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Wednesday
Aug012007

Florida Chiropractor offering IPL.

A8410D-md-b.jpgI was having a discussion with one of my consulting clients today and he dropped this nugget on me.

There's a chiropractor in Florida who is telling other chiropractors that IPL is within their scope of practice. In fact, he's training other chiropractors and selling them equipment. Here's his site: BioDerm Medical Incorporated .

You'll notice on the about page that he's got an MD and is, "licensed to practice Chiropractic Medicine in FL and KY.  He is licensed to practice Oriental Medicine and Acupuncture in WV, and is registered to practice Medicine in Montserrat."

That Monserrat medical 'registration' seems like it may come in handy.

According to this chiropractor:

  • IPL is within the scope of practice of DC's since they can use light based therapy's.
  •  He was hauled in before the Chiropractic Board of Florida and successfully defended himself by showing that: Although the state of FL regulates IPL as class 4... it's really class 2 and he proved it. The state dropped the entire investigation.
  • Any other chiropractor can do the same thing.
Since the recent changes in Florida prohibiting non plastic surgeons and dermatologists from overseeing second clinics. This seems odd to me.

Reader Comments (206)

There seems to be two questions here. (1) is IPL skin care and hair removal within the scope of a Chiropractic practice and
(2) is IPL a Laser or Light based treatment.

Regarding the first concern, I'm not a Chiropractor and am not familiar with the regulations regarding their scope of practice, and, therefore, do not feel qualified to comment on this question.

However, I am very familiar with regulations regarding the classification of Lasers and Light based treatment. As I have posted in other sections, It seems that state boards are continuing to tighten regulations regarding the classification and use of these systems.

In NJ, one of the most ridgid states regarding these matters, not only have they limited the use of these systems to "plenary licensed physician" they have also amended the state regulations to include IPL as well as Lasers into the Laser class.

The following are excerpts of those regulations copied from board communications and their website.


"LASER-The Board of Medical Examiners has consistently taken the position that the use of a laser is an invasive procedure which is the practice of medicine and may not be performed by anyone other than a plenary licensed physician. Also, please be advised that the board has amended its regulation to reflect this position."

And regarding classification of IPL:

This is and excerpt from the Medical Board minutes of their meeting on September 10, 2003.

Amendment 3:35-6.14-Delegation of Physical Modalitiesto a licensed Health Care Provideror unlicensed physician aide.

"The Board, upon motion and seconded, amend the definition of Laser to read as follows:"Laser"is defined as a device emitting electromagnetic radiation in the visible light or infrared spectrum either cohrent or incoherent, monochromatic or polychromatic from which protons form a tissue interaction with a photo-biologic effect, including an interaction with the skin, its layers or appendages. The board voted to publish this amendment in the NJ REGISTER for notice."

As you can see, in NJ IPL and Lasers are now BOTH classified as a Laser. This amendment would preclude someone from claiming use under scope of care unless they where physicians. The FL chiropracter WOULD probably BE IN TROUBLE NJ.

08.2 | Unregistered CommenterJRAMD

JRAMD and Jeff: This is certainly an interesting topic and even more complex than the issues raised in the above discussion. You are probably aware that chiropractors, PTs and others are routinely using low level lasers for pain management and certain other applications--usually with the approval of their state regulatory boards. I am sure they will be arguing that human tissue is human tissue and that if they are authorized to use light therapies for certain applications what is the difference if they also use them to disable hair follicles? They are also licensed health care practitioners so they arguably pass muster for the federal regulations for use of prescription devices.

Med Spa Guy; Apples and oranges!!!!!!!!!!!!!
Most providers other than MD's typically use 'cold' or low power lasers for their treatment modalities. High power theraputic equipment usually requires an MD license for purchase or sale. The lasers used by chiros/PT for muscle repair are cold and claim to stimulation increased blood supply. These lasers are also used for smoking cessation and hair regeneration but are (typically) not powerful enough for hair removal or skin care.

08.2 | Unregistered CommenterJRAMD

Well what a great topic I read the nugget droppers comments as well as the other ones.

I think the first problem arises when you have poor definitions or improper usage of terms from so called experts. .

I would like to start out with Class I-IV ANSI American National Standards Institute
has nothing to do with FDA class I-III, devices. When talking about the FDA and medical treatment which includes chiropractic, allopathic and osteopathic treatments the FDA regulates equipment more so then it does a physician (except if you do you homework will find Case Law in PA where the higher court ruled that the FDA does have a right to regulate physicians. Companies are required to obtain 510K prior to marketing most Class II medical devices and there are even more regulation on Class III devices.

The overall consensuses are that physicians can use Non-FDA registered devices and can use registered devices for off label use. However legally it appears that there are much greater liability issues when using a Non-registered device compared with using a registered device for off label use. I understand that to some it might seem that I got off on a tangent however I thought since Nugget started off with some misguided information I would first address that. Nugget also leads the readership astray with the comment in reference to IPL classification in Florida. Florida basically had adopted the FDA definition of what is a LASER and Florida requires registration of class 3b and class 4 LASERS. It does not classify IPL as LASER’s nor does the FDA. I am not sure of NUGGET training just that he/she is clueless.

On the other hand I agree with JRAMD that NJ chiropractors can not use IPL/LASER not because of definition but due to the chiropractic state law. I am not sure if JRAMD knows this or not but in most states specific Boards govern those licensed under that board. The Board of Medicine has no power over any other Board as long as the licensee is practicing within their specific scope. Since this article is a spin on Florida first I will continue with FL.

If you read chapter 460 which is the chiropractic practice act you will understand how it is in the scope for a chiropractor. If at first you have problems understanding that the skin is part of the body and that light is light (there is one form specifically excluded form treatment by a chiropractor and that is X-Ray). Do not feel bad because most health care attorneys in FL do not understand that fact either nor did the chiropractors that found probable cause to move this case forward. You see light is a very broad term and includes the entire spectrum of eelectromagnetic radiation of any wavelength

I guess it is time to tackle NUGGETS ignorance again because chiropractors can use LIGHT ( and LASER is LIGHT). So chiropractors can use IPL but also Non Ablative Laser’s …Class 4 Laser’s. So much to Nuggets surprise (if they ever re-visit the site) will be that he/she even posted such garbage in the first place or continue to keep their head in the sand. I would hope if I ever attack a person/profession I do not end up looking as ignorant as NUGGET (you also misspelled Montserrat).

Lastly, it is not puzzling to see State Boards incorrectly defining things nor does it surprise me that many MD/DO have very little knowledge in reference to Light. It is a relatively specking a newer modality and the pharmaceutical reps do not bring them light info as of yet. It is and never will be the letters behind ones name that makes them smart. Signing off

08.2 | Unregistered CommenterFL DC

If you correct someone you should correct yourself also.

Eelectromagnetic=electromagnetic

specking =speaking

08.3 | Unregistered CommenterFL DC

Sounds familiar. Chiros seems to like to push their limits and do procedures which are not within their scope of practice. Medical doctors who are busy with their own practices, have not been vigilant about these incursions.

09.26 | Unregistered Commentermedspadoc

I looked up Florida's Chapter 460,which are the rules for Chiropractic Physicians. Nowhere in it did I find any regulation that either permits or excludes the use of lasers or IPL for chiropractic physicians. It didn't even seem to be discussed at all. DC's can not use acupuncture or prescribe legend meds ...but the use of IPL and laser seems to be a "grey area".

Can you share with us the specific rule(s) you were referring to, FL DC?

09.26 | Unregistered CommenterTF

I believe TF, the sections which allow diathermy (IR technology with deep heat), theraputic ultrasound w/ or w/o phonophoresis, and other light therapies are all under the scope of 460 in Florida.

I am not sure why mespadoc, or any other should be that concerned with this incursion from Chiropractors, since it does not puncture the skin, and they will be held accountable for any miss steps in care, like any other physician.

Likewise, I am sure you find it irritating when a plastic or Derm implies that a FP, IM, EM doc are venturing into areas beyond their scope.
I find it somewhat hypocritical to now say the same of a Chiropractor. Its strictly turf war and money, period.

09.28 | Unregistered CommenterDRD

The use of lasers as well as IPL's can cause severe and disfiguring complications. Chiropractors have neither the training nor the knowledge to manage these problems. Their training does not qualify them to enter this field. I can guarantee that since PIP laws are either ended or will be radically modified, chiropractors will be trying to enter this area of Medicine to replace moneys they will no longer be getting.
Chiropractors believe the Physical Diagnosis course they take in school is equivalent to the ones given in Medical School. They have no clue! I have known chiropractors who think they can do prostate exams, fundoscopic exams,as well as work and school physicals which require a cardiac evaluation. They have gotten away with too much because of the lack of vigilance by the Medical community.
The use of an IPL and a powerful Class 3 and 4 laser for hair removal can cause permanent hypo or hyper-pigmentation, or severe burns.They also have no trainimg in any dermatology or dermatopathology. It would be easy for them to miss a premalignant or malignant lesion -with dire consequences for the patients.
I recommend that the Medical Board educate the appropriate government departments to demonstrate that laser hair removal and light treatment of the skin is the Practice of Medicine and should be restricted to the Medical field.

10.3 | Unregistered Commenterska

TF Please read below and pay attention to treat the human body and LIGHT below. It just requires knowledge of the English language. Skin is part of the body and Laser/IPL is LIGHT. I also highlighted Acupuncture because you erroneously stated Chiropractors could not do this either in Florida.

For all: I teach Light to DC/DO/and MD’s…. Most know very little about light. Thus DO and or MD does not equal They know everything about medicine…..

Chiropractic physicians may adjust, manipulate, or treat the human body by manual, mechanical, electrical, or natural methods; by the use of physical means or physiotherapy, including light, heat, water, or exercise; by the use of acupuncture; or by the administration of foods, food concentrates, food extracts, and items for which a prescription is not required and may apply first aid and hygiene, but chiropractic physicians are expressly prohibited from prescribing or administering to any person any legend drug except as authorized under subparagraph 2., from performing any surgery except as stated herein, or from practicing obstetrics.

11.13 | Unregistered CommenterFLDC

FLDC - I hate to say this, but your post sounds like you have a bit of a chip on your shoulder. My knowledge of the English language is, I believe, more than adequate, thank you.

I'm merely pointing out the existing regulations as I read & interpret them - the Florida Board of Medicine has defined IPL as being in the same category as laser treatments, despite introductory level physics to the contrary.

So far, the only specific laser regulation I've seen for DC's is the permission to perform laser or IPL-based hair removal. If you can share specific declaratory statements on lasers and IPLs to support your position, I'm sure that the readers here would appreciate it.

For the moment, however, according to the Board of Medicine, IPL = LASER = MD, DO, PA or ARNP usage under protocol (except for laser electrologists and HR).

11.13 | Unregistered CommenterTF

TF
I would recommend you reading my first post. I pointed out that if the Board of medicine wants to define IPL Laser atomic bombs I do not care. I am only concerned with practicing within my scope. As long as you do that you will not have to worry about turf wars. If you still do not get my point read then re-read Chapter 458. If you still do not GET IT then refer to the post again where I state it requires command of the English Language.

11.22 | Unregistered CommenterFLDC

FLDC: I'll deduce from your reply that you still do not have a specific declaratory statement from the Florida Board of Chiropractic Medicine on laser use by DC's to support the legitimacy of your claims.

11.22 | Unregistered CommenterTF

Chiropractors have more diagnostic skills than realized by most medical doctors. They are trained to recognize different skin lesions. It is time for the chiropractors and allopathic doctors to become patient centered and work together...

11.29 | Unregistered CommenterNMDC

I'm all for patient-centered care, NMDC. What we were trying to sort out here was the specifc legal status for a DC in Florida to use a laser to treat veins, skin and hair. I'd like to see some specific documentation, so that other readers of this site can be given good & correct guidance, and not put their licenses in jeopardy.

11.29 | Unregistered CommenterTF

The difficulty with comprehension of the legal status and scope of practice for chiropractors is related to the lack of uniformity. Certain state laws present a narrow scope of practice and others are broad in scope. In Florida, it is my understanding that chiropractors are permitted to perform IPL for veins, skin, and hair. I suspect that FLDC has experience with the Chiropractic Board of Examiners in Florida.

11.29 | Unregistered CommenterNMDC

FLDC:
I have checked on your website. I do hace to say there requires much good information to educate professionals on the understandings of laser and its applications. Your site is quite informative. I noticed you also said in there that there was "nothing more important than patient safety and treatment efficacy" Having said that, I noticed that you recommended treating hair "reduction" on Fitz IV-VI using 690nm.
1) Is/are there any scientific paper(s) attesting to 690nm "safety and efficacy" to these populations?
2) I assume you have used this setting in your practice, what kind of fluency/pulse width do you do on: first visit vs second visit vs third visit and at what intervals??
3) How many of these IV-VI patients have you treated??? What is the rate of adverse reactions and rate of "effective hair reduction"??? What is your definition of an effective hair reduction???
4) For adverse reactions, what is your treatment for hypopigmentation???
5) Does your manufacturer advise this 690nm for fitz IV-VI????
Thanks

11.30 | Unregistered Commenterpmdoc

I'm still in love with the woman on his site. LOL. Or lust. Whatever. I love her.

12.5 | Unregistered CommenterJarvik7

Jarvik7:
I am sure she is very hot. However, I am sure you would agree that laser services are serious ones both for sakes of safety and effectiveness. I am still waiting for FLDC to reply to my last posting.

12.7 | Unregistered Commenterpmdoc

Jarvik7:
I did check out "that" site, pretty interesting. I wondered if DC's have to provide patients with "informed consents" prior to their treatments then how this would impact their practice, thus existence altogether. By the way, did you read my posting under "what are the negatives to providing laser services in your office?"

12.11 | Unregistered Commenterpmdoc

Yes I did and thank you for the tips. Much appreciated.

12.12 | Unregistered CommenterJarvik7

Dear pmdoc,

I am sorry for the delay that upset a few. I have not been back to this site till today.
Implicitly I acknowledge the lack of genius from some of the comments posted on this site (I have a life and last time I checked I did not sign anything stating I would answer question on your time guidelines) to answer your question first I will have to correct your error. On a website that I will assume you are writing in reference to www.biodermmedical.com it states IV-V not VI as you have stated. So maybe this is enough to answer you curiosity. I personally agree with this site and would not use IPL on skin type VI. If you desire to learn more I would suggest going to more classes. I will also recommend a few books Light-Laser light dynamics by H. Haken, and/or Lasers in Medicine by Ronald Waynant.

02.19 | Unregistered CommenterFLDC

FLDC:
Thanks for your kind response. Maybe including type VI was an inadvertent oversight of mine. However please kindly address my 5 questions posted on 11/30/2007 based on your voluminous experiences in laser treatments for which I am sure ALL OF US can greatly learn from.

02.19 | Unregistered Commenterpmdoc

FLDC:
I went back to your website, here are some quotes from it:
"...#6: what about tattoo removal: Our laser emits short pulses of light in 532nm and 1064nm. THis allows the practitioner removal of tattoo pigment of virtually of the full spectrum..": Any pictures of yours to share with us from your "intelligent IPL" machine in this regard???

#5: What the non-ablative skin rejuvenation: "...Fine to moderate rhytids and ACNE SCARRING have BOTH responded to light based treatments (which I presumed your "intelligent IPL machine AGAIN"), which cause tightening of the skin via collagen neogenesis.." : Should we, medical physicians, nominate you for the Nobel Prize in Medicine for 2009????

02.19 | Unregistered Commenterpmdoc

Dear Professor FLDC:
You mentioned under #3: How does the physics of LIGHT play an important role in treatment of the body: @ 4th paragraph: To achieve this goal, the concept of thermal relaxation time must be understood and applied (GREAT TEACHING POINT, by the way). Since you told us that your "intelligent IPL" is the BEST light based machine invention since sliced bread (alas!!) please enlighten us with your (pulse width, fluency, post cooling settings) protocols with using 8mmx40mm POLYCHROMATIC 585nm head for leg veins???? Again, I am still reserving my Nobel nomination for you.

02.19 | Unregistered Commenterpmdoc

Oh, this is great stuff.
After the case mentioned above with the DC and the DC board. In 2006 the DC board put a "resolution" in the minutes. It stated DC's can do hair removal and were exempt from the 30 hour laser hair removal course. The reason was based on decades old Fl statutes saying DC can treat the body with "light". The argument could have gone the other way also. Fl statutes (One paragraph before the one FLDC quoted on 11.13.07) DC's can diagnose and treat DISEASE with light etc. I thought hair was normal anatomy. The board of medicine stated in minutes (2006). Laser/light on skin is the practice of medicine (DO,MD,PA,NP) exception was 30 hour course for hair removal done under direct supervision of doctor.

DC board "opinion" does not make this legal. They have no law making authority. This is no more then gross manipulation of the law for a self serving purpose. Same reason if a Doc Is disciplined by board, and doc disagrees it goes to appellate court. Here a Judge uses Law (Fl statute) to see who is right. In Fl loser pays winners legal costs.
To tell other DC's this is legal is actually practicing law without a licence.

DC could use this to justify ALL cosmetic lasers, but FL statues mentions Class of laser II can be used.

Do you think in a state where MD's eat there own this will fly?
I heard Board of Medicine is attaching words to several bills in this years legislation to close this loophole. We will see.

02.21 | Unregistered CommenterFlorida PA

I am just amazed such scenario would be allowed to happen in FL. THis guy (behind the back of an MD) is taking money from newly interested MD and other allied health professionals in FL to conduct these "laser seminars" espousing the ALL-IN-ONE (One size fit all) IPL's bullshit of his charging thousands of dollars. You folks in FL should attend his seminars and expose his operation. I am still waiting for his prophetic guidances on my impending inquiries (cough cough)

02.22 | Unregistered Commenterpmdoc

pmdoc....the quote on tatoo removal was referring to his Q switch ND:YAG LASER not the IPL machine they sell.

03.12 | Unregistered Commenterdrjhkdc

drjhkdc:
Thanks for your defense of him. But based on his OWN website, he touted those ALL-IN-ONE and ONE-SIZE-FIT-ALL functions strictly on his IPL, apparently the world's most significant discovery since Ian Flemming found penicillin I surmised. By the way, are you an MD?

03.13 | Unregistered Commenterpmdoc

OT: Alexander Fleming discovered penicillin. Ian Fleming wrote the James Bond novels.

03.13 | Unregistered CommenterTF

LOL, you are right. Thanks TF

03.13 | Unregistered Commenterpmdoc

I am getting the information off of his website. They sell 2 machines. The IPL and Q switch ND:YAG LASER . The laser is the one he promotes for tattoo removal not the IPL. I guess you didn't read the website carefully.

03.13 | Unregistered Commenterdrjhkdc

And no, I am not an MD. They sell 2 machines,


MACHINE 1

Derma-Clear™
Light Source: Full Spectrum Xenon Flash Lamp IPLS
Optical Blue Sapphire Lens Adapters: 4 standard (410-1200nm and 690nm-1200nm optional)
Spectrum Range: 410 nm to 1200 nm
Filters: 410nm-1200nm, 530nm-1200nm, 560nm-1200nm, 585nm-1200nm, 640nm-1200nm, and 690nm-1200nm. Spot Size: 8 mm x 40 mm
Fluence Range: 5 adjustable settings
Pulse Duration and Mode: variable
Weight: 44 lbs
Power Requirements: 110 volt 60 cycles

Optical Light Spectrum Filter Treatment Head and Indications
410-1200 Mild to moderate inflammatory and pustular inflammatory acne vulgaris

530-1200 Rosacea, hemangiomas, pigmented lesions

560-1200 Lentigenes, skin toning

585-1200 Vascular lesions, leg veins, pigmented lesions

640-1200 Pseudofolliculitis barbae, hair removal

690-1200 Pseudofolliculitis barbae, hair removal of type IV & V skin types


MACHINE 2


Photo - Dyne l™

Specifications:

Laser type: Q switch ND:YAG

Wave length: 532 nm and 1064 nm

Pulse width: < 10 ns

Energy: 300 mj -800 mj

Spot size: 1-5 mm

Repetition rate: 1-6 Hz

Cooling system: Closed H2O and ambient air circulation

Power supply: 120V 60 cycles, or 220V 50 cycles

Weight: 40 lbs

Indications breakdown by wavelength:
1. 532 nm wavelength:

- removal of light ink (red, tan, purple, and orange) tatoos and removal

of pigmented lesions, removal of vascular lesions, treatment of

Lentigines, treatment of Cafe-Au-Lait, treatment of Common Nevi,

treatment of Seborrheic Kearotoses, treatment of Post Inflammatory

Hyperpigmentation.

2. 1064 nm wavelength:

- removal of dark ink (black, blue and brown) tattoos,

treatment of Nevus of Ota, treatment of Common Nevi.

-skin resurfacing with or without adjuvant preparation


No where does he say the IPL does Tatoo removal.

03.13 | Unregistered Commenterdrjhkdc

Your point taken. My apology. However, it is not true of the statement that the 532/1064 can do "tattoo removal virtually of all color spectrum" as stated there. I used the MedLite II of 532/1064 for years and we could never do such. That is why MedLite VI now a 3rd wavelength to be more complete.

03.13 | Unregistered Commenterpmdoc

I don't know much about tatoo removal as I have no experience in it. And I can't vouch for the effectiveness of his laser for it. He does say virtually of all and not all. I don't know what colors it doesn't remove as I can see the only ones he left out is yellow and green. As as for his IPL removing leg veins I believe he was talking about spider veins and not varicose and yes i have seen it reduce the appearance of spider veins.

03.15 | Unregistered Commenterdrjhkdc

Not sure why you felt the need to be his defender for??? 532 and 1064 cannot remove: yellow, green, aqua, teal,ocean blue, orange, reddish orange, bright red and french blue. With all these colors excluded, would you have said "virtually all color spectrum???" Virtually is defined as: for the most part, almost wholly.

03.15 | Unregistered Commenterpmdoc

pmdoc

He's probably another DC pedeling the same flashlight

03.15 | Unregistered CommenterFlorida PA

Lasers


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The Board of Medicine has determined that the use of lasers, laser-like devices and intense pulsed light devices is considered the practice of medicine.

The Board of Medicine has stated that lasers, laser for hair removal, Botox injections, collagen injections, and any other noninvase injections of materials used as procedures to treat patients must be performed by a Physician, a Physician Assistant under supervision, or an Advanced Registered Nurse Practitioner working under a protocol signed by a Physician.
With respect to laser hair removal, the Board of Medicine has previously stated that a Physician, an Osteopathic Physician, a Physician Assistant under the supervision of a physician, an Advanced Registered Nurse Practitioner under protocols with a physician, or an Electrologist working under the direct supervision and responsibility of a Physician is required.
We have heard that in some states, with appropriate training, nurses are actively injecting Botox, collagen, and other injectable fillers and that licensed cosmetologist/estheticians are performing laser hair removal and photo rejuvenation with intense pulsed light devices. However, this is not the practice in Florida.
Included on this web page for your review are excerpts from the Board of Medicine June 4, 2005 and the August 12, 2005 Quality Assurance Committee meetings regarding Laser Issues and the Electrologist Rule 56.002, F.S. Also included is HB 699 and other information regarding that bill for your review.


05.22 | Unregistered Commenterfred

Freddy,

I would rather have a trained RN performing laser hair removal than a trained electrologist. I don't think many MD's want to be performing laser hair removal anyway.

05.22 | Unregistered CommenterSBJ

Florida Rules from Dept of Health web page .............

The 2007 Florida Statutes

Title XXXII
REGULATION OF PROFESSIONS AND OCCUPATIONS Chapter 458
MEDICAL PRACTICE View Entire Chapter

458.348 Formal supervisory relationships, standing orders, and established protocols; notice; standards.--

(1) NOTICE.--

(a) When a physician enters into a formal supervisory relationship or standing orders with an emergency medical technician or paramedic licensed pursuant to s. 401.27, which relationship or orders contemplate the performance of medical acts, or when a physician enters into an established protocol with an advanced registered nurse practitioner, which protocol contemplates the performance of medical acts identified and approved by the joint committee pursuant to s. 464.003(3)(d) or acts set forth in s. 464.012(3) and (4), the physician shall submit notice to the board. The notice shall contain a statement in substantially the following form:


I, (name and professional license number of physician) , of (address of physician) have hereby entered into a formal supervisory relationship, standing orders, or an established protocol with (number of persons) emergency medical technician(s), (number of persons) paramedic(s), or (number of persons) advanced registered nurse practitioner(s).


(b) Notice shall be filed within 30 days of entering into the relationship, orders, or protocol. Notice also shall be provided within 30 days after the physician has terminated any such relationship, orders, or protocol.

(2) ESTABLISHMENT OF STANDARDS BY JOINT COMMITTEE.--The joint committee created under s. 464.003(3)(d) shall determine minimum standards for the content of established protocols pursuant to which an advanced registered nurse practitioner may perform medical acts identified and approved by the joint committee pursuant to s. 464.003(3)(d) or acts set forth in s. 464.012(3) and (4) and shall determine minimum standards for supervision of such acts by the physician, unless the joint committee determines that any act set forth in s. 464.012(3) or (4) is not a medical act. Such standards shall be based on risk to the patient and acceptable standards of medical care and shall take into account the special problems of medically underserved areas. The standards developed by the joint committee shall be adopted as rules by the Board of Nursing and the Board of Medicine for purposes of carrying out their responsibilities pursuant to part I of chapter 464 and this chapter, respectively, but neither board shall have disciplinary powers over the licensees of the other board.

(3) PROTOCOLS REQUIRING DIRECT SUPERVISION.--All protocols relating to electrolysis or electrology using laser or light-based hair removal or reduction by persons other than physicians licensed under this chapter or chapter 459 shall require the person performing such service to be appropriately trained and work only under the direct supervision and responsibility of a physician licensed under this chapter or chapter 459.

(4) SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE SETTINGS.--A physician who supervises an advanced registered nurse practitioner or physician assistant at a medical office other than the physician's primary practice location, where the advanced registered nurse practitioner or physician assistant is not under the onsite supervision of a supervising physician, must comply with the standards set forth in this subsection. For the purpose of this subsection, a physician's "primary practice location" means the address reflected on the physician's profile published pursuant to s. 456.041.

(a) A physician who is engaged in providing primary health care services may not supervise more than four offices in addition to the physician's primary practice location. For the purpose of this subsection, "primary health care" means health care services that are commonly provided to patients without referral from another practitioner, including obstetrical and gynecological services, and excludes practices providing primarily dermatologic and skin care services, which include aesthetic skin care services.

(b) A physician who is engaged in providing specialty health care services may not supervise more than two offices in addition to the physician's primary practice location. For the purpose of this subsection, "specialty health care" means health care services that are commonly provided to patients with a referral from another practitioner and excludes practices providing primarily dermatologic and skin care services, which include aesthetic skin care services.

(c) A physician who supervises an advanced registered nurse practitioner or physician assistant at a medical office other than the physician's primary practice location, where the advanced registered nurse practitioner or physician assistant is not under the onsite supervision of a supervising physician and the services offered at the office are primarily dermatologic or skin care services, which include aesthetic skin care services other than plastic surgery, must comply with the standards listed in subparagraphs 1.-4. Notwithstanding s. 458.347(4)(e)8., a physician supervising a physician assistant pursuant to this paragraph may not be required to review and cosign charts or medical records prepared by such physician assistant.

1. The physician shall submit to the board the addresses of all offices where he or she is supervising an advanced registered nurse practitioner or a physician's assistant which are not the physician's primary practice location.

2. The physician must be board certified or board eligible in dermatology or plastic surgery as recognized by the board pursuant to s. 458.3312.

3. All such offices that are not the physician's primary place of practice must be within 25 miles of the physician's primary place of practice or in a county that is contiguous to the county of the physician's primary place of practice. However, the distance between any of the offices may not exceed 75 miles.

4. The physician may supervise only one office other than the physician's primary place of practice except that until July 1, 2011, the physician may supervise up to two medical offices other than the physician's primary place of practice if the addresses of the offices are submitted to the board before July 1, 2006. Effective July 1, 2011, the physician may supervise only one office other than the physician's primary place of practice, regardless of when the addresses of the offices were submitted to the board.

(d) A physician who supervises an office in addition to the physician's primary practice location must conspicuously post in each of the physician's offices a current schedule of the regular hours when the physician is present in that office and the hours when the office is open while the physician is not present.

(e) This subsection does not apply to health care services provided in facilities licensed under chapter 395 or in conjunction with a college of medicine, a college of nursing, an accredited graduate medical program, or a nursing education program; offices where the only service being performed is hair removal by an advanced registered nurse practitioner or physician assistant; not-for-profit, family-planning clinics that are not licensed pursuant to chapter 390; rural and federally qualified health centers; health care services provided in a nursing home licensed under part II of chapter 400, an assisted living facility licensed under part I of chapter 429, a continuing care facility licensed under chapter 651, or a retirement community consisting of independent living units and a licensed nursing home or assisted living facility; anesthesia services provided in accordance with law; health care services provided in a designated rural health clinic; health care services provided to persons enrolled in a program designed to maintain elderly persons and persons with disabilities in a home or community-based setting; university primary care student health centers; school health clinics; or health care services provided in federal, state, or local government facilities.

(5) REQUIREMENTS FOR NOTICE AND REVIEW.--Upon initial referral of a patient by another practitioner, the physician receiving the referral must ensure that the patient is informed of the type of license held by the physician and the type of license held by any other practitioner who will be providing services to the patient. When scheduling the initial examination or consultation following such referral, the patient may decide to see the physician or any other licensed practitioner supervised by the physician and, before the initial examination or consultation, shall sign a form indicating the patient's choice of practitioner. The supervising physician must review the medical record of the initial examination or consultation and ensure that a written report of the initial examination or consultation is furnished to the referring practitioner within 10 business days following the completion of the initial examination or consultation.

(6) LIMITATION ON RULEMAKING.--This section is self-executing and does not require or provide authority for additional rulemaking.

History.--ss. 1, 4, ch. 82-32; s. 33, ch. 83-215; s. 83, ch. 83-218; s. 65, ch. 86-220; ss. 25, 26, ch. 86-245; s. 4, ch. 88-361; s. 15, ch. 91-220; s. 4, ch. 91-429; ss. 40, 118, ch. 2000-318; s. 5, ch. 2006-251; s. 112, ch. 2007-5; s. 7, ch. 2007-167.



Copyright © 1995-2008 The Florida Legislature • Privacy Statement • Contact Us

05.22 | Unregistered Commenterfred

Well I guess Fred et al. still do not understand that the Florida Board of medicine is in charge of MD’s and unlicensed people ONLY.......... They are not the dream police of Florida that can decide what other healthcare providers can provide. It is ashamed that there are so many simpletons in this world as of 2008. I will cut and paste for the people that understand ENGLISH so as they can enjoy and laugh at the other DUPES that read stuff on this website. Please read 458.303 (a)...
If you still do not get it that the Board of Medicine has NO POWER over another health care provider practicing within their scope you are just another dirt bag.... (so what does this mean to me.... As long as I am practicing w/i my scope there are no Penalties that can be accesses against the health care provider acting w/i their scope.


458.303 Provisions not applicable to other practitioners; exceptions, etc.--

(1) The provisions of ss. 458.301, 458.303, 458.305, 458.307, 458.309, 458.311, 458.313, 458.315, 458.317, 458.319, 458.321, 458.327, 458.329, 458.331, 458.337, 458.339, 458.341, 458.343, 458.345, and 458.347 shall have no application to:

(a) Other duly licensed health care practitioners acting within their scope of practice authorized by statute.

(b) Any physician lawfully licensed in another state or territory or foreign country, when meeting duly licensed physicians of this state in consultation.

(c) Commissioned medical officers of the Armed Forces of the United States and of the Public Health Service of the United States while on active duty and while acting within the scope of their military or public health responsibilities.

(d) Any person while actually serving without salary or professional fees on the resident medical staff of a hospital in this state, subject to the provisions of s. 458.321.

(e) Any person furnishing medical assistance in case of an emergency.

(f) The domestic administration of recognized family remedies.

(g) The practice of the religious tenets of any church in this state.

(h) Any person or manufacturer who, without the use of drugs or medicine, mechanically fits or sells lenses, artificial eyes or limbs, or other apparatus or appliances or is engaged in the mechanical examination of eyes for the purpose of constructing or adjusting spectacles, eyeglasses, or lenses.

(2) Nothing in s. 458.301, s. 458.303, s. 458.305, s. 458.307, s. 458.309, s. 458.311, s. 458.313, s. 458.319, s. 458.321, s. 458.327, s. 458.329, s. 458.331, s. 458.337, s. 458.339, s. 458.341, s. 458.343, s. 458.345, or s. 458.347 shall be construed to prohibit any service rendered by a registered nurse or a licensed practical nurse, if such service is rendered under the direct supervision and control of a licensed physician who provides specific direction for any service to be performed and gives final approval to all services performed. Further, nothing in this or any other chapter shall be construed to prohibit any service rendered by a medical assistant in accordance with the provisions of s. 458.3485.

History.--ss. 1, 8, ch. 79-302; s. 290, ch. 81-259; ss. 2, 3, ch. 81-318; s. 2, ch. 84-543; s. 1, ch. 84-552; s. 2, ch. 84-553; s. 9, ch. 85-196; s. 1, ch. 85-307; ss. 2, 25, 26, ch. 86-245; s. 15, ch. 88-1; s. 4, ch. 91-429; s. 14, ch. 97-264.

05.22 | Unregistered CommenterFLDC

I hope this will be my last post (this means that people here actually understand english) I feel that someone that has 24-27 months total health care training are a danger to the public... ..... ie... PA's Get it.... I had this long of trainig in my MPH program.....

05.22 | Unregistered CommenterFLDC

FLDC

Gee, your beating this one to death. Then your going to put down PA education.

Well now we know how you feel.

It seems your just another bitter quack who could not make ends meet giving rub downs. All we have here is your personal manipulation/interpretation of Florida statue to try and justify making a buck in another arena.

In all fairness I must say your talents are wasted here. I sure you would make an excellent attorney or politician perhaps.

05.22 | Unregistered CommenterFlorida PA

FLDC I think is a DC named Michael Schaefer from Tampa..He is the CEO of Bioderm Medical.... Look at this machine below same as the one he's selling but only 1/10 of the price.......he sells the dermaclear that he gets from Hongkong for 40K..... he buys them puts stickers on them and boom makes 35K per unit..... sells really only to chiro's primarly. he takes advantage of them for sure... Sorry but true......


http://cgi.ebay.com/IPL-Laser-Hair-Wrinkle-Removal-Photon-PhotoRejuvenation_W0QQitemZ380022735592QQcmdZViewItemQQssPageNameZRSS:B:SRCH:US:101

It is ironic to see someone like this QUACK FLDC who has the nerve to abhor the medical physicians and its medical board but at the same time "snoop" behind the back of an MD to run his "laser training course" and resell essentially inferior laser machines from some lesser known companies probably because of some "internal financial kickback schemes".
FLDC, you should be ashamed of yourself. You are an IDIOT and a SCAMMER

05.23 | Unregistered Commenterpmdoc

FLDC should be and I hope brought up on ethics charges. Mike Schaefer(FLDC) is a shaddy as they come and only really cares about the all mighty dollar. It's really sad.

I am very surprised to see two physicians one DC and one MD (and who knows what pmdoc is) to conduce in this type conduct over a blog that was written because of ignorance.
Someone was obviously not happy and desired to have a monopoly on Light based skin treatments. To that point Florida Statutes contain language like-
It is the intent of the Legislature to prohibit the delivery of services by persons who do not possess the necessary skills or who otherwise present a danger to the public. However, restrictions may be imposed only to the extent necessary to protect the public and in a manner that will not unreasonably affect the competitive market for the delivery of such services.
As stated in the ending not to affect the competitive market…..
Or
458.303 Provisions not applicable to other practitioners; exceptions, etc.--
(1) The provisions of ss. 458.301, 458.303, 458.305, 458.307, 458.309, 458.311, 458.313, 458.315, 458.317, 458.319, 458.321, 458.327, 458.329, 458.331, 458.337, 458.339, 458.341, 458.343, 458.345, and 458.347 shall have no application to:
(a) Other duly licensed health care practitioners acting within their scope of practice authorized by statute.
Namely Debbie Hamster, MD and Laura Amber Johnston, DC cry ethics, why they both make defamatory remarks. I would think Boards of Chiropractic and Boards of Medicine would not look too high on doctors that would defame individuals (If these two doctors real people and not fiction characters). McGowen v. Prentice, La. App., 341 So.2d 55, 57; Wolfson v. Kirk, Fla. App., 273 So.2d 774, 776. To further complicate matters done with malice, New York Times Co. v. Sullivan, 376 U.S. 254, 84 S.Ct. 710, 11 L.Ed.2d 686.
So to put this to an end (hopefully) I will invite any physician to come to our seminar. I would also like to know if you (Dr Johnston) bought one of the illegal IPL’s units that you pasted from E-Bay. Our company is FDA registered and only sells FDA registered equipment to physicians in the United States. You see it is illegal to sell non FDA equipment in the U.S. and the FDA will gladly take it off your hands if it is not registered.

I also find it hard to believe my partner Dr. Joseph Sena is never brought up...

To quote your statement from above "...It is the intent of the Legislature to prohibit the delivery of services by persons who do not possess the necessary skills or who otherwise present a danger to the public.." I previously posted questions to you based on your "illuminary education website" on 2/29/2008 but have not received any responses since. I am not as bothered by the fact that maybe FLorida allowed DC's to provide IPL's because of some legal loophole as much as your incendiary disrespectful posts here about our medical profession in general. If you believe you have such a spine to stand alone then get off the back of an MD and show your true skin. Let the general public see you as who you are and what you are made of. I have been in this business long enough to know facts from fictions. Just because you "copied" quotes from manufacturers or some authors about laser technology in general must NOT preclude you from knowing the facts yourself and be able to have sound and fundemental discussions about it. One more, save yourself from waving the FDA flag at us, the typical 510K clearance for medical equipment in general is mostly for safety based reasons rather than clinical efficacy reasons. It is STILL the responsibility of each one of us to make sure that he/she who operates a device knows very well its technical strengths and weaknesses and its clinical indications. Thus this question, what clinical training and background do you possess to conduct medical seminars and charge other professionals money for them??? My previous question to you from 11/2007 to 2/19/2008 have ALWAYS been clinical and technical questions. I am not here to libel you but what bothers me as a clinician is WHAT gives you the professional competency to set up a clinical website promoting clinical seminars???

05.26 | Unregistered Commenterpmdoc

Question : So Dr. Mike the IPL on Ebay or other sites is or not the same junk as the product you registered with the FDA ????? True is it is the same junk that you sell. You are registed with the FDA so what !!!! Anyone can register a laser or IPL. I checked with the FDA last week and you never filed a 510K did you ??? You buy that junk from China and re-label it and sell it for 40K plus ??? True or False ????? We all want to know the truth. Mike it won't be to long until Florida closes the loop holes and you will be out of business for good. They are cracking done on this stuff up here northern florida.

Regards,


Simon Houser, ESQ

I'm going to go to one of his seminars. I think they are held in Tampa.

05.26 | Unregistered CommenterTracy

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