Dr. H. Ray Jalian
A study published online Oct. 16 in JAMA Dermatology, a journal of the American Medical Association, found that lawsuits related to procedures in which non-physicians operate the laser are increasing, particularly when performed outside a traditional medical setting.
“Procedures performed by untrained individuals, particularly in non-medical settings, are more likely to result in litigation,” said lead author Dr. H. Ray Jalian, a clinical instructor of medicine in the dermatology division at the David Geffen School of Medicine at UCLA. “Consumers should be aware that laser treatments are medical procedures and should verify the training, certification and experience of the person performing the procedure.
Researchers used an online national database of public legal documents to chart the frequency of medical professional liability claims stemming from skin-related laser surgeries.They identified 175 cases related to injury from such surgeries between 1999 and 2012. Of those cases, 75 (42.9 percent) involved a non-physician. The proportion of cases involving non-physicians increased from 36.3 percent in 2008 to 77.8 percent in 2011.
Laser hair removal was the most common of these procedures. While only one-third of laser hair-removal procedures were performed by non-physicians, 75.5 percent of hair-removal lawsuits between 2004 and 2012 involved non-physicians; between 2008 and 2012, it was 85.7 percent.
The study found that non-physicians performing skin-related laser surgery included nurse practitioners, registered nurses, medical assistants, electrologists and aestheticians, among others.
To meet the high demand for these procedures, physicians have increasingly delegated laser surgeries to non-physicians over the past decade. In many states, laser surgeries not supervised by a physician can be performed legally at non-medical facilities like medical spas that offer aesthetic and cosmetic procedures.
Jalian stressed that physicians and others who operate lasers should know their state laws regarding physician supervision of non-physician laser operators. He also noted that in the correct setting, with close on-site supervision and appropriate training, the use of non-physician operators can prove to be productive and safe for patients.
Other study authors included Chris A. Jalian; Paul Hastings LLC, New York; and Dr. Mathew Avram of the Wellman Center for Photomedicine at Massachusetts General Hospital in Boston.