In medical malpractice claims involving soft-tissue fillers, dermatologists and other doctors were frequently named as defendants for allegedly failing to supervise nonphysicians who did the procedures, in a study published in the October issue of the Journal of the American Academy of Dermatology.
In a study of 24 legal and administrative actions, physicians were sued in 13 of the cases, although physician extenders injected the fillers in half of those actions. The results were reported in a research letter (J Am Acad Dermatol. 2015 Oct;73:702-4).
Dr. Navid Ezra, a private practice dermatologist and former resident at Indiana University, Indianapolis, and colleagues analyzed public legal documents from 1995 to 2013 using the national legal research service WestlawNext. They searched three database categories: cases, trial court orders, and administrative guidance and decisions. The categories included opinions by state and federal trial, appellate, and supreme courts, as well as regulatory agencies such as medical boards. A total of 24 legal documents involving soft-tissue fillers were identified – 19 legal cases and 5 disciplinary actions.
Dermatologists and plastic surgeons were sued most often, each accounting for 17% of cases respectively, according to the study. Family practice physicians were named as defendants in 8% of cases. Radiologists, pediatricians, internists, oculoplastic surgeons, and physical medicine/rehabilitation doctors were each named as defendants in 4% of the cases, respectively. Nonphysicians were sued in 25% of cases. Many of the lawsuits named multiple defendants.
The most common injury that resulted in litigation was granuloma formation or other autoimmune reaction. Zyderm was the soft-tissue filler most commonly associated with litigation. However, the authors noted that Zyderm was the first soft-tissue filler approved and temporal bias likely explains the higher number of associated cases.
Of the five disciplinary actions, the majority of doctors were reprimanded for not being present while a nonphysician employee injected patients with soft-tissue fillers. In three of the five reprimands, physicians were functioning as medical directors of medical spas.
The authors concluded that the medico-legal culture is such that physicians are responsible for actions by their physician extenders. They called for further research to evaluate whether the presence of a physician during soft-tissue filler procedures affects the rate of developing complications. They noted that the study’s total number of cases and disciplinary actions underreports the true incidence of legal events related to soft-tissue fillers. The sample size did not include settlements or cases that did not involve an appeal.
On Twitter @legal_med