Treating Complications Caused by Non-Physicians

N early 41% of the members of the American Society for Dermatologic Surgery (ASDS) who responded to the society’s recent survey reported an increase in the number of patients they’ve seen who needed corrective treatment because they suffered from complications, misdiagnoses or ineffective treatments provided by non-physicians. Procedures cited were related to laser/light hair removal, subsurface laser/light rejuvenation techniques, chemical peels, acne therapy and misdiagnoses or delayed treatment of skin cancers and rosacea. Most Alarming Increases The greatest number of complications stemmed from laser/light hair removal procedures performed by non-physicians. With regard to these mishaps, 106 dermatologic surgeons noted such adverse effects as second- and third-degree burns, permanent nerve damage and scarring. Compared with last year’s data for hair removal procedures, this is a jump of 7%. According to ASDS President-Elect Dr. Roy G. Geronemus, in an explanation he gave during an interview, "Complications from laser hair removal were the biggest concern regarding the study outcome." He went on to say, "We had reports ranging from burns resulting in scars and changes in pigmentation. Other cases were as innocuous as the non-physician failing to use the correct device and the patient didn’t get the desired response. Some people are misled as to what the efficacy should be.” Dr. Geronemus alone has already treated 15 patients this year after having experienced complications following laser/light-based hair removal by non-physicians. "In some cases, we’re finding that store-front operations are opening, and the operators are getting access to devices and providing dermatologic care," further explained Dr. Geronemus. "A lot of this has been brought about by the allure of some of these seemingly easy to use devices," he said. "I’ve had patients come in with complications after being treated at someone’s home who operated one of these devices." Skin cancer misdiagnosis is one issue that Dr. Geronemus found "very scary." "We had more than 60 reports of physicians who actually saw patients in whom skin cancer was either misdiagnosed or was treated inappropriately. In many cases, non-physicians provided opinions, which they’re not qualified to do." Overall Results The study also revealed that ASDS members treated a number of complications related to rosacea, chemical peels and acne therapy. Here’s a look at some of the specifics. (For more information regarding this year’s results and data comparing this year’s and last year’s results, see the charts.) • For the first time, a considerable number of dermatologic surgeons (61) reported that they’d seen patients with complications from acne therapy. This seemed to come as a surprise to the ASDS president-elect. Dr. Geronemus reported in an ASDS statement that it was quite alarming to see "acne therapy come on the radar screen rather dramatically." • ASDS members treated 67 patients with rosacea who experienced complications. Dr. Geronemus said that he found the study results encouraging with regard to rosacea because these figures had improved somewhat compared with last year when the ASDS first conducted this survey. • With regard to chemical peel procedures, 66 ASDS members reported damage from these procedures that had been performed by non-physicians — a number Dr. Geronemus said is still worrisome. • Although the ASDS didn’t report on any incidences surrounding complications from non-authorized Botox injections because the drug hadn’t been approved at the time of the survey’s completion, Dr. Geronemus said he expects to see them surface in next year’s survey. "I believe the numbers of complications will increase dramatically by our next report," he said. "In fact, I just heard a news report that there were three arrests in Queens in cases where non-authorized personnel injected Botox and the recipients experienced complications," Dr. Geronemus continued. What’s Being Done to Counteract the Problem? Despite a widespread public relations effort, which included coverage in the New York Times and the Washington Post, USA Today, ABC News and more to alert the public to these concerns, Dr. Geronemus said that he’s surprised there’s not a lower incidence of complications. However, he added that many cosmetic procedures have gained in popularity and in turn abuse with devices has become widespread. Ultimately, effective legislation will be the answer, according to Dr. Geronemus. The ASDS reports that within the last year reform efforts have made some progress. For example: • in Louisiana, the state board of medical examiners has revised its position statement on the utilization of medical lasers and chemical peel under direct and onsite physician supervision. • Oregon now requires that if laser procedures are delegated, they must be performed under direct physician supervision • last month, the New York State Board of Medicine passed a resolution stating that using lasers or intense pulsed light for hair removal should be considered a medical procedure. This resolution would mandate that this procedure then be performed by a physician or under direct supervision of a physician. • the state medical board and health department in Texas are presently reviewing policies regarding laser use, as well. For more information about legislation, refer to the map. Dr. Geronemus noted in an ASDS statement that the complications reported by the study are only the "tip of the iceberg" and that clearly more progress is needed to lessen the incidence of problems. BLUE: States permitting only M.D.s to perform laser procedures: Delaware, Hawaii, Indiana, Kentucky, Maine, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, North Carolina, North Dakota and Virginia YELLOW: States permitting M.D.s to delegate laser procedures under direct supervision: Alabama, Georgia, Louisiana, New Mexico, Oklahoma, Oregon, Pennsylvania, South Carolina, Wisconsin and the District of Columbia GREEN: States permitting M.D.s to use their discretion when delegating laser procedures, but with various definitions of supervision: Connecticut, Colorado, California, Florida, Illinois, Maryland, Massachusetts, New York, Texas and Washington RED: States having no regulations regarding laser procedures: Alaska, Arizona, Arkansas, Idaho, Iowa, Kansas, Michigan, Minnesota, Nevada, Ohio, Rhode Island, South Dakota, Tennessee, Utah, Vermont, West Virginia and Wyoming