Have you noticed medical spas sprouting up in or next door to many Texas doctors’ offices? I’ve seen them present, advertised, and heavily promoted in practices ranging from chiropractors and podiatrists to plastic surgeons and internists.
There’s little wonder. Projections from 2019 say that medical spas will be a $27+ billion behemoth industry by 2025, with Texas having more medical spas than any other state. They’re cash cows for physician owners—the America Med Spa Association said the 2018 average profit was 29%.
What are medical spas?
Medical spas provide non-surgical cosmetic treatments in a comfortable, sometimes posh spa environment. Typical services include:
• Facial treatments, including procedures such as anti-wrinkle, Botox, and filler injections, fine-line reduction, and acne therapy. Facial treatments generate one-third of medical spa revenues.
• Body-shaping services, which are non-surgical procedures to freeze or laser-burn fat. These services are advertised with names like CoolSculpting and SculpSure. These account for 20% of revenue.
• Tattoo removal, which accounts for about 14% of revenue.
Women make up 85% of medical spa clients/patients.
Regulations and medical malpractice
The Texas Medical Board’s general regulations for physician delegation to lesser-trained providers, including nurses and technicians, apply to medical spas.
Since 2013, the Board has enacted additional rules that target medical spas in particular. You can find the rules, which were amended in 2019, at Texas Administrative Code Section 193.17.
Both the standard of care and Texas Medical Board rules require physicians to meet common-sense patient safety standards. Before providing any procedure, a doctor, physician’s assistant, or nurse practitioner must:
• Interview the patient to obtain a medical history.
• Perform a physical exam.
• Diagnose patient conditions, make recommendations, and prepare a detailed written treatment plan.
• Obtain the patient’s permission for treatment through the verbal and written informed consent process.
• Plan ahead, providing instructions for the patient’s follow-up and emergency care.
• Maintain a detailed medical record about the patient’s care.
In addition to those patient-focused requirements, physician-owned medical spas are required to have put some thought, organization, and planning into the way the facility will operate. Requirements include:
• Signed and dated protocols, policies, and procedures to guide the care of personnel.
• Signed and dated standing orders. A doctor can specify standing orders for prescription medications, monitoring, and discharge instructions, for example, for patients receiving certain services of procedures.
Non-physician personnel who are providing treatments can’t just be random people off the street without training. Texas Medical Board rules require evidence that staff have been trained in:
• The techniques of how to perform each procedure.
• Cosmetic or cutaneous medicine.
• Indications (reasons to do) and contraindications (reasons not to do) each procedure.
• How to provide care before and after procedures.
• What to look for and how to manage complications during or after procedures.
• Infection prevention and control.
In my experience, many medical spas significantly blur the line between safe, quality procedures that are provided by medical professionals and questionable services that one might obtain in the middle of a shopping mall hallway.
Some doctors view medical spas as a hands-off revenue stream, but that attitude doesn’t meet the professional and legal requirements that they owe to their patients. Ultimately, when there are mistakes that occur that injure a patient, it’s the physician who’s responsible for the training, supervision, and care.
If you’ve been seriously injured because of medical spa care, then contact a top-rated experienced Houston, Texas medical malpractice lawyer for help in evaluating your potential case.