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Medical Spas in Need of Regulation Across the Board
Posted: June 17, 2013
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Some treatments they provide, such as manicures and facials, are regulated by the state and require a license. But doctors are exempt from those regulations, so if a medical spa has a physician directing the facility, the doctor is expected to oversee such treatments.
When procedures go awry, the Virginia Board of Medicine steps in to determine whether a doctor is fulfilling his or her duty, which is spelled out in state code. That's a complaint-driven system, so enforcement is uneven because there are no regular inspections.
One of the most recent local cases to come before the Board of Medicine involved Dermacare in Chesapeake, a business that advertises laser hair removal, Botox injections and laser skin tightening. The board reprimanded the clinic's medical director, Michael Keverline, and fined him $4,500 in April for allowing team members to perform laser surgery, inject dermal fillers and provide facial injections without proper supervision.
He also allowed prescription drugs to be dispensed without a physical examination or medical history. His attorney, Michael Goodman, said that before Keverline opened the Dermacare clinic in 2006, he visited other medical spas and observed an "indirect" supervision model, defined as being available by telephone and within a 30-minute drive.
The interpretation of supervision, though, differs from state to state and even from board to board within the same state, Goodman said. The meaning also differs depending on who is being supervised. A nurse practitioner and physician assistant, for instance, require less oversight than a nurse.
Because of that, it's difficult for operators to understand all that's necessary. Goodman said he has represented five to 10 medical directors of spas before the Board of Medicine during the past several years, and it's not just unhappy clients who turn them in, but also competitors.
He said most of his clients have done a good job training staff but are unaware of the level of supervision required, particularly when it comes to establishing a patient-doctor relationship that includes a medical history, informed consent and examination. He said most are surprised when investigators from the Board of Health Professions arrive asking questions.