In the January issue of Aesthetics, Dr Askari Townshend argued the importance of a skilful and thorough approach to handling potential litigation. This month, he shares his personal experience of managing a legal complaint
Hamilton Fraser, the UK’s largest cosmetic insurer, include ‘top tips on how to avoid a potential claim’ in the knowledge centre1 on its website:
All of these are important to follow and will reduce your chance of facing a claim, but bear in mind that they will not eliminate the risk – as I have found out to my cost.
After opening my own clinic in 2008, patients that I had previously treated followed me. One lady was happy to travel a more than 100 mile-round trip for injectable treatments, which I felt was a compliment to my skills. After a thorough consultation with this particular patient, we agreed on Intense Pulsed Light (IPL) treatment for her mild rosacea. Before conducting the procedure I discussed each aspect of the consent form with the patient, which she signed, took good photographs of her condition and performed a test patch. When she attended the clinic for her rosacea treatments, photographs were taken on each occasion and a questionnaire on change in medical history was completed.
I gave my patient lengthy advice over the phone and asked her to keep me informed of her progress. The next day things had not settled and were, perhaps, even worse. She visited her GP and was referred to a dermatologist who saw her twice in two days and prescribed oral antibiotics to treat the complication. During this time I tried to keep in touch by phone, text and email, however, after a few days, she stopped responding to me completely.Never before (or since) have I come across such a violent reaction to a light-based treatment from such a small change in settings. It was especially unexpected as my patient had received several previous treatments, at greater energies than the one that had caused her blister, with no significant problems. My patient was adamant that there had been no recent sun exposure, changes in medical history or medication that could have contributed to the abnormal response.
I immediately stopped using my IPL system and cancelled all booked treatments. The self-test used to diagnose any problems with the device was uneventful and the company engineer found no faults after conducting a full service. I contacted the company’s trainer and two other national experts who used the same system but none could shed any light on why this had happened. Once my device received the all clear I started using it again, very cautiously to begin with, and found no problem with any other treatments. I informed the Health Care Commission (as the Care Quality Commission (CQC) was known then) and my insurer. With no channels of communication, there was nothing more that I could do to help my patient, which meant I could only wait and hope that all was healing well.
My solicitors felt that there was a weakness in our case as I had increased the energy of the treatment without a prior test patch. Some practitioners advocate test patches at the end of each treatment, though, in reality, this is not a good verification of treatment response. A single shot is not comparable to the heat generated from a full treatment – of course this is not to be confused with test patches before the first treatment, or after a significant change in settings, which are vital. This issue had been discussed at a British Medical Laser Association (BMLA) meeting I had attended after the incident, which found that the majority of members – if not all – did not routinely test patch before every minor change of settings. Despite this, my solicitor felt that a judge may rule that a test patch could have avoided the injuries caused – especially as judges are not always sympathetic towards our speciality. This was a disappointment as I felt that I had done all that I could to ensure a safe treatment, and had not been able to find any practitioner that felt otherwise.