WASHINGTON, June 30, 2013 — The last decade’s dramatic increase in the number of medical spas has given patrons a wider array of delightful aesthetic changes and an equal array of sometimes very serious injuries.

Medical spas combine beauty salon and day spa services with a medical office. Cosmetic procedures such as botox injections, liposuction and facial peels are routine services found in spas, and laser skin treatments are commonly available as well. Some spas offer breast implants, chin, face, brow and eyelid lifts, and even tummy tucks.

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Full service spa facilities like these have increased in number from around 800 in 2007 to 4,500 today, according to the International Medical Spa Association. Why? There is money to be made, technology continues to improve, and there are better results and faster recovery times from less invasive procedures.

But there is a downside to this kind of choice and convenience as well. The list of problems concerning these spas begins with the lack of uniform industry regulation. State regulations vary widely. Your state’s safety and licensing regulations may be good, indifferent, or almost non-existent.

Not all states require medical spas to be licensed. In some states it is legal for many services you would think of as being clearly medical to be administered by non-physicians. While many states require a medical doctor to oversee these services, their laws do not require the doctor to be on site or even in the same state.

When something goes wrong with a treatment, the characterization of the procedure becomes important. Was it a beauty treatment or was it a medical treatment? For this reason, state legislators must define beauty treatment and the practice of medicine more explicitly. Most states define spa procedures as being “skin deep.” That term, unfortunately, has a flexible definition.

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Medical malpractice is the failure to use due care as commonly accepted within the specialty field of the medical care provider. Licensed medical doctors are judged by medical standards of care within their specialties, such that a successful claim means establishing that the medical care provider fell below the standard of care in that specialty.

A podiatrist removing a hangnail, using the small tool commonly used for such procedures, will not be successfully sued if he accidentally cuts tissue on the toe causing bleeding. If he uses a hedge-clipper to try to cut out the hangnail and cuts off your toe, clearly, the use of the hedge-clipper is not common for such a procedure and the doctor will pay for your lost toe.

Spotty regulations surrounding medical spas have left many bruised, burned, infected, and even dead after their treatments.

Serious injuries have prompted newer laws. After one woman died and two others became seriously ill with Group A streptococcus infections traced to liposuction at a Baltimore clinic, Maryland tightened its regulations.

After two women died from overdoses of lidocaine, a local anesthetic, Florida tightened its laws requiring that liposuctions removing more than two pounds of fat be performed in a state-licensed surgical center with emergency equipment on hand.

Many states are considering “truth in advertising” laws that would require medical spas to list personnel’s training and credentials in all marketing. Leading the charge for better regulations are dermatologists who warn that allowing non-physicians to perform cosmetic procedures puts patients at risk. It’s the difference between four years of medical school and four to five years of residency versus beauty school,says Timothy Flynn, president of the American Society for Dermatologic Surgery Association.

The ASDSA considers any use of lasers, lights, electrical impulses, chemical peels, injections, insertions or tissue augmentation to be the practice of medicine, which it says should be performed by a physician or midlevel health professional such as a physician assistant under a doctor’s supervision.

Many times, an un-licensed, un-trained spa worker will administer procedures under the apparent “supervision” of the attending physician. If there is no real code to define what a spa can provide and who can provide it, injury is much more likely to occur during a procedure.

It is critical to know both the effects of a procedure and who is performing it. Every procedure has a risk. If you have someone with little or no cosmetic experience performing the procedure, you may not get the desired effect. Worse, if there is a problem there may be no doctor around to correct it.

As a consumer of cosmetic and related medical services, you must do your homework in checking out any facility and the personnel. Individuals wearing a white coat at unregulated or under-regulated facilities are not necessarily “doctors.”

Aside from regulations, doctors themselves are often the problem. Many doctors looking to supplement their income become involved in these clinics. Despite their name appearing on the door, these doctors may only visit a facility once a month to sign charts. In such cases, they are supervising in name only.

Only a few states require a doctor to actually be present at these facilities. Even then, a doctor’s presence may only be required under certain circumstances. In Florida, a doctor does not need to be at a facility if certain conditions are met.

You should find a facility with a doctor that is present when your desired procedure involves anything even moderately significant from a medical standpoint.

Lynne McNees, president of the International Spa Association, advises medical spa services consumers to do as much research as they can on the procedures, the facility and the practitioners—starting with the local Better Business Bureau. Intuition plays a big part,” she adds. “If it doesn’t feel right, don’t do it.

A doctor’s competence is the next issue.

In New Jersey, only a doctor can do laser treatments—but it could be a psychiatrist, says David Goldberg, a dermatologist who owns medical spas in three states and teaches health law at Fordham University School of Law.

Doctors from four medical specialties have traditionally handled aesthetic treatments, due to their relevant training: plastic surgery, dermatology, otolaryngology (ear, nose and throat), and ophthalmology. Experts say you should generally stick to one of these four specialties when searching for a doctor to perform cosmetic treatments.

The American Society for Dermatologic Surgery Association offers these safety tips:

Make sure a doctor is on site.

Ask questions about training and experience with your procedure.

Common sense also provides that your medical history should be taken. Throw the red flag if it is not. Despite any legal definition of the term “medical,” many of the services at these spas are indeed medical.

Finally, despite the dramatic increase in the number of medical spas popping up everywhere, appreciate that many are struggling in today’s economy, and they will do anything to survive. This includes cutting costs on equipment, ignoring safety regulations that might take time and resources, and even minimizing the training of staff.

Do your homework. This isn’t going to the hairdresser. It’s your health.

Paul A. Samakow is an attorney licensed in Maryland and Virginia, and has been practicing since 1980. He represents injury victims and routinely battles insurance companies and big businesses that will not accept full responsibility for the harms and losses they cause. He can be reached at any time by calling 1-866-SAMAKOW (1-866-726-2569), via email, or through his website. He is also available to speak to your group on numerous legal topics. Paul is the featured legal analyst on the Washington Times Radio, in Washington, D.C., on the Andy Parks show, the featured legal analyst for America’s Radio News Network, heard in 165 markets nationwide, and he is a columnist on the Washington Times Communities.

His book The 8 Critical Things Your Auto Accident Attorney Won’t Tell You is free to Maryland and Virginia residents and can be obtained by ordering it on his website; others can obtain it on Amazon.

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