A doctor told a legislative committee Wednesday that Utahns can face myriad risks if they receive laser skin treatments, Botox injections or other nonsurgical cosmetic procedures without a physician present.
Speaking to the Business and Labor Interim Committee, Dr. Steven P. Jepson, director of the Utah Dermatological and Medical Procedures Clinic in Murray, listed several scenarios he said are reality in Utah, including:
Clinics with spa services where doctors allow other people to operate the laser equipment and provide injections.
Chain medical spas where doctors spend only a brief amount of time at each location and ancillary staff do most procedures.
Physician offices where laser treatments are done by the staff.
Beauty salons or spas performing laser treatments with physicians available only for consultation.
Home parties where registered nurses provide injections, with no physician present, sometimes with diluted Botox, poor techniques and using the same needles on different people.
"As you can see under these scenarios, close M.D. supervision is not the norm in the delivery of aesthetic medicine in this state, even sometimes if the doctor is on-site," Jepson said. "I think that this is because the laws in Utah aren't clear or they're not enforced, and consequently a lot of aesthetic medicine in this state is being delivered by undertrained laser techs."
Among the risks facing those receiving the treatments without doctor supervision are burns, abnormal discoloration and complications from procedures that should not be undertaken if a person is taking a certain medication, he said.
"It's clear that in aesthetic medicine, it is still something in my opinion that should be supervised by a medical doctor," he said.
Diana Baker, bureau manager with the Utah Division of Occupational and Professional Licensing, agreed that those scenarios are taking place and are being investigated. The division also needs more-specific language regarding licensing of those conducting the procedures, she said.
"My colleagues that work within medicine, nursing and cosmetology would agree with me that there needs to be more oversight," Baker said. "We feel that these laser treatments are the practice of medicine and do require not only direct supervision but also a medical history, a medical chart and follow-up by that physician."
She suggested that physicians be "within voice range" on-site to provide help when procedures are being done.
Utah law requires a physician to be on-site when procedures are performed, but it does not specify the level of training needed for the person performing the procedure, Jepson said.
"If this is the law, though, it is not consistently enforced," he said. "Several complaints have been made to DOPL about certain med spas operating with direct physician supervision, to no avail. Some of them have been closed down. Some of them, though, are still operating."
Jepson had several recommendations, including shutting down home parties.
"I believe that well-trained RNs, nurse practitioners and physician assistants can safely deliver these treatments. I do not think that medical assistants and laser techs can consistently provide safe treatments and deal with the medical complications that can be associated with these," he said.
Vicki Weber, a licensed master aesthetician with Full Circle of Life, agreed that DOPL needs to address training levels by those conducting treatments. But with nine years of lasering — perhaps up to 4,000 people with six-plus treatments each — she chafed at the thought that she was not qualified. Jepson said he had no stance on the aestheticians issue.
"I can put my knowledge up against any doctor or anybody else who has been in this profession," Weber said. "Laser hair removal, I believe, does need to have some type of training, has to have additional certification, but as far as a physician's assistant or nurse, I think as a master aesthetician we are well-qualified to be able to work in that capacity."
Dr. Charles Harpe, an internal medicine physician and medical director at Image Medical Spa in Bountiful, said master aestheticians should not diagnose medical conditions. He also suggested that being 10 to 12 minutes away would allow adequate time for a doctor to respond if complications arise.
E-mail: bwallace@desnews.com