WASHINGTON Special consideration should be taken when conducting cosmetic dermatologic proceduresespecially with laserson skin of color, because the malpractice risk is higher, Dr. David J. Goldberg said at the annual meeting of the American Academy of Dermatology.
Dr. Goldberg, director of laser research and Mohs surgery at Mount Sinai School of Medicine, New York, and adjunct professor at Fordham University School of Law, New York, said that thinking like a first-year law student and being aware of the inherent risks associated with using lasers in darker skin can minimize risk.
Lawsuits are brought for a variety of reasons, primarily because of negligence, but also because physicians are poor communicators or because patients may be seeking retribution for unsatisfactory results or just trying to get some money, said Dr. Goldberg.
For a lawsuit to be successful, though, it must be proved that a physician breached his or her duty, that the breach caused the problem, and that it is serious enough to warrant damages. These basic tort components are drilled into first-year students, he said.
With laser and intense pulsed light (IPL) procedures, ethnic skin is more susceptible to damage because melanocytes in the skin compete with the technologies, Dr. Goldberg said.
Often, insufficient protection against cold is employed when surgeons treat patients with darker skin types.
Side effects that could lead to claims include erythema, hypo- or hyperpigmentation, infections, and scarring. Warning patients with darker skin about these potential complications is essential. White patients may experience pigmentation issues, but the changes are generally not permanent and will not likely lead to a lawsuit, said Dr. Goldberg.
Those changes can be long-lasting or even permanent in skin of color. "If it's permanent, it will be a successful lawsuit," Dr. Goldberg said. He noted one of his cases from a decade ago, in which he had used an IPL device to remove tattoos on a young man's skull. IPL devices were approved for that indication, but he said "they clearly don't work at all." He induced hypopigmentation, which was fairly long-lasting. The patient did not file a claim, but "today it would lead to a lawsuit."
Complications don't automatically lead to a claim or to a successful lawsuit. If a physician performed a procedure correctly, and there was no breach of duty but there was a complication, there would be no negligence, he said.
If there is a cold-induced injury and the patient hasn't been warned, or was warned but the physician did something wrong, and the damage is permanent, there will be a lawsuit, Dr. Goldberg said.
Getting patient consent is crucial, but if a patient says he or she does not remember the warnings in the consent, a lawsuit could proceed.
Some suits might not ever come to fruition because of the slow pace of the U.S. legal system.
"Sometimes, by the time you get in front of the jury, the jury looks and says there is not much here any more," he said, and noted that what had appeared permanent might have faded by trial time.
To reduce the risk of getting to that stage, physicians should handle disgruntled patients head on. "Keep them happy, talk to them, and think like a first-year law student. That's going to solve 99% of your problems," he said.