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« Medspa Success Key #6: Service | Main | Mona Spa and Laser Treatments: Do physicians get to deciede what 'medicine' is? »
Wednesday
Apr232008

American Society for Dermatologic Surgery pushes medical spas bill in California

crossed%20fingers.jpgI received this frantic email from " Sandy Elliott, CISR, Medspa Insurance Specialist". Evidently Sandy is concerned that her medspa insurance company may not be as relevant if California bans non-physicians from operating, owning or overseeing the operations of medical spas.

"There has been much press lately about California Assembly Bill 2398 & I feel this is such an important matter, that I am emailing information regarding this bill to medspas in all states. If this bill (sponsored by the American Society for Dermatologic Surgery) passes, it could be devastating to California medspas & since California is a bellwether state, it could very well set a precedent for other states to follow suit. Following is pertinent, current information from www.aestheticmedicinenews.com, from an article dated April 16, 2008:

“ The Business & Professions Committee of the State Assembly held a bill hearing on April 9, 2008 at which time the proposed AB 2398 (Amended April 1, 2008) was presented to the Committee. Unfortunately, following a brief discussion and only a few minor changes made, the bill was approved by the Committee.

An amended draft of the bill was drafted on 4-10-08 and was approved by the Assembly Judiciary Committee on April 15th. The bill will now go to the full Assembly where it must be approved prior to May 31, 2008 in order to be sent to the Senate or it will die. Refer to the current attached draft.

This legislation is sponsored by the American Society for Dermatologic Surgery, and if passed will have a monumental impact on physicians, nurses, NPs , PAs and management companies involved in the aesthetic field. Physicians who are involved in aesthetic practices on a part-time basis must be on-site, providing direct supervision of delegated procedures, and must personally provide good faith exams on all patients prior to delegation. RNs will not be allowed to perform any procedures without the physician on-site unless the treatment is performed in a physician owned office with certain restrictions.

Of great note included in this bill is the severe scrutiny of lay (non-physician), corporate owned entities, or management companies, that manage “medspas”, which would deemed to be the “owners / operators” of the practice in violation of the “corporate practice of medicine prohibition.” Entities in violation would be subjected to extreme penalties and even prison time. Physicians supervising aesthetic practices conducted in these entities would also risk penalties and loss of licenses.

Due to the nature of the enforcement of this legislation the Medical Board must opine on its position regarding passage. An important Board Meeting of the Medical Board will be held on April 25, 2008 from 9:00am to 1:00pm to review this amended bill. This meeting is open to the public and opposition will be heard; the location will be the Convention Center 1400 J. Street, Sacramento. Attendance at this meeting and opposition voiced by those concerned is vital, especially nurses and physicians who realize the real patient safety issues involved.

Companies and individuals involved in aesthetic practice operation and/or management must assume an immediate and aggressive opposition to this bill; the consequences of passage, even with significant modification would be disastrous. Letters of opposition, especially sent from your physician and nurses on office letterhead, should be faxed and mailed immediately to the below contacts:

Assembly Members

Assembly B &P Committee

P.O Box 942849

Sacramento, CA 9429-0049

Karen Bass, Majority Leader (916) 319-2147

Mike Eng, Chair (916) 319-2149

Ross Warren, Consultant (916) 319-2149

Alan Nakanishi (916) 319-2110

Judiciary Committee

David Jones (916) 319-2188

Medical Board

2005 Evergreen St. (1200)

Sacramento, CA 95815

Chief of Legislation Linda Whitney (916) 263-2387

You can follow the status of this bill on the legislative website (www.leginfo.ca.gov)

This is an extremely time sensitive matter and your personal involvement is important.”

I encourage all of you to send letters of opposition as soon as possible. I would also like to suggest contacting your own Assemblyman & voice your opposition to the bill. To assist you, I have attached a list of all CA Assembly Members, their District Numbers, addresses & phone numbers. You can also go to http://www.assembly.ca.gov/ to email them (click on Assembly Roster).

Thank you.
Sandy"

Of course, I'm not in California, nor are the majority of medical spa owners who probably received this email. Utah, (my state) already operates under direct physician oversight so I'm well acquainted it. Surface was built physician services and treatments as a foundation rather than as something to be skirted. What will happen I wonder?

Reader Comments (94)

Jeff,
I believe in a previous post you said it was false information re: jail time. According to this bill and the medical board you are wrong. Specifically, "The bill would also provide that multiple
acts by any person or entity in violation of that provision shall be
punishable by a fine not to exceed $25,000 or by IMPRISONMENT in a
county jail not exceeding 6 months, or by both that fine and
imprisonment. The bill would authorize the Attorney General to bring
an action to enforce those provisions."

04.23 | Unregistered Commenteryes!

This is wonderful news to the entire medical community. I hope to see ALL states follow.

04.23 | Unregistered Commentermdr

The real target of this bill are the Management Service Organizations. The only other differences that I can see are the limitation of 4 supervised sites and a physician must see the patient first if services are delegated to an RN. Other than these issues, it is pretty similar to what the medical board now has.

Not once has anyone come forward with any statistical data substantiating their claims that this restrictive legislation would provide even a nominal increase in consumer safety. These pushes have all been emotionally and politically driven.

It is going to be interesting to see if anyone in California will organize and coordinate a counter campaign to keep this legislation fair for all qualified individuals.

04.23 | Unregistered CommenterWPS

I am supporting this bill as a patient and will write to my congressman.

04.23 | Unregistered Commenterrs

What's happening here is that all med spas are being pigeon holed together as if they all operate in the same manner.Just as there are many disreputable and unethical medspas being run by one physician, there are many top quality high standard small medspas that are going to be forced out of business because of the sins of others. The govt needs to deal with the actual problem spas. Start inspecting. Start doing chart audits. Don't punish the entire industry before the wrong has been done. Just because there is an MD after someone's name does not a good practicioner make. I know because I am an RN who has had to continuously train and mentor one of our spa's physicians on skin tightening. He still is not fit to work on our paying clients. Patient safety is sometimes better served by having the nonphysician practitioner do the actual work. AB2398 will only serve to perpetuate the the revenue driven physicians who "oversee" multiple medspas and actually treat no one.

04.23 | Unregistered Commenterccg

Be careful Doctors! If something like this passes it will only be a matter of time until **** rolls down hill. This is obvioulsy and blatently an attempt to control the "market". Once the derms have succeeded in riding nurses and mid-level practicioners, they will then go after the rest of you. Funny.. a nurse can push potasium in the icu, but all ofthe suddend aren't competent enough to inject a few units of Botox or a filler. I think the law should then state that any time a nurse injects at any time (with standard orders written) a physician should be present. Even at 2 am in the morning!

04.23 | Unregistered Commentermwrn

Careful California!

Oversight is needed for patient safety, no question.

All you "non-core" Docs are next. Remember Florida 2006!

The Plastics and Derms slipped it in 11th hour. No one had a chance to lobby.

Everyone was distracted by the Family Practice Association sticking it to PA and NP's.

04.23 | Unregistered CommenterFlorida PA

I just got this email "POWER IN NUMBERS, POWER THROUGH ALLIANCE, UNITED IN VISION™



Regarding CALIFORNIA AB2398

Nurses, Spa Owners, Physician Assistants, and Physicians Who Supervise Medical Esthetic Spas and Practices

Your Right to Practice in Under “Serious” Attack
This is an Urgent Call!!!

THIS IS NOT THE TIME TO SIT BACK and be Cavalier thinking you will be ok. Don’t get caught with your pants down like they were in Florida. IT WILL MOVE FORWARD IF WE DON’T STOP IT.

We are URGING you to WRITE and FAX your letters to the assemblyman below. At the last session none of the email correspondence was even recognized by our illustrious lawmakers. They basically passed the first hearing because as they stated THERE WAS NO OPPOSITION. It makes one wonder what country we are living in when our voices are not heard. Your rights in California are seriously under attack! Your right to practice medical esthetics as you now know will drastically change.

The next hearing regarding this bill has been scheduled for April 25 in Sacramento, CA. It is very important that as many people as can attend. Make time and get up there or you won’t have a practice to think about!!! There is power in numbers let’s show them THERE IS OPPOSITION TO THIS NONSENSE!!!

We must fight back, we did in it Wisconsin, GA, AZ, CO, MASS, other states, WE CAN WIN, but we must be united and each do our part.

WRITE AND FAX YOUR STRONG OPPOSITION TO: Assemblyman Alan Nakanishi’s and Assemblyman Ross Warren’s who are responsible for this bill.

Look up fax numbers of Committee Members: http://www.assembly.ca.gov/acs/newcomframeset.asp?committee=129 "

from http://www.amen-usa.org/

04.24 | Unregistered CommenterLA Doc

Oh, contrar, I am not a derm or plastics however, I do agree with this bill and think it is in the best interest in the safety of our patients. Ask any patient how they feel about this bill and they will agree. We will be in Sacramento tomorrow to show our support ! I am calling on all my current patients to come as well. I have also asked all my patients to write/email their congressman in support of this bill. See you tomorrow.

04.24 | Unregistered CommenterMDD

mwrn makes a GREAT point that should be addressed to legislators!!! This is NONSENSE an nothing more than derms trying to corner in on the market. I'm SURE in the fine print - or last minute changes - will include that derms CAN have their patients treated by RNs. Let's not let this go on.... I think we all need to get involved and put a stop to this.

04.24 | Unregistered CommenterLA Doc

I support this bill 100% and will tell my friends about it. We will be with MDD tomorrow in Sacramento in support. Bye, Bye Pure Medspa, Nuvo Skin International, etc. I can't believe this is an issue. This is better for all of us. I was treated at a medspa and never saw a doctor around. I needed a prescription for a medication from an allergic reaction and no one knew what to do !!! They sent me to my regualar doctor !!!!

04.24 | Unregistered CommenterPatient

Dear Assemblyman Nakanishi,
I am a physician board certified in Family Practice specializing in laser aesthetics and commend you in regards to AB2398 laser procedures. Our office has seen many preventable complications (ie corneal ulcerations, scarring, burns, non FDA approved injections "fat melting mesotherapy", skin necrosis). Although, these may occur in any setting, non physicians may not know how to treat complications which may arise, admit patients to hospitals or emergency room, prescribe medications, etc. I personally feel physicians need to take full responsibility of their patients and deal with any complications which may occur. RN,PA,etc should be used as ancillary staff as is their job description. The physician must evaluate every patient and be on the premises during the procedure at ALL times. Our office, staff and patients commend you and will support this bill.

04.24 | Unregistered CommenterlaMD

While I feel that more regulation is necessary and MD's need to provide the supervision. MD's do need to be able to delegate some procedures to PA's, NP's, RN's, and estheticians. I do not believe dermatologists and plastic surgeons should be given more freedoms than other MD's that have put in the time and effort to get properly trained.

I am curious why the equipment companies are not lobbying to keep the market more open to qualified and trained MD's since if the derms and plastics have their way... they will probably lose a huge chunk of their potential customer base.

04.24 | Unregistered CommenterRichard

Everyone physician should support this bill.

There was a post from a Florida PA warning "core docs" that they'll be next. There are suggestions from many non-physicians that plastics and derms don't want other physicians owning med spas. I don't believe that is the case at all. The problem with the Florida legislation is that it allows a plastic or a derm to operate more than one medical spa. No physician should be able to operate more than one location.

If this bill does NOT pass,the next bill might prohibit anyone but an MD to operate a laser or inject Botox. To any physicians reading this just getting into this business, you may think that you'll perform each and every procedure yourself. Trust me, you won't. Successful physicians who are medical spa owners will find and train fantastic medical professionals to perform some of these services. I don't care what your laser rep tells you, you can't be successful, or even stay in business with only 1 laser and 1 provider. If you have multiple lasers and only one provider that's another problem.


Thanks Jeff for posting this. I received this email as well and I'm glad you're sharing it with others. I encourage each and every one of you to write and to forward this to as many of your colleagues as possible.

Nonderms supporting don't realize the purpose of this bill... is it coincidence its funded by derms??? why should they have multiple medspas, run by nurses, while other docs can't? that's what is coming, support this bill and see or fight this bill. don't let politics blind you.

04.25 | Unregistered CommenterNon Core

Read the law not between the lines or what derms/plastics intend. Many non-core and myself have currently signed a petition in support of this bill. ABC news to focus on this issue next week. Let the patients speak and vote themselves.

04.25 | Unregistered CommenterFPMD

Happy med spa owner

I said "non core" docs. My point is turf wars. Florida allows 4 satellite clinics with PA's for primary care. Specialty 2 satellite clinics. If it is a medspa, derm or plastic must be supervising MD. The senator who sponsored this bill has a derm husband who is well known to be anti PA,NP and also had a personal issue with non core docs and med spas.

This is politics and has nothing to do with patient safety. Has anyone ever looked at average prices for procedures nationwide. CA is more costly in almost every industry, except non invasive cosmetics. This is starting to piss some people off, and this gets the ball rolling. When there is a medspa literally on every corner in every major area prices go down due to competition. Its called capitalism. Instead of doing a better service, just lobby the others out.

I personally don't think any medical act should be done by anyone except MD, PA,NP. This is for patient safety. Lets be real about safety, can a derm who doesn't use lasers indirectly supervise a PA better then a laser experienced GYN? Not in reality, but in state statute yes.

My points are simple ALL docs should pay attention and protect there rights to practice medicine and surgery early. Otherwise you get what I have observed in Florida. Don't think it cant/wont happen.

Another thing to all the MD's who scoff at what I say. What letters on my jacket in no way dictate my knowledge or experience in medicine or any other matter. Remember I can change specialties anytime I choose to use another MD for his knowledge and experience. Being like a permanent resident doc helps to keep the ego in check also.

04.25 | Unregistered CommenterFlorida PA

"This is politics and has nothing to do with patient safety"... THANK YOU!!! at least some people can see between the lines. It amazes me how some physicians miss the big picture and are virtually fooled to support something that is created in part against THEM. If this passes, next comes the Florida law... and like this knowledgeable poster above me from Florida said ITS NOT ABOUT PATIENT SAFETY although that's what the cover might say.

04.26 | Unregistered CommenterLA Doc

Golly Gee!, You guys are starting to sound just like me.

04.26 | Unregistered CommenterWPS

Let’s require physician supervision for all PICC line insertions, intravenous narcotic administration, wound debridement, and all home care visits for that matter, especially chemo and hospice.

Add to that tattoos, body piercing,facials, a hairdo,and massage. These treatments all require one to examine the skin and determine if any disease or infections exist before proceeding. Reeks of the practice of medicine to me!

We do not need more government; we need more marketing, pr, and promotions. We need to stand united as an industry and increase the number of those interested in services rather than fighting for the few that are. America needs these treatments, they want these treatments, They just have not been told they do effectively by anyone’s advertising efforts. Start wagging the dog!

I can't wait till this bill passes. it means that a **** load of so called medspas will now need an MD to be on location. GREAT.

It means that now Medicine will be done by doctors. What a novel idea.

04.30 | Unregistered CommenterEMD

"Evidently Sandy is concerned that her medspa insurance company may not be as relevant if California bans non-physicians from operating, owning or overseeing the operations of medical spas."

It is already illegal for non-physicians to own a medical practice (ie. a MedSpa) in California. AB 2398 helps with enforcement by increasing the penalties and allowing for criminal prosecution for repeat offenders. In California physicians must own the controlling interest in a MedSpa. Other licensed medical professionals can own a lesser percentage (nurses, PAs, etc.) but laypersons (non-licensed) cannot own even a single share or percentage. Corporate chains are barred from owning medical practices. Lack of enforcement by the Medical Board has allowed many to operate in violation of the law - but the Medical Board has recently made it known that they will make a concerted effort to start cracking down. All of these regulations are available from the Medical Board at:
http://www.medbd.ca.gov/licensee/corporate_practice.html

LA Doc,

If the bill supports only Derms to be able to do cosmetic procedures, then the bill needs to be revised. We do have to learn from FL.

05.1 | Unregistered CommenterEMD

“Let’s require physician supervision for all PICC line insertions, intravenous narcotic administration, wound debridement, and all home care visits for that matter, especially chemo and hospice.
Add to that tattoos, body piercing,facials, a hairdo,and massage. These treatments all require one to examine the skin and determine if any disease or infections exist before proceeding. Reeks of the practice of medicine to me!
We do not need more government; we need more marketing, pr, and promotions. We need to stand united as an industry and increase the number of those interested in services rather than fighting for the few that are. America needs these treatments, they want these treatments, They just have not been told they do effectively by anyone’s advertising efforts. Start wagging the dog!”

Could not have said it better myself!
Some just can't see the big picture. Frankly most physicians are not very good business people. Instead of canibalizing think of marketing this industry which has an enornous room for growth and expansion, Scaring the ---t out of your would be potential clients is not the way to gain market share.

05.9 | Unregistered CommenterFN,MD

California bill status:

According to the amendment on May 5, the derms have backed off of everything with the exception of trying to run the management service organizations out of business.

Watch out non-derms and plastic surgeons, you're next!!

05.14 | Unregistered CommenterWPS

I wasnt even aware!

But fingers crossed the bill will be passed!

I agree with CA Consumer

Doctors be careful of what you ask four. This seems like just the tip of the iceberg … The Derm’s and Plastic Surgeons obtained this language in a Statute in Florida. I have spoke with a few MD/DO’s and it is the general consensus that is if Florida rule was challenged it would probably be defeated as every full licensed MD/DO has the same practice rights by Statute (I am not including doctors that have been disciplined and lost some rights). This allowed a finite group of BE/BC doctors to have a greater latitude in practice scope. This is just food for consideration, and in my opinion it is much harder to get something back after you lose then to fight to keep it.

05.28 | Unregistered Commenterjamie

I am a nurse practitioner in a medical spa setting and also work in an internal medicine practice and emergency room. I am unsupervised and work independently in all settings. The procedures I perform in internal medicine and in emergency are more invasive than what I do in the medical spa setting. An example would be Adenosine into a vein to slow a heart rate down compared to an intramuscular injection of Botox. Lumbar puncture vs injecting Restylane into the nasal labial folds. I have beeen educated to treat and diagnose conditions. Nurses work independently in Nurse Clinics doing injections and dressing changes. Home Health nurses work independently and perform chemotherapy treatments in the home. This issue is really about the money!!!!

I support the measure in California. This measure is already in the State of Washington and there doe not seem to be much problems. One difference is that NPs were not included in the language. PAs, RNs and non MD are not allowed to own or run a Medspa that deals with lasers, botox or other injectables. It is not so much doing the procedure ie. botox or dermal fillers or even lasers... it is the question as to knowing the intimate details of the human anatomy, physiology and biochemistry that is needed when an MD injects these chemicals. Any tom, dick and harry can be taught how to draw fluid into a syringe and poke it into the face at a certain "landmark" on the skin. However does this person know the science behind what is being done and why? Also if there was a complication does he or she know what to do?? or is he or she going to be sending the patient to the ER or MD clinic to have the "Physician" bail them out of a complication. I hate to say this but YES this is about turf, MDs have spent many many hours studying and training . Hours in the hospital, sleepless nights taking care of patients, understanding the science and etiology of disease processes. We do not want to trivialize procedures as there is significant consequences when this is placed in hands of non MDs.

06.4 | Unregistered CommenterSLMD

I also think that the argument about NPs knowing how to inject or administer drugs or perform procedures thus making them proficient in other areas of medicine is CRAZY.. if I am not wrong, NPs are trained in MD Offices and usually their scope is limited to what the specialty they are being trained in. So they can be proficient in a very focused area of say... oncology. They have limited exposure to the other aspects of medicine like COPD, Heart disease etc... That is why MDs go to medical School to do.. to get a more detailed education and broader knowledge of the science of the body and how to deal with diseases.

06.4 | Unregistered CommenterSLMD

MDs and DOs go to 4 years of medical and complete a post graduate training... go through sleepness nights and become licensed to practice medicine. They may write orders for nurses to perform invasive procedures as long as they are within reach. I'm sure you've seen this, as I have, during training. Why on earth should botox and restylane and lasers be the "exception"? Please see jamie's post a couple above you. There many exceptions that these specialists are trying to make to how medicine has been practiced for decades, if not over a century, in this country. And they've succeeded in Florida... and this is the process to get the same exception done in CA. What you see isn't the final desire of these specialists... and by the way, did you know a large portion of Derm docs weren't trained in these procedures when they were doing residency? These procedures weren't even allowed when they were trained... so what justifies them to own several clinics and the FP doc to own only 1? That is what is coming - I know that's not what this bill says before ammendments.

06.4 | Unregistered CommenterWhat

SLMD,

I am not sure if you understand the Nurse Practitioner Scope of Practice. Please read Section 2834 Nurse Practitioner, California Code of Regulation. Note the area on Standardized Procedures. I do not need to have the Physician at my side at all times. I can collaborate by phone or ask them to come in if needed.

In a brief summarization the NP is allowed to provide a broad range of health care services, which may include:

• Taking the patient's history, performing a physical exam, and ordering appropriate laboratory tests and procedures
• Diagnosing, treating, and managing acute and chronic diseases
• Providing prescriptions and coordinating referrals
• Promoting healthy activities in collaboration with the patient
• Performing certain procedures such as a bone marrow biopsy or lumbar puncture

Nurse practitioner work in a variety of settings, including DERMATOLOGY!
Family practice, women's health, pediatrics, geriatric, neonatology, school health, emergency, oncology, cardiology, nephrology, and primary care. NP’s are trained in multiple settings.
In all of these settings the physician is not always on site, we call if we need them. I have performed Restylane, Botox, Laser hair, Vein, Tattoo, and Pigment removal for 6 years and have had to call on the M.D. only 3 times. I have had to call more in the Internal Medicine environment if a concern came up.

Why the M.D. on site at all times only in the Med Spas and not in other clinical settings?
Why can a NP exam diagnose and treat in all settings except a Med Spa setting?
Why can a NP diagnose and treat Congestive Heart Failure and not diagnose Excessive Hair Growth that is unwanted by the patient?

FYI: You can not obtain malpractice insurance for a Medical Spa without proper proof of training in Medical Aesthetics. This is not the case for all other setting, which you only need proof of your license.

I have also spent many sleepless nights preparing for exams and performing numerous clinical hours. To become a Nurse practitioner takes about 7 years of schooling, did you know that?

Sorry SLMD,
I still think it’s about the MONEY!!

How about better training and continuing support for ALL providers. The Laser Companies, Allergan and the rest to a poor job of keeping us informed about new developments, they do a poor job of communicating complications and innovations and they actively keep us from communicating with each other so we can learn from each other.

The Laser Companies and Allergan are in danger of killing the golden goose with their corporate lawyers and their fear that open and honest communication will be a BAD thing.

We will all get much better results and much less complications if we have better continuing education and Clinical Exchange Programs. All providers can participate from the midlevels to the derms to the plastic surgeons. BTW, Derms and Plastic Surgeons don't know how to do this stuff either.

My point is that there has to be a new focus and a new emphasis on sharing good and bad information so we all have a steeper learning curve which will result in better clinical results, reduced complications and a better ability to handle complications when they occur.

06.10 | Unregistered CommenterMDR

The solution is simple: Form a Board certification or any state recognized certification for training in minimally invasive aesthestics that med spas have... if the MD/DO have the proper cert. then having a nurse there perform what the dr. prescribed should not be a problem...

06.10 | Unregistered CommenterMaker

The problem with many but all physician extenders (PA's, RN's,NP's) is that they don't know what they don't know. My only lawsuit has been from a nurse that burned a patient and caused hypopigmentation. I agree that free standing Med Spas need a physician that is trained and credentialed for everything done there. It is a turf battle; the physician is ultimately responsible for any problems. These treatments are the practice of medicine.

06.11 | Unregistered CommenterAnthony7

just got this:
June 11, 2008

Inasmuch as the Assembly passed AB2398 on May 12, 2008, opposition has been focused on the Senate Business and Professions Committee. On June 5th and 6th, 2008 our lobbyist, California Advocates, Inc and other lobbyists jointly held individual meetings with representatives of the following B & P Committee Members regarding the bill:

Senators
Representatives


Mark Ridley-Thomas
Rosielyn Pulmano

Dick Ackerman
Amber Throne

S. Joseph Simitian
Anthony Sanchez

Leland Y. Yee
Jordan C. Curley

Jeff Denham
Jennifer Tannyhill

Tom Harman
Braeden Huusfeldt

Ellen Corbett
Satinder S. Malhi

Dean Florez
Bob Alvarez

Ronald Calderon
Elise Flynn Gyore

Sam Aanestad Linda Anderson

The responses to the points of opposition discussed in these meetings were generally favorable, and it seemed likely that the AB2398 would not be approved at the B & P Senate hearing scheduled for Monday, June 9, 2008. A competing bill, SB1454 (Ridley-Thomas) (CLICK HERE), also dealing with the regulation of cosmetic laser treatment, has been passed by the Senate. This bill is not an attempt to close medspas, but further directs the Medical Board and Board of Registered Nursing to draft guidelines for increased medical supervision and training requirements for laser and cosmetic procedures.

At the Senate B & P Committee Hearing on June 9th, after presentation by several proponents and substantial opposition, AB2398 was not approved, and therefore will not proceed in this session. The B & P Committee recommended that additional collaboration between interested stakeholders and representatives of both the Senate and Assembly collaborate on legislation to specifically address the issues of medspa supervision, training requirements and corporate practice of medicine violations. Of pivotal concerns are patient safety, the challenge of RNs performing procedures independently and the ownership and control of cosmetic centers.

The California Medspa Management Association (CMMA) will continue to oppose AB 2398 and specific terms that its sponsors will attempt to have included as amendments to SB1454 during the next few weeks as it goes to the Assembly. Inasmuch as it is apparent that some legislation regulating aesthetic medicine will be approved, we are now coordinating meetings to work on this legislation. We are developing network linkages with several other groups and associations with similar objectives. This collaboration effort will require many hours and substantial expense.

We again invite all those interested in supporting the opposition restrictions on aesthetic center operations to join as a member of the CMMA prior to June 20th. As a member your review, input and support regarding any proposed aesthetic legislation is important. We will hold our organizational meeting for the over thirty members of CMMA on June 23, 2008, at which time the initial Board and officers will be appointed and direction for the legislative efforts discussed.

Thank you for your continued interest and support in this effort.

Norman C. Davis, Esq.
Acting President/ Legal Counsel
2677 North Main Street
Suite 930
Santa Ana, California 92705-6632
(714)835-1600
(714)835-3227 (Fax)

06.11 | Unregistered CommenterLA Doc

Anthony7

Do you think Physicians know what they don't know?

06.11 | Unregistered CommenterFlorida PA

Florida PA,
Some do. The sepcialists and subspecialists usually do. The Docs doing treatments outside of their area of expertise often don't. The problem is there such a large amount of information out there that it is difficult to keep informed. My point is someone without physics/chemistry to understand lasers does not realize how many variables there can be for a given treatment.

06.12 | Unregistered CommenterAnthony7

Susan thats the problem. We should have never let NPs do this in the first place. OUR BAD.

But your still not a doctor. So sorry. We don't want you near our patients without us telling you what to do.

We are the doctors.

06.12 | Unregistered CommenterEMD

Anthony, last time I checked most docs had to have lots of physics and chemistry to go to medical school. NPs on the other hand???????????????

06.12 | Unregistered CommenterEMD

FYI EMD and ANTHONY: My Drs. want me around their patients and they also agree they are my patients too!
It’s nice to be in an environment where the Nurse Practitioner and Physician work collaboratively.

I work in a Medical Spa Setting, I have performed over 40,000 procedures in the 6 years we have been open. I have agreements with several organizations to provide, at no cost, tattoo removal for gang members and parolees, teenagers and military recruits. We provide services for blue collar workers that would never be able to afford the treatments anywhere else.

- As a Nurse Practitioner I am allowed to provide care in a primary clinic without a doctor present (Drs. are okay with that)
- I can run a dialysis center without a doctor present (Drs. are okay with that)
- I can transport critical patients from an accident to hospital via helicopter or ambulance without a doctor (Drs. are okay with that)
- I can run an immunization clinic without a doctor on site and they're okay with that
- I can run a weight clinic without a doctor on site and (Drs. are okay with that)
- In rural areas Family Nurse Practitioners are the doctor, because they are the only one's available and (Drs. are okay with that).

This bill mischaracterizes the medical aesthetic field as ruff and dangerous and that is simply not true. I do believe that some of the practitioners need to be better trained but that is the issue not the fact that the doctor is present or not. This bill is about doctors who want this lucrative business kept to themselves costing everyone more money.

Susan, I told you, that is the problem. "doctors are ok with that".

It is this line of thinking that got us screwed by the insurance companies.

Why didn't you just go to Medical School? Doctors would be ok with that too.

06.12 | Unregistered CommenterEMD

Anthony7

I think you have a valid point. You mentioned the problem being "such a large amount of information....". There is a problem for the problem. With such a vast ever increasing volume of knowledge and information in every aspect of medicine, a Practitioner could not know everything about everything. For this to be regulated and enforced strictly would be a logistical nightmare. Not to mention the cost and man hours involved. So legislators let Practitioners work on the honor system so to speak. Most state statutes address this issue by stating "within scope of practice....educated and/or trained...
The problem with this is people empower themselves above and beyond scope,training and experience to make a few extra dollars. I don't know how this can be regulated with the pt safety issue number one, or without excluding Docs with a licence to "practice medicine and surgery". If this not done carefully and fairly it may have a ripple effect into other aspects to the point of being counter productive and absurd. Would anyone treat sinusitis knowing if the outcome was not favorable they could be sited with negligence because they are not an ENT?

I know my example is extreme. My point is this needs to be approached with caution for the safety of the patients and the good of the professions.

I had calculus, calculus based physics and plenty of chemistry as prerequisites for my PA education. I assure you this is no substitute for asking someone with more knowledge and experience a question before I proceed.

06.12 | Unregistered CommenterFlorida PA

The other problem in Medicine:

PA's and Nurses after start to think the are somehow an authority and their opinion counts.

06.13 | Unregistered CommenterEMD

emd

You are so full of yourself you don't really deserve a response. If you opened your eyes you would realize you are giving yourself a colonoscopy. Do you feel threatened or is it just the God Complex?

Your piss poor grammar really drives the point home on what an authority you are.

Use the spellcheck GENIUS!!

06.13 | Unregistered CommenterFlorida PA

Florida PA

Even in my worst piss poor grammar day, I'm a better clinician than you will ever be.

Genius. Thanks for the compliment.

I don't feel threatened I just can't stand the downward trend in medicine we are experiencing by using PAs and NPs.

As far as the colonoscopy goes, you sound like you are speaking from experience.

You didn't really deserve a reponse either because I don't answer to PAs or NPs.

06.13 | Unregistered CommenterEMD

FloridaPA

One last thing before I never respond to you again.

Don't kid yourself. If you think that any physician will ever truly take you serious. Even the ones that do, dont.

06.13 | Unregistered CommenterEMD

emd,

You are pathetic! Some Doctors on this blog may not be crazy about PA's and NP's, they will comment or state an opinion which everyone is entitled to. These Doctors do so while keeping their professional integrity intact, you however do not.Your ignorant comments and profession bashing are more suited to the ill mannered child on a playground, not from a professional Physician. You are a disgrace to yourself and a disgrace to Doctors everywhere.

"As far as the colonoscopy goes,"...yes I speak from experience, I have seen many people with their head up their ass.

Unfortunately for you PA's,NP's and nurses have been and integral part of medicine for many years, and will not be going anywhere soon.

Hopefully you will keep your word and not respond. I'm sure PA's,NP's and even some of the Doctors have had enough of your nonsense.

06.13 | Unregistered CommenterFlorida PA

EMD - which part of the downward trend in medicine are you blaming on PAs and NPs??

06.13 | Unregistered CommenterLA Doc

LA Doc

When an otherwise respected professional gets that bitter and nasty it usually has something to do with their bottom line. Rants like this are nothing other then a distraction from the issues we are trying to discuss with each other. It may also be stopping others from coming foward with some insight or useful info for fear of being attacked or profession bashed. This person never has anything of worth to say, it is always complaining about things, or taking jabs at other people. Even other Doctors. I wouldn't expect any wisdom if he answers your question.

06.13 | Unregistered CommenterFlorida PA

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