MedEsthetics magazines offers business education and in-depth coverage of the latest noninvasive cosmetic procedures for physicians and practice managers working in the medical aesthetics industry.
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LEGAL ISSUES | © ISTOCKPHOTO.COM 30 MAY/JUNE 2014 | Med Esthetics By Padraic B. Deighan, JD, PhD Physician Supervision Supervision of off-site employees who perform medical procedures can be legally problematic for physicians. In a prior issue we discussed regulations related to physician delegation of medical treatment. In this column, we will be looking at physician supervision of non-employee staff members. Supervision is potentially more problematic for physicians than delegation. There is long-standing regulatory guidance and acceptance of a physician's ability to delegate care. In these situations, the physician is medically and legally responsible for the delegated aesthetic medical procedure and the care of the patient. However, there is no such basis in law for many physician supervision scenarios in aesthetic medicine. These include: a physician who supervises the employees of a facility that the physician does not own or control; and a physician who supervises staff members at a satellite offi ce that he owns but seldom visits. Supervision is more problematic than del- egation, because the physician typically does not have a high level of knowledge regarding the individual staff member's skills and abilities. Supervising Personnel at a Satellite Office Many aesthetic practitioners supervise ancillary medical providers within the doctor's practice. This is a common occurrence, and the legal basis for it revolves around the physician's knowledge of the employee's skill level and certi- fi cation as well as the creation of protocols and procedures developed by the physician for the delegated staff member. The legal basis for the supervision of ancillary medi- cal personnel at a separate facility that is owned by the supervising physician is based in state supervision guidelines. Generally, a physician is permitted to supervise ancillary medical staff only to the extent of their residency or fellow- ship training. This concept can become problematic in the modern medical aesthetic practice as we will see. Legal standards that exist in all 50 states dictate that supervision of ancillary medical personnel in cosmetic or aesthetic practices should be performed by a core physi- cian (i.e., dermatologists, plastic surgeons or facial plastic surgeons). The reason for this is that the vast majority of effi cacious medical cosmetic procedures—including lasers, fi llers, neurotoxins and other energy-based devices—are A physician is permitted to supervise ancillary medical staff only to the extent of their residency or fellowship training. L e g a l I s s u e s M E D 5 - 6 1 4 . i n d d 3 0 Legal Issues MED5-614.indd 30 4 / 1 6 / 1 4 4 : 3 8 P M 4/16/14 4:38 PM