Operator, beware: Know what 'spa' means

"A lot of doctors don't realize that as soon as you use the word 'spa,' your facility and staff may now be under the jurisdiction of your state's board of cosmetology, licensing professions or whatever it's called in that state," says Susanne S. Warfield. President and CEO of PCI Publishing, she has authored and published many books, including Legal and Liability Issues of a Medical Spa and The Guide to Building a Medical Esthetic Practice. She is the executive director of the National Coalition of Estheticians, Manufacturers/Distributors & Associations (NCEA).

"That's what's causing the biggest problem right now," she tells Dermatology Times. "People are putting out shingles and calling themselves medical spas, but they have no concept of what a spa is, let alone what a medical spa is."

However, Ms. Warfield says, "In some of these medical spas, they are just letting a medical assistant perform all sorts of invasive procedures, without any type of medical supervision."

Patient safety This situation creates "tremendous issues regarding patient safety, and the issue of appropriate care and oversight of that care," says Roy G. Geronemus, M.D., American Society for Laser Medicine and Surgery (ASLMS) president. "A growing number of patients are being injured by inappropriate and ineffective care being provided by non-physicians without medical supervision. There are an alarming number of people with long-term, if not permanent, problems as a consequence of treatments for benign or cosmetic conditions."

According to a survey taken by 342 American Society for Dermatologic Surgery (ASDS) members, nearly 41 percent of respondents reported an increase in patient complications resulting from the non-physician practice of medicine (in spas and elsewhere) treated between 2001 and 2002. The percentage of physicians reporting complications from laser hair removal posted the biggest jump (approximately six percentage points).

Dr. Geronemus says, "It seems as though, in many ways, the bar has been lowered in terms of who is providing these procedures and services."

State regulations States' regulations vary widely in this regard. In New Jersey, only physicians can perform laser or light-source-based procedures. In Connecticut, a physician must be on site during these procedures, though he or she can delegate them.

"In New York," Dr. Geronemus adds, "it depends on the procedure being performed. Laser hair removal has apparently received a pass from the state, as they do not consider it a medical procedure at this time. There are efforts around the country to legislate or regulate this industry. But in many ways it's like herding cats. And legislators will have a monumental task on their hands the longer they wait to control this problem."

Meanwhile, liability issues lurk for unsuspecting physicians. Presently, at least 29 state aesthetician licensing boards do not and will not recognize the aesthetician license in a medical practice for a variety of reasons (PCI Journal. 2005, 13;1:21–28). Some boards do not want the responsibility of ensuring consumer safety when a physician delegates a procedure to an aesthetician - it is outside the board's realm of expertise, nor can the board sufficiently monitor the facility, according to Ms. Warfield.