Physician Extender Legal Issues. David J. Goldberg, MD, JD Skin Laser & Surgery Specialists Fordham Law School
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1 Physician Extender Legal Issues David J. Goldberg, MD, JD Skin Laser & Surgery Specialists Fordham Law School
2 Disclosures I run a post-graduate PA Dermatology Fellowship program I co-direct Aesthetic Extender Symposium
3 In The End Goal is to promote safety and keep you out of a lawsuit
4 Reality Most properly trained physicians deliver high quality laser treatments Most properly trained and supervised physician extenders also deliver high quality laser treatments
5 Reality Physicians will make mistakes Physician extenders will make mistakes These mistakes will lead to lawsuits
6 Perceptions Physicians will make less mistakes than physician extenders Perceptions become reality
7 Why Do People Sue? They are dissatisfied
8 Why Do Patients Sue? Poor communication Retribution Economic reasons Negligence
9 Exciting Future in Next 5 Years Body Shaping projected to grow: - (22.7% growth) Skin Tightening will expand: - (18.9% annual growth) Energy-based device sales (Increase of 6% per year)
10 AAD Membership 31% (1243/3965 surveys) members responded % using PA and NPs % using PAs and NPs % using PAs and NPs % using PAs an NPs More common among younger derms More common in cosmetic or surgical practices Resnick and Kimball. JAAD
11 Medspas The number of medspas has grown by 85% in last 2 years (International Medspa Association) Medspa Annual Revenues more the $2 billion (Aesthetic Medicine News)
12 PAs ,002 PAs ,000 PAs ,717 PAs ,515 SDPA members 2016-???
13 The Unhappy Patient
14 Why Do Patients Sue? Poor communication Retribution Economic reasons Negligence
15 Physician Extenders
16 Physicians and Extenders Physician Extender Issues Who can do it? State variability
17 Dean Faiello ASLMS Nursing/ Allied Health Care ( ) Advertised as an MD (Skin and Laser Center in NYC)
18 Dean Faiello Pleads guilty 6/26/03 to practicing medicine w/o license 9/03, before sentencing, flees to Costa Rica 2/18/04, former cosmetic patient, found dead Body encased in cement on former property in Newark, NJ
19 NC Spa Case Unregulated Spa Premier Body 22 y.o. N.C. State University biochemistry senior - Shiri Berg Death from lidocaine toxicity on 1/05/2005 Potent topical anesthesia before laser hair removal of legs
20 AZ Case 25 year old college student Bianca Bolanos 1/22/2002 applied Photocaine (6% lidocaine/6% tetracaine) ointment for legs provided by non-medical employees Cellophane occlusion for several hours No instructions provided by the clinic Golden West Medical Center or Medical Director
21 AZ Case Seizures and unconsciousness Respirator for 2 years and died 11/01/2004
22 ASDS Survey (2006) 51% of members have seen non-physician, non-supervised PE complications Most commonly misdiagnosed skin cancer Next scarring from procedures
23 Core Societies Guidelines Physician supervision Immediate physician response
24 Implications of Guidelines Guidelines do not represent law Guidelines can be used as 1 piece of evidence
25 Allied Health Care Education ASLMS AES (Aesthetic Extender Symposium)
26 Informed Consent
27 Negligence Basis of medical malpractice
28 Informed Consent Cosmetic Laser Treatments Adverse effects that may occur Erythema Pigmentation Infections Scarring
29 Expected Adverse Effects (informed) Erythema Pigmentation (hyperpigmentation)
30 Unexpected Adverse Effects (? informed) Infections Scarring Permanent Pigment Changes
31 What Must Be Included in the Consent? The reasonable standard Determined by expert witness
32 What Are the Consequences? Elements in cause of action in negligence
33 Legal Analysis Negligence Duty Breach of duty Causation Damages
34 Expected (Informed) Erythema Pigmentation (hyperpigmentation)
35 Unexpected (?Informed) Infections Scarring Permanent Pigmentary Alterations (hypopigmentation)
36 Legal Analysis Duty Breach of duty Causation Damages
37 Hypopigmentation Duty Breach of duty Causation Damages Legal Analysis Was the complication described in the medical literature at the time of the incident?
38 Laser Sculpturing of the Eyebrow
39 Thick terminal dark hairs in eyebrow Tremendous absorption and scattering of light Iris of eye has significant melanin content to absorb this light Absorption may lead to iritis and distortion of iris shape
40 Excess Hair Acne Male-pattern baldness Deepening of voice Increased muscle mass Decreased breast size Amenorrhea
41 Hirsutism Diseases - Androgen Excess Pituitary Adrenal Ovarian
42 Duty Breach of duty Causation Damages Missed Diagnosis Legal Analysis
43 Physician Extenders Perceptions
44 Continuing Education Requirements PA-C The original certification test is called the Physician Assistant National Certifying Exam (PANCE). Physician Assistants must pass the PANRE (Physician Assistant National Recertifying Exam every 6 years.) Both the PANRE and PANCE assess basic medical and surgical knowledge.
45 Extender Perceptions Continuing Educational Requirement
46 Continuing Education Requirements PA-C 100 CME credits logged in every 2 years in order to stay certified. Of the 100 CME hours at least 50 must be Category I CME. The remaining 50 hours can be Category I, Category II or a combination of both.
47 Nursing/Allied Health Care Most Allied Health Practitioners work in small offices without a Medical Staff office keeping a close eye on them National certification, CME requirements, malpractice policies, and medical certifications (ie. ACLS, BLS). It is easy enough to let these things expire.
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