Who is operating on you at MED SPAS? The hazards of cosmetic surgery and how you can protect yourself.

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Please rise, court is now in session. I strenuously object.A legal podcast brought to you by the Pittsburgh law firm of Flaherty Farto isnow in session. All those seeking information about the law and legal mattersaffecting the people of Pittsburgh and the Commonwealth of Pennsylvania, half-baked opinions and a dose of self -indulgence are invited to attend andparticipate. I want the truth! You can't handle the truth! The defensestrenuously objects. You would!

Call the first witness. Hello, hello. Greetings,salutations, and welcome to I Strenuously Object. I am Bill Rogel, partner inthe Pittsburgh law firm, Flaherty, Fardo, Rogel, and Amick. Also with us today,back after a relatively brief hiatus, it is Noah Fardo, also partner in the lawfirm, Flaherty, Fardo, Rogel, and Amick. And here to join us today, Noah, howyou doing? Good. Doing good, Bill. Good morning.

morning. Look, we're here. You love to say good morning. Youknow that our listeners don't necessarily listen at the same time that we'rerecording, right, which is why I try to be a little bit temporally ambiguous.And you love to just fasten us to a date and time for our recording, but that'sokay. Different strokes, different folks, right?

Yes. Nothing to defend yourself. That's what I like to hear.All right. So what I'd like to do here today is jump right into the meat of thematter here and talk about something that's kind of proliferating in themedical field and that we're seeing in our practice and that we know we'reseeing out and about otherwise. And that is med spas. Noah, for thoseunfamiliar, what's a med spa? Well, you know, a spa is where you get a massage.A med spa is a

advancing what's done in the form of Botox, tattoo removal,micro -needling. It's that fine line of medicine between actual surgeries in ahospital and spas at Nemicolon. It's this gray area where a lot of physicianshave found they can make money without having to comply with a lot of the otherroles associated with surgery.

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I think that's a functional answer. Other functional answersinclude, I don't know, which was the one I was kind of rooting for, by which Imean like, you're right, it's a gray area, it's undefined. If you look in fromwhat I can tell anyway in at least Pennsylvania's statutes, its regulatorycode, you're not really finding a definition for the term med spa, right? Asfar as the law here is concerned, it's a medical practice.

Right? You're performing medical procedures. You're amedical practice and you're governed essentially by the same rules as governedan outpatient surgery center or, you know, a pediatrician's office or, or anymedical practice you go to. Right? It has to have, you know, a doctoravailable. It has to have a medical director who's a, who's a doctor. it canonly be owned by physicians and medical practitioners. This is what the lawsays. I'm not necessarily convinced that all of the.

All of these med spas popping up all over out there arecomplying with these rules. And it's interesting that they do, they stick thosetwo words together as if it's landing somewhere between medicine and a spa day.And I'm not really sure that's properly speaking a thing that ought exist,right? It's creating a gray area where there isn't really one. And it'sconfusing for patients and it's confusing for lawyers sometimes too. Yeah, medspas are focusing on aesthetic procedures.

in the world of vanity, where everybody wants to lookbetter, these med spas have popped up really over the last 10 to 15 years andhave found a market where people are scared of plastic surgery, but can improvetheir aesthetics through what they look at as less invasive or less risky. AndI think that's what we're talking about today. There are risks with med spasthat I think people aren't aware of based on the qualifications.

based on their experience, their training, and I thinkthat's what we're talking about. That's right. I think a couple things toemphasize right out of the gate. Like I said, first of all, legally, these medspas should be, and the ones that are operating properly are running like anyother medical practice is, under the leadership and guidance and supervision ofan appropriate licensed physician who is his or herself trained in andcompetent in all of the services that the med spa offers.

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they don't all in practice operate that way. Some of themare, you know, run by or kind of day to day operated by, you know, nurses orother non -physician personnel. Some of them are operated by a doctor, but thatdoctor doesn't actually perform cosmetic procedures or the procedures that areoffered by the med spa. And so isn't really competent to supervise other peopledoing it.

There's a lot of red flags, a lot of issues kind ofstructurally in these places, because the thing is, it's a booming market,right? The economic incentive is there for doctors, nurses, whatever, to eitheras kind of a side hustle or as what becomes their main job in the medicalfield, working at one of these med spas that doesn't have the strictures anddoesn't have, you know, the high kind of overhead costs and payment of a moretraditional medical practice.

Yeah, and the cost is the biggest thing. Where the med spasare able to make money is if you're a plastic surgeon, most plastic surgeryprocedures have to be done in an accredited surgical facility or in a hospital.And that's what limits a lot of plastic surgeons to going out on their own tostart a practice is those procedures have to be done in an accredited surgerycenter. Well, that can cost half a million dollars. The med spas have found aloop where they don't have to have accredited surgery facilities.

and they're able to perform these aesthetic procedures in anoffice environment without that upfront cost. And now they not only don't haveto have the surgery center, but they don't have to actually have a physicianperform it either. They're supposed to have supervision. But what we see, Bill,is there's often not even adequate supervision. You're not my supervisor!Right. And I mean, and you see how that works its way out in the cost scenario,which is,

You know, look, you could compare the cost of going to get,you know, plastic surgery or procedure that's going to cost you five, 10, 15,$20 ,000. Or you can come to our med spa and our med spa can do this otherprocedure for you, you know, for $1 ,500 or $2 ,500 or whatever the cost of itis, because we don't have to pay the cost associated with a, with a hospital orsurgery center, because we don't have to pay a doctor to perform the procedure.So.

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we can charge less and it's all profit, right? And they'llcome through into our pocket. Yeah. Medspaul's selling points are less risk,allegedly lower cost. And that's their, that's their... I also suspect, andthis is, this is, this is just reckless speculation, but it's not recklessspeculation directed at anybody in particular. So it's legally safe. I look atstructurally the way that providers of whether it's, products, medications orcreams or lotions, or...

equipment that's used for these procedures. Those kinds ofproviders already get stuck in some kind of shady kickback schemes withdoctors. You scratch our backs, we'll scratch yours. It's worse as far as I cantell in the world of medical spas, right, because there is so littlesupervision beyond the people who are doing it. You know, oftentimes the persondoing the training and the accrediting to perform a particular procedure isjust the company that manufactures the equipment.

that lets people do the procedure. The obvious incentive isyeah, get everyone to perform in this they can, we'll sell more equipment thatway. So there's a lot of kind of behind the scenes stuff that does not run, itseems to me at least, on the up and up and in a way that really does run therisk of undertrained, under qualified medical professionals performingprocedures that are supposed to be supervised but aren't being supervised bydoctors. And it's a real problem and a real risk. So with that in mind, I thinkwhat I'd like to do,

is just flag for our listening audience. If any of you haveseen billboards or local ads for these med spas and you're thinking of going toget some work done, get some Botox, here are three things you can do to try tomake sure that the med spa that you are going to is on the up and up and tostay safe, right? So these are three tips for safety in getting a proceduredone in a medical spa. The first tip is diligently check the website.

You'll see a lot of these places have a website. And if youlook on that website, you don't see the name of a doctor anywhere. And you mustbe Professor Von Nostrand. Yes, yes, I am. You might not even see the name ofthe nurses or any other practitioners. You'll see their corporate name andyou'll you'll see them talk about our doctors, our nurses, our medicalprofessionals. They'll talk about the services they provide. And for what it'sworth, if they provide 50 different services, the odds of a small med spa beingcompetent at all 50 of those services they offer seems pretty small.

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But in any case, look closely at that website and you'relooking at least as much for what's not there as for what's there. If you'renot finding doctors whose names and resumes are there for you to see or nurses,people who are willing to put their name on this practice, it's a sign thatthose people are seeking insulation from being specifically associated withthis practice, either because they're doing so many others or for liabilityissues or whatever it is. But anyway, look at that website.

figure out if you can who the actual people are and not thecorporate name because that doesn't mean anything. But it's not just thewebsite, it's reviews, it's doing some actual research online, but it justalways amazes to me. I mean, whether we're going to a dentist or to go get ouroil changed or anything else, I mean, any professional services, how much duediligence is anybody really doing, especially when it comes to medicine or evenlaw, you're hiring a lawyer, how much back.

You trust that they know what they're doing. And what I'veseen on the people that have been injured in meds balls is, yeah, they read thewebsite, but they look qualified and, you know, it's sort of like a leap offaith. What, what can we say for people to do more due diligence in thesescenarios than in hiring other professionals? Looking at the website, doingsome online research, the steps that you can take.

before you go in there are just the tip of the iceberg,right? You're looking for warning signs, you're looking for red flags. Youmight find a place that looks like a fly by night operation and if it does, getout of Dodge, right? It's funny in a lot of these aesthetic procedures, thethings they're performing at med spas, they'll advertise them in part as being,look, they're less invasive, they're faster. You know, you're not gonna have tobe laid up for a month afterwards with bandages like you might if you had afull on surgery. The fix is also typically temporary, right?

You get the Botox injections, but they're going to wear out.You're going to have to come back and get more. They're advertising temporarysolutions for you. But when there's a mistake, often those mistakes arepermanent. If they burn you or if you get an infection and it leaves scars, itdoesn't matter that you were only going for some sort of temporary fix when youwent to the med spa, because when they messed up, the damage they just did toyour face is permanent. My complication had a little complication, but Dr.Chapman says I'll soon be up and...

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Yeah, I think people underestimate the damage that can bedone. We've seen cases with permanent disfigurement as a result of services atMedSpa. Just because a procedure is minimally invasive, just because aprocedure is being performed not at a surgical center and is a procedure butnot a surgery doesn't mean that the risks are any less and you really have tobe careful about that. But anyway, reviews are helpful. Reviews can also begamed, right?

You shouldn't only look at reviews, but yeah, you shouldlook at reviews and see what people say and take them into account. But likeeverything else you find online, you also need to go into it with a certainamount of skepticism. Our second tip, and this is now for when you're at themed spa and kind of talking with the provider there who's gonna be performingthe procedure. The second tip that we offer to someone to stay safe and avoidmedical errors in that context, in the context of the med spa, is to ask.

detailed questions about the experience and the trainingspecific to the procedure you're getting that the person performing it does.So, you know, I don't care if the person who's doing your micro needlingprocedure has been working at med spas for 15 or 20 years, right? Because maybethey've spent most of that time doing Botox and they only learned to do thisprocedure a month ago. Make sure not to take general claims or generalappearances of

experience and competency and professionalism as asubstitute for getting actual detailed answers. Ask these people, when were youtrained? Who trained you? Where were you trained? Did they come here? Did yougo somewhere else? Was it hands -on training? Did you use this equipment? Youknow, there's no necessary right answer here. I think sometimes we would besurprised to learn what counts.

or what is considered internally among that communitycounting as adequate training before they start using these devices, right?They may believe that they're fully trained and qualified, but when you hearwhat the actual training was, you may have second thoughts about that. Like,hold on, I'm not really comfortable having you poke this thing in my face basedon your weekend seminar. Yeah, most of the services too, Bill, that are offeredat med spas, such as you mentioned, micro -needling or injectables or laser.

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tattoo removal, those companies want the med spas to usetheir services. So they will send a representative to train them on site in aday or half a day and give them a certificate. But is that really adequatetraining? Your ability to judge is kind of limited to your gut test and yourown reason, right? You don't know. Heck, I don't know like where the line is.This is adequate training and this is not. But talk to them.

If you're feeling a little hesitant once they describe theirtraining, get out of there. Don't take the risk. Don't let the fact that it'srelatively inexpensive and promises a quick fix blind you to the potentialpermanent consequences that it has when you put yourself into the hands andcare of someone who's under qualified and under trained. Have you ever seen thegirl with the dragon tattoo? I've not. I haven't read it either. It's anexcellent movie about some psychopath. And at the end of the movie, spoileralert. Okay, go ahead.

Near the end of the movie, he asks the one gentleman, hesays, go ahead, get in the car. And the guys, you could tell the guy'sintuition and his gut feeling is, no, I should never get in that car. And hedoes. And the next thing you know, he's tied up in a basement. And the guy whodid it says to him, you know, it's amazing to me how many people ignore theirgut feeling for the fear to offend. Why don't people trust their instincts?It's hard to believe that fear of offending can be stronger than the fear ofpain. But you know what? It is.

The fear to offend someone is so high that you're willing toignore that feeling in your stomach that's telling you not to do something. Andin that case, it's going to cost him his life. But the same is true in a medschool. Your feeling is telling you, hey, maybe this isn't right, or I want toask this. But I don't want to offend this person. But this person is going toperform basically a surgery on you. And you're not offending them byquestioning their qualifications. So I always thought that was interesting.Yeah, I think that's a.

a fair description of kind of the psychology where peopleget walked down that road in other contexts, right? We've, we as a society havestarted telling like, in particular women to trust their trust their guts alittle bit more to avoid dangerous situations in kind of, you know, awfulsexual assault context or whatever. But intention with that is look, we'retrying to cultivate rationality, sometimes our gut instincts mislead us, right?

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You don't want to shut your brain off, but I think the thingyou're focusing on is specifically right. If you're worried about offending theperson who's going to be performing the procedure by asking about theirqualifications, don't. Look, if they're really good at what they do, if they'reone of the people in these med spas who is fully trained and professionallycompetent, they're going to love telling you about it because it's whatdifferentiates them from their competitors in that regard.

They're going to be more than happy to answer yourquestions. They're not going to take offense. The only people who are going totake offense are the ones who know that, yeah, I probably shouldn't be doingthis. Don't worry about offending them. Worry about protecting yourself. Yeah.And we've talked before about the need and the benefits of having a patientadvocate with you to ask questions because you're not always as focused, butspecifically with med spas. I think not only do you have to be a patient advocatefor yourself more so.

because there is this gray area where non -qualifiedindividuals who don't have medical licenses are performing basically plasticsurgery procedures. But I think having a patient advocate at MedSpa makes sensetoo. If you have somebody, a spouse, a friend that you trust, bring somebodywith you. So a really good point that we haven't talked about and that weshould talk about now. We are all aware that there is a stigma that surroundsplastic surgery, cosmetic procedures, going to MedSpa, things like that. Itleaves the patient...

isolated and without other defenses. One of the reasonsthese med spas can exist and one of the reasons that people who go in there endup not doing ample research, not bringing in an advocate is they don't wantpeople to know they got work done. That stigma against these kinds ofprocedures, people don't want to be accused of vanity or people don't wanttheir looks to be thought of as anything but natural, leaves these patientsespecially vulnerable because they are facing this industry alone.

And one person against the whole industry is a really badmatchup. Society's been telling you to tweak every little imperfection in yourappearance your whole life. Here is something that's promising to do that foryou. But you don't want anyone to know. You don't want to talk to someone aboutthat. They might judge you for it. Fight that stigma and make sure that you'renot leaving yourself in isolation. I guess the other related tips here are kindof old timey wisdom that remains true. There's no such thing as a free lunchand there's no such thing as a quick fix, right?

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If what the med spa is promising you seems too good to betrue, it probably is. You don't need plastic surgery. We can get this done foryou for $1 ,000. There's no risk, and you'll be back to work tomorrow. Andwe've had cases where the person is then disfigured for the rest of their life.Sometimes you go in there and it's fine, right? It's not like, these med spaswouldn't last long if every human being who walked through their door came outwith a horrible facial disfigurement, right? Like I went in there for poolsculpting and lost my arm. Okay, we're done.

They're not all butchers and even people who are underqualified and under trained can do procedures right most of the time, but notall the time and they might not catch their mistakes. It's just important tohave a caution and an understanding of what your risk tolerance is. The thirdtip that we do want to give before we wrap this episode today for how toprotect yourself if you're seeking services at a med spa.

is to ask to meet the doctor who's there. There's supposedto be a doctor at minimum on call and available, but hopefully on site,physically present when you're doing your consultation before the procedure andat the time of the procedure. Before you even schedule the procedure, ask tomeet, to talk to, to know who the doctor is and to be able to havecommunication with them. Calling Dr. Howard, Dr. Fine, Dr. Howard. They maytell you that it's gonna cost you more if you do that or whatever. It is worthit because,

not knowing who the doctor is or if there's a doctor therecan be pretty scary. How's my son? He's going to be all right. He's lost hisleft hand, so he's going to be all right. You son of a bitch! I hate thisdoctor! Medical spas in Pennsylvania need to have a medical director, aphysician who's in charge of the spa to make sure that the people performingthe procedures are qualified and competent. But what kind of doctors have weseen that they use as medical directors? They don't use plastic surgeons.

They use OB -GYN doctors. They use eye doctors. So you getthese varying fields of medicine where, yes, they're a doctor, but their entirehistory as a physician is not in anything related to aesthetics. That doesn'tmean they can't be the medical director, but you have to know what additionaltraining did they do to make them qualified for this job. It's not just enoughto have an MD. That's right. Look, legally speaking, you can be a medicaldirector.

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without having like a field specialty in either plasticsurgery or aesthetic medicine or anything like that. Now there's some detailedissues where generally speaking, you're not allowed as the medical director tolike legally speaking, delegate to someone else under your watch, the abilityto perform a procedure that you yourself are not competent to or able toperform. So theoretically, like even if the medical director is, you mentionedan eye doctor, right?

That eye doctor could still go get trained to do a laserprocedure or a cool sculpting procedure and then oversee other people who aredoing it. Your mileage may vary, right? You may have different views as towhether or to what extent that makes you sufficiently comfortable with theplace where you're getting your care, but that's the sort of thing you want tosuss out and figure out. There are places where there is a doctor, right?There's a medical director. First of all, there are places where there isn't.Legally, they're in violation of the law if they don't have one.

most places are going to at least cover that bare bonesminimal level of compliance and have a quote unquote medical director. Butwhether that's a person who is physically available to treat patients has evertreated patients at the facility, whether they're available to treat you ifsomething goes wrong, right? If you're in there getting a procedure andsomething goes wrong, is the doctor on site? Is the doctor gonna be there? Isthere a doctor in the house? Is there a doctor in the house?

or is he or she, you know, three counties away and is themedical director at 17 different med spas and does paperwork but isn't actuallygonna be involved in your care. That's why I'm saying ask to meet the doctor orspeak to the doctor. Just asking who the doctor is may not help you withoutactually speaking with this person and understanding that they have a real rolein your care. Certainly don't assume.

as people sometimes do, right? That look, if I'm going to aplace that's an accredited medical facility, yeah, they've got a doctor andthat doctor's in place and that doctor will take care of me. This is a weirdgray area and they don't always. The two most important things for me arenumber one, identifying, meeting the doctor. I think it's a great idea if youcan. It means it shows that they're on site. A lot of these med spas, they havea medical director that's never been to that office. They just hold him as atitle.

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where they're there like twice a year, right? Just forplausible deniability. But the point of the medical director is not only makingsure that there's physician oversight, but if there's a problem, you need tounderstand what are the risks and consequences of this potential procedure. Andthat should be explained to you by a doctor. And most importantly, if there isa problem, is the doctor going to be involved in the follow -up care? Ifsomething goes wrong, who's going to monitor me? We've had cases where

There's a medical director, there's a complication and theadvice on how to manage the complication is coming from one of the secretariesat the med spa because the doctor didn't even know the procedure existed. Imean, that's how unsafe these things can be. And I mean, look, this problemisn't unique to med spas, right? And I think we can kind of close with this allover the world of kind of cosmetic surgery, plastic surgery, aestheticmedicine.

There's been a problem that has predated the existence ofthese med spas where people without adequate training and experience in thatfield have decided this is a place they can kind of dabble in, screw around andmake some easy money. You know, non -plastic surgeons doing plastic surgery inpart because, you know, the profit margins are good and the demands, thequalifications that people impose on them are less. So I just want to kind ofgo through one example of this.

to let you out there know what kind of things we've seen inour careers, which is we dealt with a case, it was many years ago at thispoint, with a botched breast augmentation procedure. And the person whoperformed the procedure was a doctor, but was not a plastic surgeon. Thathappens. Yeah. And I'm skeptical about that, right? That should happen lessthan it happens. But okay, fine. You know,

Merely not being a plastic surgeon does not mean you cannotperform a particular type of cosmetic procedure safely. So, you know, we getthis guy in a deposition and ask him, well, where did you learn to do breastaugmentation? And the answer in that case was, well, I went to this seminar. Itwas out on the West Coast somewhere, right? I went to a seminar for a weekendand they taught us this novel way because we had our we had our experts sayingthe way he did this procedure is wild. You don't do it this way.

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And so we're trying to figure out how he was trained, whotrained him. So he was trained out on the West Coast basically over a weekendor a week full of classes. And that's it. Worse, it gets worse. The person whotaught this class out on the West Coast, also not a plastic surgeon. And whenwe talked to him in a deposition and asked how he learned to do this procedure,I kid you not, his answer was, well,

One night I had a dream and in that dream I was performing abreast augmentation in this way and that's where it came from. It came from adream that he had.

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that he then taught a class and taught a whole bunch ofother people to go out into the world and perform plastic surgery that helearned to perform in a dream. And even if that was the case that you learnedhow to do this or you were inspired to do this in a dream, why would you saythat out loud to anyone, let alone at a deposition? He was honest under oath.He told us, you know, this is how I learned to do it. I guess he had to. He wasunder oath. I mean, maybe maybe he thought this was, you know, who was myteacher? God.

He came to me in a dream with ultimate plastic surgeryauthority. Hard to argue against that one. Mike, we recently had a case wherewe asked the medical director, what is micro -needling? That's one of theservices that is typically offered in the med school. The medical director hadno idea what it was. Never heard of, I mean, he heard of it, was unable to tellme what it is. So, yeah, you know, it's a scary world out there, folks. Protectyourself as best you can. And that'll do it.

for this episode of I Strenuously Object. If you've had abad experience, well, I guess not bad experience, but a genuine experience ofmalpractice where you suffered permanent injury at a med spa, or if you haveany medical malpractice or legal questions besides, please visit our website,Flaherty Fardo's website at pghfirm .com. Please subscribe, rate, and reviewthe podcast. If you have any questions for the pod,

specifically for our mailing it in segment or any otherfeedback. You can email the podcast at iobjectatpghfirm .com. We're onInstagram at iStrenuouslyObjectPodcast. And until next time, some partingadvice. Mr. Heldman was very close to your garden. Now please, Mrs. Lowry,don't get upset. Mr. Lowry, please wait in reception. You're giving me a wrinkles.You see? Just try and relax, Mrs. Lowry. I'll make you 20 years younger.

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