Medical Spas, Med-Spas, or Medi-Spas — By Any Name, Professionals Must Follow State Rules and Regulations

by Sharon Krevor-Weisbaum and Matthias Niska

Photo of Sharon Krevor-WeisbaumMedical spas (also called med-spas or medi-spas), which seek to marry the spa/fitness industry with traditional Western medical practice, have become increasingly popular. Med-spas employ medical professionals such as dermatologists, cosmetic surgeons, nurses, and nurse practitioners and offer their clients medical or quasi-medical procedures, and as a result they have become the object of numerous and detailed regulations in many states.

For example, Maryland regulations categorize a laser used for cosmetic purposes as a “cosmetic medical device” and laser hair removal as a “cosmetic medical procedure.” The regulations permit a physician who is employed by a medical spa in Maryland to delegate the performance of laser hair removal treatment to a physician’s assistant or a registered nurse who has received the proper training, but do not allow such a procedure to be delegated to a licensed practical nurse. A physician who delegates such a procedure still must (a) develop and maintain written office protocols for each such cosmetic medical procedure at each site, (b) personally perform an initial assessment of each patient, (c) prepare a written treatment plan for each patient, which includes diagnosis, planned treatment, and specification of the device and device settings to be used, (d) obtain informed consent from the patient to be treated by a non-physician, (e)provide onsite supervision, (f) retain responsibility for all acts delegated to the non-physician, and (g) maintain medical records in compliance with applicable federal and state law.

The non-physician performing the cosmetic medical procedure must have received the proper training and must (a) follow the delegating physician’s written protocol, (b) verify that the delegating physician has assessed the patient and given written treatment instructions, (c) discuss the procedure with the patient so the patient is aware that the treatment will be provided by a non-physician, (d) inform the delegating physician about any adverse events or complications before the patient leaves the site, (e) document all relevant details of the procedure, and (f) satisfy any requirements of his/her own licensing board. A non-physician who performs a cosmetic medical procedure without complying with the above requirements is guilty of practicing medicine without a license and may be subject to a fine of up to $50,000.

A separate subtitle in the Maryland regulatory code establishes specific requirements for registered nurses who are delegated the responsibility to perform cosmetic medical procedures such as laser hair removal treatment. A nurse may only perform such a procedure when she has had the proper theoretical and clinical training and when there is a completed prescriptive order from an authorized prescriber that specifies the procedure to be performed, the specific treatment area, the medication, dosage, route, and time interval for administration of the medication for the specific cosmetic procedure, the light source and the radio frequency, current dosage, intensity, and time period it is to be applied, and the use of any topical anesthetic. Before a registered nurse performs a cosmetic medical procedure, the regulations further require that the authorized prescriber (a) complete an initial assessment and evaluation of the patient before the procedure is performed, (b) develop a treatment plan for the specific patient, (c) be physically present in the setting, and (d) be immediately available both at the time the procedure is performed and post-treatment to evaluate the patient. Furthermore, a licensed nurse is prohibited from, among other things, (a) performing cosmetic medical procedures on a standing order or protocol, (b) performing the pre-procedure medical assessment or evaluation, (c) performing medical diagnosis or prescribing cosmetic procedures, (d) developing a client treatment plan, (e) prescribing medications for cosmetic or dermatological procedures, or (f) performing the post-procedure medical evaluation of the client.

Sharon Krevor-Weisbaum often represents health care professionals who are involved in Board licensure actions and has represented professionals working in the med spa industry.