Public Safety and Use of Lasers for Cosmetic Procedures

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Testimony Presented by Ann Davis, PA-C, Director of State Government Affairs

American Academy of Physician Assistants

Medical Board of California and Board of Registered Nursing

Forum on Public Safety and the Use of Lasers for Cosmetic Procedures

Thursday, August 30, 2007

Good morning.  My name is Ann Davis.  I am the director of state government affairs for the American Academy of Physician Assistants and a physician assistant licensed in California.  The Academy is the national professional society for physician assistants, representing over 63,000 PAs.  The Academy appreciates this opportunity to address the Boards on the issue of safe and appropriate use of lasers for cosmetic procedures.

By way of introduction of the testimony, I’d like to quickly review the basic tenants of the physician assistant profession.  Let’s start with the professional title.  The first word in the title of our profession is “physician.”  That’s important.  PAs practice as members of a supervising physician’s team.  PAs recognize physicians as the most comprehensively trained members of the health care team.  Those physicians who created the PA profession envisioned a health care professional, trained in the medical model, who would derive their scope of practice from physician delegation and extend the physiican’s ability to care for patients. 

Forty years into the history of the PA profession these basic tenants are the same.  PAs practice with physician supervision and derive their scope of practice by delegation from licensed physicians.  This is unique, and I would invite the panel to hold that in mind as they deliberate on this issue. 

How are the concepts describing physician-PA practice described in current law?  The California PA regulations, which are very similar to those in states across the country, impose these requirements:

 

• PAs must practice with supervision of a licensed physician who must be available either in person or via telecommunication at all times when the PA is providing patient care
• the physician may delegate only those tasks and procedures consistent with the supervising physician’s specialty, or usual and customary practice and with the patient’s health an condition
• the physician must observe or review evidence of the PAs performance of all delegated tasks to assure the PA’s competency
• The PA and supervising physician must establish transport and back-up procedures for the immediate care of patients who need emergency care when the physician is not on site
• The PA and supervising physician must establish guidelines for adequate supervision of the PA.  This may include same day examination by the physician or protocols
• The supervising physician has continuing responsibility to follow the progress of the patient and to assure that the PA practices with supervision. The physician is responsible for all services provided by the PA.

 

PAs are also required to clearly identify themselves and their professional title.  In addition, the medical practice includes “false or misleading advertising” as grounds for discipline.

These regulatory provisions governing physician-PA practice are remarkably similar to the concepts set forth in Senator Figueroa’s legislation and to the agenda of the committee.  Regarding laser use for cosmetic treatment, the bill and the committee seek to address physician supervision, training and competence, procedures and protocols, the handling of emergency situations, ongoing responsibility for care, ultimate responsibility and liability, identification of the service provider and appropriate representation of services.

In short, the safeguards required for appropriate use of lasers in cosmetic procedures are already in place for physician assistants. 

To put the issue in perspective, there is new technology all around us.  The laws governing physician-PA teams address this by imposing requirements for supervision, delegation, physician oversight and responsibility that apply in all clinical situations.  We believe that they are more than adequate to address the issue of laser use in cosmetic treatment.

There is ample precedent for using existing scope of practice and supervision requirements for physician assistants in other states. Several states have acknowledged the special role of PAs when they developed rules or board opinions on laser use:

Michigan

Sec. 16276.

1) A licensee, registrant, or other individual shall not perform any procedure using a laser for dermatological purposes unless the procedure is performed under the supervision of a licensed physician.

(2) A licensee, registrant, or other individual shall not perform any procedure using a laser for dermatological purposes unless the patient has knowledge and consents to the procedure being performed by that licensee, registrant, or individual.

(3) Subsection (1) does not apply to any of the following:

(a) A licensed physician.
(b) A licensed physician’s assistant who performs such a procedure in a health care facility.
(c) A certified nurse practitioner who performs such a procedure in a health care facility.

(4) The department may promulgate rules to further prohibit or otherwise restrict the use of lasers for dermatological purposes.

 

North Carolina

North Carolina Medical Board Position Statement, amended July 2005

It is the position of the North Carolina Medical Board that the revision, destruction, incision, or other structural alteration of human tissue using laser technology is surgery. Laser surgery should be performed only by a physician or by a licensed health care practitioner working within his or her professional scope of practice and with appropriate medical training functioning under the supervision … of a physician or by those categories of practitioners currently licensed by this state to perform surgical services.

It is the position of the Board that good medical practice requires that each patient be examined by a physician, physician assistant or nurse practitioner licensed or approved by this Board prior to receiving the first laser hair removal treatment and at other times as medically indicated.

 

Rhode Island

In short, this policy statement defines office-based esthetic procedures including, laser hair removal and Botox injections, as the practice of medicine. As such these procedures should only be done by physicians or advanced practice clinicians [e.g. nurse practitioners and physician assistants]; or under the supervision of physicians or advanced practice clinicians. It must be emphasized that medical equipment such as medical lasers and prescription pharmaceuticals should only be purchased by and used under the direction of a physician or advanced practice clinician.

 

Texas

193.11(c) Use of lasers in the practice of medicine.

(2) The use of lasers/pulsed light devices for non-ablative procedures cannot be delegated to non-physician delegates, other than an advanced health practitioner, without the delegating/supervising physician being on-site and immediately available.

 

Advanced health practitioner” is defined in 193.11(b) as “a physician assistant or an advanced practice nurse.

 

Washington

Washington Administrative Code, 246-918-125

(5) A physician assistant may use an LLRP [laser, light, radiofrequency, and plasma] device so long as it is with the consent of the sponsoring or supervising physician, it is in compliance with the practice arrangement plan approved by the commission, and it is in accordance with standard medical practice.

 

The Academy appreciates this opportunity to provide this information and would be happy to provide additional information upon request.