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Don’t get sued

Article-Don’t get sued

While doctors are trained in medicine and to perform certain procedures, they are not well-trained in the law, one expert noted during the 36th Annual Conference of the American Society for Laser Medicine & Surgery, Boston, Mass.

“Unfortunately, with the practice of medicine, there are legal risks and pitfalls that we need to be aware of,” says Mathew M. Avram, M.D., J.D., director of the Massachusetts General Hospital Dermatology Laser and Cosmetic Center, Boston, Mass. He discussed the legal risks associated with lasers, light sources and energy-based devices and how to avoid problems.

One of the most important tips for physicians who treat patients with these devices or oversee such treatment is to observe what’s actually happening to the skin while firing the laser. Do not simply look at the numbers on a laser screen, he says.

“In other words, you can just punch in what an instruction book tells you to. What’s more important is to look at the skin and be able to recognize what is going to be safe and effective, and at what point you might be putting too much energy into the skin,” Dr. Avram says.

Dr. Avram and colleagues have published studies looking at why doctors get sued for laser, light-based and energy-based device treatments. They’ve found that the most common procedure in lawsuits of this kind is laser hair removal. And the most common reason that people get sued is for negligence or malpractice — two words that connote the same thing.

“The next most important reason for these lawsuits is failure to obtain informed consent…,” Dr. Avram says. “It also turns out that the level of training that the laser operator possesses also is correlated with the risk for being sued. Physicians who are trained on lasers are sued, on average, the least. Physicians without specialty training in lasers tend to be sued more, and the people who tend to get sued most are nonphysicians performing laser procedures.”

The setting that is most likely to cause harm and end up in a lawsuit is when non-physicians perform these procedures without a physician supervision, which might occur in a medi-spa, according to Dr. Avram. He and colleagues reported on the increased risk of litigation associated with laser surgery by nonphysician operators in JAMA Dermatology, April 2014. 1

“One of the important things about the talk is the level of supervision and the level of your training. It’s very important to be trained well before you do these procedures,” he says. “And basically, if someone performs a laser, light-based or energy-based treatment in a practice that you own, and they are doing work within the scope of their duty, the employer or the business that employs them is liable for their malpractice or their failure to get an informed consent. It’s important that physicians who are delegating more and more recognize that they are ultimately responsible.”

Physicians can avoid legal issues associated with the devices by being trained in what they do; doing the procedures and not delegating them; keeping up with the medical literature; and updating their consent forms, according to Dr. Avram.

“If there are new complications that have been reported, you need your consent forms to be updated to include any new adverse side effects…,” he says.


1.     Jalian HR, Jalian CA, Avram MM. Increased risk of litigation associated with laser surgery by nonphysician operators. JAMA Dermatol. 2014 Apr;150(4):407-11.

Disclosure: Dr. Avram reports no relelvant disclosures.

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