Patients and their families sued dermatologists in 21% of 174 lawsuits filed for injuries caused by cutaneous laser surgery from 1985 through 2011. Only plastic surgeons were more likely to be defendants, accounting for 26% of cases.
The incidence of lawsuits for cutaneous laser surgery injury generally is on the upswing, increasing from five or fewer cases per year in 1985-1999 to a peak of 22 cases in 2010, Dr. H. Ray Jalian and his associates reported.
Dr. H.Ray Jalian
The majority of the cases involved laser hair removal (36%) and rejuvenation procedures (25%). The rejuvenation procedures included conventional ablative resurfacing, nonablative resurfacing, intense pulsed light, and the use of both ablative and nonablative fractional lasers. Plaintiffs won an average of $380,700 each in 51% of the 120 cases that reached a decision or settlement. That’s more than the average $275,000 indemnity payment across all medical specialties in a 2011 report, but the two studies used different methodologies. Dr. Jalian and his associates analyzed cutaneous laser surgery cases in the national Westlaw Next database of public records that included some form of legal pleading (JAMA Dermatol. 2013;149:188-93). The previous data included all resolved claims (not only those with legal pleadings) in all specialties (N. Engl. J. Med. 2011;365:629-36).
The physicians being sued included at least 12 other kinds of specialists, suggesting that a significant number of physicians offer or supervise laser skin treatments outside the scope of their specialty, wrote Dr. Jalian, a clinical fellow at the Wellman Center for Photomedicine, Massachusetts General Hospital, Boston.
General surgeons, family physicians, ob.gyns., and otolaryngologists each accounted for 5% of cases. Others included ophthalmologists (3%), orthopedic surgeons (2%), and specialists in radiology, anesthesia, physical medicine and rehabilitation, preventative medicine, and vascular surgery (1% each). Physician extenders (including physician assistants, nurse practitioners, registered nurses, aestheticians, and technicians) were laser operators or supervisors in 20% of cases.
Notably, physicians were sued even when they weren’t operating the laser, but were responsible for supervising the operator. Nonphysician operators (including physician extenders, chiropractors, podiatrists, and others) comprised 38% of operators and 26% of defendants. Physicians comprised 58% of operators and 74% of defendants. The training status of 5% of operators was unknown. (Percentages were rounded.)
After hair removal and skin rejuvenation, the most often litigated cases involved treatment of vascular lesions and telangiectasia (8% of cases) or treatment of leg veins (another 8%). Seven percent of cases involved tattoo removal, 4% involved neoplasms, 3% stemmed from treatment of scars, 2% involved laser treatment of pigmentary disorders, 1% were the use of a laser to treat pigmented lesions, and 6% were other procedures.
The most common injuries were burns (47%), scars (39%), and hypo- or hyperpigmentation (24%). Two percent of cases involved eye injuries, and at least two patients died due to complications of anesthesia.
The researchers offered several tips for physicians to reduce the risk of a lawsuit from skin laser surgery, including ensuring proper staff training and supervising delegated tasks. Be careful to evaluate skin type and select the correct laser parameters, they said. For some patients, it may be wise to do a test spot before starting laser treatment, even though solid data are lacking to support this. Follow guidelines from professional medical associations, such as the guidelines from the American Society for Laser Medicine, on delegating laser-related tasks to nonphysicians, the researchers added.
In general, federal regulations do not specify who can operate a laser, which procedures must be supervised by physicians, or where to perform procedures. Several states, including New York and Texas, do not require a license to perform laser hair removal, the most common type of laser skin surgery, the investigators noted. The lawsuits were filed in 30 states, the District of Columbia, and federal court, with the most cases in California (27), New York (23) and Texas (23).
Dr. Jalian reported having no financial disclosures. One of his coinvestigators has been a consultant and advisor for Zeltiq Aesthetics and a consultant for Unilever.
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