Rule affects laser hair removal

Medical assistants must supervise operators

10:31 PM CST on Wednesday, November 24, 2004

By DAVE MICHAELS / The Dallas Morning News

AUSTIN -- Carol Crowley's laser has removed unwanted hair from thousands of patients. Some are adults seeking to improve their appearance. Some are young children who need hair removed from skin grafts.

But Ms. Crowley says a new state regulation that takes effect next week could make it harder for operators like her to stay in a business the state believes needs closer oversight.

The new rule, passed last year by the Texas State Board of Medical Examiners, requires operators to hire a physician's assistant or nurse practitioner to supervise their work.

At the very least, operators say, Texas consumers will pay more for the second most-popular, nonsurgical cosmetic procedure in the United States. One manufacturer of laser systems estimated the worldwide market at over $2 billion.

"I still owe for one of the lasers and a photo-facial machine," said Ms. Crowley, 67, whose clinic is in Far North Dallas. "This could really be an economic hardship."

Supporters of the rule change include dermatologists and plastic surgeons who also perform the procedure. They say there are some risks only a doctor can spot.

"I find it hard to believe that someone with no medical background would go out and get a device that can burn people," said Dr. A. Jay Burns, a plastic surgeon in Dallas who advised the board on the rule change.

State figures do not show a system deluged with complaints about laser-hair removal jobs gone wrong.

The Texas Department of State Health Services, which has investigated the complaints, said four complaints have been filed in 2004. In one case, the agency forced a clinic to pay a $1,000 fine, state officials said.

In 2002 and 2003, the department received 24 complaints. Inspectors did not find any evidence of rule violations in those cases, said Thomas Cardwell, a health department manager in the branch that oversees the use of radiation equipment.
Safety issue?

"It is not a safety issue," Ms. Crowley said. "The doctors are trying to scare people."

The rule's supporters say they are concerned that too many untrained technicians are using the lasers. Under current rules, a clinic must get a doctor to purchase the laser and act as a medical director for the business.

Under the new rule, doctors must be on the premises, or they must delegate the responsibility to a physician's assistant or nurse practitioner. The extra staff member could cost clinics between $70,000 and $100,000 a year, operators say.

Richard Phillips, owner of Renaissance Laser Hair Removal & Cosmetic Centers, says he has spent $200,000 already to comply with the law. He has added three doctors and two nurse practitioners.

"It's taken us to the brink of being out of business," Mr. Phillips said.

He said his clients will likely face steeper prices -- by at least 20 percent -- after Dec. 1. His three centers in the Dallas-Fort Worth area are responsible for about 16,000 treatments a year.

Mr. Phillips also worries about being able to keep doctors and nurse practitioners on the job.

"This is the equivalent of medical kindergarten," he said.

Sherry Berges, owner of Body Re-Nous in Las Colinas, said she has heard of doctors "charging triple what we"re charging."

"I certainly do not think people are aware of the law," Ms. Berges said. "They are fixing to have to pay. If you have a doctor who has total control they can make the price of laser hair removal anything."

The new rule has been debated off and on for the decade that lasers have been used to remove hair. Both sides agree that the treatment is mostly safe. But they disagree on a fundamental point: Whether it constitutes the practice of medicine.

Ms. Crowley and others say it doesn't. Dr. Burns and the state board believe it does.

"There are people who have reactions on a regular basis, but they are not serious reactions," said Steven Finder, a San Antonio doctor who owns five clinics and opposes the rule. "It does not matter if you are talking about a physician's office or non- physician's office. These reactions occur."
Seeking a law

Since the opponents have no way to contest the rule -- outside the courts -- they said they would next take their fight to the Texas Legislature. Dr. Finder said the group, which calls itself the Laser Hair Removal Stakeholders Group, plans to ask lawmakers next year to pass a law that says laser-hair removal is not a medical practice.

Operators who don't have doctors on staff already say they can't afford to hire them at each clinic. Dr. Finder, who is suing the State Board of Medical Examiners, and Ms. Crowley said dermatologists and plastic surgeons are trying to put non-physicians out of a business worth many millions of dollars a year.

"It is a turf war," Ms. Crowley said. "The doctors decided this is very lucrative, so they want it."

Proponents of the rule deny trying to hurt their competition. They simply believe that a doctor or a physician assistant or nurse practitioner, should be present for all procedures.

"Our job as we see it, is to protect the public. And information was put in front of us that said the public is not being protected properly with the present system," said Dr. Donald Patrick, the executive director of the state board. "So we changed it."

They also say that operators such as Dr. Finder are motivated by self-interest. Having to hire more medical staff would drive down his profits, they said.

"You could make a point that Steven Finder is very passionate about what he believes in," Dr. Adams said. "You could also make the argument that Steve Finder would like to have a higher profit margin."

Staff writer Silla Brush contributed to this report from Dallas.

How it works

The patient: Not everyone can be treated. Patients with darker pigmentation might not respond well. Also, blond, white or gray hairs are less responsive to treatment and sometimes can't be treated.

The laser: A low-energy laser is aimed through the patient's skin and absorbed by the pigment of hair follicles. A percentage of follicles are permanently disabled with each treatment. In most cases, no anesthesia is necessary.

The treatments: Depending on the area of the body involved, treatments take from several minutes to several hours.

The cost: Costs vary by the body part treated. One local clinic charges $89 per treatment to remove hair on an upper lip and $500 per treatment for back hair. Five visits or more can be needed for large areas.

The upside: Treatments are noninvasive and can be used on any part of the body. Discomfort is minimal, and patients can return to normal activity right away.

The downside: Multiple treatments can get expensive. Sometimes there is a temporary reddening of the skin or localized swelling. Patients might have to use special skin-care products and/or a prescribed skin-care regimen.

SOURCES: The American Society for Aesthetic Plastic Surgery; Dallas Morning News research

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