Increased Risk of Litigation Associated With Laser Surgery by Nonphysician Operators

Article · October 2013with16 Reads
DOI: 10.1001/jamadermatol.2013.7117 · Source: PubMed
Importance Controversy exists regarding the role of nonphysicians performing laser surgery and the increased risk of injury associated with this practice.Objective To identify the incidence of medical professional liability claims stemming from cutaneous laser surgery performed by nonphysician operators (NPOs).Design, Setting, and Participants Search of an online national database of public legal documents involving laser surgery by NPOs.Exposure Laser surgery by nonphysicians.Main Outcomes and Measures Frequency and nature of cases, including year of litigation, certification of provider and operator, type of procedure performed, clinical setting of injury, and cause of legal action.Results From January 1999, to December 2012, we identified 175 cases related to injury secondary to cutaneous laser surgery. Of these, 75 (42.9%) were cases involving an NPO. From 2008 to 2011, the percentage of cases with NPOs increased from 36.3% to 77.8%. Laser hair removal was the most commonly performed procedure. Despite the fact that approximately only one-third of laser hair removal procedures are performed by NPOs, 75.5% of hair removal lawsuits from 2004 to 2012 were performed by NPOs. From 2008 to 2012, this number increased to 85.7%. Most cases (64.0%) by NPOs were performed outside of a traditional medical setting.Conclusions and Relevance Claims related to cutaneous laser surgery by NPOs, particularly outside of a traditional medical setting, are increasing. Physicians and other laser operators should be aware of their state laws, especially in regard to physician supervision of NPOs.
  • [Show abstract] [Hide abstract] ABSTRACT: IMPORTANCE Although some have noted that malpractice litigation may be "plateauing," defensive medical practices are pervasive and make up a considerable proportion of the "indirect" costs medicolegal issues contribute toward our health care system. Accordingly, these trends have spurred considerable interest in characterizing factors that play a role in alleged medical negligence, along with outcomes and awards. OBJECTIVES To conduct a focused examination of malpractice litigation regarding laser procedures in the head and neck and to determine the reasons for initiating litigation as well as outcomes and awards. DESIGN AND SETTING Retrospective analysis of the WestlawNext legal database, encompassing publicly available federal and state court records, to identify malpractice cases involving laser procedures in the head and neck. MAIN OUTCOMES AND MEASURES Outcomes, awards, defendant specialty, and other allegations. RESULTS Most cases (28 [82%]) included in this analysis involved female plaintiffs. Of 34 cases, 19 (56%) were resolved with a defendant verdict. The median indemnity was $150 000, and dermatologists, otolaryngologists, and plastic surgeons were the most commonly named defendants. The most common procedures were performed for age-related changes, acne scarring, hair removal, and vascular lesions, although there were also several rhinologic and airway cases. Of all cases, 25 (74%) involved cutaneous procedures, and common allegations noted included permanent injury (24 cases [71%]), disfigurement/scarring (23 [68%]), inadequate informed consent (17 [50%]), unnecessary/inappropriate procedure (15 [44%]), and burns (11 [32%]). Noncutaneous procedures had higher trending median payments ($600 000 vs $103 000), although this comparison did not reach statistical significance (P = .09). CONCLUSIONS AND RELEVANCE Procedures using lasers represent a potential target for malpractice litigation should an adverse event occur. Although cutaneous/cosmetic procedures were noted among cases included in this analysis, as well as other head and neck interventions, otolaryngologists were more likely to be named as defendants in the latter category. Although cases had modest indemnities compared with prior analyses, the potential for significant amounts was present. Inclusion into the informed consent process of specific factors detailed in this analysis may potentially decrease liability. In addition, physicians and patients should undergo comprehensive discussion regarding expectations as well as contingencies should adverse events occur. LEVEL OF EVIDENCE 4.
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  • [Show abstract] [Hide abstract] ABSTRACT: Background: The public preference for provider type in performing cutaneous surgery and cosmetic procedures is unknown in the United States. Methods: An internet-based survey was administered to the lay public. Respondents were asked to select the health care provider (dermatologist, plastic surgeon, primary care physician, general surgeon, and nurse practitioner/physician's assistant) they mostly prefer to perform different cutaneous cosmetic and surgical procedures. Results: Three hundred fifty-four respondents undertook the survey. Dermatologists were identified as the most preferable health care provider to evaluate and biopsy worrisome lesions on the face (69.8%), perform skin cancer surgery on the back (73.4%), perform skin cancer surgery on the face (62.7%), and perform laser procedures (56.3%) by most of the respondents. For filler injections, the responders similarly identified plastic surgeons and dermatologists (47.3% vs 44.6%, respectively) as the most preferred health care provider. For botulinum toxin injections, there was a slight preference for plastic surgeons followed by dermatologists (50.6% vs 38.4%). Plastic surgeons were the preferred health care provider for procedures such as liposuction (74.4%) and face-lift surgery (96.1%) by most of the respondents. Conclusion: Dermatologists are recognized as the preferred health care providers over plastic surgeons, primary care physicians, general surgeons, and nurse practitioners/physician's assistants to perform a variety of cutaneous cosmetic and surgical procedures including skin cancer surgery, on the face and body, and laser procedures. The general public expressed similar preferences for dermatologists and plastic surgeons regarding filler injections.
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