The Insurance Demands for Medical Spas continues to increase…

February 15, 2012

So, we thought we’d share some of what Michael Cohen, Esq. shares about Med Spa Laws for doctors and patients.

Plastic Surgeons, Dermatologists, Otolaryngologists have for some time now added boutique, affordable and life changing procedures to their practices in the form of these ‘medispa’ services. This is not only a way to nurture relationships with clients, this is a revenue generating gateway to more procedures. The Medispa procedures allows some reticent patients to try some less invasive, less expensive procedures prior to the surgical procedure that they may have been really hoping (and saving) for.

There are some unique risks, and there are some risk management issues that patients and physicians should think about. The Doctors’ Insurance Agency provides competitive, resourceful and comprehensive insurance coverage for medispa’s Dermatologists and Plastic Surgeons (among many other specialties), Recently, I read Michael Cohen’s (esq), (from his website ‘CAM LAW) article on managing difficult and common legal questions pertaining to this growing segment of the medical world.

We wanted to summarize and share some of the important points. Michael says:

The California medical board actually has some readable information on its website about medical spa laws and regulations. Three sites in particular are helpful. The overview, Medical Spas- What You Need to Know, This takes a consumer protection stance and provides information about what to look out for,

There is a certain seduction to the environment of a Med Spa and one of the reasons we like Susan Preston’s Lloyd’s Insurance Program is that she understands this risk, she treats is professionally and prices fairly, Another insurer offers risk management tips and patient safety partnership programs for their Medispa and Surgery Center Programs.

The Doctors’ Company wants to help our physicians and other interested physicians research and understand the market when they consider venturing into this area.

These Spa’s can be alluring and it is essentially supposed to be, MedSpa’s are a marketing vehicle for the medical doctors who own interests in them. This is, after all, the practice of medicine. This is why The Doctors’ Insurance Agency focuses on this business, we want to make sure our physician policyholders and their allied healthcare, licensed nurses are properly protected.

There is no harm in seeking pampering or in wanting to look better. A visit to a spa may provide a needed respite from our stressful lives, and treatments that make us look better often make us feel better. The Medical Board, however, is concerned when medicine is being marketed like a pedicure, and consumers are led to believe that being injected, lasered, and resurfaced requires no more thought than changing hair color. The facts are that these are medical procedures which can in fact disfigure and burn patients. There is real risk, and physicians from Ophthalmologists to Family Physicians (and of course, Dermatologists and Plastic Surgeons) can see their individual medical malpractice policies eroded from these claims.

Medical treatments should be performed by medical professionals only. There is risk to any procedure, many of these procedures done in these facilities are done by properly licensed and supervised aestheticians, nurses or physicians. And, consumers should be aware that some persons and firms are operating illegally. Cosmetologists, while licensed professionals and highly qualified in superficial treatments such as facials and microdermabrasion, may never inject the skin, use lasers, or perform medical-level dermabrasion or skin peels. Those types of treatments must be performed by qualified medical personnel. In California, that means a physician, or a registered nurse or physician assistant under the supervision of a physician.

Just like with our Plastic Surgery Practices, patients should carefully examine the credentials and the experience of the physicians performing the procedures.
Know who will perform the procedure and his or her licensing status: Also, it is important to know how far away the physician who owns the facility will be …although the physician does not have to be onsite, he or she must be immediately reachable.) Again, you should check the supervising doctor's credentials, as well as the nurse or physician assistant. Those Web sites are and

Again, similar to our Plastic and Dermatology Practices, physicians should be careful about how much they advertise, or how much they promise, the malpractice claims in the area of medspa’s can frequently come from exaggerated expectations. Engage in careful client (patient) selection. Careful physician ownership means that you review the model patient selection with the nurses and technicians performing the invasive procedures.

Operate the facility like an outpatient Surgery Facility.
Observe the facility and its personnel: Medical procedures should be done in a clean environment. While one cannot see germs, one can see if the facility looks clean and personnel wash their hands, use gloves, and use sound hygienic practices.

Ask about complications, and who is available to handle them: If you should have an adverse reaction, you want to know who will be there to help. Who should you call, and what hospital or facility is available where the physician can see you? Qualified physicians have facilities or privileges at a hospital where they can handle emergencies.

Don't be swayed by advertisements and promises of low prices: There are a host of medical professionals offering competent, safe cosmetic procedures. If they are being offered at extremely low prices, there is a good possibility that what they are advertising is not what will be delivered. Genuine Botox, Collagen, Restalyne, and other injections are expensive. If someone is offering an injection for $50, when the going rate at a physician's office is $500, then you can be sure it's not the real McCoy. There have been tragic cases of unscrupulous practitioners injecting industrial silicone and toxic counterfeit drugs that have made patients critically ill, caused disfigurement, or resulted in death.

So, of course, there is an element of ‘getting what you pay for’ in this niche of the medical service business. Know that there is a substantial financial cost to obtaining qualified treatments, as well as some risk. If you want the best results, do your homework and only trust those who demonstrate competence and caution.

This is good in terms of warning about risks of medical procedures that are improperly supervised or inappropriately delegated to non-medical personnel. Aptly, the California medical board notes: "The use of the term "medical spa" is for advertising purposes to make the procedures seem more appealing. In reality, however, it is the practice of medicine." This makes the medical board's jurisdiction clear and asserts that even if dressed up as spa, an entity that offers medical procedures will be subject to the medical practice act and its practitioners and owners answerable to a possible charge of unlicensed practice of medicine.
One common question is who can perform certain procedures in a medical spa.

Michael Cohen helps us with those questions as well:

Who may perform microdermabrasion?

This is a helpful rule of thumb: If it's a cosmetic treatment, that is to say it only affects the outermost layer of the skin or the stratum corneum, then a licensed cosmetician or esthetician may perform the treatment. If it's a medical treatment, that is to say it penetrates to deeper levels of the epidermis, then it must be performed by a physician, or by a registered nurse or physician assistant under supervision. Treatments to remove scarring, blemishes, or wrinkles would be considered a medical treatment. Unlicensed personnel, including medical assistants, may not perform any type of microdermabrasion.

It is legal for physicians to hire licensed cosmetologists or estheticians to perform cosmetology services, if they have obtained a facility permit from the Bureau of Barbering and Cosmetology. All licensed cosmetologists, including estheticians, must perform their services in a facility with a permit.

Why can't I use a medical assistant instead of a nurse?

While Medical Assistants are common in medical office practices, they are not required to have any degree, nor do they have to pass an examination or be licensed. For that reason, the law only allows them to perform technical supportive services.

If you see spa’s or medical practices offering these services without proper licensure, you may file a complaint with the Medical Board. To do so, please send the advertisement, the publication name and date, and your address and telephone number where you may be reached for further information, to our Central Complaint Unit at 1426 Howe Avenue, Suite 54, Sacramento, CA 95825. The board will contact the business, inform them of the law, and direct them to cease any illegal practice. If it is simply the advertisement that is misleading, they will be directed to change or clarify the ad.

The Law Offices of Michael H. Cohen offers corporate legal services, litigation consultation, and expertise in health law with a unique focus on holistic, alternative, complementary, and integrative medical therapies. The law firm represents medical doctors, allied health professionals (from psychologists to nurses and dentists) and other clinicians (from chiropractors to naturopathic physicians, massage therapists, and acupuncturists), entrepreneurs, hospitals, and educational organizations, health care institutions, and individuals and corporations.

Michael H. Cohen is Principal in Law Offices of Michael H. Cohen and also President of The Institute for Integrative and Energy Medicine, a nonprofit organization exploring legal, regulatory, ethical, and health policy issues in the judicious integration of complementary and alternative medical therapies (such as acupuncture and traditional oriental medicine, chiropractic, naturopathic medicine, homeopathy, massage therapy, energy healing, and herbal medicine) and conventional clinical care.