Delegating in your medical spa can be a money-maker; it can also create compliance woes and legal exposure.  In today’s video, we talk about some of the compliance do’s and don’ts, especially under California law.

By the end of today’s video, you’ll understand a lot more about the use of non-physician, clinical personnel in a medical spa, and some of the legal requirements and legal sand traps that you’ll likely to face.

I’m Michael H. Cohen, founding attorney of the Cohen Healthcare Law Group.  Since 1999, our healthcare law firm has advised hundreds and hundreds of healthcare industry clients on healthcare and FDA legal compliance issues.  Medical spas are one of our core clients, as we understand the multidisciplinary healthcare space really well.

Here are some key points to keep in mind when delegating Medical Spa services to other clinical personnel.

First, think about delegating in terms of two different groups of clinical staff: those that are licensed and those that are not.

Licensed clinical staff include, for example, nurses.  Physicians may only delegate to appropriate licensed clinical staff who are capable of performing the task, and, are appropriately supervised.

However, physicians cannot delegate to licensed staff, such as estheticians, who aren’t trained for certain tasks, such as administration of drugs, or cannot legally perform such services.

Physicians cannot delegate certain tasks to unlicensed staff.  For instance, medical assistants (or “MAs”), cannot administer drugs to patients, regardless of the level of training or supervision.

In its FAQ on Cosmetics Treatments, the Medical Board of California, states:

“Physicians may use lasers or intense pulse light devices. In addition, physician assistants and registered nurses (not licensed vocational nurses) may perform these treatments under a physician’s supervision. Unlicensed medical assistants, licensed vocational nurses, cosmetologists, electrologists, or estheticians may not legally perform these treatments under any circumstance, nor may registered nurses or physician assistants perform them independently, without supervision…

“Physicians may inject Botox, or they may direct registered nurses, licensed vocational nurses, or physician assistants to perform the injection under their supervision. No unlicensed persons, such as medical assistants, may inject Botox.”

The next point I’ll make has to do with physician supervision.

What is supervision?

The Medical Board of California says that supervision is: “the act of supervising, which is to oversee, to direct, to have charge, to inspect, to provide guidance and education.  In other words, real supervision is required; not simply token supervision or supervision in name only.

California requires that the supervising physician be immediately available and able to provide guidance in the event of an emergency or if there is a need for a higher level of care that must be provided by the physician. The supervising physician needs to be within a geographical distance that they can effectively provide supervision and support, as needed.

California law doesn’t specify exactly how many miles are too little, but it does provide the guidance just mentioned.  The rubber meets the road—legally and literally—if the physician is too far to provide guidance in the event of an emergency.

One additional wrinkle here: what if the physician is located in a different state than the medical spa?  Practically speaking, that just seems to create a lot more problems that it may be worth.  When telemedicine is involved, the physician is bound by the law of the state where he or she lives as well as by the law of the state where the patient lives. So why introduce additional telemedicine complications? If the physician lives in another state that just makes things more complicated.

Thanks for watching. We look forward to speaking with you soon.