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Sunday
Sep072014

Louisiana Cosmetic Laser & IPL Law Questions & Answers

Legal issues around who can own or use a cosmetic laser or IPL are among the most common questions asked by both physicians and non-physicians who are investigating the medical spa market.

Here's a question posted inside the Medical Spa MD LinkedIn Group

What is the best way to find out what the Louisiana Laws are for operating lasers at your spa? From what I have read, it seems as though you have to have a physician present, however, most of the medi spas around run lasers but do not have physicians present so I am very confused. Does anyone know a way to find out more information?

Reader Comments (16)

this is a contentious area..to be sure. However, by federal law, lasers are federally classified medical deices. They must be owned and operated by physicians. The further spas deviate form this, the more exposure they have. Many spas adopt a resolution that I pioneered 15 years ago....agreements with physicians that somewhat mitigate the risk. New Orleans in particular has several dermatologists that are known to create problems for non-physician owned spas that engage in the practice of medicine.

Utilizing a laser...even for hair or tattoo removal..is the practice of medicine because a medical device is being utilized. You cannot perform brain surgery...similarly, you cannot perform laser. It really is that simple. I have two doctorates and I cannot own or operate a laser absent special conditions and agreements with physicians.

I know that this position is violated on a daily basis. however, compliance is a huge issue today and the federation of State Medical Boards is involved in this issue.

Just having an agreement with a physician does not make it kosher. Physicians must be present and any money other than ownership given to a physician is 'kick-back', which is illegal in the medical profession.

You should check with your insurance carrier. Chances are extremely slim that you will be covered in any way should you have a suit filed against you due to 'damage' caused to your client or medical patient.

Without questioning your ability, are you aware of the risks involved and are you trained in fixing any damage that you may cause? Laser companies that offer a few hours of training cannot possibly teach you what can happen. Certification classes are hit and miss. In the end, Paddy is correct in his assessment. Be very careful when you dive in to the water without knowing what's beneath you.

09.7 | Unregistered CommenterWD

Check with your state board for requirements and also if any federal regulations apply for your business. In my state a doctor need not be present for hair removal, but where I work we pay a physician to be our physician of record and of course make sure you carry enough insurance for your business. The laws are really hit and miss and sometimes don't really make sense to me. Always have physicians for referrals, you never know. I don't do laser, but I have spotted skin cancer a few times and it is comforting to the client when you have a ready name you trust.

Very slippery slope and the state disciplinary boards do very little to curtail this until something adverse occurs. I find that the laws are grossly overlooked by a majority of spas. The physician who blindly signs on the line basically handing over their license to someone who cannot operate the laser is to blame as well. I find that many of them never gave it a thought believing that these lasers were safe the when someone is permanently scared or disfigured they seem shocked to find they are holding the bag and on occasion sited for allowing the illegal practice of medicine. I regularly review malpractice cases they tell me I am only seeing the tip of the iceberg. I think eventually the states will pull in the reigns. Lawyers have paralegals but they don't practice law so why should aestheticians practice medicine.

09.7 | Unregistered CommenterGlenn M

All well and good, but in Iowa anyone that does tattooing can do laser removal of them. Do I agree with that? No, however I also don't like physicians trying to take over the entire skin care industry when there are very qualified people out there that have significant training. Trouble happens when people start looking at the dollar signs and forget their common sense. As I see it the physician I speak of gets paid a monthly income to not be bothered. Then gets a bonus when I am sending them a referral which gives them a chance to make even more money.

Find a physician who does not steal your clients. My wife is a Board Certified Dermatologist and one of the founders of Cosmetic Dermatology going back to 1985. She refers out to many plastic surgeons and when she finds out that they are taking her Botox and filler business buy trying to keep them, she stops referring to them. She finds others who don't want to lose a great referral. Far too many have gotten greedy. It only takes one call or note to them and the smart ones start sending everyone back.

09.7 | Unregistered CommenterWD

Actually this is incorrect. I just reviewed the Iowa recommendations and they do have rules as of this year regarding the use of medical lasers by non medical persons. Unfortunately they say in one sentence that the procedure is medical so in my humble opinion that would require a medical education. Then they go on to say that a physician can delegate to a "properly trained" non medical person but must oversee them. so where does that leave you, what is properly trained a weekend class, a 2 hour lecture from the laser company, I don't know. So why don't I train grandma who can sew a skirt in an hour and have her be my wound closure specialist or are there different meanings and grades of "medical"
The sad part is the public just doesn't know. A lot of spas are really practicing very shady, just today I saw a local ad for a year old spa. I know I have been practicing 30 years and they are now the leading injectable practice and spa in the area. Leading? They are brand new , I look at the website and they make it seem as if this is a doctors office with this caring surgeon overseeing every nuance of the practice. Yet, I know him an he has not been within 20 miles of this place. Its deceptive and worse when someone is injured often the plaintiff gets nothing because there is nothing to be gained.

09.7 | Unregistered CommenterGlenn M

I have been a medical aesthetician for 4 years now, I worked at a doctors office in Michigan where I was very thoroughly trained for about 6 months on every treatment that I was to perform and did 20-30% chemical peels, did all sorts of laser treatments including profractional and micro laser peels, tattoo removal, radio frequency treatments, ultrasound treatments, all for fat loss and cellulite, the list goes on. In all of this, the person who made the most mistakes and made people the most unhappy was the doctor himself while digging deep with smart lipo, taking too much out, leaving indentations, etc. I'm just making a quick point that I did medical treatments, while working in a physicians office (the physician was only in my office 1 and a half days a week, as he worked at his other office every other day practicing general derm and smart lipo) and although I was JUST an aesthetician, I had to frequently treat patients who had multiple mistakes made on them by a doctor.

The reason I posted this discussion is because I am a very experienced Medical Aesthetician who just moved to Louisiana from Michigan and the Louisiana laser laws are very unclear. There are many medi spas here that operate lasers without a physician on site, but most of what I read about the law states that a physician is to be on site. The owner of the spa I work at wants to be sure of the law before we invest in the equipment and are able to assist people with their skin conditions.

Thank you to everyone for your input, it is greatly appreciated.

Looked up Louisiana laser laws and medical procedures and found all the information in 5minutes. The law stated use of lasers even for hair is the practice of medicine and requires the doctor to be PRESENT ON SITE if an allied MEDICAL professional is performing the laser therapy. That allied medical professional is considered an RN or PA. I hate to say it but Im sure you have heard it 10,000 times the "medical aesthetician" is a BS term, when you spend 8 to 12 years studying then add medical to your title

09.7 | Unregistered Commentergm

@gm,
Could you post a link or provide the location where you found this info? I'm sure others could use it. Thank you.

http://www.lsbme.la.gov/sites/default/files/documents/Statements%20of%20Position/UseofMedicalLasersChemicalSkinTreatment.pdf

09.8 | Unregistered Commentergm

The ling above doesn't seem to work but the editors posted a working link to the Statement of Position as an 'update' to the original post. Thanks.

Here's the relevant passages from that document:

Accordingly, it is the position of the Board, equally as an interpretation of applicable law and as a matter of safe practice of medicine, that:

• Whether used or applied for surgical, therapeutic or cosmetic purposes on human beings the use of lasers or chemical treatments constitute the practice of medicine under Louisiana law.

• Such treatments may be performed or undertaken only by a physician currently licensed to practice medicine by the Board or by a non-physician who acts under the direct supervision of a Louisiana licensed physician who mutually observe the following conditions:

(1) A physician must insure that any non-physician acting under his supervision is appropriately trained and qualified to perform the tasks or treatments that are delegated;

(2) All treatments and procedures must be performed under the licensed physician’s direction and immediate personal supervision—i.e., where the physician is physically present on the premises and immediately available at all times that the non-physician is on duty and retains full responsibility to patients and the Board for the manner and results of all services rendered.

(3) A non-physician serving in such a position could not—and may not under any circumstances be permitted to—act independently or in the absence of a Louisiana licensed physician or exercise independent medical judgment in implementing any procedure or modality of treatment.

(4) In the context of this Statement, an “appropriately trained and qualified” nonphysician who assists a physician in the performance of laser or chemical treatments should possess, at a minimum, training in safety, application techniques of each system, cutaneous medicine, indications/contraindications for such procedures, preoperative and post-operative care, potential complications and infectious disease control involved with each treatment.

(5) As is the case with any medical procedure or treatment the standard of care requires that such treatments be preceded by a history, an appropriate physical examination conducted by a physician, a diagnosis which confirms that any treatment recommended is appropriate for the patient’s condition, informed consent, availability and instructions for emergency and follow-up care and the preparation of an appropriate medical record.

Non-physicians who perform laser or chemical treatments in contravention to the manner expressed herein will necessarily be engaged in the unauthorized practice of medicine as defined by Louisiana law. Such conduct is a crime punishable by incarceration for up to five (5) months and a criminal fine of up to $500.00 for each such offense.6 The Board is constrained to refer individuals engaged in such activities to the Louisiana Attorney General and/or the local district attorney for criminal prosecution, file a civil injunction against any continued practice and seek civil penalties and attorney’s fees associated therewith.7 A physician who participates in such a relationship or acts inconsistent with this Statement in any respect will be subject to disciplinary action by the Board, which may include revocation or suspension of licensure, a fine of up to $5,000 and imposition of all costs of the Board’s proceedings, including attorney’s fees,8 as a result of engaging in medical practice which fails to satisfy the prevailing and usually accepted standards of medical practice in this state; assisting a non-physician practice medicine; and having professional connection with, or lending one’s name to, an illegal practitioner.

Louisiana State Board of Medical Examiners

States have different laws and regulations for the specific needs of your business. It may be worth checking out if you have LEGAL QUESTIONS specific to your state.

09.10 | Unregistered CommenterMS

Louisiana State Law states that Supervision - Non-medical professionals may own business and operate the laser. Medical director (MD) is a must and does not have to be on-site. - See more at: http://avantelaserinstitute.com/state.cfm#sthash.ZAnyzP7s.dpuf

05.21 | Unregistered CommenterIsis S

Louisiana State Law states that Supervision - Non-medical professionals may own business and operate the laser. Medical director (MD) is a must and does not have to be on-site. - See more at: http://avantelaserinstitute.com/state.cfm#sthash.ZAnyzP7s.dpuf

05.21 | Unregistered CommenterIsis S

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