The spooky side of med spas

They are popping up everywhere but what is a med spa? According to the Texas Department of Licensing and Regulation, “[a] medspa typically offers esthetic and non-surgical medical treatments that are designed to enhance the look and feel of their client’s skin and body.” While the services offered may be a combination of traditional spa services (e.g., massage, facials) and medical aesthetic procedures (e.g., Botox, laser treatments, IV therapy), regardless of the service offered/performed, the appropriate license must be possessed by the individual performing the services.

Where does the Texas Medical Board (TMB) come into play? The TMB has long had standing delegation orders and the supervision of non-physician practitioners requirements. The TMB also has rules for non-surgical medical cosmetic procedures to be performed by qualified non-physicians. These “non-surgical medical cosmetic procedures” (hereinafter “Services”) include Botox, IV hydration therapy, colonic irrigation and the use of prescription medical devices for cosmetic purposes. (Tex. Admin. Code, Title 22, Part 9, TMB Section 169.25). Importantly, these Services must be performed while a physician, physician assistant, or advanced practice registered nurse must be immediately available. Crucially, advanced practice providers and non-physicians can only perform procedures under the requisite and proper physician supervision.

On June 20, Texas Governor Abbott signed “Jenifer’s Law” to increase regulation of IV infusions. The impetus behind the law was when a medical spa visitor in Wortham, Texas was given an elective IV infusion containing a common vitamin – Vitamin B complex. Notably, Vitamin B Complex via IV typically requires a prescription. Shortly following the IV’s insertion, the client became unconscious and went into cardiac arrest. Emergency medical personnel were unable to revive her and she passed away at the hospital.

Although the client signed medical treatment forms stating that she had no known cardiac risks and was not under the care of a physician, took no medication and had no known chronic conditions. The problem – the acting medical spa director was more than 100 miles away. Even prior to Jenifer’s Law becoming effective on September 1, 2025, the physician was required to comply with the appropriate supervision requirement of non-physicians and the TMB temporarily suspended his license.

What did Jenifer’s Law do? For elective IVs administered outside of a hospital, physician’s office, mental hospital or other licensed health facility – in other words, if an elective IV is administered in a “Non-Facility” – then the following requirements apply:

1. Limited Prescription Delegatory Authority.Limits delegation of the act of prescribing or ordering such therapy to only a PA or APRN acting under appropriate physician supervision.
2. Limited Administration Delegatory Authority. Limited delegation of the act of administering such therapy to a PA, an APRN or a registered nurse (RN) acting under appropriate physician supervision.
3. Prescriptive Authority Agreement Limitations. The prescriptive authority agreement is required for prescription and/or administration of elective IVs (RNs cannot prescribe), the agreement will count toward the maximum total authority agreements authorized under the law of seven PAs and APRNs combined or full-time equivalent thereof.
4. Supervising Physician Duties. Supervising physicians must perform the following:
   1. Ensuring that the individuals performing delegated medical acts have received appropriate training for each procedure, including techniques, contraindications, pre-procedural and post-procedural care, recognition and acute management of potential complications and infectious disease control. HIPAA training is also one item not to overlook.
   2. Physician must also be appropriately trained to perform the medical act. Additionally, a practitioner-patient relationship, disclosure of the identity of the person performing the IV or medical act, maintaining a complete and adequate medical record in accordance with Chapter 163 of TMB rule, ensure that at least one person is trained in basic life report, emergency plan and policies and procedures.

In sum, med spas in Texas and across the country are receiving more scrutiny. Patient safety must be a priority and consulting licensing board requirements, as well as state laws and regulations is paramount for minimizing patient adverse outcome risk, as well as mitigating compliance risk.

Rachel V. Rose, JD, MBA, advises clients on compliance, transactions, government administrative actions, and litigation involving healthcare, cybersecurity, corporate and securities law, as well as False Claims Act and Dodd-Frank whistleblower cases. She also teaches bioethics at Baylor College of Medicine in Houston. Rachel can be reached through her website, www.rvrose.com.