Medical Assistant's can not inject Botox!

I've seen and head about medical estheticians, medical assistants and even front desk staff administering Botox injections.

It's not legal, as this story on the prosicution of a medical assistant clearly shows.

Betty Guerra’s monthslong nightmare is over.

The 45-year-old former medical assistant learned today from her attorney that the 10 felony counts against her on allegations of “unlawful practice of medicine” will be dismissed, she said.

“I always believed things would work out the right way,” she said tearfully. “I cannot be punished for something I didn’t do.”

Guerra’s July arrest sparked controversy over what medical assistants can and cannot do. Specifically, there was confusion over whether they are able to give shots.

Guerra was accused of unlawfully administering cosmetic injections, an act commonly performed by medical assistants throughout Nevada.

The state attorney general’s office did not specifically say charges against Guerra would be dropped but indicated it won’t be pursuing the case.

“The complaint against Betty Guerra submitted to the Attorney General’s Office by the Board of Medical Examiners has been contradicted by the subsequent actions by the Board,” Attorney General Catherine Cortez Masto said in a statement. “Therefore, it is fair for us to conclude that it would be difficult to prosecute this case beyond a reasonable doubt.”

Guerra’s attorney, Jason Weiner, said this evening that the attorney general’s office had sent him a copy of an unfiled motion dismissing the case earlier in the day. He would not be able to provide the Review-Journal with a copy of that motion until Wednesday, he said.

After Guerra’s arrest, physicians became concerned about what duties their medical assistants could perform.

Former medical board director Louis Ling said that upon reading a 30-year-old law, he concluded that the assistants could not give shots. With flu season coming on, he then attempted to draft emergency regulations that would allow them to give flu shots, but not Botox or other cosmetic injections.

However, that effort was shot down when a judge recently ruled that the board, in considering the regulations, had violated the open meeting law.

The board later reversed its position, determining that state law allows medical assistants to administer everything from flu shots to Botox. Medical assistants could give shots as long as they are under the “direct supervision” of a physician. Most health officials and doctors take that to mean the physician is on premises.

Ling resigned on Friday.

Guerra, a mother of three who was a physician in her native Peru, said she has been under incredible stress since her arrest and lost her job because of the publicity surrounding her case.

“It was a nightmare. I could not even sleep or eat all this time, wondering what was going to happen.”

Still, she said she harbors no anger.

“Now, I start all over. But it’s just another experience in my life.”

Via Review Journal story.

Single use Botox?

Is your medical spa using a new vial of Botox for every patient?
 

If your medical spa is using a new vial of Botox for every patient, yours will be the first medical spa or cosmetic practice of any kind that I've ever know to do so.

Here's a story from the Las Vegas Review Journal that specifically points out Botox as a 'contributor' to an outbreak of hepatitis C. Of course, if you read the story you'll see that some nurses were observerd 'reusing needles' that contaminated vials of Botox. A very different cause indeed from just using the Botox on multiple patients.

And of course, there's the cost, which almost every medical spa meantioned in the story. (You'd have to get all of your Botox from Canada to afford that.)

Here's the story.

Single-use Botox vials used on more than one patient.

That practice at the Endoscopy Center of Southern Nevada, public health officials have repeatedly said, contributed to the hepatitis C outbreak in the Las Vegas Valley.

A phone call to inquire about the cost of a Botox party was greeted with this information: "It will be cheaper if all the partiers use the same vial."

One business that seems to be going well in Las Vegas is known for throwing Botox parties. That's an ongoing phenomenon across the country where friends get together and drink champagne while their wrinkles are needled away.

"We just couldn't handle it financially," said one medical assistant who asked to remain anonymous. "We would have gone out of business."

Medical assistants at two different spas said their owners only stopped multipatient use of single-use vials of Botox "until things quieted down" after the hepatitis outbreak was announced.

The Review-Journal had little trouble finding medical providers who said they and their companies knowingly broke state and federal regulations.

"You can't have doctors worrying about breaking the law or guidelines or whatever," Niamtu said.

A new company called Dysport is manufacturing a similar product, and the competition could force Allergan to provide smaller dosage vials to physicians who want them, he said.

Now a federal lawsuit filed in California by Las Vegas physician Ivan Goldsmith argues that sales representatives for Allergan Inc., maker of the popular anti-wrinkle drug Botox, promote multipatient use of its 50-unit or 100-unit single-use vials.

Goldsmith's lawsuit alleges that doctors can only make a profit using Botox if they reuse the single-use vials that the drug comes in.

But the complaint also raises issues that go beyond dollars and cents, ones that the community has been acutely aware of since the hepatitis C outbreak became public in February of last year.

The Botox business model "created an unacceptable and unreasonable risk of serious and debilitating injuries and illnesses, including HIV and Hepatitis B and C," states the lawsuit, filed Sept. 29 in U.S. District Court for the Central District of California.

Allergan spokeswoman Kellie Reagan said the product's (Botox) prescribing label has always been clear: single use only.

She wouldn't comment, however, on how Allergan's sales representatives promote the drug's use.

Goldsmith said in the lawsuit that Allergan misrepresented to him "the true and permissible use of the product."

Most patients need far less Botox than is provided by Allergan in either its 50-unit or 100-unit vials, the lawsuit said.

And, according to the suit, the medication can't be saved for later use on the same patient because, once a vial is opened, it must be thrown away within four hours of first use.

Physicians and medical spa providers of Botox contacted by the Review-Journal said Allergan's sales representatives have consistently said vials of Botox could be used for multiple patients.

"No matter what training seminar or continuing medical education course I went to, the Allergan people always said a vial was for multiuse," said Sandra Bledsoe, who operates Focus Medical Weight Loss & Spa. "Many patients only need 15 or 20 units at a time."

"Allergan seminars have demonstrated multiple patient use of the product for years," said Las Vegas plastic surgeon Dr. Julio Garcia, who said he has attended the company's seminars.

Garcia said doctors felt they could be safe if they used a new syringe and needle for each injection, which, even if against the rules, would result in sterile treatments.

The problem comes when mistakes happen, said Dr. Joseph Niamtu, a Richmond, Va.-based cosmetic facial surgeon long active with the American Academy of Cosmetic Surgeons and the Cosmetic Surgery Foundation.

"Someone inadvertently picks up a contaminated syringe and inoculates the entire vial," he said.

That may sound familiar.

Last year, health officials revealed that authorities investigating a cluster of hepatitis C cases had observed nurses at the Endoscopy Center's Shadow Lane clinic reusing syringes in a manner that contaminated single-use vials of medication.

Nine hepatitis cases were linked to the practice, and more than 50,000 people were urged to get tested for blood-borne diseases.

Medical officials say no cases of hepatitis C have been connected to Botox injections.

Still, Dr. Ihsan Azzam, state epidemiologist for the Nevada State Health Division, said concerns about blood-borne diseases in relation to the administration of Botox can't be dismissed.

He said discussions with some of the state's medical providers have made it clear to him that multipatient use of single-use Botox vials continues in Nevada.

The Review-Journal also contacted providers who say the practice is ongoing.

"I think we need to include use of Botox as a risk factor when we talk about hepatitis," Azzam said.

He noted that after he sent a bulletin to physicians and other medical providers about injection safety in the wake of the hepatitis C crisis in Las Vegas, some providers who administered Botox in their practices were not supportive.

In his directive, which echoes the position of the Centers for Disease Control and Prevention, he wrote: "Do not administer medications from single-dose vials to multiple patients or combine leftover contents for later use."

He said a number of providers called him to say that they wouldn't follow the regulations because they knew how to safely administer Botox to multiple patients from a single-dose vial.

"I was very surprised," Azzam said Thursday, adding he hopes state inspectors will catch those who refuse to abide by medical regulations. "Some seemed to be daring me to come after them."

If caught, physicians' licenses would be at risk.

Azzam said Botox providers told him it would not be possible to make a profit if the injection practices he supported were followed.

"I followed the rules," Goldsmith said last week. "And it killed me financially."

Goldsmith is asking the court that his lawsuit be certified as a class action, arguing that more than 100 doctors who invested in the product are affected nationwide, with their economic losses exceeding more than $5 million.

In his lawsuit, Goldsmith said a 100-unit vial of Botox could cost him $1,000, but a patient treatment might only be $500. Because it is a single-use drug, the rest would then have to be thrown away.

"You were losing money that way, not making it," Goldsmith said. "The patient didn't want to eat the cost."

Goldsmith has had a run-in with the Nevada State Board of Medical Examiners, which last year subpoenaed some of his patient records.

The board said it had received information that Goldsmith illegally dispensed compounded medications, dispensed medications without having a pharmacist on site, allowed clerks to dispense medications, and used human growth hormone on patients without meeting Food and Drug Administration criteria.

Goldsmith has denied the allegations and, more than a year after the board's subpoena, no action has been taken.

Garcia said he is following the rules regarding Botox injections, but knows that many in the medical community aren't doing so.

Last year he wrote a letter to the state medical board saying patient safety could be compromised because spa personnel continue to inject Botox "with the doctor not present."

That issue has been in the news lately, the result of recent attempts by the medical board to keep medical assistants from injecting Botox. That effort failed.

"The possibilities of infection, given what is going on when it comes to injecting Botox by whomever, are terrifying," Garcia said.

"We're not talking about 40,000 or 50,000 people. We're talking about hundreds of thousands of injections" in Southern Nevada.

Tracy Jones, a Las Vegas saleswoman, said while she has been a frequent user of Botox, she generally doesn't know if she is the only one receiving Botox from a vial.

"It's not something people ask," she said.

Most medical providers are well aware that Botox, like any injectable medication, can be contaminated when drawn up into a syringe.

To prevent contamination in his Botox injections, Niamtu, the Virginia facial surgeon, said he and his staff every day will draw up five sterile 20-unit syringes of Botox from a 100-unit vial.

Though he said that may not be in accordance with CDC guidelines that say single-use vials cannot be used for more than one patient, Niamtu said he must walk a tightrope between the "practical and the optimal."

He said "something will have to be done," if medical officials in other states become as aggressive in enforcing regulations as he believes they are in Nevada.

"Doctors can't throw away that much medication, and patients aren't going to pay for the extra," Niamtu said. "Allergan will have to step up to the plate and make different quantities of the drug. It may cost them a little more."

Medical Spa Lesson: The least recommend way for handling your medical spa PR problems.

Note: The identities that were in this post have been changed but the events are all as described.

A Medical Spa chain is not happy with what someone else has posted about them in the community forums of this site.

The negative comments are directed at one of the management team. I became aware of this medical spas concerns a few days ago after I received a string of emails from the medspa chain's 'CS Manager'. (Im guessing that CS is short for customer service.)

I can certainly understand why this medical spa is unhappy. Evidently the individual named in the comments was previously part of a failed franchise called Skin Nuvo and was one of three Skin Suvo operating officers who was sued by the SEC for 'Swindling investors of $11 million'. However, charges against the individual in question were dropped.

Here's an excerpt on the Skin Nuvo suit from the San Francisco Chronicle article:

Three men, including a Concord resident, were sued by the Securities and Exchange Commission on Wednesday on charges that they swindled more than $11 million from investors in a skin-care business that later filed for bankruptcy.

..."Skin Nuvo was projecting a glamorous image with their stores in very flashy and high-end malls, but beneath the surface, the company was in deep financial trouble," said Michael Dicke, an SEC supervising attorney.

Skin Nuvo, based in Henderson, has since filed for bankruptcy. During the alleged fraud from 2002 to 2004, the company's Bay Area stores -- which sold skin care and hair removal products -- were located in shopping malls in San Francisco, San Jose, Richmond, Concord, Corte Madera and Walnut Creek.

The SEC suit seeks to bar the men against any future violations of securities laws, a civil monetary penalty and the recovery of any ill-gotten gains.

So here's some of the emails that I received, and my response, over the course of the next three or four days. They start with an email from S.H. the CS (Customer Service?) Manager.

First email: S.H. of Nu U

Subject: Slanderous blog agiainst N.V./___ Medspa
Message: I need to speak with someone ASAP re: several slanderous remarks that have been made on your forum against N.V., owner of _____ Medspa.
Please contact me at 702-xxx-xxxx to discuss.

Thank you,
S.H.
CS Manager

My same-day response to S.H.:

Hello S,
What can I do for you?

S.H. want's to talk immediately. He's entirely too irate to just communicate that a comment may have gone over the line and violated Medical Spa MD's own terms. No, S.H. want's to talk. Now. Here's the next two emails:

Is it possible to call you?  Too much to put in an email.

S.H.

Jeff – there is a blog on your website re: N.V., owner of _____ Medspa.  The blog is dated 3/4/09 and is authored by “_____ Isn’t For You”.

The blog states Mr. V. only hires attractive females and then tries to date them / makes sexual advances towards them.  It goes on from there.

This is slanderous and libelous and a complete and total lie!  I am formally requesting this particular blog entry be removed immediately.  If you are unwilling to remove said blog then I will forward onto my legal department for further handling.  Please reply at your earliest convenience.

Thank you for your attention to this urgent matter.

S.H
CS Manager
_____ Medspa

I got another email amost immediately. Evidently my inability to grasp just how urgent this issue is and my lack of action in removing an anonymous post is getting under S.H's' skin. He dicides to forgo any more niceities and threaten me with his 'legal department'. Ouch. Here's S.H's next email.

This is slanderous and libelous and a complete and total lie! I am formally requesting this particular blog entry be removed immediately. If you are unwilling to remove said blog then I will forward onto my legal department for further handling. Please reply at your earliest convenience.

Have to give it to S, he's a silver-tongued devil. I mean, having an entire 'legal department' set on my like wild dogs? Terrifying.

So now I'm dealing with the 'legal department'. Here's what they sent.

Our firm, Kamensky Rubinstein Hochman & Delott, LLP, represents ___ medical spas.

Our client has informed us of various outrageous and defamatory blog postings/comments made on your website http://www.medicalspamd.com/ that impugn the character of Mr. N.V. of ___, specifically postings from "___ Isn't For You!" dated 3/4/09 and 4/10/09 and "former skin medique employee" dated 3/25/09.

In the March 4, 2009 posting, "__ _ Isn't For You!" falsely states that Mr. V only hires attractive females and then tries to date them or makes sexual advances towards them. In addition, "__ _ Isn't For You!" falsely states that if such sexual advances are not accepted, the employee does not get paid. In addition, in "__ _ Isn't For You"'s April 10, 2009 posting it falsely accuses __ _ of "multiple violations of state and federal labor laws, multiple instances of unwanted sexual advances and harassment." Similarly, "former skin medique employee" falsely states that Mr. V is "crooked," a "con artist," and "shady" and further falsely states that "if N.V. is involved . . . It is a scam from the word go."

This is not the type of content expected from a thoughtful website regarding medspas. Accordingly, we request that you immediately remove the postings posted by "__ _ Isn't For You!" dated 3/4/09 and 4/10/09 and "former skin medique employee" dated 3/25/09. We also request that you provide us with the names and all information in your possession relating to "__ _ Isn't For You" and "former skin medique employee."

Now isn't that nice? Within something like 72 hours we've progressed from a simple email request to this Medical Spas' demand that I turn over information on individuals who've made negative comments about them. This medical spa went from trying to get a single comment removed, to making the front page of Medical Spa MD. (Medical spas usually have to pay for that privledge.)

Of course this may not be the kind of publicity that __ _, S.H, and N.V wanted. I can't think that this medspa would really want the fact that one of their corporate officers was once sued by the SEC. But with the nasty-grams that S and his legal department are sending me it made me wonder what all the hubbub's about.

__ _ Medspa: Lessons for S.

Let me take a moment here and discuss what I think S could have done that would have better fit his medical spas business needs.

First: Don't take it personally. Every medical spa is going to have unhappy patients and ex-employees. You can't shut them up. Don't try. Perhaps they're unhappy for a reason. Your best bet is to engage in civil conversation. If you're making decisions on behalf of your medical spa or laser clinic, you need to keep your emotions out of the way. You're going to have dissagreements and sometimes they'll get personal. Don't let it affect your 'actions'. Medical Spa MD doesn't have any interest in harming this medical spa and no Medspa MD author wrote those comments.

But I wasn't responding fast enought to S and he took that as a slight. It wasn't. I don't know S and my first response, 'how can I help you', was an invitation for him to lay out his case. He didn't take advantage of that. Instead he lost focus on what he was trying to accomplish.

Second: Focus on your goal. Sean's goal was simply to get me to remove a comment. It's not unreasonable. I've done it before. I've removed any number of comments that attacked individuals in a way that had nothing to do with their business and was just an attempt to hurt them personally. I don't like those attacks and when I find them, I often remove them and at times, block an IP address so they can't make more.

S lost sight of the goal which was to get a comment removed. Instead, he switched his goal to getting to me. If he'd not been so agressive he'd probably have gotten the offending comment edited or removed. Instead, S pulled a gun by threatening me with his 'legal department'.

Third: Never pull a gun unless you intend to use it. S went nuclear when he had his 'legal department' fire off a demand. If S was smarter, he would have done his homework and seen that Medical Spa MD has been threatened many times by medical spa francises and their lawyers and knows well how to handel cyber-slap lawsuits. Read this Medical Spa MD post on cyberslap lawsuits, legal rights and anonymous comments on the web.

S went 'legal team' way, way too fast. I wasn't being unreasonable. I didn't tell him to 'go to hell'. It just wasn't at the top of my list of things to do. Medial Spa MD can get twenty or thirty contacts a day. I could care less that S demands to talk to me on the phone right away. Get in line. A single anonymous comment doesn't rise to the need of emergency care. S would have done much better with a simple, "I know you're busy" and a written explianation of his need to get a medspa comment removed.

__ _ Medspas legal team doesn't have a leg to stand on demanding information about people who comment on Medical Spa MD either. Anyone has a perfectly legal right to post anonymously on the web. Comments on Medical Spa MD are most commonly anonymous for exactly that reason. Physicians don't want to be held liable for the advice they give to other doctors, and laser technicians working at some laser clinic franchise don't want to lose their job.

Last: Never pull a gun on the person holding the mic. If you don't know what that means... From the begnning, S is making demands and acting pretty agressive, but he's only got one weak pair of twos (his 'legal team') and he plays them right away. Now he's got nothing left. If he's emailing some ex-employee that kind of intimidation might work, but not in this case.

By threatening Medical Spa MD and myself directly he's chosen to make an adversarial relationship when he needed a helpful one. While I don't have any axe to grind against S or __ _ Medical Spas, I don't really appreciate this kind of interaction. Any new threatening communications S or his 'legal department' they'll be posted right here on Medical Spa MD's front page where our 50,000 monthly visitors can decide for themseleves. (I can't think that any named Medspa's physicians will welcome questions about it.)

So where does that leave Medical Spa MD and __ _ medical spas?

For my part I'll put a quick notice up on the Medical Spa comments and take a look at them sometime in the next few days. If there's something that violates our terms, I'll edit or delete it.

I can't think that S has solved his Medical Spas business needs though.

PermaTox: Botox results that are permanent?

PermaTox? I was sent a link to this page by a patient who was asking my opinion about this treatment.

Has anyone heard of this Permatox proceedure? The last line of this pitch discloses that it was developed by prominent cosmetic surgeon named Guillermo Blugerman. In looking up Guillermo Blugerman on Google it seems that he's a surgeon from Argentina.

Any plastic surgeons on the boards here heard of PermaTox or have an opinion on it?

Here's the pitch for PermaTox from a medical spa web site:

PermaTox – A Brand New Procedure That Promises Botox-Like Results That Are Permanent

Tired of frequent Botox injection visits? PermaTox might be the long-term wrinkle solution for you! A new procedure that promises to give you longer lasting results without the needles!

PermaTox - has been tipped as a possible future anti-wrinkle remedy that uses a thin surgical thread to sever the specific nerves that cause frowning, which results in less movement and fewer lines.

While PermaTox patients might still receive periodic Botox® injections in other forehead areas, sometimes keeping the glabella (frowning nerves between the eyes that makes that annoying furrow between the brows) relaxed can, over time, soften wrinkles in other forehead areas, as well.

An observed effect of this treatment has been that eyebrows gradually tend to become more elevated and horizontal forehead lines reduced, potentially eliminating the need for elective surgery or Botox injections entirely for some patients.

PermaTox , is safe and quick, taking only 30 minutes in the office to perform.

Dr. B_____ is the only one performing this procedure and trained by the prominent cosmetic surgeon Guillermo Blugerman, who developed this technique.

Interestingly, all of the Google search results for PermaTox are for pest control.

Medical Spa MD: It's the Cook's Fault... Not the Stove!

Throughout Medical Spa MD you can read posts from dissatisfied patients on their procedures and disgruntled employees on their previous place of employment.

The most recent post I read tonight was from "Warning Others", a former employee of American Laser Centers, and there seems to be quite a few on that chain of medspas! These types of reviews can be found anywhere on the web including the most notorious site, RealSelf, who banishes all practitioners not deemed worthy of performing aesthetic procedures (i.e., non plastics and non derms), and  Plasmetic Forums, to mention a few.

In the American Laser Clinc employee's post, they made one statement that really should be expanded upon and that was the comment that "VelaShape does not work".  They went on to say that "all (of) the customers were very unhappy with their results - even after the recommended 6 treatments". In the same paragraph, W.O. stated they "didn't see any customers who were completely hair free either. Yes, some did see hair reduction, but no complete hair loss. I also saw my co-worker burn a lot of customers (and the clinic manager wouldn't report it!)".

This really concerns me and it should you too if you are a practice owner or director.

Equipment in the hands of a practitioner is only as good as the practitioner is trained to be. It doesn't matter if it's a laser lipo unit or microdermabrasion machine. I know, for a fact (as it has happened in my own practice) that the VelaShape does work. Really well, actually. I've seen it with the technicians who studied the technology and worked hard at obtaining positive results for their patients. We had to fire an employee who didn't take the treatment seriously and didn't strive to be the best at what she did. Not only does your technician need to be trained and enthusiastic, they also need to be monitored by YOU (the owner or director). Patient results need to be sampled and individual charts reviewed to assess the technician's skill and clinical outcomes.

Take, for example, our VelaShape technician. She is a massage therapist knowledgeable of musculature anatomy, and possesses strong hand techniques required to perform an optimal treatment. She is responsible for maintenance on the unit giving her a sense of ownership of what she does. She is also the liaison between the company, the rep, and our medical spa. Everything goes through her (with me being cc'd of course). On top of all that, I review her patients from time to time even treating them myself to make sure her techniques are where I feel they should be and patient satisfaction is high. Ownership and teamwork make VelaShape successful in our practice.

The same philosophy is even more true with laser hair reduction/removal. Many estheticians are afraid of burns, so they step back on laser settings sometimes not even following the skin typing requirements and standard parameters. While they may feel "safe" from a burn, they aren't treating the patient at the therapeutic level for optimal results. In the end the patient won't be happy either way, whether they were burned, or whether they obtained poor results. Bottom line is, it looks bad for you.

If you're not doing so already, any technician handling any device should be constantly monitored and retrained to ensure they are operating the devices as safely and efficaciously as possible. They should attend company sponsored courses or the rep should be brought back in to ensure policies and procedures have not changed, or treatment modalities wavered.

If your technicians can't comprehend the fundamentals and technology of the procedures they perform and the repercussions that could arise should they operate equipment improperly, perhaps they would benefit from the materials soon to be offered here on MedicalSpaMD, The Medical Spa Aesthetics Training Course and Study Guide or an advanced aesthetics course offered in a beauty academy.

One final comment, any technician who feels they are not being properly trained and that their clients are being cheated out of a good result for their procedure should walk like W.O. did. 

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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Beware of the Botox Bandit

Botox, Restylane, Juvederm, Thermage... We all have probably had our fair share of clients addicted to aesthetic treatments.

While the patients we deal with daily are probably not addicted to cosmetic medicine to the caliber of the “Cat Lady”, but close enough where you begin to wonder if they are suffering from body dysmorphic disorder. Especially in the category of injectable dermal fillers or laser resurfacing, you probably had to turn one or two clients away who you felt, as a professional, were pushing the boundaries of what is considered aesthetic enhancement versus disfigurement.

Many times these clients will shop amongst a variety of aesthetic physicians in and out of their area often having multiple services performed in a fashion deemed possibly dangerous. The cost of multiple procedures during our current economic status have forced some to turn to the unsavory practice of shoplifting. These thieves are very clever in their tactics, cunning in their role playing, and are worthy of the tile “Botox Bandit”.

I’m sure you have read news articles about Botox Bandits and, unfortunately, the number of Botox Bandits in the U.S. is on the rise! I have had several conversations with clinic owners across the Country who have been a victim of these cunning criminals. One clinic owner in California told me of a client who came into his practice, had her treatments and, while at the checkout counter, stated she forgot her credit card in her car. In good faith, she left her designer purse at the counter for the staff to hold while she quickly ran outside. Well, you don’t have to be a rocket scientist to figure out what happened next! After the client failed to return, the staff looked inside her so-called “designer” purse and found it to be empty. That, and it also was a counterfeit purse. Score one for the Botox Bandit.

Theft comes in many forms. Blatant like the case described above and more subtle in the form of complaints. Some clients have mastered the art of complaining to the point where they know they will end up with free services to appease them. Some even push the boundaries so far that they demand their money back after they have had all of their treatments, and then some. They will even be arrogant enough to post an undesirable posting about you on the web.

So, which form of theft is worse? The "Botox Bandit" or the "Scheming Thief"?

Do you have the right to discharge a patient from your practice only to suffer the undeserving web postings from your anonymous spurned patient? I do know this, it has caused us, and many practices like ours, to ask for payment before services for new clients we don’t have a relationship with.

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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Doctor fined for injecting fake Botox in his med spa.

Some doc named Halliday in East Syracuse NY injected fake Botox into twelve of his patients and has now received a $20,000 find as put on probation for three years. He's also restricted to practicing medicine only when monitored by another doctor who periodically reviews his records. Nice.

Here's the article:

Halliday is an ear, nose and throat doctor who practices at 4939 Brittonfield Parkway. The state Board for Professional Medical Conduct charged Halliday with 10 counts of professional misconduct including gross negligence, gross incompetence, negligence on more than one occasion and incompetence on more than one occasion.

In a signed consent agreement, Halliday pleaded no contest to two negligence allegations that he failed to advise a patient of her treatment options and failed to obtain an adequate pre-operative history from another patient. The no-contest plea satisfied all the charges against him. The uncontested charges relate to the absence of documentation, said Charles Patton, Halliday's attorney.

"In consultation with me, Dr. Halliday considered the cost and time away from his patients, which defending himself against these allegations in a lengthy proceeding would require," Patton said. "He has elected to resolve this issue by consent agreement so that he might focus his attention entirely upon patient care."

In its statement of charges against Halliday, the board said he injected 12 patients in June 2004 with unapproved botulinum neurotoxin. That drug is made from the same highly potent toxin that can cause botulism, a severe form of foodborne illness. A purified version of the toxin is used to treat wrinkles. It affects the ability of muscles to contract, smoothing out frown lines to make them nearly invisible. Botox is the only type of botulinum toxin approved by the U.S. Food and Drug Administration.

The board said the version Halliday used was labeled, "For Research Purposes Only -- Not For Human Use."

In June 2005, Halliday wrote to the 12 patients and informed them the drug they received was unapproved and he was unaware of any patients who experienced harmful effects from it, according to the board.

Halliday ordered the botulinum neurotoxin from Toxin Research Inc., the board said. That Tuczon, Ariz., company sold the cheaper, unapproved Botox substitute to more than 200 doctors nationwide, according to the FDA.

Chad Livdahl and Zarah Karim, owners of the company, were convicted of fraud and misbranding a drug and sentenced to prison in 2006. Toxin Research Inc. sold the product to doctors from Manhattan to Las Vegas who learned about the drug at conferences put on by the company, according to the FDA.

Laser treatment? Skin clinic? Who's in charge here?

It’s happened in Florida and now in Massachusetts. State legislators and physicians are trying to establish some guidelines and laws to protect the public from sustaining injury by unlicensed or untrained service providers.

We’ve read the of the lipodissolve horrors where people are offering lipodissolve, laser treatments and botox in their garage for heaven’s sake! It’s hard to believe it has come to this, but cosmetic medicine has turned into a “cash cow” for anyone!

I’m getting so sick of the turf wars amongst doctors of which specialty should be doing what... I mean seriously... can’t you all get along? Instead of fluffing your feathers to establish dominance over cosmetic medicine you should ban together to eliminate the bottom feeders who are performing services in their garages to protect the practice that IS cosmetic medicine! These are the people who are ruining your reputations! The unskilled, the unlicensed, money grubbers (and yes, I am also including lawyers here!)!

Let us also not forget that nurses and aestheticians are fighting over positions as well. There’s no certifying board for aesthetic nurses, or medical aestheticians. Here’s a funny story... when I started our medical spa with my husband years ago, I contacted both the heads of the nursing board and the cosmetology board. Since I hold both licenses I asked if I was allowed to perform a facial. I was told it’s a gray area. The nursing board said I could, in fact, perform a facial under the direct orders of a physician if the facial were deemed medically necessary. What physician do you know who will write an order for a facial? What physician wants to manage facials, and waxing, and massage, and the products which are dispensed? The cosmetology board said I could not perform a facial because the practice isn’t licensed or inspected by the board.

Huh?

With the economy the way it is, it’s no wonder everyone is jumping on the “medical spa” bandwagon! I mean, it’s like an ATM machine with no fees and no penalties. The perspective boards are all looking at each other and wondering who’s responsibility it is to be monitoring them.

The time is now upon us where legislation will take precedence, once again, on how we perform medicine and who may perform it. The powers that be will decide for us exactly if IPL is a medical device, or not. If the removal of a sunspot or tattoo can be removed by a physician, PA or nurse. Who may do cosmetic procedures, what training they must have and what certifications must be obtained prior to plucking an eyebrow (I digress, but you get my point).

Although we agree that certain treatments be performed or directly supervised by a physician, the fact is, there are many other services that aren’t deemed medical in nature. Should a physician be controlling those as well?

No current board has jurisdiction over all professions within a medical spa or laser clinic so, most likely, a new board will emerge with regulations, standards and licensing fees to add to our current practice.

It will take a few years to establish a task force and develop legislation for most states. But when all is said and done, what will arise is higher fees for service for the client, more inspectors showing up on our doorstep, higher licensing fees and insurance rates, and less control, once again, on how we treat our patients.

Are you ready for another government agency to take control of YOUR profession?

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

Submit a guest post and be heard.

Medical Spa MD: Plastic Surgery Practice & Expert Forums

Medical Spa MD get's a nice mention in PSP (Plastic Surgery Practice) as the Expert to Expert forum for Physicians. MAPA is also mentioned a number of times.

Frustrated by the lack of attention from many laser systems firms and after getting nowhere with the call center, some physicians have turned to airing their dissatisfaction in online public forums, and by firing off "e-mail carpet bombs" to the top executive management layer of these companies. The Web is filling up with their support horror stories.

One place to witness this in action is at MedicalSpaMD.com, where expert-to-expert (E2E) discussions offer insight into the high levels of anger and frustration among many physicians who claim they have been left in the dust after they signed the contract to buy or lease a laser system. Names are named. Specific problem areas are cited. Company responses—and lack of response—to complaints are aired in public.

"Direct your anger at the laser companies who do not support the doctors who buy their lasers," writes one impassioned and disgruntled practitioner on Medical Spa MD's Physician Clinical Exchange forum. "By their inaction, and active blocking of 'clinical exchange,' these companies, and specifically their executives, make treatments with their lasers risky and much less effective!"

The issue is complicated by the type of clinical support requested by physicians. For example, some want to know how they can use their laser systems in procedures that would easily be considered off-label by the FDA.

Laser systems firms have to be very careful when addressing these types of support questions. Sometimes, they offer personalized support to their customers. Some firms do not address them at all, and others promote these off-label uses in unofficial and backdoor ways and then publicly refute them.

This sort of problem does not reach a flashpoint in a vacuum. The lack of quality after-sale clinical support from laser systems firms has been one of those issues in the aesthetic industry that few will openly talk about. To be fair, some laser systems vendors offer very good customer support. Others, however, offer levels of mediocrity rather than levels of excellence in this area.... Read the rest of the article.

Illegal Botox auctions on Ebay?

Online auction site eBay has agreed to remove illegal Botox adverts in the UK after 240 unlawful listings were found over five days, a consumer watchdog said.

Via: Telegraph article; UK

16 companies and individuals were found to be advertising the prescription-only medicine to the public, with many unaware they were breaking the law.

Ebay had agreed to remove the promotions following a complaint by Which? and under the guidance of the Medicines and Healthcare products Regulatory Agency (MHRA), Which? said.

Adverts offered discount vouchers for Botox treatments and encouraged trade with "introduce-a-friend" offers.

A seller from Texas offers auction shoppers 100 units of Allergan's Botox Cosmetic. The seller markets this Botox by explaining that self-injecting Botox is easy and a money saver.

When having this treatment at the Spa, I started to think that it wasn't that hard to do after watching the girl at the MedSpa do mine, and started talking with her about options of doing it at home. She was able to obtain quantities of the products they use at the Spa for me to use at home and share with my friends (mostly other Moms). I am just a real person who wants to share my amazing find and perhaps make a little money in the process.

Dermacare Laser & Skin Clinics... goes under?

Dermacare's future uncertain in wake of closure, lawsuits

Phoenix Business Journal Story - by Angela Gonzales

A Maricopa County Superior Court judge has appointed a receiver to handle the financial future of Dermacare Laser & Skin Care Clinics Inc., which at one time planned to sign on more than 120 franchisees nationwide.

The Scottsdale-based franchisor is embroiled in several arbitration cases and lawsuits. Its corporate offices have closed, and several franchisees have abandoned the Dermacare name.

At one point, Dermacare had six facilities throughout the Valley.

The company's founder, Carl Mudd, could not be reached for comment.

Four Valley franchisees no longer are affiliated with Dermacare. A facility in Litch­field Park is keeping the brand name, but operating independently.

A records search at Maricopa County Superior Court shows 10 lawsuits have been filed within the past several years against Dermacare Laser & Skin Care Clinics Inc.; its parent, DLC Dermacare LLC; and Mudd. The lawsuits were filed by vendors, franchisees and former Derma­care employees, claiming the company didn't pay its bills.

For example, WS Inc., formerly WGS Packaging Inc., was awarded a judgment of $384,000 against Dermacare Laser & Skin Care Clinics. According to the lawsuit, WS Inc. sued Dermacare in 2006 for not making payments on the clinic Mudd operated in Paradise Valley.

Richard Thomas, attorney for WS, said his client also has a pending claim through the American Arbitration Association for nonpayment of that note.

WS has received default judgments against Mudd, DLC Dermacare and Dermacare Laser Clinics, Thomas said.

"As to both of the entities, Dermacare has obtained the appointment of a formal receiver," he said.

Also named in the WS lawsuit was a Dermacare doctor, Abraham J. Sayegh, who was one of the first doctors to join Dermacare and later became its medical director.

Sayegh also is facing censure by the Ari­zona Medical Board. In March, the board cited him for drug and/or alcohol use after an anonymous complaint was filed in February. According to those filings, Sayegh said he would cease practicing medicine. It was Sayegh's second relapse, according to the medical board.

Meanwhile, Mudd filed a lawsuit in January against a blog on MedicalSpaMD.com, which features communications by former franchisees. Many of the blog entries criticized Mudd and Dermacare. In his lawsuit, filed in Maricopa County Superior Court, Mudd asked the site to reveal the bloggers' Internet service provider addresses so he could sue former Dermacare franchisees for defamation of character.

Mudd's attorney listed in that suit was John Skiba, but he filed a motion with the court Feb. 4 to withdraw as Dermacare's counsel.

Jeff Barson, founder of MedicalSpaMD.com, said the most active Dermacare discussion includes nearly 1,000 comments from existing and former franchisees.

"MedicalSpaMD.com has received numerous 'cease and desist' letters, threats and demands, including copies of a lawsuit and threats of suit against the site and myself personally if I didn't close down the discussion forums and identify all of the individuals who may have commented," Barson said.

"I refused to comply and posted the letters and suit, as well as the case law around anonymous comments on the Web," he said.

Superior Court records show Mudd's lawsuit might be dismissed. Under Arizona law, a plaintiff has 120 days after filing a complaint to serve the defendants. If that does not happen, the court can dismiss the case.

Court records do not show affidavits have been served, said Andre Merrett, an attorney with Quarles & Brady LLP who is representing six Dermacare franchisees in an arbitration dispute through the American Arbitration Association.

When franchisees signed on with the company, their contracts included a stipulation that they would settle disputes through arbitration in lieu of lawsuits, Merrett said.

Trish Gulbranson owned the Dermacare franchises in Mesa and Chandler until February. She recently started getting calls from customers of the nearby Ahwatukee facility, saying it had closed and they were left holding prepaid packages or gift certificates.

Gulbranson decided to honor any unfinished laser services or valid gift certificates that had been purchased from the Dermacare of Ahwatukee office if customers could show their receipts.

"In light of the complete deterioration of the franchise system, (franchisees) simply want to be free from Dermacare and be allowed to go out and operate their businesses on their own in an effort to try and save their investments," Merrett said.

He said he hopes to connect with the receiver to see if the disputes his clients have with the company can be resolved without further litigation.

Other local franchise owners were not willing to discuss the matter.

Dermacare Laser Clinics: Where in the world is Carl Mudd?

a94_w10.jpgIt seems as though Dermacare and Carl Mudd have attracted the attention of the local press in Arizona. Here's an email discussion I had with Angela Gonzales, a reporter for the Phoenix Business Journal.

You'll notice that Angela is asking to be commented by the physicians on the site who may have personal experience with Dermacare and Carl Mudd. Her contact information is below. Comments welcome.

 

Via the contact form on Medical Spa MD:

Subject: Dermacare and Carl Mudd
Message: I'm writing a story about Carl Mudd and Dermacare. Do you have a phone number or email I can use to reach him? Do you have an update on the DLC Dermacare LLC v. John and Jane Does (CV2008-090071) lawsuit. It looks like there was an intent to dismiss in April Any updates?

Angela Gonzales
Senior Reporter
Phoenix Business Journal
agonzales@bizjournals.com
602 308 6521

 _________________

My Response:
Hi Angela,
I'm afraid I don't have any information about where Carl Mudd is. However, I do know that there is a tremendous amount of discussion about where he is on my site at Medical Spa MD. There are plenty of people asking that exact question. If you'd like, I can get you in touch with some of those people. The only interaction I've had with Carl Mudd or Dermacare is a couple of cease and desist letters he's sent me and a threat to sopenia and sue me if I didn't hand over all of the names and IP addresses of people discussing Dermacare on my site.

Let me know if you'd like some of these physicians to contact you.
Yours,
Jeff Barson

 _________________

On Fri, Jul 11, 2008 at 2:37 PM, Angela Gonzales writes back:
Thanks for getting back to me so quickly, Jeff. Yes, I would really like to talk to these doctors.
It looks like that lawsuit is in limbo since Dermacare’s attorney withdrew as general counsel and because it doesn’t look like Dermacare has served anyone.
Thanks for your help!
Would you like to give me an official comment for my story regarding the immense dialogue on your site?

Angela Gonzales
Senior Reporter
602.308.6521

 _________________

I responded:
Hi again Angela,
I'll see if I can't get you some feedback from the physicians on the site. I'd also be happy to provide a comment.

MedicalSpaMD.com is an active community of thousands of plastic surgeons, dermatologists, and aesthetic physicians looking to enhance the free exchange of information about the treatments and business of cosmetic medicine. (With more than 50,000 unique visitors each month and thousands of members it's by far the leading site on the web in this area.)

Among the more active  discussion threads have to do with the practices, treatments, and leadership of medical spa franchises like Dermacare, American Laser Clinics, Sona, Solana, and others. The most active Dermacare discussion has almost 1000 comments from existing and former franchisees.

The site has become the focal point for these physicians to communicate to each other and hadn't gone over well with the medspa franchises looking to isolate these physicians. MedicalSpaMD.com has received numerous cease and desist letters, threats and demands, including copies of a lawsuit and threats against the site and myself personally if I didn't close down the discussion forums and identify all of the individuals who may have commented. (The lawsuit named all of these individuals by their 'screen name'.) I refused to comply and posted the letters and suit as well as the case law around anonymous comments on the web.
Happy to provide more if needed.
Yours,
Jeff Barson
Medical Spa MD


Dermacare sues everyone on Medical Spa MD?

It appears that Dermacare has thrown in the towell regarding it reputation.

I received this email from Dermacare and it's CEO Carl Mudd regarding a suit that Dermacare has filed. Since this is the first contact I've ever had with Dermacare, I'm a little surprised. It makes me wonder what's been going on on that Dermacare thread that has 700 comments. 

Rather than engage in a back and forth or aim for clarity, which is what I would have recommended, or complaining to me that some of the remarks have crossed a line, (I have actually taken down many comments if they contain profanity directed at any specific individual.), Dermacare and it's CEO Carl Mudd have actually gone and filed suit. (I also received a PDF of the suit naming multiple John and Jane Does.)

Here's the email: 

VIA E-MAIL AND U.S. MAIL

Jeff Barson
(I've removed my address here)

                Re:         DLC Dermacare, LLC v. John and Jane Does – CV2008-090071

Dear Mr. Barson:

My office represents DLC Dermacare, LLC (“Dermacare”) and its CEO Carl Mudd.  I am writing in regards to the blog that you host located at www.medicalspamd.com .  As you know, you have allowed numerous persons to post information related Dermacare and about Mr. Mudd personally on your site.  The information posted is overwhelming incorrect and has served as a discussion board for Dermacare franchisees to not only discourage potential franchisees from partnering with Dermacare but to also promote the breaching of current franchisee agreements held by many of the bloggers on your site.

The comments that you have allowed to be posted on your site have evolved from mere discussions/complaints into actionable claims against the bloggers and possibly even you personally.  Pursuant to our filing the above referenced complaint we are now seeking the Internet Protocol (IP) address and the Internet Service Provider (ISP) for each of the following bloggers on your site:

  • Dermadoc
  • Mr. Bob
  • Just Another Ex
  • Passive Conduit
  • Pm
  • Jennifer D
  • Pengy
  • Mr. Freeze
  • Bastard Son of Dermadoc
  • GH
  • Maxwell Smart
  • The Clinician
  • The Real M. Smart
  • John Galt
  • George
  • Max
  • XYZAL
  • Christmas
  • Maxwell’s Silver Hammer
  • The Passive Conduit
  • The Riddler & The Joker
  • DoubleDermadare You
  • Mad Max
  • Manic Max
  • Mad as Hell in Dermacare Hell
  • A current Franchisee
  • FreeTheDerm@ yahoo.com
  • WPS
  • Insider
  • Thomas Jefferson, Jr
  • TF
  • T. Jefferson, Jr.
  • The Joker
  • Curious
  • Mr. X

Please provide the IP address and ISP for each of the above names no later than Friday, January 18th, 2008.  Should you not provide the requested IP addresses and ISP by this date I will be forced to have you served with a subpoena to obtain this information.  I have included a copy of the lawsuit that was filed in this matter for your files.  If you have comments or questions please direct them to my office.

                  Sincerely,

John N. Skiba

One North Macdonald Road, Suite 201
Mesa, Arizona 85201
Tel. 480.361.5643
Fax 480.704.3071
www.skibalaw.com

 

You can download the actual PDF of the Suit here.

I wasn't asked to keep any of this confidential so here it is. 

 

So what's Dermacare and Carl Mudd doing?

This is what is know as a CyberSLAPP suite. Basically it's a way of intimidating critics by threatening to find out their identity and hit them with some kind of suit. (read below)

You'll notice that Dermacare and Carl Mudd are demanding that I turn over everyones ISP. For those of you who are not that technically savvy, ISP = Internet Service Provider, which I have absolutely no way of knowing anyway as far as I can tell. The IP address is different. That's a unique identifier and could be used to find out who someone is.

These kinds of suits have become increasingly common as a way of combating free speech on the internet. It used to be that if someone said something unkind, it didn't matter that much since only a few people would hear about it. The net changed all of that and now someone who's unhappy with you or your business can be found by everyone so those whe illicit a lot of negative comments tend to have a rougher go of it.

My guess is that this is intended to intimidate those who may comment in a negative way about Dermacare or Mr. Mudd, and to find out who everyone is. While anonymous speech is protected by the constitution, its still unnerving to have someone you've been talking about know exactly who you are, especially if you're in some kind of business relationship. By filing a real suit against 'everyone' in the form of John and Jane Does, it allows him to issue a legal subpoena to get information. (It's basically a cynical way of using the courts which is why some states like California have laws specifically against this.)

Here are some links about these kinds of CyberSlapp suits and where the law comes down on free speech and other issues around this:

Chilling Effects Clearinghouse: A joint project of the Electronic Frontier Foundation and Harvard, Stanford, Berkeley, University of San Francisco, University of Maine, George Washington School of Law, and Santa Clara University School of Law clinics.

Do you know your online rights? Have you received a letter asking you to remove information from a Web site or to stop engaging in an activity? Are you concerned about liability for information that someone else posted to your online forum? If so, this site is for you.

Defamation
The law of defamation balances two important, and sometimes competing, rights: the right to engage in free speech and the right to be free from untrue attacks on reputation. In practice, the filing or even the threat to file a lawsuit for defamation has sometimes been used as a tool to shut down legitimate comments on the Internet.

John Doe Anonymity
Do you post to a public message boards or discussion areas on websites such as Yahoo, AOL or Raging Bull? Do you use a pseudonym, fake name or a "handle"? Has someone asked the host of the discussion or your ISP to turn over information about you or your identity? If so, then the John Doe/Anonymity section may answer some of your questions.
Topic maintained by Stanford Center for Internet & Society

Protest, Parody and Criticism Sites
The Internet, which offers inexpensive access to a worldwide audience, provides an unparalleled opportunity for individuals to criticize, protest and parody.

The following is long but you'll come away with a much better understanding of what this all means: 

About Defamation:

Question: What are the elements of a defamation claim?

Answer: The party making a defamation claim (plaintiff) must ordinarily prove four elements:

  1. a publication to one other than the person defamed;
  2. a false statement of fact;
  3. that is understood as
  4. a. being of and concerning the plaintiff; and
    b. tending to harm the reputation of plaintiff.
  5. If the plaintiff is a public figure, he or she must also prove actual malice.

Question: What defenses may be available to someone who is sued for defamation?

Answer: There are ordinarily 6 possible defenses available to a defendant who is sued for libel (published defamatory communication.)
1. Truth. This is a complete defense, but may be difficult to prove.
2. Fair comment on a matter of public interest. This defense applies to "opinion" only, as compared to a statement of fact. The defendant usually needs to prove that the opinion is honestly held and the comments were not motivated by actual "malice." ( Malice means knowledge of falsity or reckless disregard for the truth of falsity of the defamatory statement.)
3. Privilege. The privilege may be absolute or qualified. Privilege generally exists where the speaker or writer has a duty to communicate to a specific person or persons on a given occasion. In some cases the privilege is qualified and may be lost if the publication is unnecessarily wide or made with malice.
4. Consent. This is rarely available, as plaintiffs will not ordinarily agree to the publication of statements that they find offensive.
5. Innocent dissemination. In some cases a party who has no knowledge of the content of a defamatory statement may use this defense. For example, a mailman who delivers a sealed envelope containing a defamatory statement, is not legally liable for any damages that come about from the statement.
6. Plaintiff's poor reputation. Defendant can mitigate (lessen) damages for a defamatory statement by proving that the plaintiff did not have a good reputation to begin with. Defendant ordinarily can prove plaintiff's poor reputation by calling witnesses with knowledge of the plaintiff's prior reputation relating to the defamatory content.


Question: Can an opinion be defamatory?

Answer: No — but merely labeling a statement as your "opinion" does not make it so. Courts look at whether a reasonable reader or listener could understand the statement as asserting a statement of verifiable fact. (A verifiable fact is one capable of being proven true or false.) This is determined in light of the context of the statement. A few courts have said that statements made in the context of an Internet bulletin board or chat room are highly likely to be opinions or hyperbole, but they do look at the remark in context to see if it's likely to be seen as a true, even if controversial, opinion ("I really hate George Lucas' new movie") rather than an assertion of fact dressed up as an opinion ("It's my opinion that Trinity is the hacker who broke into the IRS database").


Question: Is there a difference between reporting on public and private figures?

Answer: Yes. A private figure claiming defamation — your neighbor, your roommate, the guy who walks his dog by your favorite coffee shop — only has to prove you acted negligently, which is to say that a "reasonable person" would not have published the defamatory statement.

A public figure must show "actual malice" — that you published with either knowledge of falsity or in reckless disregard for the truth. This is a difficult standard for a plaintiff to meet.


Question: Who is a public figure?

Answer: A public figure is someone who has actively sought, in a given matter of public interest, to influence the resolution of the matter. In addition to the obvious public figures — a government employee, a senator, a presidential candidate — someone may be a limited-purpose public figure. A limited-purpose public figure is one who (a) voluntarily participates in a discussion about a public controversy, and (b) has access to the media to get his or her own view across. One can also be an involuntary limited-purpose public figure — for example, an air traffic controller on duty at time of fatal crash was held to be an involuntary, limited-purpose public figure, due to his role in a major public occurrence.

Examples of public figures:

  • A former city attorney and an attorney for a corporation organized to recall members of city counsel
  • A psychologist who conducted "nude marathon" group therapy
  • A land developer seeking public approval for housing near a toxic chemical plant
  • Members of an activist group who spoke with reporters at public events

Corporations are not always public figures. They are judged by the same standards as individuals.

Question: May someone other than the person who originally made the defamatory statement be legally liable in defamation?

Answer: One who "publishes" a defamatory statement may be liable. However, 47 U.S.C. sec. 230 says that online service providers are not publishers of content posted by their users. Section 230 gives most ISPs and message board hosts the discretion to keep postings or delete them, whichever they prefer, in response to claims by others that a posting is defamatory or libelous. Most ISPs and message board hosts also post terms of service that give them the right to delete or not delete messages as they see fit and such terms have generally been held to be enforceable under law.

Question: Can an ISP or the host of the message board or chat room be held liable for
defamatory of libelous statements made by others on the message board?

Answer: Not in the United States. Under 47 U.S.C. sec. 230(c)(1) (CDA Sec. 230): "No provider or user of an interactive computer service shall be treated as the publisher or speaker of any information provided by another information content provider." This provision has been uniformly interpreted by the Courts to provide complete protection against defamation or libel claims made against an ISP, message board or chat room where the statements are made by third parties. Note that this immunity does not extend to claims made under intellectual property laws.

Question: Must an ISP or message board host delete postings that someone tells him/her are defamatory? Can the ISP or message board delete postings in response to a request from a third party?

Answer: 47 U.S.C. sec. 230 gives most ISPs and message board hosts the discretion to keep postings or delete them, whichever they prefer, in response to claims by others that a posting is defamatory or libelous. Most ISPs and message board hosts also post terms of service that give them the right to delete or not delete messages as they see fit and such terms have generally been held to be enforceable under law.

 

About John Doe Anonymity

 

Question: How is Internet anonymity affected by John Doe lawsuits?

Answer: Often called "CyberSLAPP" suits, these lawsuits typically involve a person who has posted anonymous criticisms of a corporation or public figure on the Internet. The target of the criticism then files a lawsuit so they can issue a subpoena to the Web site or Internet Service Provider (ISP) involved and thereby discover the identity of their anonymous critic. The concern is that this discovery of their identity will intimidate or silence online speakers even though they were engaging in protected expression under the First Amendment.

Question: Why is anonymous speech important?

Answer: There are a wide variety of reasons why people choose to speak anonymously. Many use anonymity to make criticisms that are difficult to state openly - to their boss, for example, or the principal of their children's school. The Internet has become a place where persons who might otherwise be stigmatized or embarrassed can gather and share information and support - victims of violence, cancer patients, AIDS sufferers, child abuse and spousal abuse survivors, for example. They use newsgroups, Web sites, chat rooms, message boards, and other services to share sensitive and personal information anonymously without fear of embarrassment or harm. Some police departments run phone services that allow anonymous reporting of crimes; it is only a matter of time before such services are available on the Internet. Anonymity also allows "whistleblowers" reporting on government or company abuses to bring important safety issues to light without fear of stigma or retaliation. And human rights workers and citizens of repressive regimes around the world who want to share information or just tell their stories frequently depend on staying anonymous – sometimes for their very lives.

Question: Is anonymous speech a right?

Answer: Yes. Anonymous speech is presumptively protected by the First Amendment to the Constitution. Anonymous pamphleteering played an important role for the Founding Fathers, including James Madison, Alexander Hamilton, and John Jay, whose Federalist Papers were first published anonymously.

And the Supreme Court has consistently backed up that tradition. The key U.S. Supreme Court case is McIntyre v. Ohio Elections Commission. http://www.eff.org/Legal/Cases/mcintyre_v_ohio.decision

Question: How do CyberSLAPP plaintiffs discover the identity of anonymous Internet critics?

Answer: CyberSLAPP plaintiffs usually get the personal information you gave an ISP or online message board when you signed up (name, address, telephone number, etc.). Some web sites that host discussion boards might only have your e-mail address, in which case a second subpoeana to the ISP that hosts that address will reveal your identity. In many cases, even more detailed information about your use of the Internet can be obtained; it's important to realize that when you go online, you leave electronic footprints almost everywhere you go. (With advanced knowledge of the Internet, however, there are ways to cover your tracks.)

Question: Don't judges review subpoenas before they are sent to ISPs?

Answer: No. The issuing of civil subpoenas is not monitored by the court handling the case. Under the normal rules of discovery in civil lawsuits, parties to a suit can simply send a subpoena to anyone they believe has information that could be useful. That information doesn't even have to be relevant to the lawsuit, as long as it could possibly lead to the discovery of relevant information. The only way that a court will evaluate an identity-seeking subpena is if either the ISP or the target of the subpoena files a motion asking the judge to block the subpoena. Unfortunately, in practice that rarely happens. That is because these subpoenas usually have a short, roughly 7-day deadline, and because many people never even find out that their Internet data has been subpoenaed.

Question: Isn't my ISP required by law to tell me if someone asks for my Internet-usage records and identity?

Answer: Unfortunately, in practice CyberSLAPP subpenas are rarely challenged becaue ISPs often fail to notify the individual who's personal information is sought. Even when they do, the short deadline (often as little as 7 days) does not provide enough time for the speaker to find and hire an attorney and the attorney to prepare the Constitutional arguments necessary to defend against the subpena.

Question: What is a "motion to quash" a subpoena?

Answer: This is a formal request for a court to rule that your information should not be given to the requesting party. This normally includes the request, plus a legal brief (sometimes called a memorandum of points and authorities) explaining why, by law, your information should not be turned over. Samples of briefs filed in John Doe cases are available at:

EFF Archive, Cullens v. Doe, http://www.eff.org/Privacy/Anonymity/Cullens_v_Doe/
http://www.citizen.org/litigation/briefs/IntFreeSpch/articles.cfm?ID=5801

Question: What should I do if I receive notice that my ISP has received a subpoena for my data?

Answer: First you should decide whether you wish to fight to protect your identity, Internet usage records, or whatever else is being sought. You might want to ask your ISP for a copy of the subpoena if they haven't already provided one. If you decide to fight it, you should inform the ISP immediately, and you may want to request that they delay compliance to give you time to find a lawyer. Then find a lawyer, who will file a motion to have the subpoena thrown out. (If your lawyer can later prove that the lawsuit was frivolous, you may be able to recover legal fees if your state has passed an anti-SLAPP statute.)

Question: What are the typical claims behind a CyberSLAPP suit?

Answer: The most common complaints by CyberSLAPP plaintiffs are defamation, trademark or copyright infringement, and breach of contract. Speech that involves a public figure - such as a corporation - is only defamatory if it is false and said with "actual malice." It also must be factual rather than an expression of opinion. In the US, because of our strong free speech protections, it is almost impossible to prove defamation against a public figure. Trademark and copyright complaints typically claim that defendants have violated intellectual property rights by using the name of a corporation or its products, or by quoting from some of their copyrighted materials such as an annual report. In reality, the First Amendment includes a clear right to criticize and discuss corporations and their products, and the law includes clear exceptions for the "fair use" of protected material for those purposes. Breach of contract suits often involve a claim that anonymous speakers might be employees who have violated a contract by releasing confidential information. Of course, the right to anonymous speech is meaningless if a corporation can unmask your identity at will because you might be an employee breaking a promise of confidentiality.


Question: How do judges decide whether to let a subpoena go forward?

Answer: This is a very new area of the law, and there are few well-established principles. The courts do have a duty to balance the right of anonymity against the need to prevent true defamation. So far there have been both good and bad rulings from judges; fortunately several have ruled that the plaintiff must prove that his case has at least a theoretical chance of prevailing before anonymity can be stripped away. Other cases have established a set of key factors to be used in judging anonymity-stripping subpoenas. In most of these the key factors are 1) that the party seeking the subpoena provide evidence that the identity is needed; 2) that the identity is directly needed for a key element in the case; 3) and that the identity information is not otherwise available to the party seeking it. While not yet firmly entranched in the law, these common-sense principles are clearly the right way to ensure that First Amendment rights are protected while still allowing identity to be revealed when there is a genuine need to do so.

Question: What are some of the important cases in this area of law?

Answer: Important CyberSLAPP cases include Dendrite v. Does, http://www.citizen.org/documents/dendriteappeal.pdf,
Melvin v. Doe, http://legal.web.aol.com/decisions/dlpriv/melvinop.html,
Doe v 2TheMart.com, http://www.eff.org/Cases/2TheMart_case/20010427_2themart_order.html,
Global Telemedia International v. Doe, http://www.casp.net/busted.html. Additional information about these and other cases can be found by searching the Internet or looking on the Web sites listed below.

Question: Can I do anything to help change this situation?

Answer: You can do several things. Be educated about your rights. Find out your ISP's policy on the handling of subpoenas, and encourage them - and any Web sites you frequent - to adopt good policies, especially a pledge to notify you of any subpoena before any private information is disclosed. Encourage your state legislators to pass legislation requiring such notice, and press them to amend state anti-SLAPP statutes to explicitly include Internet anonymity cases.

Question: What other resources are available?

Answer: Web sites dealing with this issue include:

www.aclu.org,
www.citizen.org,
www.eff.org,
www.epic.org,
www.johndoes.org,
www.casp.net,
www.cybersecuritieslaw.com,
cyber.findlaw.com/expression/censorship.html


Question: Can someone ask for my identity even if I am not the Defendant in the case?

Answer: Yes. The rules of civil discovery allow a party to a lawsuit (the plaintiff or defendant) to ask anyone for any information that may lead to the discovery of relevant evidence to their case. However, your ability to quash such a request if you are not named as a party to the lawsuit is the same as if you are named. You can still file a motion to quash. Below is a link to the case files for such a case:

http://www.eff.org/Cases/2TheMart_case/

Question: I am in California. Do I have a right to both resist such a subpena and to ask a court to throw out the case, right away, and award me attorneys fees?

Answer: Yes. California has a specific statute, called the anti-SLAPP statute, that allows an early motion to be brought to have a case dismissed if it is aimed at silencing protected expression and participation in matters of public concern.

Code of Civil Procedure § 425.16(b)(1) provides:

A cause of action against a person arising from any act of that person in furtherance of the person’s right of petition or free speech under the United States or California Constitution in connection with a public issue shall be subject to a special motion to strike, unless the court determines that the plaintiff has established that there is a probability that the plaintiff will prevail on the claim.

A legal brief explaining the California statute further in a case involving claims of online defamation is available at:

http://www.eff.org/Legal/Cases/Kesler_v_Doe/

Question: What are the key federal decisions involving anonymous speech?

Answer: 1. Buckley v. American Constitutional Law Foundation (1999) 525 U.S. 182, 197-200;

2. McIntyre v. Ohio Elections Commission (1995) 514 U.S. 334. In that case, on page 357, the Supreme Court said:

"[A]n author is generally free to decide whether or not to disclose his or her true identity. The decision in favor of anonymity may be motivated by fear of economic or official retaliation, by concern about social ostracism, or merely by a desire to preserve as much of one’s privacy as possible. Whatever the motivation may be, . . . the interest in having anonymous works enter the marketplace of ideas unquestionably outweighs any public interest in requiring disclosure as a condition of entry. Accordingly, an author’s decision to remain anonymous, like other decisions concerning omissions or additions to the content Amendment.
* * *
Under our Constitution, anonymous pamphleteering is not a pernicious, fraudulent practice, but an honorable tradition of advocacy and dissent.

3. Talley v. California (1960) 362 U.S. 60. (holding unconstitutional a state ordinance prohibiting the distribution of anonymous handbills)

4. Lamont v. Postmaster General (1965) 381 U.S. 301, 307 (finding unconstitutional a requirement that recipients of Communist literature notify the post office that they wish to receive it, thereby losing their anonymity);

5. ACLU of Georgia v. Miller (N.D. Ga. 1997) 977 F. Supp. 1228 (striking down a Georgia statute that would have made it a crime for Internet users to “falsely identify” themselves online).

Question: Aren’t people required to explain why they’re subpoenaing my identity and other information?

Answer: Not with the initial request. The reasons for the subpena are only provided if the subpena is challenged, through a motion to quash. In opposing the motion to quash, the person seeking the information must demonstrate, at a minimum, that it is likely to lead to the discovery of information that would be useful in a lawsuit.

Question: I signed a confidentiality/privacy agreement with my ISP that provides that they will not release my information. Doesn’t that protect me?

Answer: No. Most privacy agreements state that information will be turned over in response to legal requests, and a subpena is such a request. Even if the agreement does not say so, a legally issued subpoena overrides such agreements as a matter of public policy. Each ISP has a different policy about notifying users when their information has been subpoenaed, but they cannot simply ignore a subpoena under the law without risking legal santion themselves.

Question: What does "respond" to the subpena mean?

Answer: Usually, it means that the ISP will give the requested information to the requesting person. In some cases, ISPs have resisted requests for information on behalf of their customers, but this is not the norm. Unless specifically told differently by your ISP, you should assume that your ISP will turn over your information as part of its response.

Question: Can an ISP or the host of the message board or chat room be held liable for defamatory of libelous statements made by others on the message board?

Answer: No. Under 47 U.S.C. sec. 230(c)(1): "No provider or user of an interactive computer service shall be treated as the publisher or speaker of any information provided by another information content provider." This provision has been uniformly interpreted by the Courts to provide complete protection
against defamation or libel claims made against an ISP, message board or chat room where the statements are made by third parties. Note that this immunity does not extend to claims made under intellectual property laws.

Question: Can my ISP or the host of a message board be held liable for defamatory statements I make on the grounds that they are a "publisher" or "republisher" of the information?

Answer: No. Federal law provides: "No provider or user of an interactive computer service shall be treated as the publisher or speaker of any information provided by another information content provider." This has been interpreted to protect hosts of discussions between other people against defamation and libel claims as a "republisher" of the information. Note that this protection does not extend to claims under intellectual property laws.

Question: Must an ISP or message board host delete postings that someone tells him/her are defamatory? Can the ISP or message board delete postings in response to a request from a third party?

Answer: 47 U.S.C. sec. 230 gives most ISPs and message board hosts the discretion to keep postings or delete them, whichever they prefer, in response to claims by others that a posting is defamatory or libelous. Most ISPs and message board hosts also post terms of service that give them the right to delete or not delete messages as they see fit and such terms have generally been held to be enforceable under law.

Question: My ISP tells me it's been asked to turn over my name as part of a lawsuit against hundreds of "John Does" in a faraway state. What can I do?

Answer: You should probably contact a lawyer, and suggest that the lawyer take a look at arguments raised by the EFF, ACLU, and Public Citizen in one of these suits (e.g., http://www.eff.org/IP/P2P/RIAA_v_ThePeople/JohnDoe/20040202_UMG_Amicus_Memo.pdf)

Medspas: Laser burns and IPL horror stories.

laser.burns.jpgLaser burns on CNN:

 
Laser treatments can be dangerous in the wrong hands. 

Video of nasty burns from medical spa laser hair removal treatments.

I would like to say that I've never seen a patient who looked like this but unfortunately I have. The American Laser Clinc patient who was burned had a similar look with this kind of a 'zipper' look where the treatment area didn't even get complete coverage.

It amazes me that someone could be treated like this. I mean, look at that pattern. It looks like it was performed by a ten year old in a hurry.

This picture was taken off of video that was shown on CNN. Does anyone know where this patient was treated?  I can't imagine they're still in business.

If you have suffered clinical negligence on this scale then speak to Patient Lawyers with no obligations.

Physicians get the consultants they deserve. Part 1.

uncool.gifThe following recommendation was made last night on the comment thread of  What's wrong with medical spa franchises & medspa consultants?

"One of the best consulting companies is ____________. The physician who owns the company had his own Medical spa and sold it for a substantial profit and it was very profitable. He has had experience in implementing over 100 medical spas in the last 3 years. His references are very good, his fees are reasonable and customized, not a cookie cutter. Look on his web site, _______ and you can get some information. I had the same trouble with Med Surge trying to load up equipment and their consultants are MBAs who never owned a spa or worked with one. - goldfinger"   72.177.0.186

 Wow. Excellent references, profits, reasonable fees... I want to hire this guy myself. Look at that. 100 Medical Spas in only 3 years. That's 3 medical spas open a month and without any cookie cutting. Better yet, he's a physician and understands how difficult those MBA's at Med Surge can be in trying to pile on the technology they get kickbacks from. Look at that signature.. 'goldfinger'. Where do I sign up?

Unfortunately, I had to remove the comment since it was left by the ' medical spa consultant' it was promoting...  _______, B.A., M.D., FACOG who is _______ and a member of the Republican Presidential Task Force, 1989-present.. Surprise.

How do I know this? Let's say that I'm absolutely sure and wouldn't make an accusation like this unless I was absolutely, positively, 100% certain. (I can see the IP's of all comments.)

So, as with everything, buyer beware. I have no doubt that ___________ will be happy to take your money and give you 1.3 weeks of time on his way to his next 100 medspas. The question is, would you be happy to pay someone who conducts business by subterfuge?

And for those who want to be sneaky on my site, don't.

American Laser Clinics Part 1: Armed guards & threats.

This series of posts details how it came to be that American Laser Clinics hired an armed guard to stand in a physicians waiting room and prevent him from seeing his own patients.

draper.bio.security.jpg

While this took place years ago, there are still lessons to be learned.

In November of 2005 I was contacted by Dr. Vaugn Moody,  the medical director of an American Laser Center in Draper, Utah. (Yep. The same ALC that's running the laser hair removal infomercials.) Dr. Moody had been the medical director for ALC and had built out a new clinic in Draper. ALC had moved with him and were renting 4 treatment rooms and a front desk area. ALC had a staff of about six young women (early 20's) who were generally autonomous. About medical spa franchises.

Dr. Moody called and asked to meet and discuss the possibility of leaving American Laser Clinics and associating in some way with Surface.

According to Dr. Moody, American Laser Clinics was constantly late paying him for overseeing their operations and operating far outside the acceptable norms of ethics and acceptable medical standards. He was unhappy with a long laundry list.

  • American Laser Clinics was initiating IPL fotofacials without adequate or proper training for their staff.
  • The ALC technicians were being hired, given an hour or so of training from the other technicians and then performing treatments.
  • Dr Moody, the medical director, was entirely removed from any interaction with patients. The staff gossip was that the ALC staff had been told never to referr a patient to Dr. Moody's clinic since he'd try to 'steal them'.
  • Patients were being diagnosed and treated without being seen by anyone other than a technician with no medical licensure or training. 

Dr. Moody twas being sued by a patient who had been burned from a bikini line hair removal. The most interesting thing about this was not the fact that they had burned someone but that the burns showed the treatment pattern and that it was obvious that they had intentionally not treated the entire area but were 'skipping' ever other pulse. During later conversations with staff members they represented to me that they were actually trained to do that to save time.

The patient suing Dr. Moody (and American Laser Clinics) had been treated by a new hire who, without any supervison, had used the IPL Fotofacial head rather than the hair removal. Additonally she'd turned the device up. The result was a perfectly detailed burn that ran from her navel down to her pubis and resembling a zipper with that skipped pattern. The patient, who was supposedly a swim suit model heading for Las Vegas, was not happy. And rightly so.

Dr. Moody also told me that ALC staff treated a number of patients after he told them specifically not to because the laser was not resetting itself correctly and needed to be serviced. The result. Burns again. 

This litany of horrors went on and on. The staffs of both clinics were almost openly hostile. The situation was unmanagable and getting more so.

I should insert here that Dr. Moody went to medical school with one of our physicians and there was some pressure from that quarter to help him out. There was also the idea of converting his entire clinic to a Surface clinic which was Dr. Moodys positon from the start.

I ended up having a number of meetings with Dr. Moody. The situation was bleek but after a few weeks of dinners and a number of long conversations I agreed to convert his clinic to a Surface locaton after he disentangled himself from American Laser Clinics.

Of course there were a few problems. First, Dr. Moody claimed that he was afraid that ALC would not only retaliate by suing him, but that he might be in physical danger from them. He constantly spoke of ALC being run by 'mobsters'. At first I thought this was kind of funny.

Dr. Moody sent a letter to ALC that basically said that he would not sign a lease at that location and that they had 30 days to find another location. I saw and read the letter before it was sent and there were some other notes in there about late payment and such but that was the gist of it. (There was a letter of intent at the time but no lease so Dr. Moody was fine there.)

ALC did not go quietly into the night. 

Rick Frisk, who I think is a vice-president, was one of the founders of American Laser Clinics and had know Dr. Moody for a long time, called. Dr. Moody described the call to me as a lot of yelling and threats. Now I'm aware that people often exaggerate to make a point. But in this case I was there during a number of the calls and could hear the speaker on the other end. (Dr. Moody also recorded at least one of these calls and possibly more with a little recording device he'd bought at Radio Shack.)  I could hear some of what was said and listened to the recorded converstaton that Dr. Moody provided to me. I've never heard or seen anything quite as nasty. Rick's boss, the President of American Laser Clinics (I forget his name as I write this) threatened to spend his last cent to 'break' Dr. Moody among a long list of profanity. There were any number of these calls. The one's I was privy to were at least ten minutes long.

What had really upset Rick and the ALC gang was that Dr. Moody had spent long hours at night copying all of their patient records. Now as the medical director he actually had a right to access these records but ALC was not happy with having their entire database of clients copied by someone who was kicking them out and obviously had designs on their business. Dr. Moody now had copies of every patient contact sheet that ALC had at the clinic. I can't remember exactly how many there were but it was an entire wall full and had taken at least 30 hours of work at night to copy.  

Then the shit really hit the fan.

American Laser Clinics hired an armed guard to protect themselves, their records, and their patients, from Dr. Moody.

The picture at the top of this post is of that guard standing in the front of Dr. Moodys clinic. I took the photo. It's difficult to see but the guard actually had a gun on his hip. It was crazy. The guard had been informed that Dr. Moody was a threat to the patients and staff and he took his posting seriously. Any time that Dr. Moody would walk towards his office (where I was standing and where the picture was taken from) the guard would run down the hall and confront him to prevent him from whatever.

All the while American Laser Clinics is treating patients. That woman in the photo is a patient filling out paperwork.

Let me reiterate:

  • American Laser Clinics is performing medical treatments on patients while an armed guard prevents the physician responsible for their care from seeing them.

I thought I'd seen it all but I guess not. The ALC staff members had been instructed to have no contact with any of other clinic staff and they were telling patients that the guy with the gun was just waiting for someone to get of work or some such nonsense. I would certainly love to have been privy to what the patients were thinking. There were a lot of angry looks from the ALC girls.

By the second day even I'd had enough. 

I called a few contacts I have at the local news and had a camera crew sent out. At the same time Dr. Moody called Utah's Department of Licensure and complained to them about these 'illegal' treatments going on inside his clinic while the guards were there. (They hadn't heard of this before either.)

It was priceless watching the film crew show up. Dr. Moody, who used to be an Elvis impersonator, escorted the camera right up front and started interviewing the guard and the ALC staff. I guess he felt safe enought that the guard wouldn't shoot him in front of the TV camera. The guard went all shades of red. It was somewhat funny but I felt really bad for the entire ALC crew. They were scrambling for cell phones like they were drowning and their cell phones were reserve air tanks. The poor security guard was obviously asking his boss for directions. He didn't know if he should plug'em all or run.

Dr. Moody spent 20 minutes interviewing the ALC staff asking them who their medical director, who's clinic it is, and why there's a guy with a gun there. 

Then the inspector from DOPL showed up. (I have photos of this entire phase.)

The inspector was really a take charge kind of guy. The TV cameras didn't even phase him.

Then two police cars and the security guards company owner show up.

Let me set the stage again: We have an Elvis impersonator with a TV crew, the State, the Cops, Dr. Moodys staff, and the ALC staff.... and patients coming in for laser hair removal. 

 I have to say that the State inspector and the cops were really good. The first thing that the cops did was run the security guards off the property as soon as they determined who owned it. They left in a hurry. ALC was not as fortunate.

The State shut them down on the spot.

They reopened the next day and treated a number of patient without any medical supervison (Dr. Moody took photos of all of this) but the State was on to them and they closed for a few more days while they scrambled. They ended up hiring a PA to literally sit in the waiting area all day. They met the deadline and moved back to their previous location.

But the saga is not yet over.

The patient who was burned sued ALC and Dr. Moody making them co-defendants.

ALC sued Dr. Moody for breech of contract claiming that they had a lease (which they did not).

During these procedures Dr. Moody was ordered to turn over all the American Laser Centers patient records that he had copied. He turned over a few few hundred but the vast majority were never turned over. I don't know specifically what the order stated but every single ALC record was copied and then entered into the front desk computer database with emails and contact info.

So, that's how it happened. Any thoughts?