" negotiations to begin by the end of the year.

Eight doctors accounted for 95 percent of the billing for cosmetic surgery to the district last year.

Dr. Kulwant Bhangoo billed the district $4.3 million last year — more than double the $1.8 million he billed in 2008. He has his own practice on Cazenovia Street in Buffalo.

Two other doctors each billed about $1 million: Dr. Daniel Buscaglia of Cosmetic Vein and Laser and Dr. Samuel Shatkin of Aesthetic Associates Centre.

Many retirees also have the benefit, but only a handful use it, meaning that current teachers or their dependents account for most of the procedures.

BlueCross BlueShield of Western New York has taken steps to contain the costs of the procedures. Until early this year, doctors could charge as much as they wanted for the various procedures, union and district officials said.

"Previously there were no set reimbursement rates for these procedures, so there was a big difference in what doctors' rates were," Smith said. "[This year] BlueCross BlueShield set a fee schedule for some of the procedures and limited the number of times some procedures could be reimbursed."

The insurance company also began requiring that a "licensed medical professional" perform the procedures, according to a letter to the district from an insurance consultant.

The consultant, John G. Berger Jr. of Lawley Benefits Group, indicated in the letter that the average cost per procedure was down 18 percent this year, compared with last year, and that there seems to be a "slight reduction" in the number of procedures this year.

Smith said it's too early to know what the overall cost to the district will be for 2010.

mpasciak@buffnews.comnull