Connecticut Passes New Medical Spa Regulations

Connecticut is another in a series of states that has taken action in regard to the regulation of medical spas.  The new legislation in Connecticut seems fair and a well thought out effort to protect consumers in the state.

Many within the various related industries, such as aesthetics, believe that the regulation of medical spa procedures it’s a turf battle waged by physicians who are trying to protect their exclusive right to perform cosmetic medical procedures.  However, this law seems appropriate and my vast experience as a consultant to state medical boards and boards of cosmetology is that this type of regulation is borne out of a desire to legitimately protect citizens of a state.

Medical spas in Connecticut that offer cosmetic medical procedures must have an acting medical director who is a state-licensed physician. Bill SB-1067, which goes into effect on October 1, 2013, was passed by the state’s legislature on June 5, 2013. It states that any medical spa that offers procedures defined under the state’s sales tax laws as “cosmetic medical procedures” employ or contract with a medical director. An MD, PA, APRN or RN may perform the procedures. If a PA, APRN or RN is performing the treatment, he or she must be acting under a physician’s supervision and control. In addition, the facility must post notice of the name and specialty of the medical director, and he or she must perform an initial physical assessment of the patient before the procedure is performed. Violators are subject to fines of up to $500 per day while the violation continues.

In my opinion, there will be more new laws such as this one as state’s wrestle with this growing problem.  My only question in regard to this law is whether the nurses have to be employed by the physician. This is a growing issue.

If you wish to view a synopsis of this new law, log into http://www.cga.ct.gov/2013/BA/2013SB-01067-R01-BA.htm

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Paddy Deighan J.D. Ph.D

http://www.medicalandspaconsulting.com

SEO basics as Google Implements Penguin 2.0 Part II

Many SEO enthusiasts are in a state of panic over announced changed to Google search engine algorithms. Google is gradually implementing Penguin 2.0 and many are concerned that there SEO efforts will be adversely affected.

I decided to write some SEO basics that pertain to most search engine since Google isn't the only one ya know!! BING has made significant strides lately.

1. Check the Popularity of Keywords

In order to obtain traffic from keyword searches on the major search engines like Google, BING and Yahoo!, you need to be writing about a topic that people want to read about and are actively looking for information about. One of the easiest ways to get a basic idea of what people are looking for online is to check the popularity of keyword searches on websites like Wordtracker, Google Trends or the Yahoo! Buzz Index. These will each give you a clear indication of the keywords that are being searched and you can check many different phrases.

2. Select Specific and Relevant Keywords

It is prudent to select one keyword phrase per page then optimize that page to that keyword phrase. Keywords should be relevant to the overall content of your page. Furthermore, choose specific keywords that are more likely to give you a better search results ranking than a broad term would. For example, consider how many sites use the keyword phrase of "ancient pottery." The competition for ranking using that keyword is likely to be tough. If you choose a more specific keyword like "13^th Century Chinese Pottery," the competition is a lot easier.

3. Select a Keyword Phrase of 2 or 3 Words

Statistics show that nearly 60% of keyword searches include 2 or 3 keywords. Accordingly, optimize your pages for searches on keyword phrases of 2 or 3 words to drive the biggest results.

4. Use Your Keyword Phrase in Your Title

Once you select the keyword phrase you plan to optimize your page for, make sure you use that phrase in the title of your blog post (or web page).

5. Use Your Keyword Phrase in Your Subtitle and Headlines

Utilizing subtitles and section headlines not only makes the blog more visually appealing on a text heavy computer screen, but it also gives you additional opportunities to use your keyword phrase.

Paddy Deighan JD Ph.D

http://www.homesavers.pro

SEO Basics as Google Implements Penguin 2.0

Many SEO enthusiasts are in a state of panic over announced changed to Google search engine algorithms. Google is gradually implementing Penguin 2.0 and many are concerned that there SEO efforts will be adversely affected.

I decided to write some SEO basics that pertain to most search engine since Google isn't the only one ya know!! BING has made significant strides lately.

1. Check the Popularity of Keywords

In order to obtain traffic from keyword searches on the major search engines like Google, BING and Yahoo!, you need to be writing about a topic that people want to read about and are actively looking for information about. One of the easiest ways to get a basic idea of what people are looking for online is to check the popularity of keyword searches on websites like Wordtracker, Google Trends or the Yahoo! Buzz Index. These will each give you a clear indication of the keywords that are being searched and you can check many different phrases.

2. Select Specific and Relevant Keywords

It is prudent to select one keyword phrase per page then optimize that page to that keyword phrase. Keywords should be relevant to the overall content of your page. Furthermore, choose specific keywords that are more likely to give you a better search results ranking than a broad term would. For example, consider how many sites use the keyword phrase of "ancient pottery." The competition for ranking using that keyword is likely to be tough. If you choose a more specific keyword like "13^th Century Chinese Pottery," the competition is a lot easier.

3. Select a Keyword Phrase of 2 or 3 Words

Statistics show that nearly 60% of keyword searches include 2 or 3 keywords. Accordingly, optimize your pages for searches on keyword phrases of 2 or 3 words to drive the biggest results.

4. Use Your Keyword Phrase in Your Title

Once you select the keyword phrase you plan to optimize your page for, make sure you use that phrase in the title of your blog post (or web page).

5. Use Your Keyword Phrase in Your Subtitle and Headlines

Utilizing subtitles and section headlines not only makes the blog more visually appealing on a text heavy computer screen, but it also gives you additional opportunities to use your keyword phrase.

Paddy Deighan J.D. Ph.D

http://www.medicalandspaconsulting.com

Are We living in America or a Land of No Freedom of Choice?

Virtually every day, there is a story about something that we cannot eat or drink...or DRIVE. I am a car fanatic and when I travel to Europe, I see all of the fuel efficient and cool cars that we cannot have because of our burdensome regulations - Citroen, Alfa Romeo, Peugeot, Renault (most are French, perhaps THAT explains it - LOL), Opel (owned by GM) and Ford of Europe and Australia (will not export many types of cars to the US market). The Ford Falcon is still being produced...but not for use in the USA. Anyway, I read on the internet today that NYC has now banned the delivery of 2 liter Coca Cola with PIZZA delivery. Hey, Bloomberg, guess what ya clueless bureaucrat, PIZZA ain't real healthy either! Why don't you ban delivery of that too? Eateries are now banned from serving soft drinks in a size larger than SIXTEEN ounces in NYC. Bloomberg has taken action against salt, sugar, trans fat, smoking and baby formula. While these may be noble causes, this is AMERICA and we are allowed to be unhealthy. We are allowed to be a lot of things and it is not the government’s role to regulate BEHAVIOR!! Does this idiot think that DIET Coca Cola is healthy??? Many suggest that is may be unhealthier than regular Coca Cola…but in any event, who are these bureaucrats that keep ramming this stuff down our throats (pun intended). THIS IS AMERICA, and AMERICA is SUPPOSED to be synonymous with “freedom of choice”. Coca Cola has Ryan Seacrest as a spokesperson...is wholesome, pure Ryan Seacrest advocating bad behavior? Would he be banned from drinking it in NYC? I have stated it before and I will state it again…it is not the politicians’ fault that these things happen; it is OUR collective fault for electing these well-intentioned, but delusional idiots. Nothing will change until we have a better quality of politician…and who would want to run the way the media eviscerates anyone short of Mother Teresa (God rest her soul). Oops, I said “God”…now the media will eviscerate me for writing a religious blog… Paddy Deighan J.D. Ph.D http://www.medicalandspaconsulting.com

A Colossal Waste of Tax Payer Dollars..Wisconsin Monkey Study

I was minding my own business working out. The TV was on HLN and I was watching a Jane Velez piece on University of Wisconsin-Madison study. In these experiments, baby monkeys are separated from their mothers right after birth and later subjected to scary tests to provoke fear and anxiety. The monkeys are then killed and dissected and their brains are studied. Wanna know the truly scary part. WE ARE PAYING FOR THIS!!! It is a federally funded study!!! As a scientist, let me make the conclusion for these hapless researchers. Taking a baby monkey (or any animal) away from its mother at birth and then subjecting it to fear will cause what reaction???? Hmmm, lets cypher on this one (a la Jethro Bodine)......Hey, I got it!!! HOW 'BOUT NOT A GOOD REACTION!!!! THERE, you idiots just saved millions of taxpayer dollars. Kinda reminds me of when I was asked to comment on a Michigan State study. They spent one a and a half years and millions of taxpayer dollars studying the effect of obesity upon diabetics in the Puerto Rican community. My response: "Ladies and gentlemen than you for coming,,,,as you know, Michigan State spent millions of dollars and one and a half years studying the effects of obesity on diabetics in the Puerto Rican community...I will summarize the results: "IT DOESN'T HELP" Thank you all for coming!!! LOL A doctor in NY still has not spoken to me years after that presentation!! Paddy Deighan J.D. Ph.D http://www.medicalandspaconsulting.com

Having a Hard Time Understanding This One

Lance Armstronmg is all over the news...what he did was a disgrace to himself and our nation. However, he has done a lot of good for a lot of people. That part is genuine and true. Here is the part that I do not understand. The United States Postal Service is running in the red to the tune of BILLIONS of dollars per year, YET, they have spent $30 million sponsoring Armstrong's racing team??? WHOA!! What benefit is there to the USPS in sponsoring a cycling team?? How about NONE, zero, natta?? The USPS closes 10% of its locations during the past two years yet they are sponsoring a CYCLING team?? While I am on the subject, they closed 10% of their locations but did not lay off ONE person!!!! Small wonder they are running in the red!!! Paddy Deighan J.D. Ph.D http://www.medicalandspaconsulting.com

Ethical Considerations in an Aesthetic Medical Practice There is no question that aesthetic medical providers face a higher risk of professional liability. Aesthetic medical providers take great care in selecting appropriate liability insurance coverage. However, it is equally true that such providers also face a greater risk of ethical allegations and they can come from a variety of sources (unlike liability that typically stems from the provider – patient relationship). Ethical allegations can result from advertising or conduct unrelated to your practice of medicine. Additionally, aesthetic medical patients have higher expectations from aesthetic medical procedures and they demand a higher level of outcome and expectation. If they do not receive their expected outcome, it is your fault!! Many attorneys that represent disgruntled patients in a professional negligence matter will suggest that the patient file ethics violations first. If there is a finding of ethical violations from the state, the attorney will utilize this finding to allege negligence in the liability claim. Attorneys can argue that it is “unethical” to utilize a medical device or product in an “off label” manner. Virtually every aesthetic medical provider utilizes medical products and devices in an “off label” manner (Botox Cosmetic, dermal fillers and many laser procedures are examples). The attorneys will instruct the client/patient to file the ethics complaint that alleges that the treatment was “off label” and therefore unethical, per se. Accordingly, aesthetic medical providers are at a higher risk of ethics complaints than their traditional medical colleagues. I have discovered that most aesthetic medical providers are not clear on what they should do if they have an ethical situation.

The first consideration in this discussion is patient selection. If your instincts tell you that a particular patient may expect too much or have unrealistic expectations, do not treat them! I advise providers that “it is not the patients that you treat that will make you successful, it is the patients you choose NOT to treat that will make you successful.” Marketing 101 dictates that it takes 10 successful patients to get one referral but it only takes one disgruntled patient to lose 10 patients. Many ethical issues arise out of unrealistic expectations of the patient. Avoiding certain patients from the outset will substantially lower your risk of ethical allegations. Patients complain to a medical board because they are not happy in the result and of course it is the provider’s fault. In regard to patients, document EVERYTHING in the chart…and document proximate to the time of the discussion with the patient. Do not document a chart a week after the patient discussion! The next significant source of ethical situations is advertising. We can devote an entire series on this topic, but for the purposes of this article, understand the advertising and issues are highly correlated. Finally, ethical situations can arise from conduct in your personal life that is entirely unrelated to the practice of medicine. Even Driving While Intoxicated charges have resulted in providers facing the state medical board. The trend is toward more scrutiny. There is a global ethical issue that many aesthetic providers fail to consider and it can be very damaging. I will state in advance that this seems totally unreasonable, BUT you have a duty to disclose to your state medical board and certification board any conduct which may become an ethical issue in the future. If something occurs in the office that MAY put you in an ethical conundrum, you have to report it. Failure to report it can give rise to additional sanctions or loss of board certification. Affirmatively reporting also decreases the risk of severe sanctions for alleged unethical situations because you cooperated in advance. I strongly recommend that whenever you feel that you are in an ethical conundrum, write to the state medical board and ask for their guidance. This is very powerful. They cannot charge you with an ethical violation if they participated in the course of action! They may choose not to respond to your query, but the fact that you sought their guidance and counsel is very compelling. So, What DO I Do When I am Notified of an Ethical Investigation? If you receive a letter from your state board licensing board, pay strict attention to the action items that the board is requesting. The boards typically ask for a response within ten days. I suggest that you formulate an initial response that acknowledges receipt of the allegation and tactfully denies that any unethical conduct was conducted. Also indicate that your initial response is a preliminary one. You will provide a more thorough reply after you review the chart and interview any staff members that were involved in the patient care. I should also mention that any of your staff can create unethical situations and the medical provider is responsible for these too. Everything stated in this article pertains to the medical providers and staff since you are responsible for their conduct. An example of provider ethical liability for a staff member is when a staff member divulges confidential information. I suggest that you send a definitive response about thirty days after your initial reply. Do NOT wait for the state board to ask for the additional response. The definitive response will include your version of an incident as well as any supporting documentation. It is important to interview staff members that may have engaged the patient and include a summary of their version of the incident. The fact that you thoroughly investigated the matter prior to response will go a long way toward a successful outcome. It is prudent that you do not say anything negative about the patient! Remember that if the patient has anger issues, unrealistic expectations or other psychological issues, you should not have treated them! Refer to the disgruntled patient with empathy and respect in all of your correspondence. Express sorrow that the patient feels that something unethical occurred. You may not receive any additional correspondence from the state licensing board for a long period of time (a year is not unusual). This does not indicate that the board is no longer pursuing the matter. The entire process can take up to three or four years. It is also prudent to hire an attorney to represent you. Many physicians indicate to me that they are afraid to hire an attorney because it may appear that they are guilty. There is nothing further from the truth. There are procedural guidelines and rights that you have and it is proper to hire an attorney to represent you. The state boards expect this and it is the responsible thing to do. Another aspect of ethical allegations is that you have a duty to report the allegation to your certification board and most organizations to which you are a member. The certification boards require this as a condition of your board certification or membership. Failure to report alleged ethical violations will frequently result in loss of board certification!! This also applies to member organizations such as the American Society of Plastic Surgery (ASPS) or the American Academy of Dermatology (AAD). In fact, if you read the regulations of certification boards and member organizations, you will see that you have to report a wide variety of events such as Driving While Intoxicated or alleged insurance fraud from even a home owner’s insurance claim. In order to comply with the licensing board or member organization requirements, you only need to send a letter that indicates that an allegation has been made against you and that you are appropriately responding to the allegation and that you believe there is no merit to the allegation. You will probably never hear from them again, but you will have complied with the requirements for certification or membership. Most of your colleagues have not complied with these notice requirements, and if you do comply, there is a much greater chance that nothing will happen to your certification or membership. Paddy Deighan J.D. Ph.D http://www.medicalandspaconsulting.com