Have you researched and scheduled laser treatments of interest to you, but have you taken the time to meet those entrusted with holding this laser against your skin?
Medical spas that pay commission to estheticians or non-physician employees to perform laser treatments are being heavily scrutinized, particularly those operating in California where the medical board has made it a mission to put an end to such practices.
Legality
California law restricts laser treatments or injectables administered at medical spas to only licensed doctors or registered nurses; this rule is stricter than other states, though that doesn’t preclude doctors from owning one medi-spa. Alabama follows the doctrine of corporate practice of medicine which only permits licensed physicians to own clinics offering medical-grade Botox or dermal filler treatments such as Botox. Non-ablative laser treatments can be delegated out, though ablation treatments must always be performed by them personally.
Cosmetologists, estheticians and other licensed aesthetic professionals must also adhere to this rule; while they may offer superficial cosmetic treatments like facials or microdermabrasion, they cannot perform medical-grade dermabrasion procedures or injections of any kind.
Nurses and physician assistants must only inject Botox under the supervision of a licensed doctor, so it’s wise to visit only medical spas that employ certified professionals.
Recent research revealed that between 1985 and 2012, 174 lawsuits were filed against medical spas, clinics and doctors alleging laser-related injuries ranging from burns, blisters, scarring, discoloration and permanent hair loss.
Injurys caused by these treatments typically arise due to inadequate training or information provided about potential risks. A study published in JAMA Dermatology investigated this matter further.
The Medical Board of California is working towards passing legislation that would enable physician assistants and registered nurses to delegate certain dermatological procedures, such as using non-ablative lasers for permanent hair removal or non-ablative lasers for non-ablative laser procedures. If approved, such legislation must also require the physical presence of either a physician or registered nurse practitioner during any ablative laser procedures.
The Colorado Medical Board also follows this model when delegating laser treatments to non-physicians. Nurse Practitioners and Physician Assistants must complete a training protocol specific to the type of laser they will be using and must maintain 15 laser education credits over a two year period.
Licensing
Many medi-spas offer services like laser hair removal, botox injections, chemical peels and dermal filler treatments; these services attract many clients. Under California law however, only licensed physicians may perform procedures using lasers or intense pulsed light devices and must remain present throughout the procedure to ensure all requirements for treatment have been fulfilled.
Law dictates that only physicians are eligible to administer injectable treatments such as Botox and dermal fillers, such as Botox. Therefore, estheticians do not have the privilege of administering Botox treatments at medical spas. A doctor must first examine each patient to develop a treatment plan before any injection takes place – protecting patients while guaranteeing them optimal results.
Although not all medi-spas are operated by physicians, it’s still important to research your practitioner to ensure they possess adequate training and are operating within legal bounds of their scope of practice. Request proof of their credentials such as medical licensure and certification by state boards as proof.
Arizona law mandates that those performing laser and light-based cosmetic treatments must complete 40 hours of training, perform 100 cosmetic laser procedures under supervision, and pass a written exam to achieve certification. These regulations help prevent dangerous mistakes from being made that could result in serious medical complications or infections for themselves and other clients.
There are also rules governing who may use lasers and intense pulsed light devices in a medical spa, according to the Arizona Medical Board. Registered Nurses, Licensed Vocational Nurses or Physician Assistants cannot use such devices without physician supervision while Estheticians, Cosmetologists or Electrologists cannot make use of such devices either.
There may be exceptions, but it is crucial that physicians who own med spas are present at all times during procedures. A physician should be available to answer any queries or address concerns during the procedure as they arise and assist when necessary. Furthermore, having a physician present will allow for faster identification of potential complications as well as to ensure the appropriate treatments are used (this is especially essential when performing laser procedures involving needles as improper injection techniques have been linked with outbreaks of Hepatitis and HIV).
Supervision
Certain medical spa treatments require the expertise and supervision of a licensed physician, such as Botox injections, laser hair removal and Intense Pulsed Light devices to remove spider veins and tattoos. Only licensed physicians and licensed advanced health practitioners may perform these procedures under direct supervision from an MD; registered nurses and physician assistants trained and instructed by one may inject Botox but this must come from within an organization authorized to do so; unlicensed medical assistants, licensed vocational nurses or aestheticians cannot inject any form of cosmetic substance at any time or under any circumstance.
States vary, but most require that medical professionals are present and available during all treatments at medical spas. Furthermore, each procedure must have been preapproved by a doctor as well as comply with strict infection control measures and report any injuries or accidents to their respective state government authorities.
Consumers in Phoenix are filing more and more lawsuits against laser clinics when they experience burns and complications from poorly performed laser procedures, according to Arizona Radiation Regulatory Agency inspection reports. One in four of the facilities it inspects fail to register, while one out of eight employ unlicensed laser technicians.
The Regulatory Agency reported it issued numerous notices to laser clinics in metro Phoenix for failing to register, using unlicensed laser technicians, not properly training or testing equipment, or failing to report injuries as required. Due to increased demand, two more full-time inspectors will soon be needed by them.
Critics question whether estheticians, who typically receive only three weeks of hands-on laser training at trade school, can operate complex laser machines safely for medical aesthetic procedures. But experts insist that, given proper instruction and certification, an esthetician with ample experience and track record can offer quality laser services.
Many states have passed laws banning commissions or bonuses tied to medical revenue, such as those paid to estheticians for performing laser treatments. Consumers should avoid such practices, which may encourage unlicensed practitioners to take shortcuts that could endanger patients’ wellbeing.
Insurance
The Medical Board of California has very stringent insurance requirements when it comes to cosmetic laser and injectable treatments. Patients must be fully informed prior to having these services performed, including knowing who will perform it, their qualifications and risks that might arise during treatment. In addition, patients must sign a written consent form as well as understand how their facility handles potential complications should they arise.
Botox injections, dermal fillers and laser procedures should only be performed by licensed physicians. Nurse practitioners or other licensed healthcare professionals may perform non-ablative laser treatments; however, only physicians should perform or authorize others to perform ablative laser procedures as the Medical Board views these as medical treatments that only a licensed practitioner should perform.
While maintaining high standards in medical aesthetics is of vital importance, patients should never feel pressured into services they do not want or require. This violates state laws and has resulted in numerous tragic stories where individuals suffered serious medical consequences after receiving unsafe injections or unsuitably performed laser treatments.
The CMA Center for Legal Affairs advocates on physician rights before courts and collaborates with other advocacy centers to influence health policy made by legislators and regulatory agencies. Physicians can access CMA’s extensive online health law library that contains an abundance of information affecting their practices; including its California Physicians Legal Handbook – free for CMA members while non-members may purchase individual documents.
