The reasons an insurance company won't cover a procedure vary. Sometimes underwriters shy away from a surgery or technique because it's too risky. A miscalculation half the thinness of a dime during a chymopapain injection, for instance, could cause instant paralysis.
In other cases, insufficient research will cause Copic to reject coverage. For example, in the late 1970s Copic refused to provide malpractice insurance to physicians who treated patients with drugs derived from peach pits, Brittain says. It also initially refrained from covering ophthalmologists who performed radial keratotomy surgery, although Copic now does.
Brittain concedes that some research has been done regarding penile-enhancement surgery, but he and his company are concerned about its validity. Specifically, he explains, "The majority of the research on the fat-injection penile enlargement was done by a doctor who stood to make a profit from it." (That would be Dr. Reed, in Florida.) Until objective scientists at an uninvolved university can prove that injecting fat into a penis is worthwhile, effective and not dangerous, he adds, doctors who insist on performing the operation should not come to Copic for their insurance coverage.
A second worry for insurance companies considering penile-enhancement surgery is the presumed volatility of the patients. "We are a company of doctors, by doctors," begins Dr. Mark Gorney, executive vice-president for Medical Affairs of The Doctor's Co., based in California, the second of the three major insurance companies that write most of the medical-malpractice insurance in the state of Colorado.
"We firmly believe that we should not dictate medicine to doctors--up to a point," he continues. "And that point is crystal clear. We will not cover experimental, novel or dangerous procedures, particularly dealing with sexuality."
That definition becomes tricky when discussing, say, the difference between breast augmentation for women--which The Doctor's Co. will insure physicians for--and penile enhancement, which it won't. Much of the discussion could be summarized like this: Women who want larger breasts are normal; men who want bigger penises may not be.
"Having breasts, which can be seen, is a primary evidence of womanhood, a primary item of sexual attraction," Gorney explains. "But with men, I like to say, 'It's not how you're built, it's how you're wired.' Unless you're dancing naked, nobody goes about exposing their genitalia, except in their boudoir or bathroom."
He concludes: "Whoever comes looking for that kind of procedure [penile enhancement] has a problem with his masculinity. And that's just courting disaster in terms of liability. What you have is a patient who is unstable to begin with." Translation: Lawsuit danger. Translation: No coverage.
The third company that provides medical-malpractice insurance for Colorado physicians is Minnesota's St. Paul Insurance. How comprehensively it covers Safford is a point of debate. Safford insists he is covered. "I am very careful about that," he says. "We have a sixteen-page consent form I go over very carefully with my patients explaining all the risks. But I definitely am covered. I have a special, symbiotic relationship with St. Paul's."
One person familiar with Safford's business insists equally forcefully that the doctor does not--or at least at one time did not--have insurance coverage for the number of procedures he does, about twenty a month. St. Paul itself is unwilling to clarify. "In this instance, we are going to decline comment," says Barry Johnson, communications director for St. Paul.
For Glen Rains and his bumpy penis, Safford's unclear insurance situation has been troublesome. Rains says he has contemplated suing Safford for malpractice, but each time he met with attorneys, the lawyers were uninterested. Their reason: Recovering damages from a physician is more difficult when a lawyer must pursue a doctor's personal assets rather than negotiate with his insurance company for a settlement. Other attorneys specializing in medical cases also point out the difficulty of finding a jury sympathetic to a man who paid $7,000 to obtain a larger penis.
Penile-enhancement surgery has begun to gain a measure of professional acceptance. "I'm balding, and I have no intention of getting a hair transplant. I used to feel that way about all cosmetic surgery," says Patrick Haley, the Denver urologist. But, he adds, "I've decided that if people want to change their body image, then go ahead." He sees some of Safford's patients when Safford is unavailable, and he says he has been impressed with the doctor's work.
Many traditional medical organizations remain unreceptive, however. Their objections have less to do with actuarial risk than with technical concerns, such as the fact that the fat injected into the penis to widen it sometimes doesn't take. This can result in a bumpy, misshapen--in short, an unsightly--penis. (One recent study in The American Journal of Cosmetic Surgery warned doctors contemplating the procedure about problem patients: "Touch-ups may be required especially by fastidious patients who seek a perfectly cylindrical result.")