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Original Investigation |

Increased Risk of Litigation Associated With Laser Surgery by Nonphysician Operators

H. Ray Jalian, MD1,2; Chris A. Jalian, JD3; Mathew M. Avram, MD, JD2,4
[+] Author Affiliations
1Division of Dermatology, University of California, Los Angeles
2Wellman Center for Photomedicine, Massachusetts General Hospital, Boston
3Paul Hastings, LLC, New York, New York
4Department of Dermatology, Harvard Medical School, Boston, Massachusetts
JAMA Dermatol. 2014;150(4):407-411. doi:10.1001/jamadermatol.2013.7117.
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Importance  Controversy exists regarding the role of nonphysicians performing laser surgery and the increased risk of injury associated with this practice.

Objective  To identify the incidence of medical professional liability claims stemming from cutaneous laser surgery performed by nonphysician operators (NPOs).

Design, Setting, and Participants  Search of an online national database of public legal documents involving laser surgery by NPOs.

Exposure  Laser surgery by nonphysicians.

Main Outcomes and Measures  Frequency and nature of cases, including year of litigation, certification of provider and operator, type of procedure performed, clinical setting of injury, and cause of legal action.

Results  From January 1999, to December 2012, we identified 175 cases related to injury secondary to cutaneous laser surgery. Of these, 75 (42.9%) were cases involving an NPO. From 2008 to 2011, the percentage of cases with NPOs increased from 36.3% to 77.8%. Laser hair removal was the most commonly performed procedure. Despite the fact that approximately only one-third of laser hair removal procedures are performed by NPOs, 75.5% of hair removal lawsuits from 2004 to 2012 were performed by NPOs. From 2008 to 2012, this number increased to 85.7%. Most cases (64.0%) by NPOs were performed outside of a traditional medical setting.

Conclusions and Relevance  Claims related to cutaneous laser surgery by NPOs, particularly outside of a traditional medical setting, are increasing. Physicians and other laser operators should be aware of their state laws, especially in regard to physician supervision of NPOs.

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Figure.
Procedures Performed by Nonphysician Operators Increasingly Represent Most Lawsuits

The percentage of cases involving a nonphysician operator is expressed as a percentage of total operators per calendar year. Note the increasing trend toward a larger proportion of nonphysician operators starting in 2008.

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