Alabama
RULES OF THE
ALABAMA BOARD OF MEDICAL EXAMINERS
CHAPTER 540-X-11
GUIDELINES FOR THE USE OF LASERS
AND OTHER MODALITIES AFFECTING LIVING TISSUE
Table of Contents
540-X-11-.01 Purpose
540-X-11-.02 Definitions
540-X-11-.03 Use of Lasers and Other Modalities Affecting
Living Tissue in the Practice of Medicine
540-X-11-.04 Delegation
540-X-11-.05 Supervision
540-X-11-.06 Written Protocols
540-X-11-.07 Educational Requirements for Physicians and
Level 1 Delegates
540-X-11-.08 Educational Requirements for Level 2
Delegates
540-X-11-.09 Remote Practice Site
540-X-11-.10 Alternate Physicians
540-X-11-.11 Quality Assurance
540-X-11-.12 Equipment Safety
540-X-11-.13 Safe Use of Lasers
540-X-11-.14 Registration of Physicians Using Lasers in the
Practice of Medicine
540-X-11-.15 Reporting Requirement for Adverse Events
540-X-11-.16 Effective Date
Appendix A - Physician Registration Form
540-X-11-.01 Purpose.
(1) The use of lasers/pulsed light devices, or any energy source, chemical, or
other modality that affects living tissue (when referring to the skin, anything below the
stratum corneum), whether applied for surgical, therapeutic, or cosmetic purposes, is
the practice of medicine.
(2) The purpose of these rules is to provide guidelines for the use of these
devices for ablative and non-ablative treatment by physicians. Nothing in these rules
shall be construed to relieve the supervising physician of the professional or legal
responsibility for the care and treatment of the physician's patients.
(3) These rules shall not apply to the following:
(a) Any person licensed to practice chiropractic if the laser/pulsed light device,
energy source, chemical or other modality that affects living tissue is used exclusively
for the practice of chiropractic;
(b) Any person licensed to practice dentistry if the laser/pulsed light device,
energy source, chemical or other modality that affects living tissue is used exclusively
for the practice of dentistry;
(c) Any person licensed to practice occupational therapy if the laser/pulsed
light device, energy source, chemical or other modality that affects living tissue is used
exclusively for the practice of occupational therapy;
(d) Any person licensed to practice optometry if the laser/pulsed light device,
energy source, chemical or other modality that affects living tissue is used exclusively
for the practice of optometry;
(e) Any person licensed to practice physical therapy if the laser/pulsed light
device, energy source, chemical or other modality that affects living tissue is used
exclusively for the practice of physical therapy.
(4) These rules shall not apply to the practice of “body art,” as defined in
Chapter 420-3-23 of the Administrative Rules of the Alabama Department of Public
Health, which is not a part of patient treatment; and which is performed with equipment
specifically manufactured for performing body art procedures and specifically used
according to the manufacturer’s instructions and standard professional practice; and
which is otherwise regulated by the Alabama Department of Public Health.
(5) These rules shall not apply to the use of a laser/pulsed light device,
energy source, chemical or other modality that affects living tissue which occurs in
“hospitals” as defined in Ala. Code §22-21-20.
Authors: Alabama Board of Medical Examiners ad hoc Committee:
Jorge A. Alsip, M.D.; Kenneth W. Aldridge, M.D.; Michael S. Clinton, M.D.,
Deason C. Dunagan, M.D.; Edward C. Facundus, M.D.; Steven P. Furr,
M.D.; K. Michael Hites, P.A.; Wonsuck Kim, M.D.; Elizabeth S. Martin,
M.D.; Diantha Miller, CRNP; Gary D. Monheit, M.D.; Arthur F. Toole, III,
M.D.; and the Alabama Board of Medical Examiners
Statutory Authority: Code of Alabama §§34-24-50, 34-24-51, 34-24-53
History: Approved for publication: February 21, 2007. Approved for
publication: May 16, 2007. Final Adoption: August 15, 2007. Effective
Date: September 20, 2007.
540-X-11-.02 Definitions. For the purpose of these rules, the following definitions
will apply:
(1) Direct Physician Supervision – Direct physician supervision shall mean
that the physician is in the physical presence of the patient being treated and is directly
observing the use of the modality by a delegate.
(2) Energy Source – any therapeutic source which can cause a scar or
change in live tissue.
(3) Level 1 Delegate – A Level 1 Delegate is a Mid-level Practitioner who is
authorized in a written job description or collaborative protocol to use a specific
laser/pulsed light device or other energy source, chemical or other modality for nonablative
procedures, as designated in the written job description or collaborative
protocol and who has met the educational requirements for a Level 1 Delegate stated in
these rules.
(4) Level 2 Delegate – A Level 2 Delegate is any person, other than a Level 1
Delegate, who has met the educational requirements for Level 2 Delegates stated in
these rules.
(5) Mid-level Practitioner – A Mid-level Practitioner is an assistant to
physician, as defined in Ala. Code §34-24-290, or an advanced practice nurse.
(6) Non-ablative Treatment – Non-ablative treatment shall include any
laser/intense pulsed light treatment or other energy source, chemical or modality that is
not expected or intended to remove, burn, or vaporize tissue. This shall include
treatments related to laser hair removal.
(7) On-site Supervision – On-site supervision shall mean continuous
supervision in which the supervising physician is in the same building as the
appropriate, properly trained delegate. All treatments and procedures must be
performed under the licensed physician’s direction and immediate personal
supervision-i. e., the physician is physically present on the premises and immediately
available at all times that the non-physician is on duty, and the physician retains full
responsibility to patients and the Board for the manner and results of all services
rendered.
(8) Physician – A physician licensed by the Medical Licensure Commission of
the State of Alabama.
Authors: Alabama Board of Medical Examiners ad hoc Committee:
Jorge A. Alsip, M.D.; Kenneth W. Aldridge, M.D.; Michael S. Clinton, M.D.,
Deason C. Dunagan, M.D.; Edward C. Facundus, M.D.; Steven P. Furr,
M.D.; K. Michael Hites, P.A.; Wonsuck Kim, M.D.; Elizabeth S. Martin,
M.D.; Diantha Miller, CRNP; Gary D. Monheit, M.D.; Arthur F. Toole, III,
M.D. ; and the Alabama Board of Medical Examiners
Statutory Authority: Code of Alabama §§34-24-50, 34-24-51, 34-24-53
History: Approved for publication: February 21, 2007. Approved for
publication: May 16, 2007. Final Adoption: August 15, 2007. Effective
Date: September 20, 2007.
540-X-11-.03 Use of Lasers and Other Modalities Affecting Living Tissue in the
Practice of Medicine.
(1) The use of lasers/pulsed light devices, or other energy source, chemical,
or modality that affects living tissue, for the purpose of treating a physical disease,
disorder, deformity or injury shall constitute the practice of medicine pursuant to Ala.
Code §34-24-50.
(2) The use of lasers/pulsed light devices for non-ablative procedures cannot
be delegated to Level 2 Delegates without the delegating/supervising physician being
on-site and immediately available.
(3) The use of lasers/pulsed light devices or other energy devices for ablative
procedures may only be performed by a physician.
(4) Electrocautery may be used by a Level 1 or Level 2 delegate under direct
physician supervision.
Authors: Alabama Board of Medical Examiners ad hoc Committee:
Jorge A. Alsip, M.D.; Kenneth W. Aldridge, M.D.; Michael S. Clinton, M.D.,
Deason C. Dunagan, M.D.; Edward C. Facundus, M.D.; Steven P. Furr,
M.D.; K. Michael Hites, P.A.; Wonsuck Kim, M.D.; Elizabeth S. Martin,
M.D.; Diantha Miller, CRNP; Gary D. Monheit, M.D.; Arthur F. Toole, III,
M.D. ; and the Alabama Board of Medical Examiners
Statutory Authority: Code of Alabama §§34-24-50, 34-24-51, 34-24-53
History: Approved for publication: February 21, 2007. Approved for
publication: May 16, 2007. Final Adoption: August 15, 2007. Effective
Date: September 20, 2007.
540-X-11-.04 Delegation.
(1) If the physician provides on-site supervision, the physician may delegate
the performance of non-ablative treatment through the use of written protocols to a
properly trained delegate acting under adequate supervision.
(2) Prior to any non-ablative initial treatment, the physician must examine the
patient, establish a treatment plan, and sign the patient's chart.
Authors: Alabama Board of Medical Examiners ad hoc Committee:
Jorge A. Alsip, M.D.; Kenneth W. Aldridge, M.D.; Michael S. Clinton, M.D.,
Deason C. Dunagan, M.D.; Edward C. Facundus, M.D.; Steven P. Furr,
M.D.; K. Michael Hites, P.A.; Wonsuck Kim, M.D.; Elizabeth S. Martin,
M.D.; Diantha Miller, CRNP; Gary D. Monheit, M.D.; Arthur F. Toole, III,
M.D. ; and the Alabama Board of Medical Examiners
Statutory Authority: Code of Alabama §§34-24-50, 34-24-51, 34-24-53
History: Approved for publication: February 21, 2007. Approved for
publication: May 16, 2007. Final Adoption: August 15, 2007. Effective
Date: September 20, 2007.
540-X-11-.05 Supervision. Supervision by the delegating physician shall be
considered adequate for purposes of this section if the physician is in compliance with
this section and the physician:
(1) Ensures that patients are adequately informed and, prior to treatment,
have signed consent forms that outline reasonably foreseeable side effects and
complications which may result from the non-ablative treatment;
(2) Is responsible for the formulation or approval of a written protocol which
meets the requirements of these rules and is responsible for any patient-specific
deviation from the protocol;
(3) Reviews and signs, at least annually, the written protocol and any patient specific
deviations from the protocol regarding care provided to a patient under the
protocol on a schedule defined in the written protocol;
(4) Receives, on a schedule defined in the written protocol, a periodic status
report on the patient, including any problems or complications encountered;
(5) Remains on-site for non-ablative treatments performed by delegates
consistent with these rules and is immediately available for consultation, assistance and
direction;
(6) Personally attends to, evaluates, and treats complications that arise; and
(7) Evaluates the technical skills of the delegate performing non-ablative
treatment by documenting and reviewing at least quarterly the delegate's ability to
perform the following:
(a) To properly operate the devices and provide safe and effective care; and
(b) To respond appropriately to complications and untoward effects of the
procedures.
Authors: Alabama Board of Medical Examiners ad hoc Committee: Jorge A.
Alsip, M.D.; Kenneth W. Aldridge, M.D.; Michael S. Clinton, M.D., Deason C.
Dunagan, M.D.; Edward C. Facundus, M.D.; Steven P. Furr, M.D.; K. Michael
Hites, P.A.; Wonsuck Kim, M.D.; Elizabeth S. Martin, M.D.; Diantha Miller,
CRNP; Gary D. Monheit, M.D.; Arthur F. Toole, III, M.D. ; and the Alabama Board
of Medical Examiners
Statutory Authority: Code of Alabama §§34-24-50, 34-24-51, 34-24-53
History: Approved for publication: February 21, 2007. Approved
for publication: May 16, 2007. Final Adoption: August 15, 2007.
Effective Date: September 20, 2007.
540-X-11-.06 Written Protocols. Written protocols for the purpose of this section
shall mean, physician's order, standing delegation order, standing medical order, or
other written order that is maintained on site. A written protocol must provide, at a
minimum, the following:
(1) A statement identifying the individual physician authorized to utilize the
specified device and responsible for the delegation of the performance of the specified
procedure;
(2) A statement of the activities, decision criteria, and plan the delegate shall
follow when performing delegated procedures;
(3) Selection criteria to screen patients for the appropriateness of non-ablative
treatments;
(4) Identification of devices and settings to be used for patients who meet
selection criteria;
(5) Methods by which the specified device is to be operated;
(6) A description of appropriate care and follow-up for common complications,
serious injury, or emergencies as a result of the non-ablative treatment; and
(7) Documentation of decisions made and a plan for communication or
feedback to the authorizing physician concerning specific decisions made.
Documentation shall be recorded within a reasonable time after each procedure, and
may be performed on the patient's record or medical chart.
Authors: Alabama Board of Medical Examiners ad hoc Committee: Jorge A.
Alsip, M.D.; Kenneth W. Aldridge, M.D.; Michael S. Clinton, M.D., Deason C.
Dunagan, M.D.; Edward C. Facundus, M.D.; Steven P. Furr, M.D.; K. Michael
Hites, P.A.; Wonsuck Kim, M.D.; Elizabeth S. Martin, M.D.; Diantha Miller,
CRNP; Gary D. Monheit, M.D.; Arthur F. Toole, III, M.D. ; and the Alabama
Board of Medical Examiners
Statutory Authority: Code of Alabama §§34-24-50, 34-24-51, 34-24-53
History: Approved for publication: February 21, 2007. Approved for
publication: May 16, 2007. Final Adoption: August 15, 2007. Effective
Date: September 20, 2007.
540-X-11-.07 Educational Requirements for Physicians and Level 1 Delegates.
Physicians and Level 1 Delegates who are involved in the performance of non-ablative
treatments must:
(1) Complete sixteen (16) hours of basic training devoted to the principles of
lasers, intense pulsed light devices and thermal, radiofrequency and other non-ablative
devices, their instrumentation, physiological effects and safety requirements. The basic
training should include clinical applications of various wavelengths and hands-on
practical sessions with devices and their appropriate surgical or therapeutic delivery
systems. For each device, the physician and Level 1 Delegate must attend a training
program; and
(2) Maintain competence to perform non-ablative procedures through
documented training and experience regarding the appropriate standard of care in the
field of non-ablative procedures and the use of specific device(s).
Authors: Alabama Board of Medical Examiners ad hoc Committee: Jorge A.
Alsip, M.D.; Kenneth W. Aldridge, M.D.; Michael S. Clinton, M.D., Deason C.
Dunagan, M.D.; Edward C. Facundus, M.D.; Steven P. Furr, M.D.; K. Michael
Hites, P.A.; Wonsuck Kim, M.D.; Elizabeth S. Martin, M.D.; Diantha Miller,
CRNP; Gary D. Monheit, M.D.; Arthur F. Toole, III, M.D. ; and the Alabama
Board of Medical Examiners
Statutory Authority: Code of Alabama §§34-24-50, 34-24-51, 34-24-53
History: Approved for publication: February 21, 2007. Approved for
publication: May 16, 2007. Final Adoption: August 15, 2007. Effective Date:
September 20, 2007.
540-X-11-.08 Educational Requirements for Level 2 Delegates. A physician may
delegate non-ablative procedures to a qualified Level 2 Delegate. For the purpose of
properly assessing the Level 2 Delegate’s competency, the physician must ensure that
the Level 2 Delegate complies with paragraphs (1) - (5) of this rule prior to performing
the non-ablative procedure.
(1) The delegate has completed and is able to document clinical and
academic training in the following subjects:
(a) Fundamentals of laser operation;
(b) Bio-effects of laser radiation on the eye and skin;
(c) Significance of specular and diffuse reflections;
(d) Non-beam hazards of lasers;
(e) Non-ionizing radiation hazards;
(f) Laser and laser system classifications; and
(g) Control measures.
(2) The delegate has read and signed the facility's policies and procedures
regarding the safe use of non-ablative devices.
(3) The delegate has received or participated in at least 16 hours of
documented initial training in the field of non-ablative devices.
(4) The delegate has maintained competence to perform non-ablative
procedures through documented training and experience regarding the appropriate
standard of care in the field of non-ablative procedures and the use of specific
device(s).
(5) The delegate has completed at least ten procedures of preceptee training
for each non-ablative procedure to assess competency.
Authors: Alabama Board of Medical Examiners ad hoc Committee:
Jorge A. Alsip, M.D.; Kenneth W. Aldridge, M.D.; Michael S. Clinton, M.D.,
Deason C. Dunagan, M.D.; Edward C. Facundus, M.D.; Steven P. Furr,
M.D.; K. Michael Hites, P.A.; Wonsuck Kim, M.D.; Elizabeth S. Martin,
M.D.; Diantha Miller, CRNP; Gary D. Monheit, M.D.; Arthur F. Toole, III,
M.D. ; and the Alabama Board of Medical Examiners
Statutory Authority: Code of Alabama §§34-24-50, 34-24-51, 34-24-53
History: Approved for publication: February 21, 2007. Approved for
publication: May 16, 2007. Final Adoption: August 15, 2007. Effective
Date: September 20, 2007.
540-X-11-.09 Remote Practice Site.
(1) For the purposes of the rules in this Chapter, a remote practice site is a
practice site at which a Level 1 Delegate may, if authorized by a written job description
or collaborative protocol, use lasers/pulsed light devices for non-ablative procedures
without the delegating/supervising physician being on-site and immediately available.
(2) A Level 2 Delegate shall not use lasers/pulsed light devices or any energy
source, chemical or other modality that affects living tissue at a remote practice site.
(3) The delegating/supervising physician shall examine the patient, establish
a treatment plan, and sign the patient chart prior to a Level 1 Delegate performing the
first non-ablative treatment of a patient for a particular disease or condition at a remote
practice site. Subsequent non-ablative treatments which are a continuation of a
treatment plan documented in the patient’s chart may be performed by the Level 1
Delegate at a remote practice site without examination of the patient by the physician
before each treatment.
Authors: Alabama Board of Medical Examiners ad hoc Committee:
Jorge A. Alsip, M.D.; Kenneth W. Aldridge, M.D.; Michael S. Clinton, M.D.,
Deason C. Dunagan, M.D.; Edward C. Facundus, M.D.; Steven P. Furr,
M.D.; K. Michael Hites, P.A.; Wonsuck Kim, M.D.; Elizabeth S. Martin,
M.D.; Diantha Miller, CRNP; Gary D. Monheit, M.D.; Arthur F. Toole, III,
M.D. ; and the Alabama Board of Medical Examiners
Statutory Authority: Code of Alabama §§34-24-50, 34-24-51, 34-24-53
History: Approved for publication: February 21, 2007. Approved for
publication: May 16, 2007. Final Adoption: August 15, 2007. Effective
Date: September 20, 2007.
540-X-11-.10 Alternate Physicians.
(1) If a delegating physician will be unavailable to supervise a delegate as
required by these rules, arrangements shall be made for an alternate physician to
provide that supervision.
(2) An alternate physician must have the same training in performance of
non-ablative treatments as the primary supervising physician.
(3) Any alternate physician providing supervision shall affirm in writing to the
Board of Medical Examiners that he or she is familiar with the protocols or standing
delegation orders in use at the site, will be accountable for adequately supervising care
provided pursuant to those protocols or standing delegation orders, and has the same
training in performance of non-ablative treatments as the primary supervising physician.
Authors: Alabama Board of Medical Examiners ad hoc Committee:
Jorge A. Alsip, M.D.; Kenneth W. Aldridge, M.D.; Michael S. Clinton, M.D.,
Deason C. Dunagan, M.D.; Edward C. Facundus, M.D.; Steven P. Furr,
M.D.; K. Michael Hites, P.A.; Wonsuck Kim, M.D.; Elizabeth S. Martin,
M.D.; Diantha Miller, CRNP; Gary D. Monheit, M.D.; Arthur F. Toole, III,
M.D. ; and the Alabama Board of Medical Examiners
Statutory Authority: Code of Alabama §§34-24-50, 34-24-51, 34-24-53
History: Approved for publication: February 21, 2007. Approved for
publication: May 16, 2007. Final Adoption: August 15, 2007. Effective
Date: September 20, 2007.
540-X-11-.11 Quality Assurance. The physician must ensure that there is a
quality assurance program for the facility where non-ablative procedures are performed
for the purpose of continuously improving the selection and treatment of patients. An
appropriate quality assurance program shall consist of the elements listed in paragraphs
(1) - (5) of this section.
(1) A mechanism to identify complications and untoward effects of treatment
and to determine their cause.
(2) A mechanism to review the adherence of delegates to standing delegation
orders, standing medical orders, and written protocols.
(3) A mechanism to monitor the quality of non-ablative treatments.
(4) A mechanism by which the findings of the quality assurance program are
reviewed and incorporated into future standing delegation orders, standing medical
orders, protocols, and supervising responsibility.
(5) Ongoing training to improve the quality and performance of delegates.
Authors: Alabama Board of Medical Examiners ad hoc Committee:
Jorge A. Alsip, M.D.; Kenneth W. Aldridge, M.D.; Michael S. Clinton, M.D.,
Deason C. Dunagan, M.D.; Edward C. Facundus, M.D.; Steven P. Furr,
M.D.; K. Michael Hites, P.A.; Wonsuck Kim, M.D.; Elizabeth S. Martin,
M.D.; Diantha Miller, CRNP; Gary D. Monheit, M.D.; Arthur F. Toole, III,
M.D. ; and the Alabama Board of Medical Examiners
Statutory Authority: Code of Alabama §§34-24-50, 34-24-51, 34-24-53
History: Approved for publication: February 21, 2007. Approved for
publication: May 16, 2007. Final Adoption: August 15, 2007. Effective
Date: September 20, 2007.
540-X-11-.12 Equipment Safety. All equipment used for the purposes stated in
this Chapter must be inspected, calibrated and certified as safe to use according to the
manufacturer’s specifications.
Authors: Alabama Board of Medical Examiners ad hoc Committee:
Jorge A. Alsip, M.D.; Kenneth W. Aldridge, M.D.; Michael S. Clinton, M.D.,
Deason C. Dunagan, M.D.; Edward C. Facundus, M.D.; Steven P. Furr,
M.D.; K. Michael Hites, P.A.; Wonsuck Kim, M.D.; Elizabeth S. Martin,
M.D.; Diantha Miller, CRNP; Gary D. Monheit, M.D.; Arthur F. Toole, III,
M.D. ; and the Alabama Board of Medical Examiners
Statutory Authority: Code of Alabama §§34-24-50, 34-24-51, 34-24-53
History: Approved for publication: February 21, 2007. Approved for
publication: May 16, 2007. Final Adoption: August 15, 2007. Effective
Date: September 20, 2007.
540-X-11-.13 Safe Use of Lasers.
In addition to the requirements of these rules, all physicians, Level 1 Delegates
and Level 2 Delegates who use or operate lasers must comply with any regulations,
standards, directives and guidelines for laser safety and use issued by the Occupational
Safety and Health Administration, United States Department of Labor.
Authors: Alabama Board of Medical Examiners ad hoc Committee:
Jorge A. Alsip, M.D.; Kenneth W. Aldridge, M.D.; Michael S. Clinton, M.D.,
Deason C. Dunagan, M.D.; Edward C. Facundus, M.D.; Steven P. Furr,
M.D.; K. Michael Hites, P.A.; Wonsuck Kim, M.D.; Elizabeth S. Martin,
M.D.; Diantha Miller, CRNP; Gary D. Monheit, M.D.; Arthur F. Toole, III,
M.D. ; and the Alabama Board of Medical Examiners
Statutory Authority: Code of Alabama §§34-24-50, 34-24-51, 34-24-53
History: Approved for publication: February 21, 2007. Approved for
publication: May 16, 2007. Final Adoption: August 15, 2007. Effective
Date: September 20, 2007.
540-X-11-.14 Registration of Physicians Using Lasers in the Practice of
Medicine.
(1) A physician who uses or offers to use a laser/pulsed light device in any
facility other than a hospital, as defined in Ala. Code §22-21-20, shall register with the
Alabama Board of Medical Examiners.
(2) Registration shall be accomplished on a form provided by the Board.
(3) After initially registering, it shall be the obligation of the registrant to notify
the Board in writing of any change or addition of facility location where lasers/pulsed
light devices are used or offered for use.
Authors: Alabama Board of Medical Examiners ad hoc Committee:
Jorge A. Alsip, M.D.; Kenneth W. Aldridge, M.D.; Michael S. Clinton, M.D.,
Deason C. Dunagan, M.D.; Edward C. Facundus, M.D.; Steven P. Furr,
M.D.; K. Michael Hites, P.A.; Wonsuck Kim, M.D.; Elizabeth S. Martin,
M.D.; Diantha Miller, CRNP; Gary D. Monheit, M.D.; Arthur F. Toole, III,
M.D. ; and the Alabama Board of Medical Examiners
Statutory Authority: Code of Alabama §§34-24-50, 34-24-51, 34-24-53
History: Approved for publication: February 21, 2007. Approved for
publication: May 16, 2007. Final Adoption: August 15, 2007. Effective
Date: September 20, 2007.
540-X-11-.15 Reporting Requirement. Reporting to the Board of Medical
Examiners is required within three (3) business days of the occurrence and will include
all events related to a procedure that resulted in hospitalization or third degree dermal
injury.
Authors: Alabama Board of Medical Examiners ad hoc Committee:
Jorge A. Alsip, M.D.; Kenneth W. Aldridge, M.D.; Michael S. Clinton, M.D.,
Deason C. Dunagan, M.D.; Edward C. Facundus, M.D.; Steven P. Furr,
M.D.; K. Michael Hites, P.A.; Wonsuck Kim, M.D.; Elizabeth S. Martin,
M.D.; Diantha Miller, CRNP; Gary D. Monheit, M.D.; Arthur F. Toole, III,
M.D. ; and the Alabama Board of Medical Examiners
Statutory Authority: Code of Alabama §§34-24-50, 34-24-51, 34-24-53
History: Approved for publication: February 21, 2007. Approved for
publication: May 16, 2007. Final Adoption: August 15, 2007. Effective
Date: September 20, 2007.
540-X-11-.16 Effective Date. The deadline for compliance with the provisions of
this section will be one year following the final adoption of this rule.
Authors: Alabama Board of Medical Examiners ad hoc Committee:
Jorge A. Alsip, M.D.; Kenneth W. Aldridge, M.D.; Michael S. Clinton, M.D.,
Deason C. Dunagan, M.D.; Edward C. Facundus, M.D.; Steven P. Furr,
M.D.; K. Michael Hites, P.A.; Wonsuck Kim, M.D.; Elizabeth S. Martin,
M.D.; Diantha Miller, CRNP; Gary D. Monheit, M.D.; Arthur F. Toole, III,
M.D. ; and the Alabama Board of Medical Examiners
Statutory Authority: Code of Alabama §§34-24-50, 34-24-51, 34-24-53
History: Approved for publication: February 21, 2007. Approved for
publication: May 16, 2007. Final Adoption: August 15, 2007. Effective
Date: September 20, 2007
Alaska
**Note: The following “Guideline Regarding the Use of Lasers and Laser Surgery” represents
Alaska State Medical Board Guidelines and does not have the force of law**
ALASKA STATE MEDICAL BOARD
GUIDELINE REGARDING THE USE OF LASERS AND LASER SURGERY
The Alaska State Medical Board has adopted the policies of the American Medical Association,
following, to be its guidelines to its licensees in Alaska with regard to who may perform laser surgery.
Performance of Laser Surgery
American Medical Association's Policy H-475.989, Laser Surgery, reads:
"Laser surgery should be performed only by individuals licensed to practice medicine and surgery or
by those categories of practitioners currently licensed by the state to perform surgical services."
American Medical Association's Policy H-475.988, Laser Surgery, reads:
"The board opines that revision, destruction, incision or other structural alteration of human tissue
using laser is surgery."
The board has further adopted into its policy the American College of Surgeons' "Statement on
Surgery Using Lasers, Pulsed Light, Radiofrequency Devices, or Other Techniques" adopted
February 9, 2007 by the ACS Board of Regents attached hereto.
Adopted by the board January 16, 2004
Revised by the board October 25, 2007
Leslie A. Gallon
Executive Administrator
Alaska State Medical Board
550 West 7th Avenue, Suite 1500, Anchorage, AK 99501-3567
Telephone: (907) 269-8163 Fax: (907) 269-8196 Website: www.commerce.state.ak.us/occ/pmed.htm
American College of Surgeons
[ST -11] Statement on Surgery Using Lasers, Pulsed Light, Radiofrequency Devices, or Other
Techniques
Adopted February 9, 2007 by ACS Board of Regents
Recognizing the increased usage of laser surgery and to provide professional guidance to state and
federal regulatory bodies addressing laser and other surgery issues, the American College of
Surgeons wishes to make the following revised statement regarding these operative techniques. The
original statement was published in the March 1991 issue of the Bulletin.
Surgery is performed for the purpose of structurally altering the human body by the incision or
destruction of tissues and is part of the practice of medicine. Surgery is also the diagnostic or
therapeutic treatment of conditions or disease processes by any instruments causing localized
alteration or transposition of live human tissue which include lasers, ultrasound, ionizing radiation,
scalpels, probes and needles. The tissue can be cut, burned, vaporized, frozen, sutured, probed, or
manipulated by closed reduction for major dislocations and fractures, or otherwise altered by any
mechanical, thermal, light-based, electromagnetic, or chemical means. Injection of diagnostic or
therapeutic substances into body cavities, internal organs, joints, sensory organs, and the central
nervous system is also considered to be surgery (this does not include administration by nursing
personnel of some injections, such as subcutaneous, intramuscular and intravenous when
ordered by a physician). All of these surgical procedures are invasive, including those that are
performed with lasers, and the risks of any surgical intervention are not eliminated by using a light
knife or laser in place of a metal knife or scalpel.
In recent years, technological advances have made it possible to perform cosmetic surgical
procedures of the skin using a variety of devices and techniques. Lasers, pulsed light and radio
frequency devices are often used for ablative and non-ablative treatments. An ablative treatment is
expected to excise, bum or vaporize the skin below the dermo-epidermal junction. Non-ablative
treatments are those that are not expected or intended to excise, bum or vaporize the epidermal
surface of the skin. Any procedures that can damage the eye (cornea to retina) are ablative and
should only be performed by a licensed physician.
The American College of Surgeons believes that surgery using lasers, pulsed light, radio frequency
devices or other means is the practice of medicine and constitutes standard forms of surgical
intervention. It is subject to the same regulations that govern the performance of all surgical
procedures including those that are ablative or non-ablative, regardless of site of service (i.e.,
hospital, ambulatory surgery center, physician's office, or other locations). Patient safety and quality
of care are paramount, and the College therefore believes that patients should be assured that
individuals who perform these types of surgery are licensed physicians (defined as doctors of
medicine or
osteopathy) who meet appropriate professional standards. This is evidenced by comprehensive
surgical training and experience, including the management of complications, and the acquisition and
maintenance of credentials in both the appropriate surgical specialties (i.e., board certification) and in
the use of lasers, pulsed light and radio frequency devices of other similar techniques.
However, the College also recognizes that the use of ablative lasers may be delegated to nonphysician advanced health care practitioners (defined as Nurse Practitioners or Physician Assistants)
who are appropriately trained, and licensed by the state in which they practice. Ablative treatments or
procedures performed by non-physician advanced health care practitioners should fall within the
statutory and/or regulatory scope of the practitioner's profession. The physician may delegate the
performance of ablative treatments through the use of written protocols to an advanced health care
practitioner. Direct supervision should be provided by the physician whenever performance of ablative
treatments has been delegated to an advanced health practitioner, unless specific state regulations
allow for lesser amounts of supervision. The physician is responsible for doing the initial review of the
patient and for authorizing the treatment plan. This should be appropriately noted in the patient's chart
prior to any initial ablative treatment.
Physicians may also delegate the performance of non-ablative treatments to non-physician health
practitioners (defined as registered nurses, cosmetologists, aestheticians, and medical assistants of
other qualified personnel) provided the treatments are performed under direct supervision by the
physician consistent with state laws and regulations in the state where they practice. The physician
must also assure that these practitioners are: appropriately trained, licensed by the state in which
they practice, practicing within the scope of their licensure, and provided with written protocols.
Similar to ablative treatments, the physician is responsible for doing the initial review of the patient
and for authorizing the treatment plan, and this should be appropriately noted in the patient's chart
prior to any initial non-ablative treatment.
In those cases where the surgeon may utilize the services of a non-physician advanced health
practitioner or non-physician health practitioner as an assistant during the performance of laser
surgery (including ablative or non-ablative procedures), the assistant must:
• Be properly licensed, certified and/or credentialed to practice their profession;
• Have appropriate education and training for assisting the surgeon in laser surgery
procedures; and
• Complete their assigned duties under the direct supervision of the surgeon performing the
procedure.
Individuals who perform laser surgery utilizing lasers, pulsed light or radio frequency devices of other
techniques should meet the principles of the College
(http://www.facs.orq/fellow5info/statements/stonprin.html) in all respects, to include the avoidance of
any misrepresentations to the public regarding unfounded advantages of the laser compared with
traditional operative techniques.
Truth in Advertising
Alaska Stat. §08.02.010 (2005)
An acupuncturist, an audiologist or speech-language pathologist, a person licensed in the state as a
chiropractor, a professional counselor, a dentist, a dietitian or nutritionist, a marital and family
therapist, a medical practitioner or osteopath, a direct-entry midwife, a registered nurse, an
optometrist, a licensed pharmacist, a physical therapist or occupational therapist, a psychologist, or a
clinical social worker, shall use as professional identification appropriate letters or a title after that
person's name that represents the person's specific field of practice.
The letters or title shall appear on all signs, stationery, or other advertising in which the person offers
or displays personal professional services to the public.
In addition, a person engaged in the practice of medicine or osteopathy, or a person engaged in any
manner in the healing arts who diagnoses, treats, tests, or counsels other persons in relation to
human health or disease and uses the letters "M.D." or the title "doctor" or "physician" or another title
that tends to show that the person is willing or qualified to diagnose, treat, test, or counsel another
person, shall clarify the letters or title by adding the appropriate specialist designation, if any, such as
"dermatologist", "radiologist", "audiologist", "naturopath", or the like.
Arizona
TITLE 12. NATURAL RESOURCES
CHAPTER 1.RADIATION REGULATORY AGENCY
ARTICLE 14. REGISTRATION OF NONIONIZING RADIATION SOURCES AND
STANDARDS FOR PROTECTION AGAINST NONIONIZING RADIATION
Section
R12-1-1438. Hair Reduction and Other Cosmetic Procedures Using Laser and Intense Pulsed Light
R12-1-1438.01. Certification and Revocation of Laser Technician Certificate
R12-1-1439. Laser and IPL Laser Technician and Laser Safety Training Programs
ARTICLE 14. REGISTRATION OF NONIONIZING RADIATION SOURCES AND
STANDARDS FOR PROTECTION AGAINST NONIONIZING RADIATION
R12-1-1438. Hair Reduction and Other Cosmetic Procedures Using Laser and Intense Pulsed
Light
A.
Registration. A person who seeks to perform hair reduction or other cosmetic procedures shall
apply for registration of any medical laser or IPL device that is a Class II surgical device, certified as
complying with the labeling standards in 21 CFR 801.109, revised April 1, 2003 2010, incorporated by
reference, and available under R12-1-101. This incorporated material contains no future editions or
amendments. The applicant shall provide all of the following information to the Agency with the
application for registration:
1.
Documentation demonstrating that the health professional is qualified in accordance
with A.R.S. §§ 32-516 or 32-3233, has 24 hours of didactic training on the subjects
listed in Appendix C, and has passed an Agency-approved exam on subjects covered
with a minimum grade of 80%;
2.
For any health professional in practice prior to October 1, 2010, proof of 24 hours of
training on the subjects listed in Appendix C;
3.
Documentation endorsed by the prescribing health professional, acknowledging
responsibility for the minimum level of supervision required for hair reduction
procedures as defined in R12-1-1402 under “indirect supervision”;
4.
Procedures to ensure that the registrant has a written order from a prescribing health
professional before the application of radiation;
5.
If authorized, procedures to ensure that, in the absence of a prescribing health
professional at the facility, the registrant has established a method for emergency
6.
B.
medical care and assumed legal liability for the service rendered by an indirectlysupervised certified laser technician; and
Documentation that the indirectly-supervised certified laser technician has participated
in the supervised training required by A.R.S. §§ 32-516 or 32-3233.
Hair Reduction Procedures
1.
If a registrant is using a medical laser or an IPL device that is a Class II surgical device,
certified in accordance with the labeling standards in subsection (A), for hair reduction
procedures, the registrant shall:
a.
Ensure that the device is only used by a health professional described in A.R.S.
§§ 32-516(F)(3) and 32-3233(D)(1) or by a certified laser technician who is
working under the indirect supervision of a health professional described in
A.R.S. §§ 32-516(C)(1) and 32-3233(D) and (H)(1), and
b.
Ensure that a prescribing health professional purchases or orders the Class II
surgical device that will be used for hair reduction procedures.
2.
A registrant shall:
a.
Not permit an individual to use a medical laser or IPL device for hair reduction
procedures unless the individual:
i.
Completes an approved laser technician didactic training
program of at least 40 hours duration. To successfully complete the
training program, the individual shall pass a test that consists of at
least 50 multiple choice questions on subjects covered with a
minimum grade of 80%. The training program shall be provided by
an individual who is a health professional acting within their scope
of practice, or a certified laser technician with a minimum of 100
hours of hands-on experience per procedure being taught;
ii.
Is directly supervised present in the room for at least 24 hours of on
the job hands-on training, conducted by a licensed practitioner
health professional or a certified laser technician as described in
subsection (B)(2)(a)(i);
iii.
Performs or assists in at least 10 hair reduction procedures; and
iv.
Has the qualified health professional or qualified supervising
certified laser technician certify that the laser technician has
completed the training and supervision as described in subsection
(B)(2)(a).
b.
Ensure that the laser technician follows written procedure protocols
established by a prescribing health professional; and
c.
Ensure that the laser technician follows any written order, issued by a prescribing
health professional, which describes the specific site of hair reduction.
3.
4.
5.
6.
7.
C.
A registrant shall maintain a record of each hair reduction procedure protocol that is
approved and signed by a prescribing health professional, and ensure that each
protocol is reviewed by a prescribing health professional, at least annually.
A registrant shall:
a.
Maintain each procedure protocol onsite, and ensure that the protocol contains
instructions for the patient concerning follow-up monitoring; and
b.
Design each protocol to promote the exercise of professional judgment by the
laser technician commensurate with the individual’s education, experience, and
training. The protocol need not describe the exact steps that a qualified laser
technician should take with respect to a hair removal reduction procedure.
A registrant shall require that a prescribing health professional observe the performance
of each laser technician during procedures at intervals that do not exceed six months.
The registrant shall maintain a record of the observation for three years from the date of
the observation.
A registrant shall verify that a health professional is qualified to perform hair reduction
procedures by obtaining evidence that the health professional has received relevant
training specified in R12-1-1438(A)(1) and in physics, safety, surgical techniques, preoperative and post-operative care and can perform these procedures within the relevant
scope of practice, as defined by the health professional’s licensing board.
A registrant shall provide radiation safety training to all personnel involved with hair
reduction procedures, designing each training program so that it matches an individual’s
involvement in hair reduction procedures. The registrant shall maintain records of the
training program and make them available to the Agency for three years from the date
of the program, during and after the individual’s period of employment.
Other Cosmetic Procedures
1.
If a registrant is using a medical laser or an IPL device that is a Class II surgical device,
certified in accordance with the labeling, standards in subsection (A), for other cosmetic
procedures, the registrant shall.
a.
Ensure that the device is only used by a health professional described in A.R.S.
§§ 32-516(F)(3) and 32-3233(D)(1) or by a certified laser technician who is
directly supervised by a health professional as described in A.R.S. §§ 32516(C)(2) and 32-3233(D) and (H)(2); and
b.
Ensure that a prescribing health professional purchases or orders the Class II
surgical device that will be used for other cosmetic procedures.
2.
A registrant shall not permit an individual to use a medical laser or IPL device for other
cosmetic procedures unless the individual:
a.
Completes an approved laser technician didactic training program of at least 40
hours duration. To successfully complete the training program the individual shall
pass a test that consists of at least 50 multiple choice questions on subjects
covered with a minimum grade of 80%. The training program shall be provided
3.
4.
5.
D.
E.
by an individual who is a health professional acting within their scope of practice,
or a certified laser technician with a minimum of 100 hours of hands-on
experience per procedure being taught;
b.
Is present in the room for at least 24 hours of hands-on training, conducted by a
health professional or a certified laser technician as described in subsection
(C)(2)(a); and
c.
Performs or assists in at least 10 cosmetic procedures governed by subsection
(C), for each type of procedure (for example: spider vein reduction, skin
rejuvenation, non-ablative skin resurfacing);
d.
Has the qualified health professional or qualified supervising certified laser
technician certify that the laser technician has completed the training and
supervision as described in subsection (C)(2).
A registrant shall maintain a record of each protocol for a cosmetic procedure governed
by subsection (C) that is approved and signed by a prescribing health professional, and
ensure that each protocol is reviewed by a prescribing health professional, at least
annually. The registrant shall:
a.
Maintain each protocol onsite, and ensure that the protocol contains instructions
for the patient concerning follow-up monitoring; and
b.
Design each protocol to promote the exercise of professional judgment by the
laser technician commensurate with the individual’s education, experience, and
training. The protocol need not describe the exact steps that a qualified laser
technician should take with respect to a cosmetic procedure governed by
subsection (C).
A registrant shall verify that a health professional is qualified to perform laser, IPL, and
related procedures, by obtaining evidence that the health professional has received
relevant training specified in R12-1-1438(A)(1) and in physics, safety, surgical
techniques, pre-operative and post-operative care and can perform these procedures
within the relevant scope of practice, as defined by the health professional’s
licensing board.
A registrant shall provide radiation safety training to all personnel involved with cosmetic
procedures governed by subsection (C), designing each training program so that it
matches an individual’s involvement in each procedure. The registrant shall maintain
records of the training program and make them available to the Agency for three years
from the date of the program, during and after the individual’s period of employment.
Persons governed by this Section shall also comply with other applicable licensing and safety
laws.
A laser shall be secured so that the laser cannot be removed from the facility and the on/off
switch is turned to the “off” position with the key removed when a certified laser technician or a
health professional is not present in the room where the laser is located.
R12-1-1438.01. Certification and Revocation of Laser Technician Certificate
A.
An applicant for a laser technician certificate shall submit a completed application and
certification that the applicant has received the training specified in A.R.S. §§ 32-516(A) or 323233(E).
B.
The applicant shall pay a nonrefundable fee of $30.00. A duplicate certificate may be
requested at the time of initial application or renewal at a fee of $10.00 per certificate. To
obtain a duplicate certificate at other times a laser technician shall pay $20.00 per certificate.
C.
Initial certificates are issued for 12 months and expire on the last day of the month. A renewal
application shall be accompanied by a renewal fee of $30.00 each year in addition to $10.00
per duplicate certificate requested.
D.
Under A.R.S. § 32-3233(I) and (J), the Agency may take appropriate disciplinary action,
including revocation of the certificate of a certified laser technician. The Agency may discipline
a certified laser technician who has had a relevant professional license suspended or revoked,
or been otherwise disciplined by a health professional board or the Board of Cosmetology. The
Agency may also discipline the certified laser technician for falsifying documentation related to
training, prescriptions, or other required documentation. As provided in Article 12 of this
Chapter, the Agency may assess civil penalties, suspend, revoke, deny, or put on probation a
certified laser technician.
E.
A laser technician that has been using laser and IPL devices prior to November 24, 2009 may
continue to do so if the technician applies for and receives a certificate from the Agency before
October 1, 2010.
F.
Certification may be issued for one or more of the following procedures:
1.
Hair Reduction,
2.
Skin Rejuvenation,
3.
Non-Ablative Skin Resurfacing,
4.
Spider Vein Reduction,
5.
Skin Tightening,
6.
Wrinkle Reduction,
7.
Laser Peel,
8.
Telangiectasia Reduction,
9.
Acquired Adult Hemangioma Reduction,
10.
Facial Erythema Reduction,
11.
Solar Lentigo Reduction (Age Spots),
12.
Ephelis Reduction (Freckles),
13.
Acne Scar Reduction,
14.
Photo Facial, or
15.
Additional procedures as approved by the Agency after consultation with other health
professional boards as defined in A.R.S. §§ 32-516(F)(3) or 32-3233(D)(1).
G.
For any application relating to the certification of laser technicians, as described in A.R.S. § 411072, there is an administrative completeness review time-frame of 30 days and a substantive
review time-frame of 30 days with an overall timeframe of 60 days.
H.
Certified laser technicians shall display a valid original certificate as issued by the Agency in a
location that is viewable by the public.
R12-1-1439. Laser and IPL Laser Technician and Laser Safety Training Programs
A.
A person seeking to initiate a medical laser or IPL laser technician training program shall
submit an application to the Agency for certification that contains a description of the training
program. In addition, the person shall submit a syllabus and a test that consists of at least 50
multiple choice questions on subjects covered. In the program materials, the person shall
address the subjects in R12-1-1438 through R12-1-1439, and Appendix C.
B.
The Agency shall review the application and other documents required by subsections
(A) and (E) in a timely manner, using an administrative completeness review time-frame
of 40 days and a substantive review time-frame of 20 days with an overall time-frame of
60 days.
C.
The Agency shall maintain a list of certified laser or IPL training programs.
D.
Applicants for approval as a certified laser or IPL training program shall pay a
nonrefundable $100.00 fee.
E.
Initial certification shall be issued for 12 months and shall expire on the last day of the
month. A renewal application shall be accompanied by a renewal fee of $100.00 each
year.
F.
A person seeking to initiate a medical laser or IPL laser technician safety training
program shall submit an application to the Agency for certification that contains a
description of the training program. In addition, the person shall submit a syllabus
and a test that consists of at least 50 multiple choice questions on subjects covered. In
the program materials, the person shall address the subjects in R12-1-1421 through
R12-1-1444, Appendix C, and Appendix D, with emphasis on personal and public
safety. The program shall also contain the training required by A.R.S. § 32-3233(E) or
clearly state the portions of the training that are not provided or met if didactic
certification is to take place in another program. The applicant shall conduct training in
accordance with the program submitted to the Agency and certified by the Agency.
Truth in Advertising
Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 32, chapter 32, article 1, Arizona Revised Statutes, is amended by adding section 323213, to read:
32-3213. Health professionals; disclosure; unprofessional conduct; definition
A. AN ADVERTISEMENT FOR HEALTH CARE SERVICES THAT INCLUDES A HEALTH
PROFESSIONAL'S NAME SHALL IDENTIFY THE TITLE AND TYPE OF LICENSE THE HEALTH
PROFESSIONAL HOLDS AND UNDER WHICH THE HEALTH PROFESSIONAL IS PRACTICING.
B. A HEALTH PROFESSIONAL WHO VIOLATES THIS SECTION COMMITS AN ACT OF
UNPROFESSIONAL CONDUCT.
C. FOR THE PURPOSES OF THIS SECTION, "ADVERTISEMENT" INCLUDES BILLBOARDS,
BROCHURES, PAMPHLETS, RADIO AND TELEVISION SCRIPTS, ELECTRONIC MEDIA,
PRINTED TELEPHONE DIRECTORIES, TELEPHONE AND DIRECT MAIL SOLICITATIONS AND
ANY OTHER MEANS OF PROMOTION INTENDED TO DIRECTLY OR INDIRECTLY INDUCE ANY
PERSON TO ENTER INTO AN AGREEMENT FOR SERVICES WITH THE HEALTH
PROFESSIONAL. ADVERTISEMENT DOES NOT INCLUDE MATERIALS THAT PROVIDE
INFORMATION ABOUT NETWORK PROVIDERS AND THAT ARECREATED BY AN ENTITY
REGULATED UNDER TITLE 20.
Corporate Practice of Medicine
Case Law:
A corporation may not practice optometry through employing a licensed optometrist or through any
arrangement that subjects the optometrist to the corporation's direction and control. See State ex re.
Bd. of Optometry v. Sears, Roebuck & Co., 427 P.2d 126 (Ariz. 1967).
Corporations are not endowed with the necessary moral and intellectual properties for optometry and
dentistry. See Funk Jewelry Co. v. State ex rel. La Prade, 50 P.2d 945 (Ariz. 1935).
Arkansas
Arkansas Medical Practice Act
REGULATION NO. 22
LASER SURGERY GUIDELINES
Pursuant to Ark. Code Ann. 17-95-202, the practice of medicine involves the use of surgery for the
diagnosing and treatment of human disease, ailment, injury, deformity, or other physical conditions.
Surgery is further defined by this Board as any procedure in which human tissue is cut, altered, or
otherwise infiltrated by mechanical means, to include the use of lasers. The Board further finds that
the use of medical lasers on human beings, for therapeutic or cosmetic lasers, constitutes the
practice of medicine.
Ark. Code Ann. 17-95-409(a)(2)(g) states that the Board may revoke an existing license, or suspend
the same, if a physician has committed unprofessional conduct, further defined as committing gross
negligence or ignorant malpractice. The Board finds that a physician has, in fact, committed gross
negligence if he performs laser surgery on patients without benefit of: a) clinical experience in the use
of lasers; b) training of clinical management of patients; c) continuing medical education courses in
the use of lasers; d) providing appropriate preoperative, operative, and post operative management.
History: Adopted, June 5, 1998.
Ark. Code Ann. §17-95-202. Definitions
"Practice of medicine" means:
(A) Holding out one's self to the public within this state as being able to diagnose, treat, prescribe for,
palliate, or prevent any human disease, ailment, injury, deformity, or physical or mental condition,
whether by the use of drugs, surgery, manipulation, electricity, or any physical, mechanical, or other
means whatsoever;
(B) Suggesting, recommending, prescribing, or administering any form of treatment, operation, or
healing for the intended palliation, relief, or cure of any physical or mental disease, ailment, injury,
condition, or defect of any person with the intention of receiving, either directly or indirectly, any fee,
gift, or compensation whatsoever;
(C) Maintaining an office or other place to meet persons for the purpose of examining or treating
persons afflicted with disease, injury, or defect of body or mind;
(D) Using the title “M.D.,” “M.B.,” “D.O.,” “Physician,” “Surgeon,” or any word or abbreviation to
indicate or induce others to believe that one is engaged in the diagnosis or treatment of persons
afflicted with disease, injury, or defect of body or mind, except as otherwise expressly permitted by
the laws of this state relating to the practice of any limited field of the healing arts; or
(E) Performing any kind of surgical operation upon a human being.
History. Acts 2001, No. 464, § 1
REGULATION
17-105-109. Supervision.
(a) Supervision of physician assistants shall be continuous but shall not be construed as necessarily
requiring the physical presence of the supervising physician at the time and place that the services
are rendered.
(b) It is the obligation of each team of physicians and physician assistants to ensure that:
(1) The physician assistant’s scope of practice is identified;
(2) The delegation of medical task is appropriate to the physician assistant’s level of competence;
(3) The relationship and access to the supervising physician is defined; and
(4) A process of evaluation of the physician assistant’s performance is established.
(c) The physician assistant and supervising physician may designate back-up physicians who are
agreeable to supervise the physician assistant during the absence of the supervising physician.
Ark. Reg. 060 00 CARR 001
The physician may delegate the performance of certain tasks in the treatment non-physician
personnel skilled in the procedure if the physician personally diagnoses the condition of the patient
and prescribes the treatment and procedures to be performed, makes himself available to the patient
should complications occur, ensure and document patient records that adequately describe the
condition of the patient and the procedure to be performed, and who performed said procedure.
Arkansas State Board of Health
Rules and Regulations for Cosmetology in Arkansas
Rule No. 12 EQUIPMENT AND CHEMICAL USE IN COSMETOLOGY
AND ITS RELATED BRANCHES
(A)
Equipment
(1)
A licensed cosmetologist and aesthetician may use equipment classified by the
U. S. Food and Drug Administration (FDA) as a Class I device. Class I devices
are considered to be less invasive and the potential for harm to the public is
minimal. Examples of a Class I device are electrolysis, red light LED, Galvanic
and microdermabrasion.
(2)
(3)
(4)
(B)
Equipment classified by the FDA as a Class II device shall not be used in the
cosmetology industry. Examples of a Class II device are intense pulse light (IPL),
blue light LED, ultrasound and laser.
Equipment classified by the FDA as a Class III or Class IV device shall not be
used in the cosmetology industry.
A licensed cosmetologist and aesthetician shall immediately provide proof of the
FDA classification for equipment found in their possession during an inspection,
as it is the licensee’s responsibility to research this matter prior to purchasing the
equipment.
Chemical
(1)
A licensed cosmetologist and aesthetician may use the following chemical
exfoliation substances:
(a)
no more than 50% alpha hydroxyl acid (AHAs which includes glycolic,
tartaric, malic or lactic acids. Such AHAs shall not be lower than a pH of
2);
(b)
no more than 20% beta hydroxyl acid (BHAs which include salicylic acid);
(c)
Trichloroacetic Acid (TCA) with levels of less than 20%;
(d)
Jessner’s solutions;
(e)
2% resorcinol; and
(f)
Proteolytic enzymes (such as papain and bromelain) when used with an
accelerator.
(2)
No person performing any type of cosmetological services is permitted to use the
following:
(a)
Retinoids;
(b)
Carbolic acid (phenol);
(c)
Products listed above that exceed the stated maximum levels or
combinations thereof;
(d)
All adulterated chemical exfoliating/peeling substances.
(C)
Equipment and chemical exfoliation substance services shall only be administered in an
establishment or school licensed by the Board and shall only be performed by a licensed
practitioner that follows the appropriate health and safety guidelines.
(D)
Prior to providing services related to cosmetic resurfacing and/or exfoliating, cosmetologists or
aestheticians shall inform each client that the following may increase the client’s susceptibility
to adverse reactions as a result of the procedure:
(1)
currently under physician’s care or treatment;
(2)
HSV (cold sores) predisposition;
(3)
whether client is currently pregnant;
(4)
history of cosmetic related irritant or allergic reaction;
(5)
(6)
(7)
(8)
frequency of sun exposure or tanning bed use;
use of topical and/or oral medications, such as tretinoin (aka Retin-A, Renova);
isotretinoin (aka Accutane);
previous facial plastic/reconstructive surgery.
(E)
If the client history indicates a positive answer to any questions set forth in subsection (D)
above, a predisposition patch test must be performed 24-hours before the procedure is
performed and/or written approval from a physician must be provided to authorize the
procedure.
(F)
Prior to providing any services related to cosmetic resurfacing and/or exfoliating,
cosmetologists and aestheticians shall do a visual inspection of the client’s skin for the
following conditions:
(1)
degree of sebaceous activity (skin oiliness), acne, telangiectasias (broken capillaries)
and degree of photodamage;
(2)
open cuts, sores, lesions or apparent skin irritation or sensitivity.
(G)
Cosmetologists and aestheticians shall conclude all cosmetic resurfacing and/or exfoliating
procedures with application of UVA/UVB SPF 15 (or higher) sunscreen to client before
discharge.
Truth in Advertising
17-80-111. Restrictions on “Doctor” as title in advertising.
No person shall advertise or allow oneself to be advertised by the title “Doctor” in association with the
practice of one of the healing arts, except in the practice of one of the health care professions
regulated under § 17-1-101 et seq. in which case that person shall use the title in accordance with the
statutes and regulations governing the particular health care profession or unless that person has
been granted a doctoral degree in any healing arts profession and is licensed in that profession under
§ 17-1-101 et seq.
History. Acts 1999, No. 338, § 3.
17-80-112. Use of “Doctor” as title in provision of health care services.
In connection with the provision of health care services, no person shall call oneself or allow oneself
to be called by the title “Doctor”, except in the practice of one of the health care professions regulated
under § 17-1-101 et seq. in which case the person shall use the title in accordance with the statutes
and regulations governing the particular health care profession.
History. Acts 1999, No. 338, § 4.
17-80-113. Authorized use of “Doctor” as title.
This act shall not be construed to authorize any person to use the title “Doctor”, unless that title is
authorized under § 17-1-101 et seq. of the Arkansas Code, in which case that person shall use the
title in accordance with the statutes and regulations governing the particular health care profession or
unless that person has been granted a doctoral degree in any healing arts profession and is licensed
in that profession under § 17-1-101 et seq.
History. Acts 1999, No. 338, § 5.
17-95-409. Denial, suspension, or revocation - Grounds.
(a) (1) The board may revoke an existing license, impose penalties as listed in § 17-95-410, or refuse
to issue a license in the event the holder or applicant, as the case may be, has committed any of the
acts or offenses defined in this section to be unprofessional conduct.
(L) (i) Soliciting for patronage;
(ii) Advertising for patronage in a false, fraudulent, deceptive, or misleading manner;
(iii) Advertising the quality of medical services; or
(iv) Advertising illegal procedures and practices;
(M) Offering, undertaking, attempting, or agreeing to cure or treat disease by a secret method,
procedure, treatment, or medicine or representing, directly or indirectly, that he can treat, operate on,
or prescribe for any human condition by a method, means, or procedure which he refuses to divulge
upon demand to the Arkansas State Medical Board;
Corporate Practice of Medicine
An Attorney General Opinion appears to prohibit corporations from employing physicians.
A limited liability company may be organized for any lawful purpose, including the performance of
professional services. However, a limited liability company that will engage in the practice of medicine
must register with the Arkansas State Medical Board and comply with the Medical Corporation
Act. See Ark. Code. Ann. § 4-32 (2006). (Note: Only licensed physicians may be officers, directors or
shareholders of a medical corporation.)
A nonphysician-owned corporation may not employ physicians for profit. Three entities may practice
medicine: (1) medical corporations if all shareholders and directors are licensed physicians; (2)
hospital or medical service corporations; and (3) health maintenance organizations. See
1994 Op. Ark. Att'y Gen. No. 94-204.
California
Business and Professions Code 2050, 2051, 2052, 2053.5
2050.
The Division of Licensing shall issue one form of certificate to all physicians and
surgeons licensed by the board which shall be designated as a "physician's and
surgeon's certificate."
2051.
The physician's and surgeon's certificate authorizes the holder to use drugs or devices
in or upon human beings and to sever or penetrate the tissues of human beings and to
use any and all other methods in the treatment of diseases, injuries, deformities, and
other physical and mental conditions.
2052.
(a)
Notwithstanding Section 146, any person who practices or attempts to practice,
or who advertises or holds himself or herself out as practicing, any system or mode of treating the
sick or afflicted in this state, or who diagnoses, treats, operates for, or prescribes for any ailment,
blemish, deformity, disease, disfigurement, disorder, injury, or other physical or mental condition of
any person, without having at the time of so doing a valid, unrevoked, or unsuspended certificate as
provided in this chapter or without being authorized to perform the act pursuant to a certificate
obtained in accordance with some other provision of law is guilty of a public offense, punishable by a
fine not exceeding ten thousand dollars ($10,000), by imprisonment in the state prison, by
imprisonment in a county jail not exceeding one year, or by both the fine and either imprisonment.
(b)
Any person who conspires with or aids or abets another to commit any act
described in subdivision (a) is guilty of a public offense, subject to the punishment described in that
subdivision.
(c)
The remedy provided in this section shall not preclude any other remedy
provided by law.
2053.5.
(a)
Notwithstanding any other provision of law, a person who complies with the
requirements of Section 2053.6 shall not be in violation of Section 2051 or 2052 unless that person
does any of the
following:
(1)
Conducts surgery or any other procedure on another person that
punctures the skin or harmfully invades the body.
(2)
Administers or prescribes X-ray radiation to another person.
(3)
Prescribes or administers legend drugs or controlled
substances to another person.
(4) Recommends the discontinuance of legend drugs or controlled
substances prescribed by an appropriately licensed practitioner.
(5) Willfully diagnoses and treats a physical or mental condition
of any person under circumstances or conditions that cause or create
(6)
(7)
(8)
a risk of great bodily harm, serious physical or mental illness, or
death.
Sets fractures.
Treats lacerations or abrasions through electrotherapy.
Holds out, states, indicates, advertises, or implies to a client or prospective client
that he or she is a physician, a surgeon, or a physician and surgeon.
(b)
A person who advertises any services that are not unlawful under Section 2051 or 2052
pursuant to subdivision (a) shall disclose in the advertisement that he or she is not licensed by the
state as a healing arts practitioner.
Business and Professions Code 2725.1; 2725.3; 2726
2725.1. Notwithstanding any other provision of law, a registered nurse may dispense drugs or
devices upon an order by a licensed physician and surgeon if the nurse is functioning within a
licensed clinic as defined in paragraphs (1) and (2) of subdivision (a) of Section 1204 of, or within a
clinic as defined in subdivision (b) or (c) of Section 1206, of the Health and Safety Code.
No clinic shall employ a registered nurse to perform dispensing duties exclusively. No
registered nurse shall dispense drugs in a pharmacy, keep a pharmacy, open shop, or drugstore for
the retailing of drugs or poisons. No registered nurse shall compound drugs. Dispensing of drugs by a
registered nurse, except a certified nurse-midwife who functions pursuant to a standardized
procedure or protocol described in Section 2746.51 or a nurse practitioner who functions pursuant to
a standardized procedure described in Section 2836.1, or protocol, shall not include substances
included in the California Uniform Controlled Substances Act (Division 10 (commencing with Section
11000) of the Health and Safety Code). Nothing in this section shall exempt a clinic from the
provisions of Article 13 (commencing with Section 4180) of Chapter 9.
2725.3. (a) A health facility licensed pursuant to subdivision (a), (b), or (f), of Section 1250 of the
Health and Safety Code shall not assign unlicensed personnel to perform nursing functions in lieu of
a registered nurse and may not allow unlicensed personnel to perform functions under the direct
clinical supervision of a registered nurse that require a substantial amount of scientific knowledge and
technical skills, including, but not limited to, any of the following:
(1)
Administration of medication.
(2)
Venipuncture or intravenous therapy.
(3)
Parenteral or tube feedings.
(4)
Invasive procedures including inserting nasogastric tubes,
inserting catheters, or tracheal suctioning.
(5)
Assessment of patient condition.
(6)
Educating patients and their families concerning the patient's health care
problems, including postdischarge care.
(7)
Moderate complexity laboratory tests.
(b) This section shall not preclude any person from performing any act or function that he or
she is authorized to perform pursuant to Division 2 (commencing with Section 500) or pursuant to
existing statute or regulation as of July 1, 1999.
2726. Except as otherwise provided herein, this chapter confers no authority to practice medicine or
surgery.
Physician Assistants
A physician assistant, (“PA”) is a licensed and skilled health professional trained to provide patient
evaluation, education and health care services. PAs assist physicians in basic care of patients. PAs
are licensed by the Physician Assistant Committee, which is part of the California Department of
Consumer Affairs’ Medical Board of California. A PA may perform only those services he is (1)
competent to perform (2) are consistent with his/her education, training and experience (3) are
delegated in writing by the supervising physician responsible for the patients cared for by the PA.
The orders from the supervising physician do not have to be patient-specific. California Code of
Regulations, Tit. 16, § 1399.541.
All physicians must complete a Delegation of Services Agreement indicating in writing those services
a PA may provide. (Exh. E) PAs may write their own drug orders and obtain their own DEA numbers
to distribute drugs. PAs may write and sign prescription drug orders when authorized to do so by
their supervising physician for medications listed on Schedules II-V. A PA may only administer,
provide or transmit a drug order for Schedule II-V controlled substances with the advance approval of
a supervising physician for each patient.
Under CCR Tit. § 1399.541 of the California Code of Regulations, physician assistants are limited to
providing the following medical services:
1. Take patient history, perform physical exams, make assessments and diagnosis therefrom; initiate,
review and revise treatment and therapy plans, including plans for those services described in §
1399.541(b) through § 1399.541(i). § 1399.541(a).
2. Order or transmit an order for x-ray, other studies, therapeutic diets, physical therapy, occupational
therapy, respiratory therapy and nursing services.
3. Participate or order the performance of laboratory procedures, screening procedures and
therapeutic procedures.
4. Recognize and evaluate situations, which call for the immediate attention of a physician and
commencement of life-saving procedures.
5. Counsel and instruct patients on matters pertaining to their physical or mental health.
6. Initiate arrangements for admissions, complete medical record forms, and provide continuing care,
as well as referral to community resources.
7. administer medication or transmit orally or in writing in a patient’s record, a prescription from his or
her supervising physician. The supervising physician’s prescription shall be based on either on a
patient-specific order by the supervising physician or on written protocol specifying all criteria for use
of the specific drug or device and any contraindications for the selection.
8. A PA may perform surgical procedures without the personal presence of the supervising physician
customarily performed under local anesthesia. Prior to delegating such procedures, the supervising
physician shall review the documentation indicating that the PA is trained to perform such surgical
procedures. Surgical procedures requiring other forms of anesthesia may be performed only in the
personal presence of an approved supervising physician.
9. A PA may act as first or second assistant in surgery under the supervision of an approved
supervising physician.
Under the California Code of Regulations, supervising physicians need only be available in person or
by electronic communication at all times when the PA is caring for a patient. Cal. Code Regs. Tit. 16
§ 1399.543(a). A supervising physician may only delegate those tasks and procedures consistent
with the supervising physician’s specialty or usual and customary practice and with the patient’s
health and condition. Cal. Code Regs. Tit. 16 § 1399.543(b).
Section 1399.545 of the California Code of Regulations describes the supervision required of
physician assistants. A supervising physician must be available in person or by electronic
communication at all times when the PA is caring for patients. Cal. Code Regs. Tit. 16 § 1399.545(a).
PA’s and their supervising physicians must establish transport and back-up plans for immediate care
of patients when the supervising physician is not available on-site. Cal. Code Regs. Tit. 16 §§
1399.545(d). The Regulations grant the authority to issue citations for violations to the executive
officer of the Physician Assistant’s Committee of the Medical Board of California. Cal. Code Regs.
Tit. 16 § 1399.570(a). Citable offenses are listed in § 1399.571(a)(1)-(70). (See Exhibit F).
Section 3500.5 of the California Business and Professions Code and the ensuing statutes are known
as the Physician Assistant Practice Act (“Act”). The Physician’s Assistant Practice Act is intended to
operate as a supplement to Chapter 13.8 of Title 16 of the California Code of regulations,
commencing with § 1399.500. Under § 3502 of the Act, PA’s are not allowed to perform a variety of
opthamalic services, including the determination of the refractive states of the eye, or prescribing
contact lenses. West’s Ann.Cal.Bus. & Prof. Code § 3502(c)(1)&(3). Additionally, PA’s may not
perform the work of a dental auxiliary. West’s Ann.Cal.Bus. & Prof. Code § 3502(c)(4).
Medical Assistants
The Medical Practice Act, (Business and Professions Code §§ 2069-2071) define the roles and duties
of a medical assistant. A medical assistant is a person who may be unlicensed, who performs basic
administrative, clerical and technical support services for a licensed physician or physician assistant.
West’s Ann.Cal.Bus. & Prof. Code § 2069(b)(1). Medical assistants must complete and receive a
certificate for the minimum amount of appropriate training under standards developed by the Division
of Licensing. Id. Medical assistants may administer medication only by intradermal, subcutaneous or
intramuscular injections and perform skin tests and other technical support services under the specific
authorization and supervision of a licensed physician, surgeon or podiatrist. West’s Ann.Cal.Bus. &
Prof. Code § 2069(a)(1).
“Specific authorization” means a specific written order placed in the patient’s medical record or the
physician, surgeon or podiatrist may execute a standing order, which also must be noted in the
patient’s medical record. West’s Ann.Cal.Bus. & Prof. Code § 2069(b)(2). “Supervision” means the
physician, surgeon or podiatrist must be physically present in the treatment facility. West’s
Ann.Cal.Bus. & Prof. Code § 2069(b)(3). The only exception to the supervision requirements is in a
community clinic, where a supervising physician may delegate supervisory authority over the medical
assistant to a nurse practitioner or nurse midwife. See West’s Ann.Cal.Health & Safety Code § 1204.
“Technical support services” are those routine medical tasks that may safely be performed by
someone with limited training. West’s Ann.Cal.Bus. & Prof. Code § 2069(b)(3)(4). Medical assistants
are not allowed to administer local anesthetic agents. West’s Ann.Cal.Bus. & Prof. Code § 2069(c).
Medical assistants are permitted to draw blood after earning a certificate of training. West’s
Ann.Cal.Bus. & Prof. Code § 2070. Medical assistants are also permitted to call in refill prescriptions.
They may not, however, call in new prescriptions or prescriptions that have changes. Additionally,
medical assistants may perform hearing tests. See West’s Ann.Cal.Bus. & Prof. Code § 2350.5(a).
Under Section 2544 of the Business and Professions Code, medical assistants are permitted to
perform the following under the direct supervision of a physician, surgeon or optometrist :
1. Prepare patients for examinations.
2. Collect preliminary patient data, including taking a patient history.
3. Perform simple non-invasive testing of visual acuity, pupils, and ocular motility.
4. Perform automated visual field testing.
5. Perform opthamalic photography and digital imaging.
6. Perform tonometry.
7. Perform lensometry.
8. Perform nonsubjective auto refraction in connection with subjective refraction procedures
performed by an opthamologist or optometrist.
9. Administer cycloplegiacs, mydriatics, and topical anesthetics that are not controlled substances, for
opthamalic purposes.
10. Perform pachymetry, keratometry, A scans, B scans and electodiagnostic testing.
Medical assistants are not permitted to perform such invasive procedures as:
1. Placing the needle or starting and disconnecting the infusion tube of an IV.
2. Administer medications or injections in to the IV line.
3. Chart pupillary responses.
4. Insert a urine catheter.
5. Independently perform telephone triage.
6. Inject collagen.
7. Administer chemotherapy
8. Use lasers to remove hair, wrinkles, scars, moles or other blemishes.
Under the California Code of Regulations, medical Assistants are permitted to perform the technical
supportive services listed under Business and Professions Code, § 2069(c). Tit. 16 CCR §
1366(a)(1). Medical assistants must complete the training required under CCR §§ 1366.2, 1366.3
and 1366.4. Tit. 16 CCR § 1366(a)(3). Sections (4) and (5) of § 1366(a) repeat the ability of a
physician to note in a patient chart technical supportive services performed by a medical assistant, as
well as provide written instruction of the task. Additionally, under subdivision (b) of §1366 of the
California Code of Regulations, medical assistants may perform the following functions:
1. Administer medication orally, sublingually, topically, vaginally or rectally, or by providing a single
does for immediate self-administration. A licensed physician must verify it is the correct does. No
anesthetic agent may be administered by a medical assistant.
2. Perform electrocardiogram, electroencephalogram or plethysmosgraphy tests, except full body
plethysmography. Medical assistants are not allowed to perform tests involving penetration of the
human tissues except those permitted under § 2069 of the California Business and Professions
Code.
3. Apply and remove bandages and dressings, apply orthopedic appliances such as knee
immobilizers and envelope slings; remove casts, splints and other external devices, obtain
impressions for orthotics, select and adjust crutches and instruct patients as to their proper use.
4. Remove sutures or staples from superficial incisions or lacerations.
5. Perform ear lavage to remove impacted cerumen.
6. Collect by non-invasive techniques and preserve specimens for testing, including urine, sputum,
stool and semen.
7. Assist patients in ambulation and transfers.
8. Assist physicians, physician assistants and registered nurses in examinations or procedures,
including positioning, draping, shaving and disinfecting treatment sites, prepare patients for gait
analysis testing.
9. As authorized by the physician or podiatrist, provide patient information and instruction.
10. Collect and record data such as height, weight, blood pressure, and basic information about
presenting and previous conditions.
11. Perform simple laboratory and screening tests customarily performed in a medical office.
12. Cut the nails of otherwise healthy patients.
Under Cal. Code Regs. § 1366(d), medical assistants are not allowed to practice physical therapy.
Under (e), the Regulations cite and reaffirm that their licensed physician or podiatrist must be
physically present at the facility. Under (f), medical assistants may also fit prescription lenses or use
any optical device in connection with ocular exercises, visual training, vision training or orthoptics
pursuant to §§ 2544 and 3042 of the California Business and Professions Code.
Training to perform venipuncture injections and inhalation of medications generally requires 10 clock
hours per technical skill. See CCR Tit. 16 § 1366.1(a)-(e). Section 1366.3 describes the location and
procedures for the administration of training for technical skills. Medical assistants may be trained
under a licensed physician or podiatrist, or under a registered nurse, licensed vocational nurse,
physician assistant or qualified medical assistant acting under the direction of a licensed physician or
podiatrist. CCR Tit. 16 § 1366(a)(1). A qualified medical assistant, for purposes of § 1366.3 only, is
a medical assistant who is certified by a medical assistant certifying organization, holds a credential
to teach a medical assistant program in a community college, or is authorized to teach medical
assistants in a private institution recognized by the U.S. Department of Education or approved by the
Bureau for Private Postsecondary and Vocational Education. CCR Tit. 16 § 1366.3(c)(1)-(3).
Truth in Advertising
680.5. (a) (1) A health care practitioner licensed under Division 2 (commencing with Section 500)
shall communicate to a patient his or her name, state-granted practitioner license type, and highest
level of academic degree, by one or both of the following methods:
(A) In writing at the patient’s initial office visit.
(B) In a prominent display in an area visible to patients in his or her office.
(2) An individual licensed under Chapter 6 (commencing with Section 2700) or Chapter 9
(commencing with Section 4000) is not required to disclose the highest level of academic degree he
or she holds.
(b) A person licensed under Chapter 5 (commencing with Section 2000) or under the Osteopathic
Act, who is certified by (1) an American Board of Medical Specialties member board, (2) a board or
association with requirements equivalent to a board described in paragraph (1) approved by
that person’s medical licensing authority, or (3) a board or association with an Accreditation Council
for Graduate Medical Education approved postgraduate training program that provides complete
training in the person’s specialty or subspecialty, shall disclose the name of the board or association
by either method described in subdivision (a).
(c) A health care practitioner who chooses to disclose the information required by subdivisions (a)
and (b) pursuant to subparagraph (A) of paragraph (1) of subdivision (a) shall present that information
in at least 24-point type in the following format:
HEALTH CARE PRACTITIONER INFORMATION
1. Name and license....................................................................................... .
2. Highest level of academic degree.............................................................. .
3. Board certification (ABMS/MBC)............................................................ .
(d) This section shall not apply to the following health care practitioners:
(1) A person who provides professional medical services to enrollees of
a health care service plan that exclusively contracts with a single medical group in a specific
geographic area to provide or arrange for professional medical services for the enrollees of the plan.
(2) A person who works in a facility licensed under Section 1250 of the Health and Safety Code or in
a clinical laboratory licensed under Section 1265.
(3) A person licensed under Chapter 3 (commencing with Section 1200), Chapter 7.5 (commencing
with Section 3300), Chapter 8.3 (commencing with Section 3700), Chapter 11 (commencing with
Section 4800), Chapter 13 (commencing with Section 4980), or Chapter 14 (commencing with
Section 4990.1).
(e) A health care practitioner, who provides information regarding health care services on an Internet
Web site that is directly controlled or administered by that health care practitioner or his or her office
personnel, shall prominently display on that Internet Web site the information required by this section.
651. (a) It is unlawful for any person licensed under this division or under any initiative act
referred to in this division to disseminate or cause to be disseminated any form of public
communication containing a false, fraudulent, misleading, or deceptive statement, claim, or image for
the purpose of or likely to induce, directly or indirectly, the rendering of professional services or
furnishing of products in connection with the professional practice or business for which he or she is
licensed. A "public communication" as used in this section includes, but is not limited to,
communication by means of mail, television, radio, motion picture, newspaper, book, list or directory
of healing arts practitioners, Internet, or other electronic communication.
(b) A false, fraudulent, misleading, or deceptive statement, claim, or image includes a
statement or claim that does any of the following:
(1) Contains a misrepresentation of fact.
(2) Is likely to mislead or deceive because of a failure to disclose material facts.
(3) (A) Is intended or is likely to create false or unjustified expectations of favorable results,
including the use of any photograph or other image that does not accurately depict the results of the
procedure being advertised or that has been altered in any manner from the image of the actual
subject depicted in the photograph or image.
(B) Use of any photograph or other image of a model without clearly stating in a prominent
location in easily readable type the fact that the photograph or image is of a model is a violation of
subdivision (a). For purposes of this paragraph, a model is anyone other than an actual patient, who
has undergone the procedure being advertised, of the licensee who is advertising for his or her
services.
(C) Use of any photograph or other image of an actual patient that depicts or purports to depict
the results of any procedure, or presents "before" and "after" views of a patient, without specifying in
a prominent location in easily readable type size what procedures were performed on that patient is a
violation of subdivision (a). Any "before" and "after" views (i) shall be comparable in presentation so
that the results are not distorted by favorable poses, lighting, or other features of presentation, and (ii)
shall contain a statement that the same "before" and "after" results may not occur for all patients.
(4) Relates to fees, other than a standard consultation fee or a range of fees for specific types
of services, without fully and specifically disclosing all variables and other material factors.
(5) Contains other representations or implications that in reasonable probability will cause an
ordinarily prudent person to misunderstand or be deceived.
(6) Makes a claim either of professional superiority or of performing services in a superior
manner, unless that claim is relevant to the service being performed and can be substantiated with
objective scientific evidence.
(7) Makes a scientific claim that cannot be substantiated by reliable, peer reviewed, published
scientific studies.
(8) Includes any statement, endorsement, or testimonial that is likely to mislead or deceive
because of a failure to disclose material facts.
(c) Any price advertisement shall be exact, without the use of phrases, including, but not
limited to, "as low as," "and up," "lowest prices," or words or phrases of similar import. Any
advertisement that refers to services, or costs for services, and that uses words of comparison shall
be based on verifiable data substantiating the comparison. Any person so advertising shall be
prepared to provide information sufficient to establish the accuracy of that comparison. Price
advertising shall not be fraudulent, deceitful, or misleading, including statements or advertisements of
bait, discount, premiums, gifts, or any statements of a similar nature. In connection with price
advertising, the price for each product or service shall be clearly identifiable. The price advertised for
products shall include charges for any related professional services, including dispensing and fitting
services, unless the advertisement specifically and clearly indicates otherwise.
(d) Any person so licensed shall not compensate or give anything of value to a representative
of the press, radio, television, or other communication medium in anticipation of, or in return for,
professional publicity unless the fact of compensation is made known in that publicity.
(e) Any person so licensed may not use any professional card, professional announcement
card, office sign, letterhead, telephone directory listing, medical list, medical directory listing, or a
similar professional notice or device if it includes a statement or claim that is false, fraudulent,
misleading, or deceptive within the meaning of subdivision (b).
(f) Any person so licensed who violates this section is guilty of a misdemeanor. A bona fide
mistake of fact shall be a defense to this subdivision, but only to this subdivision.
(g) Any violation of this section by a person so licensed shall constitute good cause for
revocation or suspension of his or her license or other disciplinary action.
(h) Advertising by any person so licensed may include the following: (1) A statement of the
name of the practitioner. (2) A statement of addresses and telephone numbers of the offices
maintained by the practitioner. (3) A statement of office hours regularly maintained by the practitioner.
(4) A statement of languages, other than English, fluently spoken by the practitioner or a person in the
practitioner's office.
(5) (A) A statement that the practitioner is certified by a private or public board or agency or a
statement that the practitioner limits his or her practice to specific fields.
(B) A physician and surgeon licensed … by the Medical Board of California may include a
statement that he or she limits his or her practice to specific fields, but shall not include a statement
that he or she is certified or eligible for certification by a private or public board or parent association,
including, but not limited to, a multidisciplinary board or association, unless that board or association
is (i) an American Board of Medical Specialties member board, (ii) a board or association with
equivalent requirements approved by that physician and surgeon's licensing board, or (iii) a board or
association with an Accreditation Council for Graduate Medical Education approved postgraduate
training program that provides complete training in that specialty or subspecialty.
A physician and surgeon licensed under Chapter 5 (commencing with Section 2000) by the
Medical Board of California who is certified by a board or association referred to in clause (i), (ii), or
(iii) shall not use the term "board certified" unless the full name of the certifying board is also used
and given comparable prominence with the term "board certified" in the statement.
For purposes of this subparagraph, a "multidisciplinary board or association" means an educational
certifying body that has a psychometrically valid testing process, as determined by the Medical Board
of California, for certifying medical doctors and other health care professionals that is based on the
applicant's education, training, and experience. For purposes of the term "board certified," as used in
this subparagraph, the terms "board" and "association" mean an organization that is an American
Board of Medical Specialties member board, an organization with equivalent requirements approved
by a physician and surgeon's licensing board or an organization with an Accreditation Council for
Graduate Medical Education approved postgraduate training program that provides complete training
in a specialty or subspecialty.
(j) The Attorney General shall commence legal proceedings in the appropriate forum to enjoin
advertisements disseminated or about to be disseminated in violation of this section and seek other
appropriate relief to enforce this section. Notwithstanding any other provision of law, the costs of
enforcing this section to the respective licensing boards or committees may be awarded against any
licensee found to be in violation of any provision of this section. This shall not diminish the power of
district attorneys, county counsels, or city attorneys pursuant to existing law to seek appropriate relief.
(k) A physician and surgeon or doctor of podiatric medicine licensed pursuant to Chapter 5
(commencing with Section 2000) by the Medical Board of California who knowingly and intentionally
violates this section may be cited and assessed an administrative fine not to exceed ten thousand
dollars ($10,000) per event. Section 125.9 shall govern the issuance of this citation and fine except
that the fine limitations prescribed in paragraph (3) of subdivision (b) of Section 125.9 shall not apply
to a fine under this subdivision.
Corporate Practice of Medicine
Under existing law, the Medical Board of California administers and enforces the laws regulating the
licensed practice of medicine. (Business and Professions Code Section 2000 et seq.)
Existing law prohibits the employment of physicians by corporations to protect the physician's
independent professional judgment; authorizes limited exceptions to this doctrine for the employment
of physicians in specific clinics. Requires clinics to meet specified criteria in order to be licensed and
receive reimbursement; exempts federal, Indian tribe, hospital-tied, community-based, and other
specified clinics from this requirement. (Business and Professions Code Section 2400 et seq.)
Colorado
RULE 800
3 CCR 713-30
COLORADO MEDICAL BOARD
RULES REGARDING THE DELEGATION AND SUPERVISION OF MEDICAL SERVICES TO
UNLICENSED HEALTH CARE PROVIDERS PURSUANT TO SECTION 12-36-106(3)(l), C.R.S.
Table of Contents
Introduction: Basis, purpose and statutory provision
Rules:
I. Scope of Rules
A. Exemption from these Rules: Licensed providers practicing within their scope of practice.
B. Exemption from these Rules: Acts that do not constitute “medical services” as defined by
the Medical Practice Act.
C. Limitations: Persons not eligible to serve as delegatees under these Rules.
D. Limitations: Physicians not eligible to delegate medical services under these Rules.
E. Limitations: Delegation by the delegatee prohibited.
II. What “medical services” may be delegated under these Rules.
III. Determination that a delegatee is “qualified by education, training or experience” to perform
delegated medical services under these Rules.
IV. “Personal and responsible direction and supervision” required under these Rules.
V. Identification of authority to act.
VI. Special provisions applicable to the delegation of Medical-Aesthetic Services.
A. Purpose of the section.
B. Definition of Medical-Aesthetic Services.
C. General applicability of other sections.
D. Additional requirements.
E. Physician-patient relationship for delegated Medical-Aesthetic Services.
VII. Unlicensed practice of medicine.
VIII. Unprofessional conduct.
INTRODUCTION
Basis. The general authority for promulgation of these Rules by the Colorado Medical Board(“Board”)
is set forth in sections12-36-104(1)(a) and 24-4-103, C.R.S.
Purpose. The Colorado Board of Medical Examiners (“Board”) finds that immediate adoption of this
rule is imperatively necessary to comply with state law, specifically House Bill 10-1260 signed by the
Governor on June 10, 2010. The Board further finds that compliance with the requirements of § 24-4-
103, C.R.S., applicable to non-emergency rules, would be contrary to the public interest. Specifically,
House Bill 10-1260 repeals § 12-36-132, C.R.S., governing injunctive relief, and re-codifies the
provision at § 12-36-129(6), C.R.S. The purpose of these amendments is to conform to House Bill 101260.
The following Rules have been adopted by the Board to clarify the requirements of section 12-36106(3)(l), C.R.S. (the “Delegation Statute”). The Delegation Statute governs the delegation of medical
services to, and personal and responsible direction and supervision over, a person who is not
licensed to practice medicine or otherwise licensed to perform the delegated medical services.
Additionally, these Rules clarify particular requirements applicable to the delegation of medical
services pursuant to section 12-36-106(3)(l), C.R.S. when the delegatee is performing MedicalAesthetic Services as defined in Section VI(B) of these Rules.
Statutory provision. These Rules interpret and clarify the requirements of section 12-36-106(3)(l),
C.R.S., which provides as follows: Under the personal and responsible direction and supervision of a
person licensed under the laws of this State to practice medicine, a license to practice medicine is not
required for the rendering of services, other than the prescribing of drugs, by persons qualified by
experience, education, or training. Nothing in this exemption, however, shall be deemed to extend or
limit the scope of any license, and this exemption shall not apply to persons otherwise qualified to
practice medicine but not licensed to so practice in this State.
RULES
I. Scope of Rules. These Rules apply to the delegation of medical services constituting the practice of
medicine to a person who is not licensed to practice medicine, is not qualified for licensure as a
physician or physician assistant, and is not otherwise exempt pursuant to section 12-36-106, C.R.S.
from holding a license to practice medicine.
A. Exemption from these Rules: Licensed providers practicing within their scope of practice.
1. These Rules do not apply to health care providers who are licensed, registered or
certified by the state of Colorado and who are acting within their scope of practice. By
way of example and not by way of limitation, these Rules do not apply to:
a. a licensed dentist practicing dentistry as defined by article 35 of title 12,
C.R.S.,
b. a licensed pharmacist practicing pharmacy as defined by article 22 of title 12,
C.R.S.,
c. a licensed physical therapist practicing physical therapy as defined by article
41 of title 12, C.R.S.
2. These Rules do not apply to a registered nurse (also known as a professional nurse
or an RN). Services provided by a registered nurse, either as an independent nursing
function or a delegated medical function, are governed by the Nurse Practice Act.
3. These Rules do not apply to any person who is otherwise exempt pursuant to section
12-36-106, C.R.S. from holding a license to practice medicine and who is acting within
the scope of the specific statutory exemption.
4. These Rules do not apply to an emergency medical technician (“EMT”) performing
acts allowed pursuant to Board Rule 500. Such services are governed by Board Rule
500. If an EMT seeks to perform services beyond the scope of acts allowed pursuant to
Rule 500, the following provisions apply:
a. In a prehospital environment, if an EMT seeks to perform services beyond the
scope of the acts allowed pursuant to Board Rule 500, the EMT’s medical
director must employ the waiver process outlined in Rule 500 regarding the
additional medical acts.
b. In an office or hospital setting, it is not necessary to apply for a waiver
pursuant to Board Rule 500 so long as the supervision of, and delegation to, the
EMT is in compliance with Section III(C) of these Rules.
5. These Rules do apply to a licensed, registered or certified health care provider (other
than a registered nurse) who acts outside his or her scope of practice. See section III(C)
of these Rules. Additionally, these Rules do apply to individuals who are certified by a
national or private body but who do not have Colorado state licensure, registration or
certification.
B. Exemption from these Rules: Acts that do not constitute “medical services” as defined by
the Medical Practice Act.
1. These Rules do not apply to a person performing acts that do not constitute the
practice of medicine as defined by section 12-36-106(1), C.R.S. of the Medical Practice
Act.
2. In part, “medical services” are defined by the Medical Practice Act to include
suggesting, recommending, prescribing, or administering any form of treatment,
operation, or healing for the intended palliation, relief, or cure of any physical or mental
disease, ailment, injury, condition or defect of any person. “Medical services” also
include holding oneself out to the public as being able to diagnose, treat, prescribe for,
palliate or prevent any human disease, ailment, pain, injury, deformity, or physical or
mental condition. “Medical services” are further defined by section 12-36-106(1), C.R.S.
3. The definition of medical services under the Medical Practice Act does not include
gathering data. A person who merely gathers data is not subject to these Rules. For
example, performing phlebotomy, measuring vital signs, and gathering historical patient
information is not subject to these Rules.
4. The definition of medical services under the Medical Practice Act does not include
acting as an intermediary by communicating a physician’s message or order to another
person, and therefore a person who merely acts as an intermediary to communicate a
physician’s message or order to another person is not subject to these Rules.
C. Limitations: Persons not eligible to serve as delegatees under these Rules.
1. A physician shall not delegate medical services to any person who is otherwise
qualified to be licensed by the Board as a physician or physician assistant but who is
not so licensed, including, but not limited to:
a. Any physician or physician assistant with an inactive, lapsed, revoked,
restricted, limited, suspended or surrendered license;
b. Any physician or physician assistant who meets all qualifications for licensure
but who is not licensed in Colorado; and
c. Any physician or physician assistant whose application for licensure in the
State of Colorado has been denied unless the denial is pursuant to section 1236-116(1)(a), C.R.S.
2. Section 12-36-106(3)(l), C.R.S. shall not be deemed to extend or limit the scope of
any license and may not be used to circumvent the revocation, suspension, surrender,
restriction, limitation, inactivation, non-renewal or denial of a license to practice any field
of the healing arts in the State of Colorado.
3. Medical services shall not be delegated to any person who holds a physician training
license pursuant to section 12-36-122, C.R.S.
D. Limitations: Physicians not eligible to delegate medical services under these Rules.
1. A person who holds a physician training license pursuant to section 12-36-122,
C.R.S. is not authorized to delegate medical services pursuant to section 12-36106(3)(l), C.R.S. and these Rules.
E. Limitations: Delegation by the delegatee prohibited.
1. Delegated services cannot be subsequently delegated to another party by the
delegatee.
II. What “medical services” may be delegated under these Rules.
A. The prescribing of drugs may not be delegated under section 12-36-106(3)(l), C.R.S. and
these Rules. The ordering of a prescription refill by a delegatee, however, does not constitute
“the prescribing of drugs” provided that:
1. The prescription refill is ordered at the same dose and for the same medication as the
original prescription for that patient; and
2. The prescription refill is ordered pursuant to a written refill protocol developed and
authorized by one or more delegating physicians.
B. In addition to other requirements set forth in these Rules, Medical-Aesthetic Services
performed by a delegatee must comply with the particular requirements set forth in Section VI
of these Rules.
C. To delegate a medical service, the physician must be:
1. Qualified by education, training and experience to perform the medical service;
2. Actively performing the medical service as part of his or her medical practice and not
exclusively by delegating the service to a delegatee;
3. Insured to perform the medical service; and
4. Actively practicing medicine and available in the community where the delegated
medical services occur.
D. Delegated medical services must be of the type that a reasonable and prudent physician
would find within the scope of sound medical judgment to delegate. Consequently, delegated
services should be routine, technical services, the performance of which do not require the
special skills of a licensed physician.
III. Determination that a delegatee is “qualified by education, training or experience” to perform
delegated medical services under these Rules.
A. It is the responsibility of the physician to ensure that the delegatee has the necessary
education, training or experience to perform each delegated medical service.
B. Upon request, the delegating physician must provide written documentation of the
delegatee’s qualifications to the Board. Such documentation may include, but not be limited to:
1. Copies of diplomas, certificates or professional degrees from bona fide training
program(s) appropriate to the specific services delegated;
2. Documentation of direct observation of the repeated and successful performance of
the delegated services; and/or
3. Appropriate credentialing by a bona fide agency or institution, if applicable.
C. If a physician wishes to delegate medical services to a person holding a license, certification
or registration and the services are beyond the scope of that person’s license, certification, or
registration, the following requirements apply:
1. The person must have education, training or experience qualifying the person to
perform the medical service in question, and this education, training or experience must
be in addition to the education, training or experience related to the license, certification
or registration. As an illustration, if consistent with these Rules, a physician may
delegate a medical service that is beyond the scope of the practice of respiratory
therapy to a respiratory therapist. It is insufficient, however, to rely solely on that
respiratory therapist’s education, training or experience as a respiratory therapist when
evaluating qualifications to perform the delegated medical service. Instead, the
physician must assure that the respiratory therapist has sufficient additional education,
training or experience to qualify that person to perform the delegated medical service at
issue.
2. Additionally, the delegation of the medical service must otherwise be in compliance
with these Rules.
3. This section III(C) does not apply to delegation of medical services to a registered
nurse. Instead, such delegation would be governed by the Nurse Practice Act.
IV. “Personal and responsible direction and supervision” required under these Rules.
A. One or more physicians shall have explicitly agreed to provide the necessary direction and
supervision of the delegatee(s). The agreement need not be written.
B. The delegating physician is accountable for the acts of the delegatee(s).
C. The physician’s direction and supervision of the delegatee shall be sufficient to limit the
need for the exercise of the judgment required of a physician.
D. The delegating physician must:
1. Provide ongoing inspection, evaluation, advice and control;
2. Make decisions as to the necessity, type, effectiveness and method of treatment;
3. Provide sufficient on-the-spot inspection to determine that the physician’s directions
are regularly being followed;
4. Monitor the quality of the services provided by the delegatee; and
5. Provide personal and responsible direction and supervision that is consistent with
generally accepted standards of medical practice.
E. Delegated services must be provided in the context of an appropriate physician/patient
relationship.
1. Section VI of these Rules sets forth the requirements for a physician/patient
relationship when delegating Medical-Aesthetic Services.
2. For all other delegations, ongoing care of a particular patient without direct physician
involvement is inappropriate and demonstrates insufficient personal and responsible
direction and supervision of a delegatee. Factors establishing the presence of an
appropriate physician/patient relationship include, but are not limited to, some or all of
the following: physician performance of an initial consultation with the patient, direct
observation by the physician of delegated services rendered by the delegatee, review
by the physician of care rendered to the patient by the delegatee, review by the
physician of outcomes following the performance of delegated services, and other
active physician involvement in the provision, review and documentation of services
provided by the delegatee.
F. In the event of an adverse outcome resulting from a delegated medical service, the
delegating physician must provide appropriate follow-up care and/or referrals.
G. Any medical service rendered by the delegatee must conform to the same standard
applicable if the delegating physician performed the service personally.
H. Except as otherwise provided in these Rules, a physician must be on the premises and
readily available to provide adequate personal and responsible direction and supervision.
I. Where a delegatee is acting pursuant to specific and detailed written protocols and where
adequate written emergency protocols are in place, the presence of the delegating physician
on the premises may not be necessary. However, a delegating physician must be available to
attend to the patient.
J. A delegating physician shall assure that there is a timely chart note for all patient contacts
with the delegatee and with the delegating physician.
V. Identification of authority to act:
A. The delegating physician must provide information to patients regarding delegatees
performing medical services pursuant to the physician’s delegation.
B. The delegating physician and the delegatee shall take appropriate measures to assure that
delegatees are identified in a manner that prevents confusion as to the delegatees’
qualifications and legal authority to provide medical services. Following are examples of
situations in which confusion as to the delegatees’ qualifications and legal authority to provide
medical services is likely and in which the physician and the delegatee shall be responsible for
taking effective measures to prevent such confusion. This list is illustrative and not exhaustive.
1. A delegatee uses a title such as “nurse” or “LPN”. Note that even a delegatee who is
licensed as a practical nurse may not use the title “nurse” or “LPN” when performing
acts as a delegatee that are beyond the scope of the practice of practical nursing;
2. A delegatee acting as an EMT or paramedic uses the title EMT or paramedic outside
of the prehospital care setting, such as in the emergency room;
3. A delegatee who is a “radiology practitioner assistant” uses the acronym “RPA”,
which is easily confused with the title of a licensed physician assistant or PA;
4. A delegatee uses the word “licensed” as part of a title when the delegatee does not
possess a Colorado license to perform the medical services at issue; or
5. A delegatee uses the word “doctor” or the abbreviation “Dr.” when acting as a
delegatee.
VI. Special provisions applicable to the delegation of Medical-Aesthetic Services.
A. Purpose of the section. The Board finds that the delegation of medical services in the area
of Medical-Aesthetic Services involves a broad range of changing technologies and practices,
and is an area in which insufficient personal and responsible delegation and supervision of
medical services has led to public safety concerns in Colorado and nationwide. Such public
safety concerns have also been identified by the Colorado Office of Barber and Cosmetology
Licensure, which has referred numerous cases of concern to the Board. Representatives of the
Colorado Office of Barber and Cosmetology Licensure have appeared before the Board on
more than one occasion to address public safety concerns stemming from improper or
inadequate physician delegation of Medical-Aesthetic Services, poor outcomes and the
difficulty in identifying whether appropriate equipment is used in this field under appropriate
supervision. These representatives have also reported that many practitioners in this field use
devices that are not approved by the Food and Drug Administration, or devices that have been
altered from their approved form. Additionally, the Board is concerned about fraudulent
practices in this field, including the sham or inadequate supervision provided to many
delegatees rendering Medical-Aesthetic Services.
B. Definition of “Medical-Aesthetic Services.” “Medical-Aesthetic Services” are medical
services in the cosmetic or aesthetic field that constitute the practice of medicine. Such
Medical-Aesthetic Services include, but are not limited to: (a) the use of a laser, radiofrequency device, intense pulsed light, or other technique that results in the revision,
destruction, incision or other structural alteration of human tissue and/or for hair removal; and
(b) the performance of injections of Botox, Collagen, Restylane, or any other substance
injected for a primarily cosmetic purpose.
1. As with all delegated medical services, delegated Medical-Aesthetic Services must
be of the type that a reasonable and prudent physician would find within the scope of
sound medical judgment to delegate. Consequently, delegated Medical-Aesthetic
Services should be routine, technical services, the performance of which do not require
the special skills of a licensed physician.
2. Off-label use of medications or devices when performing delegated Medical-Aesthetic
Services is generally prohibited unless:
a. the delegating physician has specifically authorized and delegated the off-label
use, and
b. the off-label use is within generally accepted standards of medical practice.
C. General applicability of other sections. Except as explicitly provided in this Section VI of
these Rules, all requirements set forth in other Sections of these Rules apply to delegation of
Medical-Aesthetic Services.
D. Additional requirements. In addition to the other provisions of these Rules, the personal and
responsible direction and supervision of delegatees performing Medical-Aesthetic Services
must include the following:
1. The delegating physician and the delegatee
must have a written agreement documenting and detailing the relationship. This written
agreement is attached in Appendix A of these Rules. The written agreement as set forth
in Appendix A must be available to the public at the site where the delegated medical
services are performed.
2. The delegating physician must maintain a list of all delegatees to whom the physician
has delegated Medical-Aesthetic Services. The list must include a comprehensive and
specific list of the delegated Medical-Aesthetic Services the physician has authorized
the delegatee to perform. The list shall be maintained with documentation of the
delegatee’s qualifications to perform the Medical-Aesthetic Services as described in
paragraph III(B) of these Rules. Upon request, all documentation maintained by the
physician in accordance with this paragraph shall be provided to the Board.
3. The delegating physician is responsible for assuring the qualifications and
competence of the delegatee to perform the delegated Medical-Aesthetic Services as
follows:
a. Prior to authorizing a delegatee to perform any Medical-Aesthetic Services, the
delegating physician must personally assess the qualifications and competence
of the delegatee to perform the Medical-Aesthetic Services. This assessment
must include a review the delegatee’s education and training as relevant to
performance of the delegated medical service(s). Additionally, this assessment
must include, but must not be limited to, initial over-the-shoulder monitoring of
the delegatee’s performance of each delegated Medical-Aesthetic Service.
b. On at least an annual basis, the delegating physician must personally
reassess the qualifications and competence of the delegatee to perform the
Medical-Aesthetic Services. This reassessment must include, but must not be
limited to, over-the-shoulder monitoring of the delegatee’s performance of each
delegated Medical-Aesthetic Service.
c. The delegating physician must document the initial assessment and follow-up
reassessments of the delegatee’s performance of the delegated MedicalAesthetic Services. Upon request, the delegating physician must provide such
documentation to the Board.
4. Medical-Aesthetic Services must be delivered within a facility appropriate to the
delegated service provided and listed on the written agreement as set forth in Appendix
A.
E. Physician-patient relationship for delegated Medical-Aesthetic Services. The delegating
physician’s physician-patient relationship with a patient receiving delegated Medical-Aesthetic
Services pursuant to these Rules need not comply with Section IV(E) of these Rules, but must
include the following:
1. The delegating physician must ensure that each patient receives all information
necessary to give appropriate informed consent for any Medical-Aesthetic Service and
that such informed consent is timely documented in the patient’s chart.
2. All patients receiving a delegated Medical-Aesthetic Service must be informed that
the delegating physician is available personally to consult with them or provide
appropriate evaluation or treatment in relation to the delegated Medical-Aesthetic
Services. Upon request, the delegating physician must timely and personally provide
such consultation, evaluation or treatment.
3. The delegating physician must assure that the delegatee maintains appropriate
patient charts for each patient receiving Medical-Aesthetic Services.
4. At least weekly, the delegating physician must monitor the quality of the services
provided by the delegatee through such means as direct observation, review of care,
review of outcomes, review of equipment, review of protocols and procedures and
review of charts. The weekly monitoring must occur at the site where the delegated
services are performed.
VII. Unlicensed practice of medicine.
A. Pursuant to section 12-36-106(2), C.R.S., any person who performs any of the acts
constituting the practice of medicine as defined by section 12-36-106(1), C.R.S. and who is not
licensed by the Board to practice medicine or exempt from licensure requirements by some
provision of section 12-36-106, C.R.S. shall be deemed to be practicing medicine without a
license. No person shall be exempt from medical licensure requirements pursuant to section
12-36-106(3)(l), C.R.S., unless such person is acting in conformance with these Rules.
B. A person who practices medicine without a license may be the subject of a cease and desist
order pursuant to section 12-36-118, C.R.S. Such person may also be the subject of injunctive
proceedings by the Board in the name of the People of the State of Colorado pursuant to
section 12-36-129(6), C.R.S. Such person may also be held criminally liable pursuant to
section 12-36-129(1), C.R.S. Finally, such person may be subject to any other enforcement
allowed under the law.
VIII. Unprofessional conduct.
A. It shall be unprofessional conduct pursuant to section 12-36-117(1)(u), C.R.S. for any
licensee to have delegated medical services or to have performed delegated medical services
pursuant to section 12-36-106(3)(l), C.R.S. without complying with the provisions of these
Rules.
B. It shall also be unprofessional conduct pursuant to section 12-36-117(1)(u), C.R.S. for any
person who is not licensed by this Board but who applies for licensure by this Board to have
performed delegated medical services or to have delegated medical services pursuant to
section 12-36-106(3)(l), C.R.S. prior to licensure in Colorado.
Adopted 11/15/02, Effective 1/30/03; Revised 04/14/05, Effective 06/30/05; Revised 10/13/05,
Effective 11/30/05, Revised 5/11/06, Effective 7/2/06; Repealed and Readopted 5/22/08, Effective
6/30/08; Revised 06/22/10; Effective 07/01/10
BOARD RULE 800, APPENDIX A
Agreement Between Delegating Physician and Delegatee Performing Medical-Aesthetic Services
Under Colorado Medical Board Rule 800
___________________________________________________________ and
(Print Name & Title of Delegating physician)
___________________________________________________________, attest that:
(Print Name & Title of Delegatee)
The delegating physician is licensed in the state of Colorado to practice medicine.
The delegating physician is qualified to perform each delegated medical service listed below, and
actively performs each listed medical service as part of his or her medical practice and not exclusively
by delegating the medical service to a delegatee.
The delegated services listed below are routine, technical services, the performance of which does
not require the special skills of a licensed physician.
The delegating physician is insured to delegate the delegated services listed below.
The delegating physician is not legally restricted from performing the delegated services listed below.
The delegating physician is providing personal and responsible direction and supervision to the
delegatee by complying with Colorado Medical Board Rule 800 (“Rule 800”).
The delegating physician is delegating the following services and understands that (s)he is fully
accountable for the performance of these services by the delegatee. (Note: the description of the
delegated medical services must be specific and detailed.) _____________________________
The delegated medical services will be performed at the following facilities. (Note: please include the
name and address of each facility.]
The delegating physician has personally assessed the qualifications and competence of the
delegatee to perform the Medical-Aesthetic Services listed above. The assessment included, but was
not limited to, initial over-the-shoulder monitoring of the delegatee’s performance of each delegated
Medical-Aesthetic Service. The delegating physician will reassess the competence and performance
of the delegatee on at least an annual basis as set forth in Rule 800.
It is agreed that all patients receiving a delegated Medical-Aesthetic Service will be informed that the
delegating physician is available personally to consult with them or provide appropriate evaluation or
treatment in relation to the delegated Medical-Aesthetic Services. The delegating physician shall
timely and personally provide such consultation, evaluation or treatment to the patient upon request.
The delegating physician will ensure that each patient receives all information to give appropriate
informed consent for any Medical-Aesthetic Services and that such informed consent is timely
documented in the patient’s chart.
In the event of an adverse outcome resulting from a delegated medical service, the delegating
physician will provide appropriate follow-up care and/or referrals.
It is expressly agreed that the delegatee will only provide the delegated services listed in this
document, unless the delegatee is separately licensed or otherwise legally authorized to provide
other services not listed in this document.
This agreement shall remain in effect until formally rescinded in writing by either party.
________________________________
_________________________________
(Signature & Title of Delegating physician)
(Signature of Delegatee)
________________________________
(Date)
_________________________________
(Date)
§12-36-106. Practice of medicine
(1) For the purpose of this article, “ practice of medicine” means:
(a) Holding out one's self to the public within this state as being able to diagnose, treat,
prescribe for, palliate, or prevent any human disease, ailment, pain, injury, deformity, or
physical or mental condition, whether by the use of drugs, surgery, manipulation, electricity,
telemedicine, the interpretation of tests, including primary diagnosis of pathology specimens,
images, or photographs or any physical, mechanical, or other means whatsoever;
(b) Suggesting, recommending, prescribing, or administering any form of treatment, operation,
or healing for the intended palliation, relief, or cure of any physical or mental disease, ailment,
injury, condition, or defect of any person with the intention of receiving therefor, either directly
or indirectly, any fee, gift, or compensation whatsoever;
(c) The maintenance of an office or other place for the purpose of examining or treating
persons afflicted with disease, injury, or defect of body or mind;
(d) Using the title M.D., D.O., physician, surgeon, or any word or abbreviation to indicate or
induce others to believe that one is licensed to practice medicine in this state and engaged in
the diagnosis or treatment of persons afflicted with disease, injury, or defect of body or mind,
except as otherwise expressly permitted by the laws of this state enacted relating to the
practice of any limited field of the healing arts;
(e) Performing any kind of surgical operation upon a human being; or
(f) The practice of midwifery, except:
(I) Services rendered by certified nurse-midwives properly licensed and practicing in
accordance with the provisions of article 38 of this title; or
(II)(A) Services rendered by a person properly registered as a direct-entry midwife and
practicing in accordance with the provisions of article 37 of this title.
with respect to, any of the following acts:
(a) The gratuitous rendering of services in cases of emergency;
(c) The practice of dentistry
(d) The practice of podiatry;
(e) The practice of optometry;
(f) The practice of chiropractic;
(g) The practice of religious worship;
(h) The practice of Christian Science, with or without compensation;
(s) The rendering of services by an athletic trainer;
(t)(I) The rendering of prescriptions by an advanced practice nurse.
(3) Nothing in this section shall be construed to prohibit, or to require a license or a physician training
license under this article
Truth in Advertising
DEPARTMENT OF REGULATORY AGENCIES
2091053 Colorado Medical Board
2091054 RULE 290 - Misleading, Deceptive or False Advertising: Clarification of 12-36-117(1)(hh),
C.R.S.
2091055 3 CCR 713-31
2091056 [Editor’s Notes follow the text of the rules at the end of this CCR Document.]
2091057 BASIS: The general authority for promulgation of these rules by the Colorado Medical Board
(“Board” ) is set forth in § §12-36-104(1)(a), C.R.S. and 24-4-103, C.R.S.
2091058 PURPOSE: To provide guidance to physicians and physician assistants regarding the
Board's position with respect to misleading, deceptive or false advertising, which is unprofessional
conduct pursuant to §12-36-117 (1)(hh), C.R.S. This rule applies to advertising in all types of media
including, but not limited to, print, radio, television and the Internet.
2091059 RULES:
2091060 Physicians should take special care to advertise truthfully and avoid exploitation of their
position of trust. Because of the potential consequences of misinformation regarding health care and
the importance of the interests affected by the choice of a physician, physicians must avoid
misleading the public. Physicians are responsible for the contents of their own advertisements and
should review such advertisements to assure adherence to ethical standards.
2091061 Therefore, physicians shall avoid the following types of advertising:
2091062 a.) Claims that the services performed, personnel employed, and/or materials or office
equipment used are professionally superior to that which is ordinarily performed, employed, and/or
used, or that convey the message that one licensee is better than another unless superiority of
services, personnel, materials or equipment can be substantiated;
2091063 b.) The misleading use of a claim regarding board certification or of an unearned or nonhealth degree in any advertisement that is likely to cause confusion or misunderstanding as to the
credentials, education, or licensure of a health care professional;
2091064 c.) Advertising that has the effect of intimidating or exerting undue pressure;
2091065 d.) Advertising that uses unsubstantiated testimonials;
2091066 e.) Advertising that creates an unjustified expectation or guarantees satisfaction or a cure;
2091067 f.) Advertising that offers gratuitous services or discounts, the purpose of which is to
deceive the public, or
2091068 g.) Advertising that is otherwise misleading, deceptive or false.
2091069 At the time any type of advertisement is placed, the physician must possess and rely upon
information that, when produced, would substantiate the truthfulness of any assertion, omission or
claim set forth in the advertisement. When using a subjective testimonial whose truthfulness cannot
be substantiated, the advertisement should also include disclaimers or warnings as to the credentials
of the person making the testimonial.
2091070 Adopted: MAY 13, 2004, EFFECTIVE AUGUST 1, 2004; Revised 08/19/10; Effective
10/15/10
History2091074 Entire Rule eff. 10/15/2010.
Colo. Rev. Stat. §12-36-129. Violation – penalties
The unlawful practice of medicine is a class 2 misdemeanor; a second or subsequent offense
commits a class 6 felony.
Corporate Practice of Medicine
Corporations shall not practice medicine. See Colo. Rev. Stat. § 12-36-134(1)(g)(7) (2005).
It is unprofessional conduct to practice medicine with any corporation other than a professional
service corporation.
This does not create an exception to the CPOM doctrine. See Colo. Rev. Stat. § 12-36-117(m)
(2005).
A hospital may employ physicians, although the hospital may not exert control over the employed
physician's independent judgment. See Colo. Rev. Stat. § 25-3-103.7.
Connecticut
STATE OF CONNECTICUT
CONNECTICUT MEDICAL EXAMINING BOARD
IN RE:PETITION SUBMITTED BY TERESA PETRICCA, PRESIDENT OF THE AMERICAN
ELECTROLOGY ASSOCIATION, ON. USE OF LASERS FOR HAIR REMOVAL BY HEALTH CARE
PROVIDERS OTHERTHAN LICENSED PHYSICIANS DECLARATORY RULING
In November of 1996, Teresa Petricca, President of the American Electrology Association, requested
the position of the Connecticut Medical Examining Board (“Board”) as to whether lasers may be used
for hair removal by anyone other than a licensed physician in this State.
Pursuant to Connecticut General Statutes §4-176 and Regulations of Connecticut State Agencies
§19-2a-31, the Board ruled that it would hold a hearing and issue a declaratory ruling in response to
Ms. Petriccá’s petition. The declaratory ruling proceeding was intended to address whether health
care providers other than licensed physicians can use lasers for the purpose of hair removal: By law,
the Board’s determination on this issue is binding upon those who participated in the hearing and may
also be used by the Board, on a case by case basis, in future proceedings.
A hearing was scheduled and held V V on August 19, 1997 and September 16, 1997. Prior to the first
day of hearing, the following organizations were granted party status: American Electrology
Association, ThermoLase Corporation, and the Connecticut State Medical Society. The Connecticut
Society of Eye Physicians was granted intervenor status. The Board received oral and written
testimony from parties and persons otherwise authorized to participate.
The Board conducted the hearing in accordance with Connecticut General Statutes Chapter 54 and
the Regulations of Connecticut State Agencies §19-2a-1, etseq.
Connecticut General Statutes §20-9 provides, in pertinent part:
(a) No person shall, for compensation, gain or reward, received or expected, diagnose, treat, operate
for or prescribe for any injury, deformity, ailment or disease, actual or imaginary, of another person,
nor practice surgery, until he has obtained such a license as provided in section 20-10, and then only
in the kind or branch of practice’ stated in such license.
(b) The provisions of this chapter shall not apply to:
(14) any person rendering service as a physician assistant licensed pursuant to section 20-12b, a
registered nurse, a licensed practical nurse or a. paramedic, as defined in subsection (o) of. section
19a-175, acting within the scope of regulations pursuant to section 19a179, if such service is
rendered under the supervision, control and responsibility of a licensed physician.
Section 20-9 provides the framework for determining whether a particular activity is within the scope
of practice of medicine. The Board finds that the use of lasers for hair removal is within the scope of
medical practice. The Board finds that a licensed physician with appropriate knowledge, experience,
and training should assess each patient prior to and during the course of hair removal treatment with
laser therapy. The Board finds that such physician may delegate the operation of the laser for hair
removal to those persons listed in §20-9(b)(14) who may render service under the supervision,
control, and responsibility of a licensed physician, provided the assessment of each patient is
performed by the physician. The physician shall provide direct on-site supervision in the course of
hair removal treatment with laser therapy.
The Board uses the following analysis to reach this conclusion: A laser is a means of manipulating
light.The use of a laser to remove hair is a medical, not cosmetic, procedure. Such a procedure alters
the surface of skin. A laser may cause or aggravate certain types of dermatological conditions. The
process itself is more critical than the result. Laser hair removal is an evolving technology which does
not currently provide permanent results. Results vary; there can be a risk of eye damage. In making
this ruling, the Board is choosing to err on the side of safety to best protect the public.
A reasonable amount of time for practitioners to conform to the standards set forth in this ruling
should be allowed, not to exceed nine (9) months.
Connecticut Medical Examining Board
by Richard M. Ratzan, M.D., Chairman
December 17, 1997
Sec. 20-9. Who may practice medicine or surgery.
(a) No person shall, for compensation, gain or reward, received or expected, diagnose, treat, operate
for or prescribe for any injury, deformity, ailment or disease, actual or imaginary, of another person,
nor practice surgery, until he has obtained such a license as provided in section 20-10, and then only
in the kind or branch of practice stated in such license.
(b) The provisions of this chapter shall not apply to:
(1) Dentists while practicing dentistry only;
(2) Any person in the employ of the United States government while acting in the scope of his
employment;
(3) Any person who furnishes medical or surgical assistance in cases of sudden emergency;
(4) Any person residing out of this state who is employed to come into this state to render
temporary assistance to or consult with any physician or surgeon who has been licensed in
conformity with the provisions of this chapter;
(5) Any physician or surgeon residing out of this state who holds a current license in good
standing in another state and who is employed to come into this state to treat, operate or prescribe for
any injury, deformity, ailment or disease from which the person who employed such physician, or the
person on behalf of whom such physician is employed, is suffering at the time when such nonresident
physician or surgeon is so employed, provided such physician or surgeon may practice in this state
without a Connecticut license for a period not to exceed thirty consecutive days;
(6) Any person rendering service as (A) an advanced practice registered nurse if such service is
rendered in collaboration with a licensed physician, or (B) an advanced practice registered nurse
maintaining classification from the American Association of Nurse Anesthetists if such service is
under the direction of a licensed physician;
(7) Any nurse-midwife practicing nurse-midwifery in accordance with the provisions of chapter
377;
(8) Any podiatrist licensed in accordance with the provisions of chapter 375;
(9) Any Christian Science practitioner who does not use or prescribe in his practice any drugs,
poisons, medicines, chemicals, nostrums or surgery;
(10) Any person licensed to practice any of the healing arts named in section 20-1, who does not
use or prescribe in his practice any drugs, medicines, poisons, chemicals, nostrums or surgery;
(11) Any graduate of any school or institution giving instruction in the healing arts who has been
issued a permit in accordance with subsection (a) of section 20-11a and who is serving as an intern,
resident or medical officer candidate in a hospital;
(12) Any student participating in a clinical clerkship program who has the qualifications specified
in subsection (b) of section 20-11a;
(13) Any person, otherwise qualified to practice medicine in this state except that he is a graduate
of a medical school located outside of the United States or the Dominion of Canada which school is
recognized by the American Medical Association or the World Health Organization, to whom the
Connecticut Medical Examining Board, subject to such regulations as the Commissioner of Public
Health, with advice and assistance from the board, prescribes, has issued a permit to serve as an
intern or resident in a hospital in this state for the purpose of extending his education;
(14) Any person rendering service as a physician assistant licensed pursuant to section 20-12b, a
registered nurse, a licensed practical nurse or a paramedic, as defined in subdivision (15) of section
19a-175, acting within the scope of regulations adopted pursuant to section 19a-179, if such service
is rendered under the supervision, control and responsibility of a licensed physician;
(15) Any student enrolled in an accredited physician assistant program or paramedic program
approved in accordance with regulations adopted pursuant to section 19a-179, who is performing
such work as is incidental to his course of study;
(16) Any person who, on June 1, 1993, has worked continuously in this state since 1979
performing diagnostic radiology services and who, as of October 31, 1997, continued to render such
services under the supervision, control and responsibility of a licensed physician solely within the
setting where such person was employed on June 1, 1993;
(17) Any person practicing athletic training, as defined in section 20-65f;
(18) When deemed by the Connecticut Medical Examining Board to be in the public's interest,
based on such considerations as academic attainments, specialty board certification and years of
experience, to a foreign physician or surgeon whose professional activities shall be confined within
the confines of a recognized medical school;
(19) Any technician engaging in tattooing in accordance with the provisions of section 19a-92a
and any regulations adopted thereunder; or
(20) Any person practicing perfusion, as defined in section 20-162aa.
(c) This section shall not authorize anyone to practice optometry, as defined in chapter 380, or to
practice dentistry, as defined in chapter 379, or dental hygiene, as defined in chapter 379a.
(d) The provisions of subsection (a) of this section shall apply to any individual whose practice of
medicine includes any ongoing, regular or contractual arrangement whereby, regardless of residency
in this or any other state, he provides, through electronic communications or interstate commerce,
diagnostic or treatment services, including primary diagnosis of pathology specimens, slides or
images, to any person located in this state. In the case of electronic transmissions of radiographic
images, licensure shall be required for an out-of-state physician who provides, through an ongoing,
regular or contractual arrangement, official written reports of diagnostic evaluations of such images to
physicians or patients in this state. The provisions of subsection (a) of this section shall not apply to a
nonresident physician who, while located outside this state, consults (A) on an irregular basis with a
physician licensed by section 20-10 who is located in this state or (B) with a medical school within this
state for educational or medical training purposes. Notwithstanding the provisions of this subsection,
the provisions of subsection (a) of this section shall not apply to any individual who regularly provides
the types of services described in this subsection pursuant to any agreement or arrangement with a
short-term acute care general hospital, licensed by the Department of Public Health, provided such
agreement or arrangement was entered into prior to February 1, 1996, and is in effect as of October
1, 1996.
(e) On and after October 1, 1999, any person licensed as an osteopathic physician or osteopath
pursuant to chapter 371 shall be deemed licensed as a physician and surgeon pursuant to this
chapter.
General Statutes of Connecticut Chapter 370, Section 20-9
No person shall, for compensation, gain or reward, received or expected, diagnose, treat, operate for
or prescribe for any injury, deformity, ailment or disease, actual or imaginary, of another person, nor
practice surgery, until he has obtained such a license as provided in section 20-10, as amended, and
then only in the kind or branch of practice stated in such license.
Connecticut General Statutes Chapter 388, Section 20-277
No provision of this chapter shall be construed to confer any authority to practice medicine or surgery;
nor shall this chapter prohibit the practice of electrology by a person licensed to practice the healing
arts or a person employed in a hospital or in the office of a licensed physician under such physician's
immediate direction; nor shall this chapter prohibit the use of nonelectrical cosmetic devices or the
use of wax or other proprietary depilatories used for the temporary removal of superfluous hair from
the surface of the skin.
Conn. Gen. Stat. §20-1 Healing arts defined
The practice of the healing arts means the practice of medicine, chiropractic, podiatry, natureopathy
and, except as used in chapters 384a and 388, the practice of optometry.
§20-13a. Definitions
“Physician” means a person holding a license issued pursuant to this chapter, except a homeopathic
physician.
Corporate Practice of Medicine
Case law indicates that non-licensed individuals may not employ dentists to provide dental services.
No similar guidance related to physicians employed by corporations.
District of Columbia
D.C. Code §6-201 (1981)
“Physician” means an individual authorized to practice medicine or osteopathy in the District.
D.C. Code §2-3301.2
“Practice of medicine” means suggesting, recommending, prescribing, or administering, with or
without compensation, any form of treatment, operation, drug, medicine, manipulation, electricity, or
any physical, mechanical, or healing treatment by other means, for the prevention, diagnosis,
correction, or treatment of a physical or mental disease, ailment, injury, condition, or defect of any
person, including:
(i) The management of pregnancy and parturition;
(ii) The interpretation of tests, including primary diagnosis of pathology specimens, images, or
photographs;
(iii) Offering or performing a surgical operation upon another person;
(iv) Offering or performing any type of invasive procedure of the body, whether through a body
opening or a cutting of the skin, or otherwise affecting the layer of skin below the stratum corneum,
for surgical, therapeutic, or cosmetic purposes, excluding procedures known as body tattooing or
body piercing;
(v) Rendering a written or otherwise documented medical opinion relating to the diagnosis and
treatment of a person within the District, or the actual rendering of treatment to a person within the
District, by a physician located outside the District as a result of transmission of the person's medical
data by electronic or other means from within the District to the physician or to the physician's agent;
(vi) Maintaining an office or other place for the purpose of examining persons afflicted with disease,
injury, or defect of body or mind;
(vii) Advertising or representing in any manner that one is authorized to practice medicine; or
(viii) Using the designation “Doctor of Medicine,” “Doctor of Osteopathy,” “physician,” “surgeon,”
“physician and surgeon,” “M.D.,” or “D.O.,” or a similar designation, or any combination thereof, in the
conduct of an occupation or profession pertaining to the prevention, diagnosis, or treatment of human
disease or condition, unless the designation additionally contains the description of another branch of
the healing arts for which one holds a valid license.
(B) Nothing in this paragraph shall be construed as preventing or restricting other health professionals
from offering or undertaking any type of invasive procedure of the body, whether through a body
opening or a cutting of the skin, or otherwise affecting the layer of skin below the stratum corneum,
for surgical, therapeutic, or cosmetic purposes, if the procedure:
(i) Has been authorized by a licensed physician; or
(ii) Is performed by an advanced practice registered nurse, an anesthesiologist assistant, a dentist, a
physician assistant, a podiatrist, a practical nurse, a registered nurse, or a surgical assistant who has
received the necessary training and experience to perform the procedure in a safe and effective
manner.
(C) Nothing in this paragraph shall be construed as preventing or restricting advanced practice
registered nurses from performing their duties as advanced practice registered nurses.
4612.5
A licensed physician shall not accept or perform professional responsibilities which the licensed
physician is not competent to perform.
Delaware
TITLE 24
Professions and Occupations
CHAPTER 17. MEDICAL PRACTICE ACT
Subchapter I. General Provisions
§ 1702. Definitions.
The following definitions apply to this chapter unless otherwise expressly stated or implied by the
context.
(9) "Practice of medicine" or "practice medicine" includes:
a. Advertising, holding out to the public, or representing in any manner that one is authorized to
practice medicine in this State;
b. Offering or undertaking to prescribe, order, give, or administer any drug or medicine for the use of
another person;
c. Offering or undertaking to prevent or to diagnose, correct, and/or treat in any manner or by any
means, methods, or devices a disease, illness, pain, wound, fracture, infirmity, defect, or abnormal
physical or mental condition of another person, including the management of pregnancy and
parturition;
d. Offering or undertaking to perform a surgical operation upon another person;
e. Rendering a written or otherwise documented medical opinion concerning the diagnosis or
treatment of a person or the actual rendering of treatment to a person within the State by a physician
located outside the State as a result of transmission of the person's medical data by electronic or
other means from within the State to the physician or to the physician's agent;
f. Rendering a determination of medical necessity or a decision affecting or modifying the diagnosis
and/or treatment of a person;
g. Using the designation Doctor, Doctor of Medicine, Doctor of Osteopathy, physician, surgeon,
physician and surgeon, Dr., M.D., or D.O., or a similar designation, or any combination thereof, in the
conduct of an occupation or profession pertaining to the prevention, diagnosis, or treatment of human
disease or condition, unless the designation additionally contains the description of another branch of
the healing arts for which one holds a valid license in the State.
For the purposes of this chapter, in order that the full resources of the State are available for the
protection of persons using the services of physicians, the act of the practice of medicine occurs
where a person is located at the time a physician practices medicine upon the person.
CHAPTER 51. COSMETOLOGY AND BARBERING AND CERTIFICATION OF AESTHETICIANS
Subchapter I. Board of Cosmetology and Barbering
5101. Definitions.
As used in this chapter:
(7) "Cosmetology" includes any or all work done for monetary compensation by any person, which
work is generally and usually performed by cosmetologists. Such work shall include, but not be
limited to, the embellishment, cleansing and beautification of the human hair, such as arranging,
dressing, curling, waving, cutting, bleaching or coloring, the removal of superfluous hair and nail
technology. The term "cosmetology" shall also include, but not be limited to, the massaging,
stimulating or beautifying, or similar work, of the scalp, face, arms, hands or the upper body. All work
performed under the definition of "cosmetology" may be done by hand or by mechanical or electrical
devices and may include the use of cosmetic preparations, tonics, lotions or creams.
Del. Code. Ann. tit 2, §1702 (2005)
"Physician" means an allopathic doctor of medicine and surgery or a doctor of osteopathic medicine
and surgery who is registered and certified to practice medicine pursuant to this chapter.
--
Florida
Florida Statutes
Title XXXIII
REGULATION OF TRADE, COMMERCE, INVESTMENTS, AND SOLICITATIONS
Chapter 501
CONSUMER PROTECTION
501.122 Control of nonionizing radiations; laser; penalties.-(1) DEFINITIONS.--For the purposes of this section:
(a) "Laser" means light amplification by stimulated emission of radiation, encompassing wavelengths
above and below those in visual range, if produced by laser devices.
(b) "Laser device" means any device designed or used to amplify electromagnetic radiation by
stimulated emission.
(c) "Nonionizing radiation" means electromagnetic or sound waves which do not produce or result in
ionization.
(d) "Ionizing radiation" means gamma and X rays, alpha and beta particles, high-speed electrons,
neutrons, protons, and other nuclear particles.
(e) "Department" means the Department of Health.
(2) AUTHORITY TO ISSUE REGULATIONS.--Except for electrical transmission and distribution lines
and substation facilities subject to regulation by the Department of Environmental Protection pursuant
to chapter 403, the Department of Health shall adopt rules as necessary to protect the health and
safety of persons exposed to laser devices and other nonionizing radiation, including the user or any
others who might come in contact with such radiation. The Department of Health may:
(a) Develop a program for registration of laser devices and uses and of identifying and controlling
sources and uses of other nonionizing radiations.
(b) Maintain liaison with, and receive information from, industry, industry associations, and other
organizations or individuals relating to present or future radiation-producing products or devices.
(c) Study and evaluate the degree of hazard associated with the use of laser devices or other
sources of radiation.
(d) Establish and prescribe performance standards for lasers and other radiation control, including
requirements for radiation surveys and measurements and the methods and instruments used to
perform surveys; the qualifications, duties, and training of users; the posting of warning signs and
labels for facilities and devices; recordkeeping; and reports to the department, if it determines that
such standards are necessary for the protection of the public health.
(e) Amend or revoke any performance standard established under the provisions of this section.
(3) PENALTIES FOR USING UNREGISTERED LASER DEVICE OR PRODUCT.-(a) No person licensed to practice the healing arts, nor any other person, may use a Class III or a
Class IV laser device or product as defined by federal regulations unless she or he has complied with
the rules governing the registration of such devices with the department promulgated pursuant to
subsection (2).
(b) Any person who violates the provisions of this subsection is guilty of a misdemeanor of the
second degree, punishable as provided in s. 775.082 or s. 775.083.
CHAPTER 458
MEDICAL PRACTICE
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(2)
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(2) 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(2) 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)7., 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; 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. Subsection (3) and this subsection do not apply to
offices at which the exclusive service being performed is laser hair removal by an advanced
registered nurse practitioner or physician assistant.
(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.
Chapter 459
OSTEOPATHIC MEDICINE
459.025 Formal supervisory relationships, standing orders, and established protocols; notice;
standards.-(1) NOTICE.-(a) When an osteopathic 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 an osteopathic 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) (c) or acts set forth in s. 464.012(3) and (4), the osteopathic physician shall
submit notice to the board. The notice must contain a statement in substantially the following form:
I, (name and professional license of osteopathic physician) of (address of osteopathic 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 after entering into the reLationship, orders, or protocol. Notice
also shall be provided within 30 days after the osteopathic physician has terminated any such
relationship, orders, or protocol.
(2) PROTOCOLS REQUIRiNG DIRECT SUPERVISION,--All protocols relating to electrolysis or
electrology using laser or light-based hair removal or reduction by persons other than osteopathic
physicians licensed under this chapter or chapter 458 shall require the person performing such
service to be appropriately trained and to work only under the direct supervision and responsibility of
an osteopathic physician licensed under this chapter or chapter 458.
(3) SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE SETTINGS. --An osteopathic physician
who supervises an advanced registered nurse practitioner or physician assistant at a medical office
other than the osteopathic physician’s primary practice Location, where the advanced registered
nurse practitioner or physician assistant is not underthe onsite supervision of a supervising
osteopathic physician, must comply with the standards set forth in this subsection. For the purpose of
this subsection, an osteopathic physician’s “primary practice location” means the address reflected on
the physician’s profile published pursuant to s. 456.041.
(a) An osteopathic physician who is engaged in providing primary health care services may not
supervise more than four offices in addition to the osteopathic physicians 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) An osteopathic physician who is engaged in providing specialty health care services may not
supervise more than two offices in addition to the osteopathic 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) An osteopathic physician who supervises an advanced registered nurse practitioner or physician
assistant at a medical office other than the osteopathic physician’s primary practice location, where
the advanced registered nurse practitioner or physician assistant is not under the onsite supervision
of a supervising osteopathic 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.
459.022(4)(e)8., an osteopathic 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 osteopathic physician shall submit to the Board of Osteopathic Medicine the addresses of all
offices where he or she is supervising or has a protocol with an advanced registered nurse
practitioner or a physician’s assistant which are not the osteopathic physician’s primary practice
location.
2. The osteopathic physician must be board certified or board eligible in dermatology or plastic.
Surgery as recognized by the Board of Osteopathic Medicine pursuant to s. 459.0152.
3. All such offices that are not the osteopathic physician’s primary place of practice must be within 25
mites of the osteopathic physician’s primary place of practice or in a county that is contiguous to the
county of the osteopathic physician’s primary place of practice. However, the distance between any of
the offices may not exceed 75 miles.
4. The osteopathic physician may supervise only one office other than the osteopathic physician’s
primary place of practice except that until July 1, 2011, the osteopathic physician may supervise up to
two medical offices other than the osteopathic physician’s primary place of practice if the addresses
of the offices are submitted to the Board of Osteopathic Medicine before July 1, 2006. Effective July 1
2011, the osteopathic physician may supervise only one office other than the osteopathic physician’s
primary place of practice, regardless of when the addresses of the offices were submitted to the
Board of Osteopathic Medicine.
(d) An osteopathic physician who supervises an office in addition to the osteopathic physician’s
primary practice location must conspicuously post in each of the osteopathic physicians offices a
current schedule of the regular hours when the osteopathic physician is present in that office and the
hours when the office is open while the osteopathic 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 or college of nursing or an accredited
graduate medical or 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, familyplanning 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 III of chapter 400, a continuing care facility licensed under
chapter 651, or a retirement community consisting of independent living units and either 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.
(4) REQUIREMENTS FOR NOTICE AND REVIEW.—Upon initial referral of a patient by another
practitioner, the osteopathic physician receiving the referral must ensure that the patient is informed
of the type of license held by the osteopathic 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 osteopathic physician or any
other licensed practitioner supervised by the osteopathic physician and, before the initial examination
or consultation, shall sign a form indicating the patient’s choice of practitioner. The supervising
osteopathic 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.
(5) LIMITATION ON RULEMAKING. --This section is self-executing and does not require or provide
authority for additional rulemaking.
Chapter 463
OPTOMETRY
463.014
Certain acts prohibited.
—
(1)(a)
No corporation, lay body, organization, or individual other than a licensed
practitioner shall engage in the practice of optometry through the means of engaging
the services, upon a salary, commission, or other means or inducement, of any
person licensed to practice optometry in this state. Nothing in this section shall be
deemed to prohibit the association of a licensed practitioner with a multidisciplinary
group of licensed health care professionals, the primary objective of which is the
diagnosis and treatment of the human body.
(b)
No licensed practitioner shall engage in the practice of optometry with any
corporation, organization, group, or lay individual. This provision shall not prohibit
licensed practitioners from employing, or from forming partnerships or professional
associations with, licensed practitioners licensed in this state or with other licensed
health care professionals, the primary objective of whom is the diagnosis and
treatment of the human body.
(c)
No rule of the board shall forbid the practice of optometry in or on the premises of
a commercial or mercantile establishment.
(d)
No licensed practitioner may practice under practice identification names, trade
names, or service names, unless any dissemination of information by the practitioner
to consumers contains the name under which the practitioner is licensed or that of
the professional association in which the practitioner participates. Any advertisement
or other dissemination of information to consumers may contain factual information
as to the geographic location of licensed practitioners or of the availability of
optometric services.
(e)
No licensed practitioner shall adopt and publish or cause to be published any
practice identification name, trade name, or service name which is, contains, or is
intended to serve as an affirmation of the quality or competitive value of the
optometric services provided at the identified practice.
(2)
A corporation or labor organization may employ licensed practitioners to provide
optometric services to bona fide employees of such corporation and members of
their immediate families or to bona fide members of such labor organization and
members of their immediate families, provided the provision of such services is
incidental to the legitimate business of such corporation or labor organization.
Nothing in this section shall be deemed to authorize the employment of licensed
practitioners by corporations or organizations formed primarily for such purposes.
(3)
Prescribing, ordering, dispensing, administering, supplying, selling, or giving any
systemic drugs by a licensed practitioner is prohibited.
(4)
Surgery of any kind, including the use of lasers, is expressly prohibited. Certified
optometrists may remove superficial foreign bodies. For the purposes of this
subsection, the term “superficial foreign bodies” means any foreign matter that is
embedded in the conjunctiva or cornea but which has not penetrated the globe.
(5)
No rule of the board shall prohibit a licensed practitioner from authorizing a boardcertified optician to fill, fit, adapt, or dispense a contact lens prescription as
authorized under chapter 484.
Truth in Advertising
Fla. Stat. §456.065 et seq.
456.072 Grounds for discipline; penalties; enforcement.
(1) The following acts shall constitute grounds for which the disciplinary actions
specified in subsection (2) may be taken:
Making misleading, deceptive, or fraudulent representations in or related to the
practice of the licensee's profession.
Making deceptive, untrue, or fraudulent representations in or related to the
practice of a profession or employing a trick or scheme in or related to the practice of
a profession.
Practicing or offering to practice beyond the scope permitted by law or accepting
and performing professional responsibilities the licensee knows, or has reason to
know, the licensee is not competent to perform.
Failing to identify through written notice, which may include the wearing of a name
tag, or orally to a patient the type of license under which the practitioner is practicing.
Any advertisement for health care services naming the practitioner must identify the
type of license the practitioner holds. This paragraph does not apply to a practitioner
while the practitioner is providing services in a facility licensed under chapter 394,
chapter 395, chapter 400, or chapter 429. Each board, or the department where
there is no board, is authorized by rule to determine how its practitioners may
comply with this disclosure requirement
(2) When the board, or the department when there is no board, finds any person
guilty of the grounds set forth in subsection (1) or of any grounds set forth in the
applicable practice act, including conduct constituting a substantial violation of
subsection (1) or a violation of the applicable practice act which occurred prior to
obtaining a license, it may enter an order imposing one or more of the following
penalties:
(a) Refusal to certify, or to certify with restrictions, an application for a license.
(b) Suspension or permanent revocation of a license.
(c) Restriction of practice or license, including, but not limited to, restricting the
licensee from practicing in certain settings, restricting the licensee to work only
under designated conditions or in certain settings, restricting the licensee from
performing or providing designated clinical and administrative services, restricting
the licensee from practicing more than a designated number of hours, or any other
restriction found to be necessary for the protection of the public health, safety, and
welfare.
(d) Imposition of an administrative fine not to exceed $10,000 for each count or
separate offense. If the violation is for fraud or making a false or fraudulent
representation, the board, or the department if there is no board, must impose a fine
of $10,000 per count or offense.
(e) Issuance of a reprimand or letter of concern.
(f) Placement of the licensee on probation for a period of time and subject to
such conditions as the board, or the department when there is no board, may
specify. Those conditions may include, but are not limited to, requiring the licensee
to undergo treatment, attend continuing education courses, submit to be
reexamined, work under the supervision of another licensee, or satisfy any terms
which are reasonably tailored to the violations found.
(g) Corrective action.
(h) Imposition of an administrative fine in accordance with s. 381.0261 for
violations regarding patient rights.
(i) Refund of fees billed and collected from the patient or a third party on behalf of
the patient.
(j) Requirement that the practitioner undergo remedial education.
In determining what action is appropriate, the board, or department when there is
no board, must first consider what sanctions are necessary to protect the public or to
compensate the patient. Only after those sanctions have been imposed may the
disciplining authority consider and include in the order requirements designed to
rehabilitate the practitioner. All costs associated with compliance with orders issued
under this subsection are the obligation of the practitioner.
In addition to, or in lieu of, any other remedy or criminal prosecution, the
department may file a proceeding in the name of the state seeking issuance of an
injunction or a writ of mandamus against any person who violates any of the
provisions of this chapter, or any provision of law with respect to professions
regulated by the department, or any board therein, or the rules adopted pursuant
thereto.
(6) If the board, or the department when there is no board, determines that
revocation of a license is the appropriate penalty, the revocation shall be permanent.
However, the board may establish by rule requirements for reapplication by
applicants whose licenses have been permanently revoked. The requirements may
include, but are not limited to, satisfying current requirements for an initial license.
Corporate Practice of Medicine
An Attorney General Opinion appears to prohibit corporations from employing
physicians to provide medical services.
A corporation may not practice medicine directly or indirectly by hiring licensed
members of a profession to do professional work. See Fla. Op. Att'y Gen. No. 05571 (Mar. 25, 1955).
Georgia
O.C.G.A. TITLE 43 Chapter 34 Article 9
*** Current Through the 2010 Regular Session ***
*** Annotations Current Through August 20, 2010 ***
TITLE 43. PROFESSIONS AND BUSINESSES
CHAPTER 34. PHYSICIANS, ACUPUNCTURE, PHYSICIAN ASSISTANTS, CANCER AND
GLAUCOMA TREATMENT, RESPIRATORY CARE, CLINICAL PERFUSIONISTS, AND
ORTHOTICS AND PROSTHETICS PRACTICE
ARTICLE 9. COSMETIC LASER SERVICES
O.C.G.A. TITLE 43 Chapter 34 Article 9 (2010)
§ 43-34-240. (For effective date, see note.) Short title
This article shall be known and may be cited as the "Georgia Cosmetic Laser Services Act."
§ 43-34-241. (For effective date, see note.) Legislative findings; purpose
This article is enacted for the purpose of safeguarding the public health, safety, and welfare by
providing for state administrative control, supervision, and regulation of the practice of providing
cosmetic laser services. It is the intention of the General Assembly that cosmetic laser services be
made available and affordable to the people of this state in a safe, reliable manner. Unregulated
cosmetic laser services do not adequately meet the needs or serve the interests of the public.
Licensure of those performing cosmetic laser services and required education and training of such
practitioners will help ensure the health and safety of consumers. The practice of providing cosmetic
laser services is declared to be affected with the public interest; and this article shall be liberally
construed so as to accomplish the purpose stated in this Code section.
§ 43-34-242. (For effective date, see note.) Definitions
As used in this article, the term:
(1) "Board" means the Georgia Composite Medical Board created by Code Section 43-34-2.
(2) "Consulting physician" means a person licensed to practice medicine under Article 2 of this
chapter and:
(A) Whose principal place of practice is within this state; or
(B) Whose principal place of practice is outside this state but is within 50 miles from the facility
with whom he or she has an agreement to provide services in accordance with Code
Section 43-34-248.
(3) "Consumer" means a person on whom cosmetic laser services are or are to be performed.
(4) "Cosmetic laser practitioner" means a person licensed under this article to provide cosmetic
laser services as defined in this article and whose license is in good standing.
(5) "Cosmetic laser services" means nonablative elective cosmetic light based skin care, photo
rejuvenation, or hair removal using lasers or pulsed light devices approved by the
United States Food and Drug Administration for noninvasive procedures. Such services
and the provision thereof shall not be considered to be the practice of medicine.
(6) "Facility" means any location, place, area, structure, office, institution, or business or a part
thereof in which is performed or provided cosmetic laser services regardless of whether
a fee is charged for such services.
(7) "License" means a valid and current certificate of registration issued by the board which shall
give the person to whom it is issued authority to engage in the practice prescribed
thereon.
(8) "Licensee" means any person holding a license under this article.
(9) "Medical practitioner" means a registered professional nurse, nurse practitioner, physician
assistant, or physician.
(10) "Nurse" means a registered professional nurse or nurse practitioner.
(11) "Person" means a natural person.
§ 43-34-243. (For effective date, see note.) Permitted activities
This article shall not be construed to prohibit:
(1) A licensed physician from engaging in the practice for which he or she is licensed;
(2) A licensed physician assistant from engaging in the practice for which he or she is licensed;
(3) A person licensed by this state as a registered professional nurse, licensed practical nurse, or
nurse practitioner from engaging in his or her profession;
(4) A licensed esthetician from engaging in his or her profession;
(5) A master cosmetologist from engaging in his or her profession;
(6) Any person licensed under any other article of this chapter from engaging in the practice for
which he or she is licensed;
(7) A person licensed in this state under any other law from engaging in the practice for which he or
she is licensed;
(8) The practice of providing cosmetic laser services by a person who is employed by the federal
government or any bureau, division, or agency of the federal government while in the
discharge of the employee's official duties;
(9) The practice of providing cosmetic laser services by a student enrolled in an accredited school
of nursing or medical school as part of his or her training; or
(10) Employees or authorized representatives of a manufacturer of a laser used for cosmetic laser
services from engaging in one or more of the following: evaluating, adjusting,
measuring, designing, fabricating, assembling, fitting, servicing, training, repairing,
replacing, or delivering a laser used to provide cosmetic laser services under the order,
direction, or prescription of a physician or health provider operating within his or her
licensed scope of practice.
§ 43-34-244. (For effective date, see note.) Two levels of license; application
(a) There shall be two levels of a license for a cosmetic laser practitioner: assistant laser
practitioner and senior laser practitioner.
(b) Any person desiring to obtain a license as a cosmetic laser practitioner under the terms of this
article shall make application to the board as follows:
(1) An applicant for an "assistant laser practitioner" license shall present proof that he or she:
(A) Holds a current valid license or certificate of registration as a physician assistant, licensed
practical nurse, nurse, esthetician, or master cosmetologist, or has previously held a
license or certificate of registration as a medical practitioner; and
(B) Has received at least three laser certificates from attending laser/intense pulsed light (IPL)
courses as approved by the board, directly taught by a licensed physician or certified
continuing medical education or continuing education educator.
If, after review of the application, it is determined that the applicant is at least 21 years of age; has
met the minimum educational requirements; is of good moral character; and is
possessed of the requisite skill to perform properly cosmetic laser services, a license
shall be issued to the applicant entitling the applicant to practice the occupation of
cosmetic laser practitioner at the assistant laser practitioner level under the on-site
supervision of a senior laser practitioner.
§ 43-34-245. (For effective date, see note.) Expiration of licenses; license renewal
(a) All licenses shall expire biennially unless renewed. All applications for renewal of a license shall
be filed with the board prior to the expiration date, accompanied by the biennial renewal
fee prescribed by the board. A license which has expired for failure of the holder to
renew may only be restored after application and payment of the prescribed restoration
fee within the time period established by the board and provided the applicant meets
such requirements as the board may establish by rule. Any license which has not been
restored within such period following its expiration may not be renewed, restored, or
reissued thereafter. The holder of such a canceled license may apply for and obtain a
valid license only upon compliance with all relevant requirements for issuance of a new
license.
(b) As a condition of license renewal, the board shall require licensees to provide proof, in a form
approved by the board, of a minimum of five hours of continuing education courses as
approved by the board in the area of cosmetic laser services, equipment safety and
operation, procedures, and relative skin modalities, directly taught by a licensed
physician or certified continuing medical education or continuing education educator.
§ 43-34-246. (For effective date, see note.) Sanctions
The board may impose on a cosmetic laser practitioner or applicant any sanction authorized under
subsection (b) of Code Section 43-34-8 upon a finding of any conduct specified in
subsection (a) of Code Section 43-34-8.
§ 43-34-247. (For effective date, see note.) Petition to restrain or enjoin unlicensed cosmetic laser
practitioner
The practice of providing cosmetic laser services is declared to be an activity affecting the public
interest and involving the health, safety, and welfare of the public. Such practice when
engaged in by a person who is not licensed as a cosmetic laser practitioner or otherwise
licensed to practice a profession which is permitted under law to perform cosmetic laser
services is declared to be harmful to the public health, safety, and welfare. The board or
the district attorney of the circuit where such unlicensed practice exists, or any person
or organization having an interest therein, may bring a petition to restrain and enjoin
such unlicensed practice in the superior court of the county where such unlicensed
person resides. It shall not be necessary in order to obtain an injunction under this Code
section to allege or prove that there is no adequate remedy at law, or to allege or prove
any special injury.
§ 43-34-248. (For effective date, see note.) Agreement with consulting physician
(a) Any facility providing cosmetic laser services other than hair removal using lasers or pulsed light
devices shall have an agreement with a consulting physician who shall:
(1) Be trained in laser modalities;
(2) Establish proper protocols for the cosmetic laser services provided at the facility and file such
protocols with the board;
(3) Examine each patient prior to any cosmetic laser service other than hair removal using lasers or
pulsed light devices being performed; provided, however, that a consulting physician
may delegate the authority to perform such examination to a physician assistant who is
a licensed cosmetic laser practitioner, in accordance with a job description approved by
the board, or to a registered professional nurse who is also an advanced practice
registered nurse as defined in paragraph (1.1) of Code Section 43-26-3 and who is a
licensed cosmetic laser practitioner, pursuant to a protocol approved by the board; and
provided, further, that in facilities subject to the provisions of Code Section 43-34-249.1
such delegation may be to: (A) a physician assistant who is not required to be a
licensed cosmetic laser practitioner, in accordance with a job description approved by
the board; or (B) a registered professional nurse who is also an advanced practice
registered nurse who is not required to be a licensed cosmetic laser practitioner, in
accordance with a protocol approved by the board; and
(4) Be available for emergency consultation with the cosmetic laser practitioner or anyone
employed by the facility.
(b) Any facility providing cosmetic laser services other than hair removal using lasers or pulsed light
devices shall have a supervisor present at the facility or immediately available for
consultation and supervision either personally or via telecommunications. The
supervisor shall supervise the performance of all cosmetic laser services performed by
a person other than the consulting physician. The supervisor shall be a physician
licensed under this chapter who is trained in laser modalities or a senior laser
practitioner.
(c) (1) Any facility providing cosmetic laser services other than hair removal using lasers or pulsed
light devices shall post a sign listing the consulting physician's name, emergency
contact number, his or her board certification and specialty, and the address of his or
her principal place of practice, and indicating whether he or she is presently on site at
the facility.
(2) If the consulting physician is not on site for any period of time during which the facility is open,
the facility shall post a sign indicating who is presently acting as the supervisor for the
facility and that person's name, emergency contact number, his or her degrees and
qualifications, and the type of cosmetic laser practitioner license held.
§ 43-34-249. (For effective date, see note.) Informed consent
(a) Prior to receiving cosmetic laser services from a cosmetic laser practitioner, a person must
consent in writing to such services and shall be informed in writing of the general terms
of the following:
(1) The nature and purpose of such proposed procedure;
(2) Any material risks generally recognized and associated with the cosmetic laser service to be
performed which, if disclosed to a reasonably prudent person in the customer's position,
could reasonably be expected to cause such prudent person to decline such proposed
cosmetic laser services on the basis of the material risk of injury that could result from
such proposed services;
(3) The name of, degrees and qualifications held by, and type of licenses obtained by the individual
who will be performing the cosmetic laser service, and with respect to cosmetic laser
services other than hair removal, the supervisor and the consulting physician;
(4) The steps to be followed after the cosmetic laser service is performed in the event of any
complications; and
(5) With respect to cosmetic laser services other than hair removal, the emergency contact
information for the consulting physician and the address of his or her principal place of
practice.
(a.1) After receiving each cosmetic laser service other than hair removal, a person shall be informed
in writing of the information required by paragraphs (4) and (5) of subsection (a) of this
Code section.
(b) It shall be the responsibility of the cosmetic laser practitioner to ensure that the information
required by subsections (a) and (a.1) of this Code section is disclosed and that the
consent provided for in this Code section is obtained.
(c) Where the consumer is under 18 years of age, the consent of the consumer's parent or legal
guardian shall be required.
(d) The board shall be required to adopt and have the authority to promulgate rules and regulations
governing and establishing the standards necessary to implement this Code section
specifically including but not limited to the disciplining of a cosmetic laser practitioner
who fails to comply with this Code section.
(e) Nothing in this Code section shall prohibit the information provided for in this Code section from
being disclosed through the use of video tapes, audio tapes, pamphlets, booklets, or
other means of communication or through conversations with the cosmetic laser
practitioner; provided, however, that such information is also provided in writing and
attached to the consent form which the consumer signs.
§ 43-34-249.1. (For effective date, see note.) Waiver
The board shall have the authority to waive the requirements of subsection (c) of Code Section 4334-248 and paragraph (5) of subsection (a) of Code Section 43-34-249 for facilities
offering cosmetic laser services which serve as a principal place of practice at which a
physician regularly sees patients if medical services are regularly performed at such
facilities. For purposes of this Code section, "medical services" shall mean the general
and usual services and care rendered and administered by a physician.
§ 43-34-250. (For effective date, see note.) Advisory committee
The board shall appoint an advisory committee. The advisory committee shall include licensed
cosmetic laser practitioners licensed under this article and such members as the board
in its discretion may determine. The advisory committee shall include at least one
person licensed to practice medicine under this chapter and specialized in a field with
expertise in the biologic behavior of the skin. Members shall receive no compensation
for service on the committee. The committee shall have such advisory duties and
responsibilities as the board may determine, including but not limited to consulting with
the board on the issuance, denial, suspension, and revocation of licenses and the
promulgation of rules and regulations under this article. The initial members of the
advisory committee may include persons eligible for licensing under this article.
Subsequent advisory committee members must be licensed pursuant to this article.
§ 43-34-251. (For effective date, see note.) Prohibited activities
(a) It shall be unlawful for any person licensed as a cosmetic laser practitioner to perform cosmetic
laser services within any area within one inch of the nearest part of the eye socket of
any consumer.
(b) It shall be unlawful for any person licensed as a cosmetic laser practitioner to administer any
pharmaceutical agent or other substance by injection.
§ 43-34-252. (For effective date, see note.) Noncompliance of facility owner; penalty
Any person who owns a facility in which cosmetic laser services are offered or performed in
noncompliance with the requirements of this article shall be guilty of a misdemeanor.
§ 43-34-253. (For effective date, see note.) Violation; penalty
Any person convicted of violating any provision of this article shall be guilty of a misdemeanor.
Truth in Advertising
Ga. Code Ann. §43-34-26 (2005)
§ 43-34-26. Practicing medicine without a license; titles and abbreviations; exceptions
(a) If any person shall hold himself out to the public as being engaged in the diagnosis or treatment
of disease or injuries of human beings, or shall suggest, recommend, or prescribe any
form of treatment for the palliation, relief, or cure of any physical or mental ailment of
any person, with the intention of receiving therefor, either directly or indirectly, any fee,
gift, or compensation whatsoever, or shall maintain an office for the reception,
examination, or treatment of diseased or injured human beings, or shall attach the title
"M.D.," "Oph.," "D.," "Dop.," "Surgeon," "Doctor," "D.O.," "Doctor of Osteopathy," either
alone or in connection with other words, or any other word or abbreviation to his name
indicative that he is engaged in the treatment of diseased, defective, or injured human
beings, and shall not in any of these cases then possess a valid license to practice
medicine under the laws of this state, he shall be deemed to be practicing medicine
without complying with this chapter and shall be deemed in violation of this chapter.
Ga. Code Ann. § 10-1-422 (2005)
§ 10-1-422. Degree to be designated in advertisements using "Doctor" or "Dr."; penalty for violation
Each individual who uses the term "Doctor" or "Dr." in conjunction with his name in any letter,
business card, advertisement, sign, public listing, display, or circular of any nature shall
designate:
(A) The degree to which he is entitled by reason of his diploma of graduation from a school or other
entity, professional or otherwise;
(B) The degree as honorary when an honorary acknowledgment has been made;
(C) "No degree" if he is not entitled to any such recognition.
The designation required by this subsection shall not be necessary:
(A) If the term is a part of the person's legal name;
(B) In the case of the use in a corporate charter of the name of a professional association or
professional corporation organized in this state as provided by law.
Any person willfully violating, with intent to defraud, shall be guilty of a misdemeanor.
§ 43-34-8
§ 43-34-8. Authority to refuse license, certificate, or permit or issue discipline;
suspension; restoration; enforcement investigations; evidentiary privileges; closed
hearings; immunity for reporting violations; when investigation or assessment of
fitness to practice required; failure to appear; publication of final disciplinary actions
(a) The board shall have authority to refuse to grant a license, certificate, or
permit to an applicant or to discipline a person regulated under this chapter or any
antecedent law upon a finding by the board that the licensee, certificate holder, or
permit holder or applicant has:
(2) Knowingly made misleading, deceptive, untrue, or fraudulent representations
in the practice of a profession licensed, certified, or permitted under this chapter or
in any document connected therewith, or practiced fraud or deceit or intentionally
made any false statement in obtaining a license, certificate, or permit under this
chapter to practice pursuant to this chapter, or made a false statement or deceptive
registration with the board;
(6) Advertised for or solicited patients; obtained a fee or other thing of value on
the representation that a manifestly incurable disease can be permanently cured; or
made untruthful or improbable statements, or flamboyant or extravagant claims
concerning his or her professional excellence or treatment protocols;
Corporate Practice of Medicine
Although a statute that prohibited a physician from being employed by a corporation was repealed in
1982, recent case law indicates that a corporation may not employ a physician to provide medical
services.
Physicians may be disciplined or refused a license if they knowingly aid an unlicensed person or
entity in practicing medicine. See Ga. Code § C24 43-34-37(a)(9) (2005). A court indicated that Ga.
Code § 43-34-37 still does not allow a corporation to employ a professional to perform his or her
profession on behalf of the corporation. See Clower v. Orthalliance, Inc., 337 F. Supp. 2d 1322, 1330
(N.D. Ga. 2004).
Hawaii
Chapter 453 Medicine and Surgery
§453-1 Practice of medicine defined. For the purposes of this chapter the practice of medicine by a
physician or an osteopathic physician includes the use of drugs and medicines, water, electricity,
hypnotism, osteopathic medicine, or any means or method, or any agent, either tangible or intangible,
for the treatment of disease in the human subject; provided that when a duly licensed physician or
osteopathic physician pronounces a person affected with any disease hopeless and beyond recovery
and gives a written certificate to that effect to the person affected or the person's attendant nothing
herein shall forbid any person from giving or furnishing any remedial agent or measure when so
requested by or on behalf of the affected person.
This section shall not amend or repeal the law respecting the treatment of those affected with
Hansen's disease.
For purposes of this chapter, "osteopathic medicine" means the utilization of full methods of
diagnosis and treatment in physical and mental health and disease, including the prescribing and
administration of drugs and biologicals of all kinds, operative surgery, obstetrics, radiological, and
other electromagnetic emissions, and placing special emphasis on the interrelation of the neuromusculoskeletal system to all other body systems, and the amelioration of disturbed structurefunction relationships by the clinical application of the osteopathic diagnosis and therapeutic skills for
the maintenance of health and treatment of disease. [L 1896, c 60, §2; am L 1909, c 133, §1; RL
1925, §1023; RL 1935, §1201; RL 1945, §2502; am L 1949, c 53, §29 and c 63, §1; RL 1955, §64-1;
am L 1965, c 218, §1; HRS §453-1; am L 1969, c 152, §1; am L 1981, c 185, §1; am L 1983, c 124,
§16; gen ch 1985; am L 2008, c 5, §1]
Hawaii Chapter 459: Optometry
§459-1.5 Definitions. As used in this chapter:
"Board" means the board of examiners in optometry.
"Director" means the director of commerce and consumer affairs.
"Surgery" means any procedure in which human tissue is cut, altered, or otherwise infiltrated by
mechanical or laser means. [L 1987, c 152, §2; am L 1997, c 335, §1]
§459‑1 Optometry; practice of, defined. (a) The practice of optometry, for the purpose of this
chapter, is defined to be:
(1) The examination, diagnosis, treatment, and management of diseases and disorders of the
human visual system, the eye, and the eyelids;
(2) The employment of trial frame or trial lenses, and any objective or subjective means or
methods, other than the use of surgery, including refractive or therapeutic laser surgery, but including
the use and prescription of pharmaceutical agents, as established by the board, and the performance
of non-invasive diagnostic procedures or ordering of laboratory tests related to the use of
pharmaceutical agents for the purpose of examining, diagnosing, treating, and managing visual,
muscular, or other diseases and disorders of the human visual system, the eye, and the eyelids; or
(3) The prescribing, fitting, or adaptation of any ophthalmic lenses, contact lenses, prisms,
frames, mountings, or orthoptic exercises for the correction or relief of the visual or muscular
anomalies of the human eye.
Superficial foreign bodies may be removed from the human eye and eyelids, including the removal of
corneal superficial foreign bodies above Bowman's Layer.
(b) Any person who engages in the prescribing of visual training, with or without the use of
scientific instruments to train the visual system or other abnormal condition of the eyes, or claims to
be able to do so, shall be deemed to be engaged in the practice of optometry and shall first secure
and hold an unrevoked and unsuspended license as provided in this chapter; provided that an
orthoptist may give visual training, including exercises, under the supervision of a physician or
optometrist. The use and prescription of pharmaceutical agents and the removal of superficial foreign
bodies from the human eye and eyelid shall be granted to an optometrist licensed under this chapter
who has met the requirements under sections 459‑7 and 459-7.4.
(c) If while examining or treating a patient a licensed optometrist finds, by history or examination,
any ocular abnormality or any evidence of systemic disease requiring further diagnosis and possible
treatment beyond the scope of practice as defined in this section, the optometrist shall refer that
patient to an appropriate licensed physician. [L 1917, c 187, §1; RL 1925, §1112; RL 1935, §1370; RL
1945, §2801; am L 1949, c 58, §1(1); RL 1955, §68-1; HRS §459-1; am L 1985, c 224, §1 and c 294,
§2; am L 1997, c 335, §2; am L 2002, c 164, §3; am L 2004, c 46, §2]
Chapter 448F Electrologists
[§448F-2] Definitions. As used in this chapter:
"Department" means the department of commerce and consumer affairs.
"Director" means the director of commerce and consumer affairs.
"Electrologist" means any person who removes hair from the human body using a needle inserted
in the hair follicle and uses direct electric current or shortwave alternating current to destroy the
follicle but does not include any hair removal system that does not penetrate the skin. [L 1990, c 285,
pt of §1]
Truth in Advertising
§453-8 Revocation, limitation, suspension, or denial of licenses. (a) In addition to any other actions
authorized by law, any license to practice medicine and surgery may be revoked, limited, or
suspended by the board at any time in a proceeding before the board, or may be denied, for any
cause authorized by law, including but not limited to the following:
(1) Procuring, or aiding or abetting in procuring, a criminal abortion;
(2) Employing any person to solicit patients for one's self;
(3) Engaging in false, fraudulent, or deceptive advertising, including but not limited to:
(A) Making excessive claims of expertise in one or more medical specialty fields;
(B) Assuring a permanent cure for an incurable disease; or
(C) Making any untruthful and improbable statement in advertising one's medical or surgical
practice or business;
Attorney General Opinion
There is no prohibition against the use by unlicensed doctor of the letters "Dr." or any synonym
thereof if the possibility for deception is removed. Att. Gen. Op. 63-55.
Attorney General Opinions
Giving insufficient direction or failure to indicate status of an unlicensed physician may subject a
licensed physician to license revocation. Att. Gen. Op. 63-55.
Haw. Rev. Stat. §453
Except as otherwise provided by law, no person shall practice medicine or surgery in the State either
gratuitously or for pay, or shall offer to so practice, or shall advertise or announce one's self, either
publicly or privately, as prepared or qualified to so practice, or shall append the letters "DR." or "M.D."
to one's name, with the intent thereby to imply that the individual is a practitioner of medicine or
surgery, without having a valid unrevoked license or a limited and temporary license, obtained from
the board of medical examiners, in form and manner substantially as hereinafter set forth.
Haw. Rev. Stat. § 671D-4 (2004)
§ 671D-4 Definitions
"Physician" means an individual licensed under chapter 453 or 460, or both, or section 463E-1, to
practice medicine or surgery or osteopathy or podiatric medicine; an individual licensed under chapter
448 to practice dentistry or dental surgery; or any individual who, without authority, holds oneself out
to be so authorized.
Haw. Rev. Stat. § 453-13. Penalty.
Any person who violates this chapter, or who offers or in any way attempts to engage in the practice
of medicine as defined in section 453-1 and fails to comply with any of the requirements or provisions
of this chapter, penalty for which violation or failure to comply is not otherwise provided for, shall be
fined not more than $500 or imprisoned not more than six months and each day's violation or failure
to comply shall be deemed a separate offense.
All tools, implements, medicine, and drugs used in the practice of medicine by any person convicted
of practicing medicine without a license shall be declared forfeited to the State by the court and
ordered destroyed.
Idaho
Guidelines for Hair Removal using Intense Pulsed Light
and/or Laser Devices by Supervised Medical Personnel
Intense pulsed light and laser devices that use precisely focused light sources to penetrate and alter
human tissue are prescriptive medical devices. The use of these prescriptive medical devices can
result in complications such as visual impairment, blindness, inflammation, burns, scarring,
hypopigmentation and hyperpigmentation. Cosmetic treatments using prescriptive medical/cosmetic
devices and products is the practice of medicine as defined in Section 54-1803(1), Idaho Code.
The Medical Practice Act provides an exemption from medical licensure for persons using Class I or
Class II, nonprescriptive, approved, medical devices. Section 1804(1)(j)(iii), Idaho Code.
IDAPA 22.01.04.010.11, defines “Medical Personnel” as those persons who provide cosmetic
treatments using prescriptive medical/cosmetic devices and products that are exclusively non-incisive
or non-ablative under the direction and supervision of a supervising physician registered with the
Board.
IDAPA 22.01.04.010.17, defines a “Supervising Physician of Medical Personnel” as an Idaho licensed
physician, registered with the Board, who supervises and has full responsibility for cosmetic
treatments using prescriptive medical/cosmetic devices and products provided by medical personnel.
The Idaho State Board of Medicine, in accordance with the Medical Practice Act, IDAPA 22.01.04,
“Rules of the Board of Medicine for Supervising and Directing Physicians,” and federal requirements,
recognizes the following guidelines for hair removal using intense pulsed light and/or laser devices by
qualified supervised medical personnel to ensure public health and safety in Idaho:
1.
The use of an intense pulsed light and/or laser prescriptive device to
cosmetically alter human tissue must be under the prescription of an Idaho
licensed physician; and
2.
The actual treatment for hair removal using an intense pulsed light and/or
laser prescriptive device may be delegated by an Idaho licensed physician
registered as a supervising physician with the Idaho State Board of Medicine to
properly trained medical personnel in accordance with IDAPA 22.01.04.
Guidelines generated—September 14, 2007.
TITLE 54
PROFESSIONS, VOCATIONS, AND BUSINESSES
CHAPTER 51
NATUROPATHIC PHYSICIANS LICENSING ACT
54-5105. PROHIBITIONS. A naturopathic physician shall not:
(1) Prescribe, dispense or administer any controlled substance or device
identified under the controlled substance act, chapter 27, title 37, Idaho
Code, or identified in the federal controlled substance act, 21 U.S.C.
sections 801 through 971 (1988), as amended, except as authorized by this
chapter;
(2) Perform surgical procedures except those minor office procedures
authorized by this chapter;
(3) Practice or claim to practice as a medical doctor, osteopath,
dentist, podiatrist, optometrist, psychologist, advanced practice
professional nurse, physician assistant, chiropractor, physical therapist,
acupuncturist, or any other health care professional not authorized in this
chapter unless licensed by the state of Idaho to do so;
(4) Use general or spinal anesthetics;
(5) Administer ionizing radioactive substances for therapeutic purposes;
(6) Perform surgical procedures using a laser device;
(7) Induce or perform an abortion;
(8) Perform surgical procedures involving the eye, ear, tendons, nerves,
veins or arteries extending beyond superficial tissue;
(9) Treat any lesion suspicious of malignancy or requiring surgical
removal. Lesions suspicious of malignancy or requiring surgical removal shall
be referred to an appropriately licensed health care professional. Nothing in
this chapter shall prohibit treatment of a person with suspicious or malignant
lesions in conjunction with a physician licensed pursuant to chapter 18, title
54, Idaho Code.
(10) Perform chiropractic adjustments as defined in section 54-704, Idaho
Code.
(11) Perform physical therapy as defined in section 54-2203, Idaho Code.
Truth in Advertising
101.ADDITIONAL GROUNDS FOR SUSPENSION, REVOCATION OR DISCIPLINARY
SANCTIONS.
01. Discipline. In addition to the statutory grounds for medical discipline set forth in Idaho Code,
Section 54-1814, every person licensed to practice medicine or registered as an extern, intern,
resident or physician assistant is subject to discipline by the Board upon any of the following grounds:
(3-26-08)
02. Unethical Advertising. Advertising the practice of medicine in any unethical or unprofessional
manner, includes but is not limited to: (7-1-93)
a. Using advertising or representations likely to deceive, defraud or harm the public. (7-1-93)
b. Making a false or misleading statement regarding his or her skill or the efficacy or value of the
medicine, treatment or remedy prescribed by him or her at his or her direction in the treatment of any
disease or other condition of the body or mind.
Idaho Code Ann. §54-1803. Definitions
The “practice of medicine” means:
(a) To investigate, diagnose, treat, correct, or prescribe for any human disease, ailment, injury,
infirmity, deformity, or other condition, physical or mental, by any means or instrumentality, or
(b) To apply principles or techniques of medical science in the prevention of any of the conditions
listed in subsection (a) of this section, or
(c) To offer, undertake, attempt to do or hold oneself out as able to do any of the acts described in
subsections (a) and (b) of this section.
The term “physician” means any person who holds a license to practice medicine and surgery,
osteopathic medicine and surgery, or osteopathic medicine, provided further, that others authorized
by law to practice any of the healing arts shall not be considered physicians for the purposes of this
chapter.
A “license to practice medicine and surgery” means a license issued by the board to a person who
was graduated from an acceptable school of medicine and who has fulfilled the licensing
requirements of this chapter.
A “license to practice osteopathic medicine and surgery” means a license issued by the board to a
person who either graduated from an acceptable osteopathic school of medicine subsequent to
January 1, 1963, or who has been licensed by endorsement of a license issued by another state
where a composite examining board exists and where physicians licensed to practice medicine and
surgery and osteopathic physicians take the same examination and hold equal licenses, and who has
fulfilled the licensing requirements of this chapter.
A “license to practice osteopathic medicine” means a license issued by the state board of medicine to
a person who graduated from an acceptable osteopathic school of medicine and who prior to January
1, 1963 has fulfilled the licensing requirements of this chapter.
§54-1804 Unlicensed practice--Penalties and remedies relating to unlicensed practice
(1) Under the circumstances described and subject in each case to limitations stated, the following
persons, though not holding a license to practice medicine in this state, may engage in activities
included in the practice of medicine:
(a) A medical officer of the armed forces of the United States, of the United States public health
service, or of the veteran's administration, while engaged in the performance of his official duties;
(b) A person residing in another state or country and authorized to practice medicine there, who is
called in consultation by a person licensed in this state to practice medicine, or who for the purpose of
furthering medical education is invited into this state to conduct a lecture, clinic, or demonstration,
while engaged in activities in connection with the consultation, lecture, clinic, or demonstration, so
long as he does not open an office or appoint a place to meet patients or receive calls in this state;
(c) A person authorized to practice medicine in another state or country while rendering medical care
in a time of disaster or while caring for an ill or injured person at the scene of an emergency and while
continuing to care for such person;
(d) An extern, intern or resident who is registered with the board as provided in this chapter and while
engaged in programs authorized pursuant to rules of the board or a physician assistant licensed by
the board;
(e) A person authorized or licensed by this state to engage in activities which may involve the practice
of medicine;
(f) A person engaged in good faith in the practice of the religious tenets of any church or religious
beliefs;
(g) A person administering a remedy, diagnostic procedure or advice as specifically directed by a
physician;
(h) A person rendering aid in an emergency, where no fee for the service is contemplated, charged or
received;
(i) A person administering a family remedy to a member of the family;
(j) A person who administers treatment or provides advice regarding the human body and its
functions that:
(i) Does not use legend drugs or prescription drugs in such practice;
(ii) Uses natural elements such as air, heat, water and light;
(iii) Only uses class I or class II nonprescription, approved, medical devices as defined in section 513
of the federal food, drug and cosmetic act;
(iv) Only uses vitamins, minerals, herbs, natural food products and their extracts, and nutritional
supplements; and who
(v) Does not perform surgery;
(vi) Requires each person receiving services to sign a declaration of informed consent which includes
an overview of the health care provider's education which states that the health care provider is not
an “M.D.” or “D.O.” and is not licensed under the provisions of this chapter.
(2) Except as provided in subsection (1) of this section, it shall constitute a felony for any person to
practice medicine in this state without a license and upon conviction thereof shall be imprisoned in the
state prison for a period not to exceed five (5) years, or shall be fined not more than ten thousand
dollars ($10,000), or shall be punished by both such fine and imprisonment.
(3) Except as provided in subsections (1)(a), (1)(b), and (1)(c) above, it is unlawful for any person to
assume or use the title or designation “medical doctor,” “medical physician,” “osteopathic doctor,”
“osteopathic physician,” “M.D.” or “D.O.” or any other title, designation, words, letters, abbreviation,
sign, card, or device to indicate to the public that such person is licensed to practice medicine
pursuant to this chapter unless such person is so licensed, and upon conviction thereof, such person
shall be imprisoned not to exceed one (1) year, or shall be fined not more than three thousand dollars
($3,000), or shall be punished by both fine and imprisonment.
(4) When a person has been the recipient of services constituting the unlawful practice of medicine,
whether or not he knew the rendition of the services was unlawful, proof of the rendition of such
unlawful services by the recipient or his personal representative in an action against the provider of
such services for damages allegedly caused by the services constitutes prima facie evidence of
negligence shifting the burden of proof to such provider of unlawful services. The following damages
in addition to any other remedies provided by law may be recovered in such an action:
(a) The amount of any fees paid for the unlawful services.
(b) Reasonable attorney fees and court costs.
(5) The board shall refer all violations of this section made known to it to appropriate prosecuting
attorneys. The board may render assistance to a prosecuting attorney in the prosecution of a case
pursuant to this section.
Corporate Practice of Medicine
An Attorney General Opinion appears to prohibit hospitals from employing physicians to provide
medical services.
A hospital may not practice medicine or surgery, even though it may own or provide facilities for such
activities. There must be a direct relationship between the patient and the medical professional. See
Idaho Op. Att'y Gen. (May 26, 1954).
Illinois
TITLE 68: PROFESSIONS AND OCCUPATIONS
CHAPTER VII: DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
SUBCHAPTER b: PROFESSIONS AND OCCUPATIONS
PART 1285 MEDICAL PRACTICE ACT OF 1987
Section 1285.336 Use of Lasers
a)
Definitions
For the purposes of this Section, the following definitions apply. "An ablative treatment is expected to
excise, burn or vaporize the skin below the dermo-epidermal junction. Non-ablative treatments are
those that are not expected or intended to excise, burn or vaporize the epidermal surface of the skin."
(The Bulletin of the American College of Surgeons, Vol. 92, No. 4, April 2007)
b)
Use of Light Emitting Devices
1)
The use of a light emitting device, including, but not limited to, Class 3b and Class 4 lasers
required to be registered with the Illinois Emergency Management Agency, Division of Nuclear
Safety, under 32 Ill. Adm. Code 315, intense pulsed-light, radiofrequency and medical microwave
devices used for the treatment of dermatologic conditions or cosmetic procedures that disrupt the
epidermal surface of the skin, whether ablative or non-ablative, is considered to be the practice of
medicine, which shall only be performed by a physician licensed to practice medicine.
2)
An ablative or non-ablative procedure that can potentially disrupt the eye (cornea to retina)
may only be performed by a physician licensed to practice medicine in all of its branches and may not
be delegated pursuant to this Section.
3)
The physician must examine the patient and determine a course of treatment appropriate to
the patient prior to any ablative or non-ablative procedure being performed. If the established course
of treatment requires multiple procedures, a subsequent examination shall not be required prior to the
performance of each individual procedure.
A)
A physician licensed to practice medicine in all of its branches may delegate the performance
of ablative procedures to a licensed practical nurse, a registered professional nurse or other persons,
with on-site supervision by the physician.
B)
A physician licensed to practice medicine in all of its branches may delegate the performance
of non-ablative procedures to a licensed practical nurse, a registered professional nurse or other
persons, with on-site supervision by the physician or the physician must be available by telephone or
other electronic means to respond promptly to any question or complication that may occur.
4)
A licensed practical nurse, registered professional nurse or other person delegated the
authority to perform any ablative or non-ablative procedures must have received appropriate,
documented training and education in the safe and effective use of each system utilized.
c)
Nothing in this Section shall be deemed or construed to prevent any person licensed in this
State under the Illinois Dental Practice Act as a dentist, the Podiatric Medical Practice Act of 1987,
the Nurse Practice Act as an advanced practice nurse as specifically authorized by a written
collaborative agreement with a physician licensed to practice medicine in all its branches, or the
Physician Assistant Practice Act of 1987 as specifically authorized by written guidelines with a
physician licensed to practice medicine in all its branches from engaging in the practice for which he
or she is licensed. Nothing in this Section shall be deemed or construed to restrict the use of any
device used for therapeutic treatment or procedures that cannot cut, excise, burn or vaporize the skin
by a physician licensed to treat human aliments without the use of drugs and without operative
surgery. Nothing in this Section shall be deemed or construed to restrict any person licensed under
the Electrologist Licensing Act from performing electrology, defined as the practice or teaching of
services for permanent hair removal utilizing only solid probe electrode type epilation, which may
include thermolysis (shortwave, high frequency), electrolysis (galvanic), or a combination of both
(superimposed or sequential blend [225 ILCS 412/10].
(225 ILCS 412/23)
(Section scheduled to be repealed on January 1, 2014)
Sec. 23. Scope of practice.
(a) The scope of practice of an electrologist is limited to the following:
(1) The application of an antiseptic on the area of
the individual's skin to which electrology will be applied.
(2) The use of a sterile needle/probe electrode type
epilation, which includes (i) electrolysis, known as direct current/DC, (ii) thermolysis, known as
alternating current/AC, or (iii) a combination of both electrolysis and thermolysis, known as
superimposed or sequential blend.
(b) Nothing in this Act shall be construed to authorize an electrologist to perform surgery. Services
involving laser technology may only be performed if they are delegated by a physician licensed to
practice medicine in all its branches consistent with Section 20 of this Act and the Medical Practice
Act of 1987 and any rules promulgated thereto. An electrologist shall refer to a licensed physician any
individual whose condition, at the time of evaluation or service, is determined to be beyond the scope
of practice of the electrologist, such as an individual with signs of infection or bleeding.
(Source: P.A. 96‑569, eff. 8‑18‑09.)
Truth in Advertising
AN ACT concerning professional regulation.
Be it enacted by the People of the State of Illinois, represented in the General Assembly:
Section 1. Short title. This Act may be cited as the Truth in Health Care Professional Services Act.
Section 5. Purpose. The General Assembly hereby finds and declares that:
(a) There are widespread differences regarding the training and qualifications required to earn
the professional degrees. These differences often concern the training and skills necessary to
correctly detect, diagnose, prevent, and treat illness or health care conditions.
(b) There is a compelling State interest in patients being promptly and clearly informed of the
training and qualifications of the health care professionals who provide health care services.
(c) There is a compelling State interest in the public being protected from potentially
misleading and deceptive health care advertising that might cause patients to have undue
expectations regarding their treatment and outcome.
Section 10. Definitions. For purposes of this Act:
"Advertisement" denotes any communication or statement, SB3509 Enrolled LRB096 19788 ASK
35228 b Public Act 096-1340 whether printed, electronic, or oral, that names the health care
professional in relation to his or her practice, profession, or institution in which the individual is
employed, volunteers, or otherwise provides health care services. This includes business cards,
letterhead, patient brochures, e-mail, Internet, audio, and video, and any other communication or
statement used in the course of business.
"Deceptive" or "misleading" includes, but is not limited to, any advertisement or affirmative
communication or representation for health care services that misstates, falsely describes, or falsely
represents the health care professional's skills, training, expertise, education, board certification, or
licensure.
"Health care professional" means any person who treats human ailments and is subject to licensure
or regulation by the State, including students and residents.
"Licensee" means a health care professional who holds an active license with the licensing board
governing his or her practice in this State.
Section 15. Requirements.
(a) An advertisement for health care services must identify the type of license held by the
health care professional advertising or providing services pursuant to the definitions, titles, and
initials authorized under his or her licensing Act or examination designations required for
licensure under his or SB3509 Enrolled LRB096 19788 ASK 35228 b Public Act 096-1340
her licensing Act. The advertisement shall be free from any and all deceptive or misleading
information.
(b) A health care professional providing health care services in this State must conspicuously
post and affirmatively communicate the professional's specific licensure by doing the following:
(1) The health care professional shall wear a name tag during all patient encounters that
clearly identifies the type of license held by the health care professional, unless
precluded by adopted sterilization or isolation protocols. The name tag shall be of
sufficient size and be worn in a conspicuous manner so as to be visible and
apparent;
(2) If the health care professional has an office in which he or she sees current or
prospective patients, then the health care professional shall display in his or her
office a writing that clearly identifies the type of license held by the health care
professional. The writing must be of sufficient size so as to be visible and apparent
to all current and prospective patients; and
(3) The health care professional must only use the licensure titles or initials authorized
by his or her licensing Act, examination designations required for licensure under his or
her licensing Act, or the titles authorized by the professional licensing Act for students
in training. SB3509 Enrolled LRB096 19788 ASK 35228 b Public Act 096-1340 A health
care professional who practices in more than one office shall comply with these
requirements in each practice setting.
(c) Health care professionals working in non-patient care settings, and who do not have any
direct patient care interactions, are not subject to the provisions of subsection (b) of this
Section.
(d) Under this Section, a health care professional who is a student or resident and does not
have a state license shall only be required to wear a name tag that clearly identifies himself or
herself by name and as a student or resident, as authorized by the professional licensing Act.
Section 20. Violations and enforcement.
(a) Failure to comply with any provision under this Section shall constitute a violation under this
Act.
(b) Each day this Act is violated shall constitute a separate offense and shall be punishable as
such.
(c) Any health care professional who violates any provision of this Act is guilty of
unprofessional conduct and subject to disciplinary action under the appropriate provisions of
the specific Act governing that health care profession.
Section 97. Severability. The provisions of this Act are severable under Section 1.31 of the Statute on
Statutes. Section 99. Effective date. This Act takes effect July 1, SB3509 Enrolled LRB096 19788
ASK 35228 b Public Act 096-1340 2010. SB3509 Enrolled LRB096 19788 ASK 35228 b Public Act
096-1340
Corporate Practice of Medicine
State statutes allow a hospital or hospital affiliate corporation to employ physicians to provide medical
services.
Case law appears to prohibit unlicensed corporations from employing physicians to provide medical
services; however, case law allows licensed hospitals to employ physicians because licensed
hospitals possess legislative authority to provide medical services.
Licensed hospitals and hospital affiliates may employ licensed physicians if they meet certain
requirements. See 210 Ill. Comp. Stat. 85/10.8 (2005).
Licensed hospitals may employ physicians and practice medicine. See Berlin v. Sarah Bush Lincoln
Health Ctr., 688 N.E.2d 106, 113 (Ill. 1997).
The hospital exception to the prohibition of the CPOM doctrine is very narrow. The court refused to
extend it to a non-profit health care institute (not a hospital) that employed a physician. See CarterShields, M.D. v. Alton Health Inst., 777 N.E.2d 948, 958 (Ill. 2002).
Indiana
INDIANA CODE § 25-22.5
ARTICLE 22.5. PHYSICIANS
IC 25-22.5-1-1.1 Definitions
Sec. 1.1. As used in this article:
(a) "Practice of medicine or osteopathic medicine" means any one
(1) or a combination of the following:
(1) Holding oneself out to the public as being engaged in:
(A) the diagnosis, treatment, correction, or prevention of any disease,
ailment, defect, injury, infirmity, deformity, pain, or other condition of
human beings;
(B) the suggestion, recommendation, or prescription or
administration of any form of treatment, without limitation;
(C) the performing of any kind of surgical operation upon a
human being, including tattooing, except for tattooing (as
defined in IC 35-42-2-7), in which human tissue is cut, burned,
or vaporized by the use of any mechanical means, laser, or
ionizing radiation, or the penetration of the skin or body orifice
by any means, for the intended palliation, relief, or cure; or
(D) the prevention of any physical, mental, or functional ailment
or defect of any person.
(2) The maintenance of an office or a place of business for the reception, examination,
or treatment of persons suffering from disease, ailment, defect, injury, infirmity,
deformity, pain, or other conditions of body or mind.
(3) Attaching the designation "doctor of medicine", "M.D.", "doctor of osteopathy",
"D.O.", "osteopathic medical physician", "physician", "surgeon", or "physician and
surgeon", either alone or in connection with other words, or any other words or
abbreviations to a name, indicating or inducing others to believe that the person is
engaged in the practice of medicine or osteopathic medicine (as defined in this section).
(4) Providing diagnostic or treatment services to a person in Indiana when the
diagnostic or treatment services:
(A) are transmitted through electronic communications; and
(B) are on a regular, routine, and nonepisodic basis or under an oral or written
agreement to regularly provide medical services. In addition to the exceptions
described in section 2 of this chapter, a nonresident physician who is located
outside Indiana does not practice medicine or osteopathy in Indiana by providing
a second opinion to a licensee or diagnostic or treatment services to a patient
in Indiana following medical care originally provided to the patient while outside
Indiana.
IC 25-22.5-1-2 Exclusions
Sec. 2. (a) This article, as it relates to the unlawful or unauthorized practice of medicine or
osteopathic medicine, does not apply to any of the following:
(20) An employee of a physician or group of physicians who performs an act, a duty, or a function that
is customarily within the specific area of practice of the employing physician or group of physicians, if
the act, duty, or function is performed under the direction and supervision of the employing physician
or a physician of the employing group within whose area of practice the act, duty, or function falls. An
employee may not make a diagnosis or prescribe a treatment and must report the results of an
examination of a patient conducted by the employee to the employing physician or the physician of
the employing group under whose supervision the employee is working. An employee may not
administer medication without the specific order of the employing physician or a physician of the
employing group. Unless an employee is licensed or registered to independently practice in a
profession described in subdivisions (9) through (18), nothing in this subsection grants the employee
independent practitioner status or the authority to perform patient services in an independent practice
in a profession.
Truth in Advertising
844 IAC 5-2-13 Advertising
Authority: IC 25-22.5-2-7
Affected: IC 25-1-9; IC 25-22.5-1
Sec. 13. (a) A practitioner shall not, on behalf of himself/herself, a partner, associate, shareholder in a
professional corporation, or any other practitioner or specific health care provider affiliated with the
practitioner, use, or participate in the use of, any form of public communication containing a false,
fraudulent, misleading, deceptive, or unfair statement or claim.
(b) Subject to the requirements of subsection (a), and in order to facilitate the process of informed
selection of a practitioner by the public, a practitioner may advertise services through the public
media including, but not limited to, a telephone directory, physicians' or osteopaths' directory,
newspaper or other periodical, radio or television, or through written communication not involving
personal contact, provided that the advertisement is dignified and confines itself to the existence,
scope, nature, and field of practice of the practitioner.
(c) If the advertisement is communicated to the public by radio, cable, or television, it shall be
prerecorded, approved for broadcast by the practitioner, and a recording and transcript of the actual
transmission shall be retained by the practitioner for a period of five (5) years from the last date of
broadcast.
(d) If a practitioner advertises a fee for a service, treatment, consultation, examination, radiographic
study, or other procedure, the practitioner must render that service or procedure for no more than the
fee advertised.
(e) Unless otherwise specified in the advertisement, if a practitioner publishes or communicates any
fee information in a publication that is published more frequently than one (1) time per month, the
practitioner shall be bound by any representation made therein for a period of thirty (30) days after
the publication date. If a practitioner publishes or communicates any fee information in a publication
that is published once a month or less frequently, the practitioner shall be bound by any
representation made therein until the publication of the succeeding issue. If a practitioner publishes or
communicates any fee information in a publication which has no fixed date for publication of a
succeeding issue, the practitioner shall be bound by any representation made therein for one (1)
year.
(f) Unless otherwise specified, if a practitioner broadcasts any fee information by radio, cable, or
television, the practitioner shall be bound by any representation made therein for a period of ninety
(90) days after such broadcast.
(g) Except as otherwise specified in this article, a practitioner shall not contact or solicit individual
members of the public personally or through an agent in order to offer services to such person or
persons unless that individual initiated contact with the practitioner for the purpose of engaging that
practitioner's professional services. (Medical Licensing Board of Indiana; 844 IAC 5-2-13; filed Nov
30, 1990, 4:15 p.m.: 14 IR 752; readopted filed Nov 9, 2001, 3:16 p.m.: 25 IR 1325; readopted filed
Oct 4, 2007, 3:36 p.m.: 20071031-IR-844070050RFA)
Corporate Practice of Medicine
State regulations appear to allow certain entities or professionals to employ physicians to provide
medical services if they do not direct or control the judgment of the licensed physician.
An employment or other contractual relationship between the following entities and a licensed
physician does not constitute the unlawful practice of medicine: (1) a hospital; (2) a physician; (3) a
psychiatric hospital; (4) a health maintenance organization; (5) a health facility; (6) a dentist; (7) a
registered or licensed practical nurse; (8) a midwife; (9) an optometrist; (10) a podiatrist; (11) a
chiropractor; (12) a physical therapist; or (13) a psychologist. See Ind. Code 25-22.5-1-2(c) (2006).
Iowa
ARC 8925B
MEDICINE BOARD [653]
Rule 653—13.8(148,272C) establishes the standards of practice for a physician or surgeon or
osteopathic physician or surgeon who serves as a medical director at a medical spa. Subrules
23.1(43) and 23.1(44) establish as grounds for discipline improper delegation and supervision with
regard to rule 653—13.8(148,272C).
Item 1. Adopt the following new rule 653—13.8(148,272C):
653—13.8(148,272C) Standards of practice—medical directors at medical spas—delegation and
supervision of medical aesthetic services performed by qualified licensed or certified nonphysician
persons. This rule establishes standards of practice for a physician or surgeon or osteopathic
physician or surgeon who serves as a medical director at a medical spa.
13.8(1) Definitions. As used in this rule:
“Alters” means a change in the cellular structure of living tissue.
“Capable of” means any means, methods, devices or instruments, which if used as intended or
otherwise to its greatest strength, has the potential to alter or damage living tissue below the
superficial epidermal cells.
“Damages” means a harmful change in the cellular structure of living tissue.
“Delegate” means to entrust or transfer the performance of a medical aesthetic service to qualified
licensed or certified nonphysician persons.
“Medical aesthetic service” means the diagnosis, treatment, or correction of human conditions,
ailments, diseases, injuries, or infirmities of the skin, hair, nails and mucous membranes by any
means, methods, devices, or instruments including the use of a biological or synthetic material,
chemical application, mechanical device, or displaced energy form of any kind if it alters or damages
or is capable of altering or damaging living tissue below the superficial epidermal cells, with the
exception of hair removal. Medical aesthetic service includes, but is not limited to, the following
services: ablative laser therapy; vaporizing laser therapy; nonsuperficial light device therapy;
injectables; tissue alteration services; nonsuperficial light-emitting diode therapy; nonsuperficial
intense pulse light therapy; nonsuperficial radiofrequency therapy; nonsuperficial ultrasonic therapy;
nonsuperficial exfoliation; nonsuperficial microdermabrasion; nonsuperficial dermaplane exfoliation;
nonsuperficial lymphatic drainage; botox injections; collagen injections; and tattoo removal.
“Medical director” means a physician who assumes the role of, or holds oneself out as, medical
director or a physician who serves as a medical advisor at a medical spa. The medical director is
responsible for implementing policies and procedures to ensure quality patient care and for the
delegation and supervision of medical aesthetic services to qualified licensed or certified
nonphysician persons.
“Medical spa” means any entity, however organized, which is advertised, announced, established, or
maintained for the purpose of providing medical aesthetic services. Medical spa shall not include a
dermatology practice which is wholly owned and controlled by one or more Iowa-licensed physicians
if at least one of the owners is actively practicing at each location.
“Nonsuperficial” means any therapy that alters or damages or is capable of altering or damaging
living tissue below the superficial epidermal cells.
“Qualified licensed or certified nonphysician person” means any person who is not licensed to
practice medicine and surgery or osteopathic medicine and surgery but who is licensed or certified by
another licensing board in Iowa and qualified to perform medical aesthetic services under the
supervision of a qualified physician.
“Supervision” means the oversight of qualified licensed or certified nonphysician persons who perform
medical aesthetic services delegated by a medical director.
13.8(2) Practice of medicine. The performance of medical aesthetic services is the practice of
medicine. A medical aesthetic service shall only be performed by qualified licensed or certified
nonphysician persons if the service has been delegated by the medical director who is responsible for
supervision of the services performed. A medical director shall not delegate medical aesthetic
services to nonphysician persons who are not appropriately licensed or certified in Iowa.
13.8(3) Medical director. A physician who serves as medical director at a medical spa shall:
a. Hold an active unrestricted Iowa medical license to supervise each delegated medical
aesthetic service;
b. Possess the appropriate education, training, experience and competence to safely supervise
each delegated medical aesthetic service;
c. Retain responsibility for the supervision of each medical aesthetic service performed by
qualified licensed or certified nonphysician persons;
d. Ensure that advertising activities do not include false, misleading, or deceptive
representations; and
e. Be clearly identified as the medical director in all advertising activities, Internet Web sites and
signage related to the medical spa.
13.8(4) Delegated medical aesthetic service. When a medical director delegates a medical
aesthetic service to qualified licensed or certified nonphysician persons, the service shall be:
a. Within the medical director’s scope of practice and medical competence to supervise;
b. Of the type that a reasonable and prudent physician would conclude is within the scope of
sound medical judgment to delegate; and
c. A routine and technical service, the performance of which does not require the skill of a
licensed physician.
13.8(5) Supervision. A medical director who delegates performance of a medical aesthetic service
to qualified licensed or certified nonphysician persons is responsible for providing appropriate
supervision. The medical director shall:
a. Ensure that all licensed or certified nonphysician persons are qualified and competent to
safely perform each medical aesthetic service by personally assessing the person’s education,
training, experience and ability;
b. Ensure that a qualified licensed or certified nonphysician person does not perform any
medical aesthetic services which are beyond the scope of that person’s license or certification unless
the person is supervised by a qualified supervising physician;
c. Ensure that all qualified licensed or certified nonphysician persons receive direct, in-person,
on-site supervision from the medical director or other qualified licensed physician at least four hours
each week and that the regular supervision is documented;
d. Provide on-site review of medical aesthetic services performed by qualified licensed or
certified nonphysician persons each week and reviews at least 10 percent of patient charts for
medical aesthetic services performed by qualified licensed or certified nonphysician persons;
e. Be physically located within 60 miles of the location where qualified licensed or certified
nonphysician persons perform medical aesthetic services at all times;
f. Be available, in person or electronically, at all times, to consult with qualified licensed or
certified nonphysician persons who perform medical aesthetic services, particularly in case of injury
or an emergency;
g. Assess the legitimacy and safety of all equipment or other technologies being used by
qualified licensed or certified nonphysician persons who perform medical aesthetic services;
h. Develop and implement protocols for responding to emergencies or other injuries suffered by
persons receiving medical aesthetic services performed by qualified licensed or certified nonphysician
persons;
i. Ensure that all qualified licensed or certified nonphysician persons maintain accurate and
timely medical records for the medical aesthetic services they perform;
j. Ensure that each patient provides appropriate informed consent for medical aesthetic services
performed by the medical director or other qualified licensed physician and all qualified licensed or
certified nonphysician persons and that such informed consent is timely documented in the patient’s
medical record;
k. Each patient receiving medical aesthetic services performed by qualified licensed or certified
non physician persons is informed of the identity of the medical director if requested The identity and
licensure and certification of the medical director, other qualified licensed physicians and all licensed
or certified nonphysician persons are visibly displayed at each medical spa and provided in writing to
each patient receiving medical aesthetic services at a medical spa; and
l. Ensure that the board receives written verification of the education and training of all qualified
licensed or certified nonphysician persons who perform medical aesthetic services at a medical spa,
within 14 days of a request by the board.
13.8(6) Exceptions. This rule is not intended to apply to physicians who serve as medical
directors of licensed medical facilities, clinics or practices that provide medical aesthetic services as
part of or incident to their other medical services.
13.8(7) Physician assistants. Nothing in these rules shall be interpreted to contradict or supersede
the rules established in 645—Chapters 326 and 327.
Item 2. Adopt the following new subrules 23.1(43) and 23.1(44):
23.1(43) Violation of the standards of practice for medical directors who delegate and supervise
medical aesthetic services performed by nonphysician persons at a medical spa as set out at rule
653—13.8(148,272C).
23.1(44) Failure to provide the board, within 14 days of a request by the board as set out at 653—
paragraph 13.8(5)“l,” written verification of the education and training of all nonphysician persons who
perform medical aesthetic services at a medical spa.
CHAPTER 60
LICENSURE OF COSMETOLOGISTS, ELECTROLOGISTS, ESTHETICIANS,
MANICURISTS, NAIL TECHNOLOGISTS, AND INSTRUCTORS
OF COSMETOLOGY ARTS AND SCIENCES
[Prior to 7/29/87, Health Department[470] Ch 149]
645—60.1(157) Definitions. For purposes of these rules, the following definitions shall apply:
“Active license” means a license that is current and has not expired.
“Board” means the board of cosmetology arts and sciences.
“Certified laser product” means a product which is certified by a manufacturer pursuant to the
requirements of 21 Code of Federal Regulations (CFR) Part 1040.
“Chemical exfoliation” means the removal of surface epidermal cells of the skin by using only
non-medical-strength cosmetic preparations consistent with labeled instructions and as
specified by rule. This procedure is not intended to elicit viable epidermal or dermal
wounding, injury, or destruction.
“Core curriculum” means the basic core life sciences curriculum that is required for completion of
any course of study of the cosmetology arts and sciences except for manicuring.
“Cosmetology arts and sciences” means any or all of the following disciplines performed with
or without compensation by a licensee: cosmetology, electrology, esthetics, nail technology and
manicuring.
“Depilatory” means an agent used for the temporary removal of superfluous hair by dissolving it at
the epidermal surface.
“Examination” means any of the tests used to determine minimum competency prior to the issuance
of a cosmetology arts and sciences license.
“Exfoliation” means the process whereby the superficial epidermal cells are removed from the
skin.
“General supervision” means the supervising physician is not onsite for laser procedures or
use of an intense pulsed light device for hair removal conducted on minors, but is available
for direct communication, either in person or by telephone, radio, radiotelephone, television,
or similar means.
“Grace period” means the 30-day period following expiration of a license when the license is still
considered to be active. In order to renew a license during the grace period, a licensee is required to
pay a late fee.
“Inactive license” means a license that has expired because it was not renewed by the end of the
grace period. The category of “inactive license” may include licenses formerly known as lapsed,
inactive, delinquent, closed, or retired.
“Intense pulsed light device” means a device that uses incoherent light to destroy the vein of
the hair bulb.
“Laser” means light amplification by the stimulated emission of radiation.
“Licensee” means any person or entity licensed to practice pursuant to Iowa Code chapter 157 and
645—Chapters 60 to 65, Iowa Administrative Code.
“Licensure by endorsement” means the issuance of an Iowa license to practice cosmetology to an
applicant who is or has been licensed in another state for 12 months during the last 24 months.
“Mechanical exfoliation” means the physical removal of surface epidermal cells by means that
include but are not limited to brushing machines, granulated scrubs, peel-off masques,
peeling creams or drying preparations that are rubbed off, and microdermabrasion.
“Mentor” means a licensee providing guidance in a mentoring program.
“Mentoring” means a program allowing students to experience cosmetology arts and sciences in a
licensed salon under the guidance of a mentor.
“Microdermabrasion” means mechanical exfoliation using an abrasive material or apparatus
to remove surface epidermal cells with a machine which is specified by rule…
645—60.3(157) Criteria for licensure in specific practice disciplines.
60.3(1) A cosmetology license is not a requirement for an electrology, esthetics, nail technology or
manicurist license.
60.3(2) Core life sciences curriculum hours shall be transferable in their entirety from one practice
discipline to another practice discipline.
60.3(3) Theory hours earned in each practice discipline of cosmetology arts and sciences may be
used in applying for a cosmetology license.
60.3(4) A cosmetologist licensed after July 1, 2005, is not eligible to be certified in chemical
peels, microdermabrasion, laser or intense pulsed light (IPL) and shall not provide those
services.
60.3(5) Pedicuring shall only be done by a cosmetologist or nail technologist.
60.3(6) Facial waxing shall only be done by a cosmetologist or esthetician.
60.3(7) An initial license to practice manicuring shall not be issued by the board after December
31, 2007. A manicurist license issued on or before December 31, 2007, may be renewed subject to
licensure requirements identified by statute and administrative rule unless the license becomes
inactive.
A manicurist license that becomes inactive cannot be reactivated or renewed.
645—60.4(157) Practice-specific training requirements.
The board shall approve a licensee to provide the appropriate services once a licensee has complied
with training requirements and submitted a completed application, the required supporting evidence,
and applicable fees as specified in these rules. The applicant shall receive a certification card
following board approval.
60.4(1) Microdermabrasion.
a. Microdermabrasion shall only be performed by a licensed, certified esthetician or a
cosmetologist who was licensed prior to July 1, 2005, and is certified by the board.
b. To be eligible to perform microdermabrasion services, the licensee shall:
(1) Complete 14 contact hours of education specific to the material or apparatus used for
microdermabrasion. Before an additional material or apparatus is utilized in the licensee’s practice,
the licensee shall provide official certification of training on the material or apparatus.
(2) Obtain from the program a certification of training that contains the following information:
1. Date, location, course title;
2. Number of contact hours; and
3. Specific identifying description of the microdermabrasion machine covered by the course.
(3) Complete a board-approved certification application form and submit to the board office the
completed form, a copy of the certification of training, and the required fee pursuant to 645—subrule
62.1(19). The fee is nonrefundable.
60.4(2) Chemical exfoliation.
a. Chemical exfoliation shall only be performed by a cosmetologist who was licensed prior to July
1, 2005, and is certified by the board to perform those services. Additional certification is not required
for licensed estheticians.
b. Chemical exfoliation procedures are limited to the removal of surface epidermal cells of the
skin by using only non-medical-strength cosmetic preparations consistent with labeled instructions
and as specified by these rules. This procedure is not intended to elicit viable epidermal or dermal
wounding, injury, or destruction.
c. To be eligible to perform chemical peels, a cosmetologist who was licensed prior to July 1,
2005, shall:
(1) Complete 21 hours of training specific to the process and products to be used for chemical peels.
Before an additional process or product is utilized in the licensee’s practice, the licensee shall provide
official certification of training on the new process or product.
(2) Obtain from the program a certification of training that contains the following information:
1. Date, location, course title;
2. Number of contact hours; and
3. Specific identifying description of the chemical peel process and products covered by the course.
(3) Complete a board-approved certification application form and submit to the board office the
completed form, a copy of the certification of training, and the required fee pursuant to 645—subrule
62.1(19). The fee is nonrefundable.
60.4(3) Laser services.
a. A cosmetologist licensed after July 1, 2005, shall not use laser products.
b. An electrologist shall only provide hair removal services when using a laser.
c. Estheticians and cosmetologists shall use laser for cosmetic purposes only.
d. Cosmetologists licensed prior to July 1, 2005, electrologists and estheticians must be certified
to perform laser services.
e. When a laser service is provided to a minor by a licensed cosmetologist, esthetician or
electrologist who has been certified by the board, the licensee shall work under the general
supervision
of a physician. The parent or guardian shall sign a consent form prior to services being provided.
Written permission shall remain in the client’s permanent record for a period of five years.
f. To be eligible to perform laser services, a cosmetologist who was licensed on or before July 1,
2005, an electrologist, or an esthetician shall:
(1) Complete 40 hours of training specific to each laser machine, model or device to be used for
laser services. Before an additional machine, model or device is utilized in the licensee’s practice, the
licensee shall submit official certification of training on the new machine, model or device.
(2) Obtain from the program a certification of training that contains the following information:
1. Date, location, course title;
2. Number of contact hours;
3. Specific identifying description of the laser equipment; and
4. Evidence that the training program includes a safety training component which provides
a thorough understanding of the procedures to be performed. The training program shall address
fundamentals of nonbeam hazards, management and employee responsibilities relating to control
measures, and regulatory requirements.
(3) Complete a board-approved certification application form and submit to the board office the
completed form, a copy of the certification of training, and the required fee pursuant to 645—subrule
62.1(19). The fee is nonrefundable.
60.4(4) IPL hair removal treatments.
a. A cosmetologist licensed after July 1, 2005, shall not use IPL devices.
b. An IPL device shall only be used for hair removal.
c. Cosmetologists licensed prior to July 1, 2005, electrologists and estheticians must be certified
to perform IPL services.
d. When IPL hair removal services are provided to a minor by a licensed cosmetologist, esthetician
or electrologist who has been certified by the board, the licensee shall work under the general
supervision of a physician. The parent or guardian shall sign a consent form prior to services being
provided. Written permission shall remain in the client’s permanent record for a period of five years.
e. To be eligible to perform IPL hair removal services, a cosmetologist who was licensed on or
before July 1, 2005, an electrologist, or an esthetician shall:
(1) Complete 40 hours of training specific to each IPL machine, model or device to be used for
IPL hair removal services. Before an additional machine, model or device is utilized in the licensee’s
practice, the licensee shall submit official certification of training on the new machine, model or
device.
(2) Obtain from the program a certification of training that contains the following information:
1. Date, location, course title;
2. Number of contact hours;
3. Specific identifying description of the IPL hair removal equipment; and
4. Evidence that the training program includes a safety training component which provides
a thorough understanding of the procedures to be performed. The training program shall address
fundamentals of nonbeam hazards, management and employee responsibilities relating to control
measures, and regulatory requirements.
(3) Complete a board-approved certification application form and submit to the board office the
completed form, a copy of the certification of training, and the required fee pursuant to 645—subrule
62.1(19). The fee is nonrefundable.
60.4(5) Health history and incident reporting.
a. Prior to providing laser or IPL hair removal, microdermabrasion or chemical peel services, the
cosmetologist, esthetician, and electrologist shall complete a client health history of conditions related
to the application for services and include it with the client’s records. The history shall include but is
not
limited to items listed in paragraph 60.4(5)“b.”
b. A licensed cosmetologist, esthetician, or electrologist who provides services related to the use
of a certified laser product, IPL device, chemical peel, or microdermabrasion shall submit a report to
the board within 30 days of any incident in which provision of such services resulted in physical injury
requiring medical attention. Failure to comply with this requirement shall result in disciplinary action
by the board. The report shall include the following:
(1) A description of procedures;
(2) A description of the physical condition of the client;
(3) A description of any adverse occurrence, including:
1. Symptoms of any complications including, but not limited to, onset and type of symptoms;
2. A description of the services provided that caused the adverse occurrence;
3. A description of the procedure that was followed by the licensee;
(4) A description of the client’s condition on termination of any procedures undertaken;
(5) If a client is referred to a physician, a statement providing the physician’s name and office
location, if known;
(6) A copy of the consent form.
60.4(6) Failure to report. Failure to comply with paragraph 60.4(5)“b” when the adverse occurrence
is related to the use of any procedure or device noted in the attestation may result in the licensee’s
loss of authorization to administer the procedure or device noted in the attestation or may result in
other sanctions provided by law.
60.4(7) A licensee shall not provide any services that constitute the practice of medicine.
645—60.5(157) Licensure restrictions relating to practice.
60.5(1) A certified laser product or an intense pulsed light device shall only be used on surface
epidermal layers of the skin except for hair removal.
60.5(2) A laser hair removal product or an intense pulsed light device shall not be used on a minor
unless the minor is accompanied by a parent or guardian and then shall be used only under general
supervision of a physician.
60.5(3) Persons licensed under Iowa Code chapter 157 shall not administer any practice of removing
skin by means of a razor-edged instrument.
60.5(4) Persons licensed under this chapter who provide hair removal, manicuring and nail
technology services shall not administer any procedure in which human tissue is cut, shaped,
vaporized,
or otherwise structurally altered, except for the use of a cuticle nipper.
60.5(5) Board-certified licensees providing microdermabrasion, chemical peels, laser or IPL hair
removal treatments in a salon or barbershop setting shall not include any practice, activity, or
treatment that constitutes the practice of medicine, osteopathic medicine, chiropractic or acupuncture.
645—60.6(157) Consent form requirements.
A licensed esthetician, cosmetologist, or electrologist,
prior to providing services relating to a certified laser product, intense pulsed light device, chemical
peel, or microdermabrasion, shall obtain from a client a consent form that:
1. Specifies in general terms the nature and purpose of the procedure(s);
2. Lists known risks associated with the procedure(s) if reasonably determinable;
3. States an acknowledgment that disclosure of information has been made and that questions
asked about the procedure(s) have been satisfactorily answered;
4. Includes a signature of either the client for whom the procedure is performed or, if that client
for any reason lacks legal capacity to consent, includes the signature of a person who has legal
authority to consent on behalf of that client in those circumstances.
Truth in Advertising
The board may discipline a licensee who is guilty of knowingly making misleading, deceptive, untrue
or fraudulent representation in the practice of the physician's profession.
§147.72. Professional titles and abbreviations
Any person licensed to practice a profession under this subtitle may append to the person's name any
recognized title or abbreviation, which the person is entitled to use, to designate the person's
particular profession, but no other person shall assume or use such title or abbreviation, and no
licensee shall advertise in such a manner as to lead the public to believe that the licensee is engaged
in the practice of any other profession than the one which the licensee is licensed to practice.
§147.73. Titles used by holder of degree
Nothing in section 147.72 shall be construed:
1. As authorizing any person licensed to practice a profession under this subtitle to use or assume
any degree or abbreviation of the degree unless such degree has been conferred upon the person by
an institution of learning accredited by the appropriate board, or by some recognized state or national
accredited agency.
2. As prohibiting any holder of a degree conferred by an institution of learning accredited by the
appropriate board created in this chapter, or by some recognized state or national accrediting agency,
from using the title which such degree authorizes the holder to use, but the holder shall not use such
degree or abbreviation in any manner which might mislead the public as to the holder's qualifications
to treat human ailments.
Iowa Code Ann. §147.1 Definitions
§147.1 Definitions
“Profession” means medicine and surgery, podiatry, osteopathic medicine and surgery, practice as a
physician assistant, psychology, chiropractic, nursing, dentistry, dental hygiene, dental assisting,
optometry, speech pathology, audiology, pharmacy, physical therapy, physical therapist assisting,
occupational therapy, occupational therapy assisting, respiratory care, cosmetology arts and
sciences, barbering, mortuary science, marital and family therapy, mental health counseling, social
work, dietetics, massage therapy, athletic training, acupuncture, nursing home administration, hearing
aid dispensing, or sign language interpreting or transliterating.
§148.1 Persons engaged in practice
For the purpose of this subtitle, the following classes of persons shall be deemed to be engaged in
the practice of medicine and surgery or osteopathic medicine and surgery:
1. Persons who publicly profess to be physicians and surgeons or osteopathic physicians and
surgeons or who publicly profess to assume the duties incident to the practice of medicine and
surgery or osteopathic medicine and surgery.
2. Persons who prescribe, or prescribe and furnish, medicine for human ailments or treat the same by
surgery.
3. Persons who act as representatives of any person in doing any of the things mentioned in this
section.
§148.2. Persons not engaged in practice
Section 148.1 shall not be construed to include the following classes of persons:
1. Persons who advertise or sell patent or proprietary medicines.
2. Persons who advertise, sell, or prescribe natural mineral waters flowing from wells or springs.
3. Students of medicine and surgery or osteopathic medicine and surgery who have completed at
least two years' study in a medical school or a college of osteopathic medicine and surgery, approved
by the board, and who prescribe medicine under the supervision of a licensed physician and surgeon
or licensed osteopathic physician and surgeon, or who render gratuitous service to persons in case of
emergency.
4. Licensed podiatric physicians, chiropractors, physical therapists, nurses, dentists, optometrists,
and pharmacists who are exclusively engaged in the practice of their respective professions.
5. Physicians and surgeons or osteopathic physicians and surgeons of the United States army, navy,
air force, marines, public health service, or other uniformed service when acting in the line of duty in
this state, and holding a current, active permanent license in good standing in another state, district,
or territory of the United States, or physicians and surgeons or osteopathic physicians and surgeons
licensed in another state, when incidentally called into this state in consultation with a physician and
surgeon or osteopathic physician and surgeon licensed in this state.
Corporate Practice of Medicine
State statutes and regulations do not address CPOM.
Modifying an earlier opinion, an Attorney General Opinion appears to allow a corporation to employ a
physician to provide medical services if the corporation does not interfere with the physician's
independent medical judgment.
After reviewing Iowa case law, the Attorney General determined that the question of whether the
employment of a physician violates the CPOM doctrine turns on the degree of dominion or control
exercised over the physician and is decided on an individual case basis. See Iowa Op. Att'y Gen.
91-7-1 (July 12, 1991).
Kansas
Article 27.--LIGHT-BASED MEDICAL TREATMENT
K.A.R. 100-27-1. Supervision of light-based medical treatment.
(a)
(1) The phrase “class III or class IV device” shall mean a medical instrument that meets either
of the following conditions:
(A) Is a class IIIa, class IIIb, or class IV laser product as defined by 21 C.F.R. §
1040.10, as in effect on March 31, 2000; or
(B) emits radiation in a continuous wave of more than one milliwatt or at a pulsed rate of
more than five milliwatts.
(2) The phrase “immediately available” shall mean that the licensee either is physically present
in the same building or can be present at the location where the service is performed within
five minutes.
(3) “Licensee” shall mean a person licensed to practice medicine and surgery or osteopathic
medicine and surgery in this state.
(4) The phrase “light-based medical device” shall mean any instrument that produces or
amplifies electromagnetic radiation at wavelengths equal to or greater than 180 nanometers,
but less than or equal to 1.0 X 106 nanometers, for the purpose of affecting the structure or
function of any part of the living human body.
(5) The phrase “physically present” shall mean that the licensee is capable of constant, direct
communication and is in the same office within the building where the service is performed
throughout the entire time during which the service is performed.
(b) A licensee shall not authorize another person to perform a professional service using a
light-based medical device unless either the licensee is immediately available or, except as
limited by subsection
(c), there is a written practice protocol signed by the licensee and the person performing the
treatment that requires all of the following:
(1) The person performing the treatment will not provide any service for which the person is not
competent by training, education, and experience.
(2) The person receiving the treatment is required to give consent to the treatment, after being
informed of the nature and purpose of the treatment, risks, and expected consequences of
treatment, alternatives to light-based medical treatment, and identification of the treatment as a
medical and surgical procedure.
(3) The person performing the treatment is required to inform the person receiving the
treatment of the licensee’s identity, emergency telephone number, and practice location, if
different from the location at which the treatment is performed.
(4) Each treatment is required to be performed only at a location that the licensee maintains for
the practice of the branch of the healing arts for which the licensee is licensed.
(5) Each treatment provided while the licensee is not physically present is required to be
performed within written operating parameters.
(6) Creation of an adequate patient record is required.
(7) The licensee is required to review the patient record and authenticate this review within 14
days following the treatment.
(8) The person performing the treatment is prohibited from delegating the use of the lightbased medical device to another person.
(c) A licensee shall not authorize another person to perform a professional service using a class III or
class IV device or an intense pulsed-light device substantially equivalent to a laser surgical device as
defined by 21 C.F.R. § 878.4810, as in effect on January 16, 1996, unless either of the following
conditions is met:
(1) The licensee is physically present.
(2) The licensee is immediately available, and there is a written protocol signed by the licensee
and the person performing the treatment that meets the requirements of paragraphs (b)(1)
through (b)(8).
(d) This regulation shall not apply to an order by a licensee to any appropriate person for the
application of light-based medical devices for phototherapy in the treatment of hyperbilirubinemia in
neonates.
(e) This regulation shall not apply to any of the following:
(1) Any person licensed under the healing arts act to practice chiropractic who engages in
light-based physiotherapy;
(2) any licensed physical therapist who provides treatments as authorized by law; or
(3) any licensed occupational therapist who provides treatments as authorized by law.
(Authorized by K.S.A. 65-2865; implementing K.S.A. 2005 Supp. 65-28,127; effective June 1, 2001;
amended March 22, 2002; amended Sept. 15, 2006.)
Kan. Stat. Ann. §65-2802. Definitions
For the purpose of this act the following definitions shall apply:
(a) The healing arts include any system, treatment, operation, diagnosis, prescription, or practice for
the ascertainment, cure, relief, palliation, adjustment, or correction of any human disease, ailment,
deformity, or injury, and includes specifically but not by way of limitation the practice of medicine and
surgery; the practice of osteopathic medicine and surgery; and the practice of chiropractic.
(e) "Healing arts school" shall mean an academic institution which grants a doctor of chiropractic
degree, doctor of medicine degree or doctor of osteopathy degree.
Truth in Advertising
§65-2837
"Unprofessional conduct" means:
(1) Solicitation of professional patronage through the use of fraudulent or false advertisements, or
profiting by the acts of those representing themselves to be agents of the licensee.
(2) Representing to a patient that a manifestly incurable disease, condition or injury can be
permanently cured.
(3) Assisting in the care or treatment of a patient without the consent of the patient, the attending
physician or the patient's legal representatives.
(4) The use of any letters, words, or terms, as an affix, on stationery, in advertisements, or otherwise
indicating that such person is entitled to practice a branch of the healing arts for which such person is
not licensed.
(5) Performing, procuring or aiding and abetting in the performance or procurement of a criminal
abortion.
(6) Willful betrayal of confidential information.
(7) Advertising professional superiority or the performance of professional services in a superior
manner.
(8) Advertising to guarantee any professional service or to perform any operation painlessly.
(9) Participating in any action as a staff member of a medical care facility which is designed to
exclude or which results in the exclusion of any person licensed to practice medicine and surgery
from the medical staff of a nonprofit medical care facility licensed in this state because of the branch
of the healing arts practiced by such person or without just cause.
Corporate Practice of Medicine
State statutes and regulations do not address CPOM.
Case law indicates that a corporation may not employ a physician to provide medical services.
However, case law also suggests that a hospital may employ physicians to provide medical services
because it is a licensed facility subject to regulation and oversight.
Licensed physicians may be employed by licensed hospitals because such contracts do not violate
the public health, safety or welfare. Hospitals are licensed healthcare facilities and as such are
subject to regulation and oversight. See St. Francis Reg'l Med. Ctr. v. Weiss, 869 P.2d 606, 618 (Kan.
1994). General corporations may not employ physicians. See Early Detection Ctr. v. Wilson, 811 P.2d
860, 877 (Kan. 1991).
Kentucky
§ 311.550 – Definitions
(10) Except as provided in subsection (11) of this section, the “practice of medicine or osteopathy”
means the diagnosis, treatment, or correction of any and all human conditions, ailments, diseases,
injuries, or infirmities by any and all means, methods, devices, or instrumentalities;
(11) The “practice of medicine or osteopathy” does not include the practice of Christian Science, the
domestic administration of family remedies, the rendering of first aid or medical assistance in an
emergency in the absence of a person licensed to practice medicine or osteopathy under the
provisions of this chapter, the use of automatic external defibrillators in accordance with the
provisions of KRS 311.665 to 311.669, the practice of podiatry as defined in KRS 311.380, the
practice of a midlevel health care practitioner as defined in KRS 216.900, the practice of dentistry as
defined in KRS 313.010, the practice of optometry as defined in KRS 320.210, the practice of
chiropractic as defined in subsection (2) of KRS 312.015, the practice as a nurse as defined in KRS
314.011, the practice of physical therapy as defined in KRS 327.010, the performance of duties for
which they have been trained by paramedics licensed under KRS Chapter 311A, first responders, or
emergency medical technicians certified under Chapter 311A, the practice of pharmacy by persons
licensed and registered under KRS 315.050, the sale of drugs, nostrums, patented or proprietary
medicines, trusses, supports, spectacles, eyeglasses, lenses, instruments, apparatus, or
mechanisms that are intended, advertised, or represented as being for the treatment, correction,
cure, or relief of any human ailment, disease, injury, infirmity, or condition, in regular mercantile
establishments, or the practice of midwifery by women. KRS 311.530 to 311.620 shall not be
construed as repealing the authority conferred on the Cabinet for Health and Family Services by KRS
Chapter 211 to provide for the instruction, examination, licensing, and registration of all midwives
through county health officers;
(12) “Physician” means a doctor of medicine or a doctor of osteopathy;
Estheticians
317B.015 Prohibited activities -- Applicability of KRS 317B.010 to 317B.060.
(1) Estheticians practicing under KRS 317B.010 to 317B.060 shall not perform any of the following:
Botox or collagen injections, laser treatments, electrolysis, tattoo, permanent makeup,
microdermabrasion, or piercing unless practicing under the immediate supervision of a licensed
physician.
(2) The provisions of KRS 317B.010 to 317B.060 shall not apply to any other person licensed,
certified, or registered under any other chapter of the Kentucky Revised Statutes, or any student
within an accredited training program of any of these professions. Nothing in KRS 317B.010 to
317B.060 shall be construed to limit, interfere, or restrict the practice, descriptions of services, or
manner in which that person holds himself or herself out to the public so long as that person does not
hold himself or herself out as an esthetician unless that person is licensed as an esthetician under
KRS 317B.010 to 317B.060.
Effective: June 24, 2003
History: Created 2003 Ky. Acts ch. 137, sec. 2, effective June 24, 2003.
PLEASE NOTE: THE FOLLOWING ARE GUIDELINES ONLY AND DO NOT HAVE THE FORCE
OF LAW.
Laser Surgery and Intense Pulsed Light Therapy Position Statement
The Kentucky Board of Medical Licensure adopts the position that the revision, destruction, incision
or other structural alteration of human tissue is the practice of medicine.
Because laser surgery and intense pulsed light therapy involve the revision, destruction, incision, and
removal of human tissue, laser and intense pulsed light therapy should be performed only by
individuals licensed to practice medicine.
Laser surgery on the eye (cornea to retina) and the ocular adnexa should only be performed by a
licensed physician.
A physician with appropriate specific training in acceptable laser surgery and intense pulsed light
therapy may delegate certain other procedures to certified or licensed non-physicians in compliance
with appropriate statutes and regulations. The physician must supervise the non-physician to protect
the best interests and welfare of each patient. The physician must direct the course of the patient’s
treatment and must supervise the person performing the procedure.
A physician may delegate certain other procedures to certified or licensed non-physician in
compliance with appropriate statutes and regulations. The physician must supervise the nonphysician to protect the best interests and welfare of each patient.
o The supervising physician shall be physically present on- site, immediately available, and
able to respond promptly to any question or problem that may occur while the procedure is
being performed (except Laser Hair Removal)
o It is the physician's obligation to ensure that, with respect to each procedure performed, the
non-physician possesses the proper training in cutaneous medicine, the indications for the
procedure, and the pre- and post- operative care involved.
o The supervising physician performs and documents an initial assessment prior to treatment
and as needed during the course of therapy.
o The non-physician has satisfactorily completed a documented special education and training
program on applicable, laser physics, safety, techniques and pre and post operative care and
laser safety, which includes supervised practice and clinical skill competency.
o The facility has applicable written policies and procedures.
o Continuing education for these procedures is ongoing and documented.
Certain Procedures – Specific
o Treatment of vascular irregularities
Laser of facial veins
Treatment of leg veins by laser
o Treatment of pigmented irregularities
o Treatment of acne
o Treatment of collagen stimulation
o Treatment of microlaser peel
o Treatment of rosacea
For Laser Hair Reduction
o Treatment of laser hair reduction (off-site treatment may be allowed)
When physicians are involved with non-physicians in laser hair removal, the following minimum
standards must apply.
1. There must be a responsible physician for each patient undergoing laser hair removal
procedures. The responsible physician must be qualified to do the procedure
themselves, i.e., appropriately trained in laser physics, safety, techniques and pre and
post operative care to perform laser hair removal using the specific device with which
the patient is being treated.
2. Personnel to whom the procedure of laser hair removal is delegated must undergo
formal training in order to ensure competence with laser hair removal. All personnel
must provide written documentation of the successful completion of the following:
a) A didactic laser course that includes instruction in laser safety and the basic
principles of laser operation. In addition, they must have documentation of
training and education in the safe and effective use of each laser system to be
used in the facility.
b) Satisfactory completion of a minimum of 30 cases under the direct supervision
of the facility’s medical director.
3. All personnel performing these procedures must recognize unexpected, adverse,
immediate and delayed reactions to treatment, which should be part of their annual
documented competence review by the medical director.
Advertisements Involving Cosmetic Medical Procedures
Any public communication offering the performance or administration of a cosmetic medical
procedure or treatment (i) shall identify the physician and surgeon responsible for provision of, or
direct supervision of the provision of, the procedure or treatment, and (ii) shall include a statement
that the supervising physician or surgeon is certified, or eligible for certification by a private or public
board, parent association, or multidisciplinary board or association that is an American Board of
Medical Specialties member board, a board or association with equivalent requirements approved by
that physician and surgeon’s licensing board, or a board or association with an Accreditation Council
for Graduate Medical Education approved postgraduate training program that provides complete
training in that specialty or subspecialty, and (iii) shall identify the particular such specialty or
subspecialty in which the physician and surgeon holds such certification.
As used in this subparagraph, “cosmetic medical procedure” means a treatment or procedure that
uses a biologic or synthetic material, chemical application, mechanical device, or displaced energy
form of an kind if it alters or damages or is capable of altering or damaging living tissue to improve the
patient’s appearance or achieve an enhanced aesthetic result. Such acts or procedures include, for
example, the use of all lasers, light sources, microwave energy, chemical application, the injection or
insertion of foreign or natural substances, or soft tissue augmentation.
Adopted: June 20, 2002
Amended March 20, 2008
AOS #35 Dermatology
(Approved 02/08)
KENTUCKY BOARD OF NURSING
312 Whittington Parkway, Suite 300
Louisville, Kentucky 40222-5172
http://kbn.ky.gov
ADVISORY OPINION STATEMENT
COSMETIC AND DERMATOLOGICAL PROCEDURES BY NURSES
Introduction
The Kentucky Board of Nursing is authorized by Kentucky Revised Statutes (KRS) Chapter 314 to
regulate nurses, nursing education and practice, and to issue advisory opinions on nursing practice,
in order to assure that safe and effective nursing care is provided by nurses to the citizens of the
Commonwealth.
The Kentucky Board of Nursing issues advisory opinions as to what constitutes safe nursing practice.
As such, an opinion is not a regulation of the Board and does not have the force and effect of law. It is
issued as a guidepost to licensees who wish to engage in safe nursing practice, and to facilitate the
delivery of safe, effective nursing care to the public.
Accountability and Responsibility of Nurses
The Kentucky Nursing Laws (KRS Chapter 314)—KRS 314.021(2) holds nurses individually
responsible and accountable for rendering safe, effective nursing care to clients and for judgments
exercised and actions taken in the course of providing care.
KRS 314.021(2) imposes individual responsibility upon nurses. Acts which are within the permissible
scope of practice for a given licensure level may be performed only by those licensees who
personally possess the education and skill proficiency to perform those acts in a safe, effective
manner.
Nursing practice should be consistent with the Kentucky Nursing Laws, established standards of
practice, and be evidence based.
Advisory Opinion
The Board has received multiple inquiries as to whether the performances of various health care and
medical aesthetic related cosmetic and dermatological procedures are within the scope of nursing
practice. As technology changes and practice evolves, nurses are increasingly involved in procedures
of a cosmetic and/or dermatologic nature. Many of the clinical competencies required to perform
these acts in a safe, effective manner are not gained through prelicensure nursing education, but
would be gained through the acquisition of additional education preparation and supervised clinical
practice.
After review of the statutes governing nursing practice, curricula of prelicensure and continuing
education nursing programs, standards of nursing practice, evidence based articles, and study of the
issues and concerns regarding cosmetic and dermatological procedures, the Kentucky Board of
Nursing issued this advisory opinion statement.
I. Aesthetic Cosmetic and Dermatological Procedures, and Scope of Practice
Aesthetic cosmetic and dermatological procedures may be performed by a nurse as a part of a
nursing prescribed plan of care, patient/client’s personal care, health maintenance/health promotion
regime, or medically prescribed plan of care for treatment of various dermatological conditions.
Procedures referenced in this statement include, but are not limited to:
A. Nursing prescribed care procedures, patient/client’s personal care procedures, and health
maintenance and health promotion regime, as incorporated into the patient/client’s nursing
plan of care plan, such as:
• Hand and foot care, manicures, pedicures, facials, and massages. Such care may
include, but is not limited to, physical assessment of skin and extremities, promotion of
skin integrity, promotion of self image/esteem, hygiene, patient education, and nail
trimming. The performance of these acts is within the scope of nursing practice.
B. Medical aesthetic procedures as ordered by a duly authorized prescriber for treatment of
various dermatological conditions, as follows:
• Light treatments, such as, topical photodynamic therapy (PDT); infrared light; magenta
light; UVB light, and UVA light.
• Laser treatments, such as non-ablative lasers, cosmetic lasers for skin peels which
involve ablation and removal of the superficial skin layer; intense pulsed light (IPL) and
long pulsed dye (LPDL) lasers, sclerotherapy for telangiectasia, laser hair removal and
non-invasive radio frequency procedures.
• Peels/Topical procedures such as superficial chemical peels and microdermabrasion
using agents such as salicylic acid, glycolic acid, jessner’s solution and tichloroacetic
acid at less than 20%, but do not include the use of phenol.
• Injectable treatments (using FDA approved products only), such as Botox®,
absorbable dermal fillers, and sclerotherapy of superficial veins.
It is within the scope of licensed practical nursing practice, for the LPN who is educationally prepared
and clinically competent to perform medical aesthetic procedures (except sclerotheraphy) under
direct supervision of a physician or advanced registered nurse practitioner (designated nurse
practitioner or clinical nurse specialist performing within scope of certification/practice). “Direct
supervision” means the physician or ARNP provides direction to the LPN, is accessible in the
immediate patient care area and available to intervene in patient care if necessary. The LPN who
performs these acts should meet the criteria described in Sections II and III of this statement.
It is within the scope of registered nursing practice, for the RN to perform medical aesthetic
procedures under supervision of a qualified physician or ARNP. “Supervision” means the physician or
ARNP is physically on the premises where the patient is being cared for or readily available by
telephone. The RN may use established standing orders or protocols1 that have been determined by
the physician/ARNP. The RN who performs these acts should meet the criteria described in Sections
II and III of this statement.
In addition to the definitions cited above, the degree of supervision that should be present is
addressed in various agency/organization’s position statements, such as:
•
The Kentucky Board of Medical Licensure’s position statement on the role of the physician in
supervision of laser related activities.
•
The Dermatology Nurses’ Association’s position paper entitled “The Nurse’s Role in Laser
Procedures” which advises that…nurses will deliver laser light under the direct supervision of
the physician who is on-site, utilizing established protocols that have been determined by the
physician at the time of his/her consultation with the patient, or at each pre-treatment session
when applicable.
•
The American Society for Laser Medicine and Surgery’s “Policy for Use of Laser and Related
Technology by the Non-Physician” which states that…a properly trained and licensed medical
professional may carry out these specifically designed procedures only under direct, onsite
physician supervision.
C. Medical procedures that are not within the scope of registered nursing or licensed practical
nursing practice include:
• Liposuction; hair transplants/implants; implants; ablative laser; phenol peels, and
sclerotherapy of other than superficial veins. A nurse may assist a qualified provider in
the performance of these procedures.
D. Other related procedures, such as body piercing, tattooing, application of permanent makeup, and electrolysis are not the practice of nursing, but are not prohibited by the Kentucky
Nursing Laws. If a nurse chooses to perform these procedures, then the nurse is accountable
and responsible for performing the acts in a safe and legal manner.
II. Educational Preparation and Clinical Competency
Each nurse is required to possess the educational preparation and current clinical competency to
perform acts within a safe and effective manner. The nurse should have documented educational
preparation, supervised clinical practice experience, and ongoing competency validation appropriate
to responsibilities, treatment provided, and the patient/population served. The documentation should
be readily available in the nurse’s personal file and/or personnel file.
1 See excerpt from Advisory Opinion Statement (AOS) #14 “Roles of Nurses in the Implementation of
Patient Care Orders” on Page 5 of the statement. See the Board’s website at www.kbn.ky.gov for the
complete statement.
In order to ensure patient safety, the nurse should minimally gain and demonstrate the following
knowledge and skill prior to engaging in cosmetic and dermatological procedures:
A. Anatomy, physiology, pathophysiology regarding the integumentary system as well as
systems specific to the procedure(s) being performed.
B. Proper technique for each dermatologic procedure.
C. Proper client selection, history taking, physical assessment parameters, indications and
contraindications for treatment.
D. Pharmacology including drug actions/interactions, side effects, contraindications, and
untoward effects.
E. Proper selection, maintenance and utilization of equipment.
F. Ability to articulate realistic and expected outcomes of the procedure.
G. Ability to describe potential complications and side effects.
H. Nursing care required and appropriate nursing interventions in the event of complications or
untoward outcomes.
I. Management of complications or adverse reactions.
J. Infection control.
K. Safety precautions.
L. Documentation appropriate to the type of the procedure being performed.
III. Practice Setting
Any nurse who is going to engage in medical aesthetic cosmetic or dermatologic procedures should
ensure that the following criteria are met prior to participating in those procedures:
A. Medical aesthetic procedures are performed after an initial assessment/evaluation has been
performed and treatment plan developed by a physician or ARNP. The registered nurse may
apply standing orders and protocols.
B. The prescribing/supervising physician/ARNP has the knowledge and ability to perform the
procedure(s) independently.
C. The institution or practice setting maintains written policies and protocols consistent with
KRS Chapter 314, applicable standards of practice, and evidence based practice, which
includes, but is not limited to, provision of specific direction on equipment, patient monitoring,
and directions for dealing with complications of procedures.
D. The institution or practice setting has in place an educational/competency validation
demonstration of the knowledge, skills, and abilities to safely perform the specific procedures.
In addition, evaluation and documentation of competence occurs on a periodic basis according
to institutional policy.
Determining Scope of Practice
In addition to this advisory opinion statement, KBN has published “Scope of Practice Determination
Guidelines” that contains a decision tree chart providing guidance to nurses in determining whether a
selected act is within an individual nurse’s scope of practice now or in the future. A copy of the
guidelines may be obtained from the KBN office or downloaded from the KBN website at
http://kbn.ky.gov.
Applicable Statutes
KRS 314.021(2) states:
All individuals licensed under provisions of this chapter shall be responsible and accountable for
making decisions that are based upon the individuals' educational preparation and experience in
nursing and shall practice nursing with reasonable skill and safety.
KRS 314.011(8) defines "advanced registered nursing practice" as:
…The performance of additional acts by registered nurses who have gained added knowledge and
skills through an organized post-basic program of study and clinical experience and who are certified
by the American Nurses' Association or other nationally established organizations or agencies
recognized by the board to certify registered nurses for advanced nursing practice. The additional
acts shall, subject to approval of the board, include but not be limited to prescribing treatment, drugs,
devices, and ordering diagnostic tests. Advanced registered nurse practitioners who engage in these
additional acts shall be authorized to issue prescriptions for and dispense nonscheduled legend drugs
as defined in KRS 217.905 and to issue prescriptions for but not to dispense Schedules II through V
controlled substances as classified in KRS
A copy of the KENTUCKY NURSING LAWS may be purchased from the KBN office, or downloaded
from the KBN website at http://kbn.ky.gov.
218A….. The performance of these additional acts shall be consistent with the certifying organization
or agencies' scopes and standards of practice recognized by the board by administrative regulation.
KRS 314.011(6) defines "registered nursing practice" as:
…The performance of acts requiring substantial specialized knowledge, judgment, and nursing skill
based upon the principles of psychological, biological, physical, and social sciences in the application
of the nursing process in:
a) The care, counsel, and health teaching of the ill, injured or infirm.
b) The maintenance of health or prevention of illness of others.
c) The administration of medication and treatment as prescribed by a physician, physician
assistant, dentist, or advanced registered nurse practitioner and as further authorized or limited
by the board, and which are consistent either with American Nurses' Association Standards of
Practice or with Standards of Practice established by nationally accepted organizations of
registered nurses. Components of medication administration include, but are not limited to:
1. Preparing and giving medication in the prescribed dosage, route, and frequency,
including dispensing medications only as defined in subsection (17)(b) of this section;
2. Observing, recording, and reporting desired effects, untoward reactions, and side
effects of drug therapy;
3. Intervening when emergency care is required as a result of drug therapy;
4. Recognizing accepted prescribing limits and reporting deviations to the prescribing
individual;
5. Recognizing drug incompatibilities and reporting interactions or potential interactions
to the prescribing individual; and
6. Instructing an individual regarding medications.
d) The supervision, teaching of, and delegation to other personnel in the performance of
activities relating to nursing care.
e) The performance of other nursing acts which are authorized or limited by the board, and
which are consistent either with American Nurses' Association Standards of Practice or with
Standards of Practice established by nationally accepted organizations of registered nurses.
KRS 314.011(10) defines "licensed practical nursing practice" as:
…The performance of acts requiring knowledge and skill such as are taught or acquired in approved
schools for practical nursing in:
a) The observing and caring for the ill, injured, or infirm under the direction of a registered
nurse, a licensed physician, or dentist.
b) The giving of counsel and applying procedures to safeguard life and health, as defined and
authorized by the board.
c) The administration of medication or treatment as authorized by a physician, physician
assistant, dentist, or advanced registered nurse practitioner and as further authorized or limited
by the board which is consistent with the National Federation of Licensed Practical Nurses or
with Standards of Practice established by nationally accepted organizations of licensed
practical nurses.
d) Teaching, supervising, and delegating except as limited by the board.
e) The performance of other nursing acts, which are authorized or limited by the board and
which are consistent with the National Federation of Licensed Practical Nurses' Standards of
Practice or with Standards of Practice established by nationally accepted organizations of
licensed practical nurses.
Excerpts from Advisory Opinion Statement (AOS) #14: “Roles of Nursing in the
Implementation of Patient Care Orders,” Use of Protocols and/or Standing Orders
The terms ”protocol,” and “standing or routine orders,” are not defined in the Kentucky Nursing Laws
(KRS Chapter 314) and are often used differently in various health care settings. Such orders may
apply to all patients in a given situation or be specific pre-printed orders of a given physician/provider.
The determination as to when and how “protocols and standing/routine orders” may be implemented
by nurses is a matter for internal deliberation by the health care facility.
It was the advisory opinion of the Board that nurses may implement physician/provider issued
protocols and standing/routine orders, including administration of medications, following nursing
assessment. Protocols/orders should be written to reflect treatment of signs and symptoms, and
should include parameters for the nurse to consult the physician/provider. In addition, protocols and
standing/routine orders should be officially approved by the facility medical and nursing staff, or
approved by the prescriber for the individual patient.
Approved: February 2008
Truth in Advertising
311.597 Acts declared to constitute dishonorable, unethical, or unprofessional conduct.
As used in KRS 311.595(9), "dishonorable, unethical, or unprofessional conduct of a character likely
to deceive, defraud, or harm the public or any member thereof" shall include but not be limited to the
following acts by a licensee:
(2) Issues, publishes, or makes oral or written representations in which grossly improbable or
extravagant statements are made which have a tendency to deceive or defraud the public, or a
member thereof, including but not limited to:
(a) Any representation in which the licensee claims that he can cure or treat diseases,
ailments, or infirmities by any method, procedure, treatment, or medicine which the licensee
knows or has reason to know has little or no therapeutic value;
(b) Represents or professes or holds himself out as being able and willing to treat diseases,
ailments, or infirmities under a system or school of practice:
1. Other than that for which he holds a certificate or license granted by the board, or
2. Other than that for which he holds a degree or diploma from a school otherwise
recognized as accredited by the board, or
3. Under a school or system which he professes to be self-taught.
§311.375. Conditions governing use of title "Doctor" or "Dr."
No person shall, in connection with the practice of medicine, surgery, osteopathy, optometry,
dentistry, podiatry, pharmacy, chiropractic, psychology or psychiatry, nursing, anesthesiology, physio
or physical therapy, or any other profession or business having for its purpose the diagnosis,
treatment, correction or cure of any human ailment, condition, disease, injury or infirmity, hold himself
out as a doctor or employ or use in any manner the title "Doctor" or "Dr.," unless he actually has
graduated and holds a doctor degree from a school, college, university or institution authorized by its
governing body to confer such degree.
No person who holds a doctor degree, as provided in this section, shall use or employ the title
"Doctor" or "Dr." in or upon any letter, statement, card, prescription, sign, listing or other writing
without affixing suitable words or letters designating the particular doctor degree held by such person.
Corporate Practice of Medicine
State statutes and regulations do not address CPOM.
A physician licensing board opinion appears to allow a hospital to employ a physician to provide
medical services. However, case law adopts a CPOM prohibition.
Courts have adopted the CPOM doctrine. See Kendall v. Beiling, 175 S.W.2d 489 (Ky. 1943);
Johnson v. Stumbo, 126 S.W.2d 165 (Ky. 1938).
Even though court decisions adopting the CPOM doctrine have not been overturned, the Kentucky
Board of Medical Licensure indicates that it is acceptable for physicians to be full-time employees of
hospitals. See Kentucky Board of Medical Licensure, Private Opinion Letter, September, 1993.
The Kentucky Board of Medical Licensure states that a for-profit corporation may hire a physician.
See Kentucky Board of Medical Licensure, February, 1995.
Louisiana
§1262. Definition
(2) "Physician" means a natural person who is the holder of an allopathic (M.D.) degree or an
osteopathic (D.O.) degree from a medical college in good standing with the board who holds a
license, permit, certification, or registration issued by the board to engage in the practice of medicine
in the state of Louisiana. Doctors of allopathic medicine (M.D.) and doctors of osteopathic medicine
(D.O.) shall be accorded equal professional status and unrestricted privileges in the practice of
medicine. The use of the term "physician" in this Part shall not be construed to prohibit the use of
such term by other health care providers specifically authorized to use such term by any other lawful
provision of this state.
(3) "The practice of medicine", whether allopathic or osteopathic, means the holding out of one's self
to the public as being engaged in the business of, or the actual engagement in, the diagnosing,
treating, curing, or relieving of any bodily or mental disease, condition, infirmity, deformity, defect,
ailment, or injury in any human being, other than himself, whether by the use of any drug, instrument
or force, whether physical or psychic, or of what other nature, or any other agency or means; or the
examining, either gratuitously or for compensation, of any person or material from any person for
such purpose whether such drug, instrument, force, or other agency or means is applied to or used
by the patient or by another person; or the attending of a woman in childbirth without the aid of a
licensed physician or midwife.
§1274.1. Laser surgery; requirements
Only persons licensed under the laws of this state to practice medicine, veterinary medicine,
dentistry, or podiatry shall perform laser surgery.
Louisiana State Board of Medical Examiners
630 Camp Street, New Orleans, LA 70130
(504) 568-6820
*** STATEMENT OF POSITION ***
LA. REV. STAT. §37:1261-92
USE OF MEDICAL LASERS,
CHEMICAL SKIN TREATMENTS
REVISED—November 13, 2001
In recent months, the Louisiana State Board of Medical Examiners (the “Board”) has received a
number of inquiries and complaints from physicians and others respecting the utilization of medical
lasers and the application of chemical peel skin treatments by non-physicians in the absence of onsite or adequate physician direction and supervision. In consideration of this issue the Board is given
to understand that medical lasers, as well as acidic solutions and chemicals in concentrations that
may affect living skin tissue or alter or cause biological change or damage below the stratum
corneum, are being utilized for treatment of a variety of conditions, either individually or in
combination with others (“laser or chemical treatments” or “treatments”).
We understand that these treatments are being offered to the public and performed in some
instances in offices, walk-in clinics, spas, hair and other salons and even health clubs by nonphysicians with infrequent or no physician supervision. Such inquiries and complaints—and the
Board’s own investigation—suggest that some firms and individuals offering laser or chemical
treatments may function through various arrangements among owners/managers of the equipment or
facilities, physicians and medical equipment companies. It also appears that such services may be
promoted by medical equipment manufacturers or suppliers who de-emphasize the need or
requirement for on-site physician supervision, offer weekend training seminars to non-physicians
which focus on operation of equipment and application of treatments and, we have been informed, for
a fee are even willing to refer prospective purchasers of equipment to physicians who are available,
also for a fee, to serve in title (but not in physical presence) as “medical directors” for non-physician
operated/owned enterprises. Typically, the personnel actually performing such treatments do so in
the absence of a physician, in most instances with individuals presenting themselves without a
physician’s prescription, prior examination, diagnosis, referral, informed consent or appropriate
instructions for follow-up care. In this context such an individual may act either wholly without
physician authority, with laser or chemical treatments being performed by one who has
little or no academic or clinical medical education or training whatsoever. In other instances the
nonphysician may act pursuant to a standing protocol or “blanket” authorization of a physician who
may either own or be employed by the venture or for compensation serve in title as the “medical
director” but who has no role in the day-to-day operation or supervision of the enterprise and is not
physically present at all times when such services are being performed.
The concerns expressed to the Board over the administration of laser or chemical treatments with
inadequate or no physician supervision are consistent with those reported in a survey recently
released by the American Society for Dermatologic Surgery (“ASDS”). According to that
organization’s survey of its 2,400 members, approximately 45% of respondents indicated an increase
over the past year in the number of patients seeking corrective treatment for complications such as
burns, splotching and irreversible pigmentation or scarring due to laser or chemical treatments that
were performed by non-physicians or in the absence of appropriate physician supervision. More than
five hundred (500) cases involving complications were included in the information reported. The
survey results were attributed primarily to the practice of increasingly aggressive and invasive
procedures by paraprofessionals, technicians or employees of physicians who are not adequately
trained or supervised. And while the information reported by the ASDS is concerning in and of itself, it
expressed the view that the survey results may not fully represent the severity of the problem, noting
that many cases and complications go unreported as a result of pending litigation, reluctance to seek
curative measures and patients’ failure to recognize misdiagnoses.1
The Louisiana State Board of Medical Examiners (the “Board”) first addressed itself to the use of
medical lasers, chemical peels and other treatments of the skin in 1997.2 At that time it emphasized
that the use of medical lasers, when used by individuals other than trained physicians, could result in
seriously debilitating and deforming injuries including blindness. For similar reasons the Board noted
that the use of chemical peels or treatment of the skin through application of such techniques,
particularly involving the use of alphahydroxy acid in concentrations greater than 14%, presents a
clear potential for causing severe scarring when used by persons who do not have the knowledge or
training to understand the risks of acid peels or to prevent or manage consequent injuries. Given such
developments the Board then expressed its opinion that the use of lasers or alphahydroxy acid in a
concentration exceeding 14% for peeling or other chemical treatments of the skin constitute the
practice of medicine and may be performed or undertaken in this state only by a physician licensed to
practice medicine by the Board or by another appropriately trained and licensed allied health
professional acting under the direction and supervision of a licensed physician.
Since issuance of our last Statement, our investigation reveals that a number of chemicals other than
alphahydroxy acid are being employed, either individually or in combination, for peels, cosmetic or
other chemical treatments of the skin, i.e.— glycolic acid, lactic acid, resorcinol, salicylic acid,
trichloroacetic acid, etc. Unfortunately, these chemicals carry an equal or even greater potential risk
of danger to the public as alphahydroxy acid, when used for chemical peel or in other treatments of
the skin by nonphysicians or in the absence of adequate physician supervision, i.e.—scarring,
systemic toxicity, respiratory, circulatory and central nervous system irregularities and even death. No
doubt that future developments and commercial interest in cosmetic applications will lead to the use
of other chemicals and new products that pose equally as significant a risk of danger and adverse
consequences as those identified in this Statement due to their capacity to affect living skin tissue or
alter or cause biological change or damage below the stratum corneum.
That the use of lasers or chemical treatments for therapeutic or cosmetic purposes constitutes the
practice of medicine is unequivocally clear. As defined by the Louisiana Medical Practice Act the
scope of the “practice of medicine” explicitly encompasses: [T]he holding out of one’s self to the
public as being engaged in the business of, or the actual engagement in, the diagnosing, treating,
curing, or relieving of any bodily or mental disease, condition, infirmity, deformity, defect, ailment, or
injury in any human being…whether by the use of any drug, instrument or force…or any other
agency or means….La. Rev. Stat. §37:1262(1). [Emphasis supplied]
Even beyond the comprehensive scope of this definition, several years ago the Louisiana Legislature
emphasized the substantial risks, dangers and potential complications inherent in the use of medical
lasers by enacting a statute expressly declaring that “[O]nly persons licensed under the laws of this
state to practice medicine, veterinary medicine, dentistry, or podiatry shall perform laser surgery.”3
Thus, as a matter of law, and in the opinion of the Board, there can be no doubt but that the use of
laser or chemical treatments for therapeutic or cosmetic purposes constitute the practice of medicine4
which only physicians licensed to practice medicine in this state have the authority to perform.5
Nevertheless, it has long been the position of the Board that physicians may delegate certain medical
procedures and functions that constitute the practice of medicine to non-physicians under specific
conditions and safeguards. The Board’s traditional view of delegation of such authority has uniformly
required physician on-site supervision and direction of any non-physician in the performance of
medical activities involving patient treatment. As was the case when it issued its prior Statement, the
Board perceives no reason to justify deviation from its traditional view of delegation as to laser or
chemical treatments. That is, neither the spirit nor intent of the prior Statement was contemplated to
deviate from its traditional view. To the extent that it may have been misconstrued, because the
Board’s position may affect parties other than those with which it has communicated directly, and in
light of the fact that inquiries concerning its position in this area are recurring, the Board has
concluded that it is timely and appropriate that its views on this subject be expressed in a formal
revised Statement of Position.
Accordingly, it is the position of the Board, equally as an interpretation of applicable law and as a
matter of safe practice of medicine, that:
• Whether used or applied for surgical, therapeutic or cosmetic purposes on human beings the
use of lasers or chemical treatments constitute the practice of medicine under Louisiana law.
• Such treatments may be performed or undertaken only by a physician currently licensed to
practice medicine by the Board or by a non-physician who acts under the direct supervision of
a Louisiana licensed physician who mutually observe the following conditions:
(1) A physician must insure that any non-physician acting under his supervision is
appropriately trained and qualified to perform the tasks or treatments that are
delegated;
(2) All treatments and procedures must be performed under the licensed physician’s
direction and immediate personal supervision—i.e., where the physician is physically
present on the premises and immediately available at all times that the non-physician
is on duty and retains full responsibility to patients and the Board for the manner and
results of all services rendered.
(3) A non-physician serving in such a position could not—and may not under any
circumstances be permitted to—act independently or in the absence of a Louisiana
licensed physician or exercise independent medical judgment in implementing any
procedure or modality of treatment.
(4) In the context of this Statement, an “appropriately trained and qualified”
nonphysician who assists a physician in the performance of laser or chemical
treatments should possess, at a minimum, training in safety, application techniques of
each system, cutaneous medicine, indications/contraindications for such procedures,
preoperative and post-operative care, potential complications and infectious disease
control involved with each treatment.
(5) As is the case with any medical procedure or treatment the standard of care requires
that such treatments be preceded by a history, an appropriate physical examination
conducted by a physician, a diagnosis which confirms that any treatment
recommended is appropriate for the patient’s condition, informed consent,
availability and instructions for emergency and follow-up care and the preparation of
an appropriate medical record.
Non-physicians who perform laser or chemical treatments in contravention to the manner expressed
herein will necessarily be engaged in the unauthorized practice of medicine as defined by Louisiana
law. Such conduct is a crime punishable by incarceration for up to five (5) months and a criminal fine
of up to $500.00 for each such offense.6 The Board is constrained to refer individuals engaged in
such activities to the Louisiana Attorney General and/or the local district attorney for criminal
prosecution, file a civil injunction against any continued practice and seek civil penalties and
attorney’s fees associated therewith.7 A physician who participates in such a relationship or acts
inconsistent with this Statement in any respect will be subject to disciplinary action by the Board,
which may include revocation or suspension of licensure, a fine of up to $5,000 and imposition of all
costs of the Board’s proceedings, including attorney’s fees,8 as a result of engaging in medical
practice which fails to satisfy the prevailing and usually accepted standards of medical practice in this
state; assisting a non-physician practice medicine; and having professional connection with, or
lending one’s name to, an illegal practitioner.9
Louisiana State Board of Medical Examiners
1
Complications from the Non-Physician Practice of Medicine, American Society for Dermatologic Surgery (Aug. 2001).
Statement of Position, Use of Medical Lasers, Alphahydroxy Acid, La. St. Bd. Med. Exam. (March 26, 1997).
3
Acts 1991, No. 433, La. Rev. Stat. §37:1274.1.
4
Our Statement of Position would be equally applicable to the use of any light source, microwave energy, chemical
application, the
injection or insertion of foreign or natural substances or soft tissue augmentation.
5
By explicit statutory provision, veterinarians, dentists and podiatrists may also utilize lasers within the authority and
limitations of law governing their professions. La. Rev. Stat. §37:1274.1.
6
La. Rev. Stat. §37:1290.
7
La. Rev. Stat. §§37:1271 and 37:1286.
8
La. Rev. Stat. §37:1285C.
9
La. Rev. Stat. §37:1285A(14), (18).
2
Truth in Advertising
§1285. Causes for nonissuance; suspension; revocation; or the imposition of restrictions;
fines; reinstatement; publication of action; stays
A. The board may refuse to issue, or may suspend or revoke any license or permit, or impose
probationary or other restrictions on any license or permit issued under this Part for the following
causes:
(7) Solicitation of patients or self-promotion through advertising or communication, public or private,
which is fraudulent, false, deceptive, or misleading;
(10) Efforts to deceive or defraud the public;
(11) Making or submitting false, deceptive, or unfounded claims, reports, or opinions to any patient,
insurance company or indemnity association, company, individual, or governmental authority for the
purpose of obtaining anything of economic value;
Corporate Practice of Medicine
State statutes and regulations do not address CPOM.
An Attorney General Opinion appears to allow a corporation to employ a physician to provide medical
services if the corporation does not interfere with the physician's independent medical judgment.
Corporate employment of a physician is not by itself a violation of the Louisiana Medical Practice Act.
A physician employment arrangement is lawful if it does not interfere with the physician-patient
relationship. See Louisiana State Board of Medical Examiners Statement of Position "Employment of
Physician By Corporation Other Than A Professional Medical Corporation", September 24, 1992,
reviewed March 21, 2001.
Maine
02
DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
373
BOARD OF LICENSURE IN MEDICINE
§1
DEFINITIONS
5.
“Clinical medicine” includes but is not limited to:
A.
Direct involvement in patient evaluation, diagnosis and treatment,
B.
Prescribing any medication,
C.
Delegating medical acts or prescriptive authority, or
D.
The supervision of physicians, physician assistants, or advanced practice
registered nurses in the practice of clinical medicine.
M.R.S.A. §3270. Licensure required
Unless licensed by the board, an individual may not practice medicine or surgery or a branch of
medicine or surgery or claim to be legally licensed to practice medicine or surgery or a branch of
medicine or surgery within the State by diagnosing, relieving in any degree or curing, or professing or
attempting to diagnose, relieve or cure a human disease, ailment, defect or complaint, whether
physical or mental, or of physical and mental origin, by attendance or by advice, or by prescribing or
furnishing a drug, medicine, appliance, manipulation, method or a therapeutic agent whatsoever or in
any other manner unless otherwise provided by statutes of this State.
§3270-A. Assistants
This chapter may not be construed to prohibit an individual from rendering medical services if these
services are rendered under the supervision and control of a physician or surgeon and if that
individual has satisfactorily completed a training program approved by the Board of Licensure in
Medicine and a competency examination determined by this board. Supervision and control may not
be construed as requiring the personal presence of the supervising and controlling physician at the
place where these services are rendered, unless a physical presence is necessary to provide patient
care of the same quality as provided by the physician. This chapter may not be construed as
prohibiting a physician or surgeon from delegating to the physician's or surgeon's employees certain
activities relating to medical care and treatment carried out by custom and usage when the activities
are under the control of the physician or surgeon who must be present on the premises at the time
the activities are performed. The physician delegating these activities to employees, to program
graduates or to participants in an approved training program is legally liable for the activities of those
individuals, and any individual in this relationship is considered the physician's agent. This section
may not be construed to apply to registered nurses acting pursuant to chapter 31. [1999, c. 159, §1
(AMD).]
Truth in Advertising
2. Grounds for discipline. The board may suspend or revoke a license pursuant to Title 5, section
10004. The following are grounds for an action to refuse to issue, modify, restrict, suspend, revoke or
refuse to renew the license of an individual licensed under this chapter:
I. Engaging in false, misleading or deceptive advertising; [1983, c. 378, §53 (NEW).]
M.R.S.A. §3270.
An individual licensed under chapter 36 may prefix the title "Doctor" or the letters "Dr." to that
individual's name, as provided in section 2581, or a chiropractor licensed by this State may prefix the
title "Doctor" or the letters "Dr." to that individual's name when accompanied by the word
"Chiropractor," or a dentist duly licensed by this State may prefix the title "Doctor" or the letters "Dr."
to that individual's name or a naturopathic doctor licensed by this State may prefix the title "Doctor" or
the letters "Dr." to that individual's name when accompanied by the word "Naturopathy" or the words
"Naturopathic Medicine" or an optometrist duly licensed under the laws of this State may prefix the
title "Doctor" or the letters "Dr." to that individual's name when accompanied by the word
"Optometrist" or a podiatrist licensed under the laws of this State may prefix the title "Doctor" or the
letters "Dr." to that individual's name when accompanied by the word "Podiatrist" or "Chiropodist."
[1995, c. 671, §11 (AMD).]
Whoever, not being duly licensed by the board, practices medicine or surgery or a branch of medicine
or surgery, or purports to practice medicine or surgery or a branch of medicine or surgery in a way
cited in this section, or who uses the title "Doctor" or the letters "Dr." or the letters "M.D." in
connection with that individual's name, contrary to this section, commits a Class E crime. The
prefixing of the title "Doctor" or the letters "Dr." or the appending of the letters "M.D." by an individual
to that individual's name or the use of the title of doctor or physician in any way by an individual not
licensed as described is prima facie evidence that that individual is purporting to practice medicine or
surgery contrary to this section, except that nothing contained in this section prevents an individual
who has received the doctor's degree from a reputable college or university, other than the degree of
"Doctor of Medicine" from prefixing the letters "Dr." to that individual's name, if that individual is not
engaged, and does not engage, in the practice of medicine or surgery or the treatment of a disease or
human ailment. Nothing in this chapter may be construed as to affect or prevent the practice of the
religious tenets of a church in the ministration to the sick or suffering by mental or spiritual means.
[1993, c. 600, Pt. A, §204 (AMD).]
Corporate Practice of Medicine
State statutes and regulations do not address CPOM.
In an opinion of the Maine Board of Licensure in Medicine, the Board stated that each medical license
holder is individually responsible for his or her own conduct regardless of any employment
relationship. See Opinion of the Board of Licensure in Medicine (Nov. 2, 1992).
Maryland
COMAR 10.32.09.01 Scope.
A. This chapter governs the performance, delegation, assignment, and supervision of cosmetic
medical procedures , and the use of cosmetic medical devices by a physician or under a
physician's direction.
B. This chapter does not govern use of medical procedures or medical devices for the purpose of
treating a disease.
C. This chapter does not endorse or certify the safety of any cosmetic medical device or cosmetic
medical procedure .
D. This chapter does not authorize the delegation of any duties to any person who is not licensed
under Health Occupations Article, Annotated Code of Maryland.
COMAR 10.32.09.02 Definitions.
A. In this chapter, the following terms have the meanings indicated.
B. Terms Defined.
(1) "ACCME" means the Accreditation Council on Continuing Medical Education.
(2) "ACGME" means the Accreditation Council for Graduate Medical Education.
(3) "AOA" means the American Osteopathic Association.
(4) Cosmetic Medical Device.
(a) " Cosmetic medical device" means a device that alters or damages living tissue .
(b) " Cosmetic medical device" includes any of the following items, when the item is
used for cosmetic purposes:
(i) Laser ;
(ii) Device emitting light or intense pulsed light;
(iii) Device emitting radio frequency, electric pulses, or sound waves;
(iv) Microdermabrasion device; and
(v) Devices used for the injection or insertion of foreign or natural substances into the
skin , fat, facial tissue, muscle, or bone.
(5) Cosmetic Medical Procedure .
(a) " Cosmetic medical procedure" means a procedure using a cosmetic medical device
or medical product to improve an individual's appearance.
(b) " Cosmetic medical procedure" includes the following:
(i) Skin treatments using lasers;
(ii) Skin treatments using intense pulsed light;
(iii) Skin treatments using radio frequencies, microwave, or electric pulses;
(iv) Deep skin peels;
(v) Skin treatments with phototherapy;
(vi) Microdermabrasion ;
(vii) Subcutaneous, intradermal, or intramuscular injections of medical products;
(viii) Treatments intended to remove or cause destruction of fat; and
(ix) Any treatment using a cosmetic medical device for the purpose of improving an
individual's appearance.
(6) "Delegate" means to entrust a duty to a physician assistant under Health Occupations Article, Title
15, Annotated Code of Maryland.
(7) "Delegation" means the entrusting of a duty by a physician to a physician assistant under Health
Occupations Article, Title 15, Annotated Code of Maryland.
(8) "Direct supervision" means oversight exercised by a supervising physician who is:
(a) In the physical presence of a non-physician and a patient; and
(b) Instructing the non-physician in the performance of a cosmetic medical procedure , or
observing the performance of a non-physician being trained in the procedure .
(9) "Immediately available supervision" means the responsibility of a licensed physician to provide
necessary direction in person, by telephone, or by other electronic means.
(10) “Non-physician”means an individual who:
(a) Meets the requirements of Regulation .04 of this chapter; and
(b) Is not licensed in Maryland as a physician.
(11) "On-site supervision" means oversight exercised by a supervising physician who is:
(a) Present at the site; and
(b) Able to respond in person during a delegated or assigned cosmetic medical procedure .
(12) "Physician assistant" means a physician assistant with a current certificate to practice in
Maryland.
COMAR 10.32.09.03 Physician Qualifications.
A. License. A physician shall obtain a license to practice medicine in Maryland before the physician
may perform, delegate, assign, or supervise cosmetic medical procedures or the use of cosmetic
medical devices.
B. Education.
(1) A physician who performs, assigns, supervises, or delegates the performance of cosmetic
medical procedures by a non-physician first shall obtain training in the indications for and
performance of the cosmetic medical procedures and operation of any cosmetic medical device
to be used.
(2) Training programs provided by a manufacturer or vendor of cosmetic medical devices or supplies
may not be a physician's only education in the cosmetic medical procedures or the operation of
the cosmetic medical devices to be used.
(3) ACCME or AOA approved continuing education, or completion of an ACGME or AOA accredited
postgraduate program that includes training in the cosmetic medical procedure performed
satisfies this requirement.
COMAR 10.32.09.04 Qualifications of Individual to Whom Acts May Be Delegated and
Assigned.
A. A cosmetic medical procedure may be delegated to a physician assistant or assigned to any
other health care provider licensed under Health Occupations Article, Annotated Code of Maryland,
whose licensing board has determined that the procedure falls within the provider's scope of
practice.
B. A physician may not permit any individual who performs cosmetic medical procedures
delegated or assigned by that physician to operate a cosmetic medical device or perform a
cosmetic medical procedure unless the individual has received:
(1) Training as described in Regulation .07 of this chapter; and
(2) Any training required by that individual's health occupations board.
COMAR 10.32.09.05 Physician Responsibilities.
A. A physician shall:
(1) Develop and maintain at each site where the delegated, assigned, or supervised cosmetic
medical procedures will be rendered written office protocols for each such cosmetic medical
procedure ;
(2) Personally perform the initial assessment of each patient;
(3) Prepare a written treatment plan for each patient, including diagnosis and planned course
of treatment and specification of the device and device settings to be used;
(4) Obtain informed consent of the patient to be treated by a non-physician;
(5) Except as indicated in §B or C of this regulation, provide onsite supervision whenever a
non-physician is performing cosmetic medical procedures or using cosmetic medical
devices;
(6) Retain responsibility for any acts delegated to a non-physician; and
(7) Create and maintain medical records in a manner consistent with accepted medical
practice and in compliance with Health-General Article, Title 4, Subtitles 3 and 4, Annotated
Code of Maryland, and with Health Insurance Portability and Accountability Act of 1996 (42
U.S.C. §1320d-2, as amended, and 45 CFR Parts 160 and 164, as amended).
B. The Board may approve a delegation agreement for a physician assistant that permits the
physician to delegate performance of cosmetic medical procedures under immediately available
supervision after the physician has evaluated the patient and developed a written treatment plan.
C. A delegation agreement for a physician assistant that includes cosmetic medical procedures
and is approved by the Board before May 2009, is not affected by this chapter.
COMAR 10.32.09.06 Written Protocols.
Written protocols for cosmetic medical procedures and equipment shall include the following:
A. List of all equipment, including:
(1) Manufacturer's specifications;
(2) Operating instructions; and
(3) Maintenance log;
B. Documentation regarding initial and periodic training of all users of the equipment;
C. Role of the physician for each procedure;
D. Role of the non-physician for each procedure;
E. Steps to address common complications and emergency situations; and
F. Appropriate care and follow-up for the patient after the procedure.
COMAR 10.32.09.07 Training of Non-Physicians.
A. The physician is responsible for assuring that any individual to whom the physician delegates or
assigns the performance of a cosmetic medical procedure or the operation of a cosmetic medical
device is properly trained. Training shall include both theoretical instruction and clinical instruction.
B. Theoretical instruction shall include:
(1) Cosmetic -dermatological indications and contraindications for treatment;
(2) Identification of realistic and expected outcomes of each procedure;
(3) Selection, maintenance, and utilization of equipment;
(4) Appropriate technique for each procedure, including infection control and safety;
(5) Pharmacological intervention specific to the procedure;
(6) Identification of complications and adverse reactions for each procedure;
(7) Emergency procedures to be used in the event of:
(a) Complications;
(b) Adverse reactions;
(c) Equipment malfunction; or
(d) Any other interruption of a procedure; and
(8) Appropriate documentation of the procedure in the patient's chart.
C. Clinical instruction shall include:
(1) Observation of performance of the procedure or use of the device by an individual
experienced in performing the procedure; and
(2) Performing the procedure or using the device under the direct supervision of the delegating
physician who is present and observing the procedure a sufficient number of times to assure
that the non-physician is competent to perform the procedure without direct supervision.
COMAR 10.32.09.08 Non-physician's Responsibility
A. A physician who delegates or assigns a cosmetic medical procedure or the use of a cosmetic
medical device to a non-physician or who supervises a non-physician performing these functions
shall assure that the non-physician complies with this regulation.
B. A non-physician may not use a cosmetic medical device or perform a cosmetic medical
procedure unless the individual has received:
(1) The training described in Regulation .07 of this chapter; and
(2) Any training required by that individual's health occupations board.
C. A non-physician shall:
(1) Review and follow the written protocol with respect to a cosmetic medical procedure ;
(2) Verify that the physician has assessed the patient and given written treatment instructions
for the procedure ;
(3) Discuss the procedure with the patient to ensure that the patient:
(a) Is aware that the treatment will be provided by a non-physician; and
(b) Has given consent in writing to treatment by a non-physician;
(4) Notify the delegating physician about any adverse events or complications before the
patient leaves the site;
(5) Document all relevant details of the procedure in the patient's chart, including any adverse
events and complications; and
(6) Satisfy any requirements imposed by the licensing board of the non-physician.
COMAR 10.32.09.09 Grounds for Discipline.
A. Physician. A physician may be disciplined for any of the following:
(1) Delegating, assigning, or supervising a cosmetic medical procedure performed by an
individual who is not a physician assistant or another licensed health care provider whose
licensing board has determined that the procedure is within the scope of practice of the
individual;
(2) Delegating cosmetic medical procedures to an individual who has not had:
(a) The training specified in Regulation .07 of this chapter; and
(b) The training required by that individual's health occupations board; or
(3) Failure to adhere to any requirement of this chapter.
B. Non-Physician. A non-physician who violates any provision of this chapter is guilty of the practice
of medicine without a license and may be subject to a fine of not more than $50,000 under Health
Occupations Article, §14-606, Annotated Code of Maryland.
C. Other Individual. An individual using a cosmetic medical device or performing a cosmetic
medical procedure who is not a licensed physician and is not authorized to perform the cosmetic
medical procedure under this chapter, or under regulations promulgated by another licensing board
established by Health Occupations Article, Annotated Code of Maryland, is guilty of the practice of
medicine without a license and may be subject to a fine of not more than $50,000 under Health
Occupations Article, §14-606, Annotated Code of Maryland.
Truth in Advertising
.12 Advertising.
A. A physician may place advertisements with directories, newspapers, periodicals, and radio or television
stations.
B. An advertisement may not contain:
(1) Statements containing misrepresentation of facts;
(2) Statements that cannot be verified by the Board for truthfulness;
(3) Statements likely to mislead or deceive because in context the statements make only a partial
disclosure of relevant facts;
(4) Statements intended to, or likely to, create false or unjustified expectations of favorable results;
(5) Statements specifying a fee for professional service which does not include the cost of all related
procedures, services, and products which to a substantial likelihood will be necessary for the
completion of the advertised service as it would be understood by an ordinarily prudent person;
(6) Statements advertising discounted or free services, examinations, or treatments when there will be
an additional charge for any additional services, examinations, or treatments which are performed as a
result of and within 72 hours of the initial office visit in response to the advertisement unless the
professional services rendered are a result of a bona fide emergency;
(7) Statements conveying the impression that the physician could improperly influence any public body,
official, corporation, or any person on behalf of a patient;
(8) Statements containing representations or implications that in reasonable probability can be
expected to cause an ordinary prudent person to misunderstand or be deceived;
(9) Statements containing representations that the physician is willing to perform any procedure which
is illegal under the laws or regulations of Maryland or the United States;
(10) Statements that state or imply that the physician has received formal recognition as a specialist in
any aspect of the practice of medicine unless:
(a) The physician has received this recognition by the following or their successors:
(i) The Board of Physician Quality Assurance before October 1, 1996,
(ii) The American Board of Medical Specialties, or
(iii) The American Osteopathic Association; or
(b) The physician is certified by a board that requires as a prerequisite of certification that the
physician:
(i) Maintains certification from an appropriate member board of the American Board of
Medical Specialties or The American Osteopathic Association,
(ii) Completes an accredited training program that includes identifiable training in the
field of medicine that the physician is advertising as the physician's specialty, and
(iii) Successfully completes a rigorous examination in the field of medicine the physician
is advertising.
C. An advertisement may represent that a physician subspecializes in an area of medicine if the physician first
identifies the physician's specialty.
D. This regulation does not prevent a physician from accurately describing a focus of the physician's practice in
a field within the scope of the physician's training and board certification.
E. A physician shall also be accountable under this regulation if he uses an agent, partnership, professional
association, or health maintenance organization to implement actions prohibited by this regulation.
F. An advertisement may state a range of prices for specifically described services if reasonable disclosure of
all relevant variables and consideration is made.
G. The Board shall keep a record of those physicians who have been:
(1) Identified by the Board of Physician Quality Assurance as specialists before October 1, 1996; or
(2) Certified by the American Board of Medical Specialties and the American Osteopathic Association.
Md. Code Ann., [HEALTH OCC.] §14-602 (2006)
§ 14-602. Misrepresentation as practitioner of medicine
(a) In general. -- Unless authorized to practice medicine under this title, a person may not represent
to the public, by description of services, methods, or procedures, or otherwise, that the person is
authorized to practice medicine in this State.
(b) Certain representations prohibited. -- Except as otherwise provided in this article, a person may
not use the words or terms
"Dr.", "doctor", "physician", "D.O.", or "M.D." with the intent to represent that the person practices
medicine, unless the person is:
(1) Licensed to practice medicine under this title;
(2) A physician licensed by and residing in another jurisdiction, while engaging in consultation with a
physician licensed in this State;
(3) A physician employed by the federal government while performing duties incident to that
employment;
(4) A physician who resides in and is licensed to practice medicine by any state adjoining this State
and whose practice extends into this State; or
(5) An individual in a postgraduate medical program that is approved by the Board.
(c) Same -- Exception for certain unlicensed individuals. -- An unlicensed individual who acts under §
14-302 or § 14-306 of this title may use the word "physician" together with another word to describe
the occupation of the individual as in phrases such as "physician's assistant" or "physician's aide".
§ 14-606. Penalties
(a) Imposition of penalties. --
(1) A person who violates any provision of this subtitle is guilty of a misdemeanor and on conviction is
subject to a fine not exceeding $ 5,000 or imprisonment not exceeding 5 years or both.
(2) A person who violates any provision of § 14-503 of this title is
guilty of a misdemeanor and on conviction is subject to a fine not exceeding $ 500.
(3) Any person who is required to give notice under § 14-505 ("Reporting burn treatment") of this title,
and who fails to give the required notice, is liable for a civil penalty of not more than $ 100.
(4) Any person who violates § 14-601 of this subtitle is subject to a civil fine of not more than $ 50,000
to be levied by the Board.
(b) Disposition of funds. -- The Board shall pay any penalty collected under this section into the Board
of Physicians Fund.
Corporate Practice of Medicine
State statutes and regulations do not address CPOM.
Maryland Board of Physician Quality Assurance prohibits corporations from employing physicians to
provide medical services, with limited exceptions.
The Maryland Board of Physician Quality Assurance states that a corporation may not employ a
physician except in the case of: (1) a professional service corporation; (2) a hospital; or (3) a health
maintenance organization.
Massachusetts
243 CMR 2.00: THE PRACTICE OF MEDICINE
(4) Definitions. For the purposes of 243 CMR 2.00, the terms listed below have the following
meanings:
The Practice of Medicine: The following conduct, the purpose of or reasonable foreseeable affect of
which is to encourage the reliance of another person on an individual’s knowledge or skill in the
maintenance of human health by the prevention allievation or cure of disease and involving or
reasonably thought to involve an assumption of responsibility for the other person’s physical or
mental well-being: diagnosis, treatment, use of instruments or other devices, or the prescription or
administration of drugs for the relief of diseases or adverse physical or mental conditions. A person
who holds himself out to the public as a “physician” or “surgeon” or with the initials “M.D.” or “D.O.” in
connection with his name, and who also assumes responsibility for another person’s physical or
mental well being, is engaged in the practice of medicine. The practice of medicine does not mean
conduct of the type described above lawfully engaged in by persons licensed by other boards or
registration with authority to regulate such conduct; nor does it mean assistance rendered in
emergency situations by persons other than licensees.
Massachusetts Medical Society’s Office-Based Surgery Guidelines
II. TYPES OF SURGERY
a. “Surgery” means any operative or manual procedure, including the use of lasers, performed
under the direction of a physician in certain cases, performed for the purpose of preserving
health, diagnosing or treating disease, repairing injury, correcting deformity or defects,
prolonging life or relieving suffering, or any elective procedure for aesthetic or cosmetic
purposes. This includes, but is not limited to, incision with suction removal of subcutaneous tissue;
incision or curettage of tissue or an organ; suture or other repair of tissue or an organ; extraction of
tissue from the uterus; insertion of natural or artificial implants; closed or open fracture reduction; or
an endoscopic examination with use of local or general anesthetic.
Corporate Practice of Medicine
State statutes and regulations do not address CPOM. Case law appears to prohibit corporations from
employing physicians to provide medical services.
The Massachusetts Supreme Court has adopted the CPOM doctrine prohibiting corporate
employment of physicians. See McMurdo v. Getter, 10 N.E.2d 139, 142 (Mass. 1937).
Michigan
PUBLIC HEALTH CODE (EXCERPT)
Act 368 of 1978
333.17001 Definitions; principles of construction.
(f) "Practice of medicine" means the diagnosis, treatment, prevention, cure, or relieving of a human
disease, ailment, defect, complaint, or other physical or mental condition, by attendance, advice,
device, diagnostic test, or other means, or offering, undertaking, attempting to do, or holding oneself
out as able to do, any of these acts.
(h) "Supervision" means that term as defined in section 16109, except that it also includes the
existence of a predetermined plan for emergency situations, including, but not limited to, the
designation of a physician to supervise a physician's assistant in the absence of the primary
supervising physician.
333.16276 Use of laser for dermatological purposes; supervision of licensed physician
required; exceptions; rules; definitions.
Sec. 16276.
(1) A licensee, registrant, or other individual shall not perform any procedure using a laser for
dermatological purposes unless the procedure is performed under the supervision of a licensed
physician.
(2) A licensee, registrant, or other individual shall not perform any procedure using a laser for
dermatological purposes unless the patient has knowledge and consents to the procedure being
performed by that licensee, registrant, or individual.
(3) Subsection (1) does not apply to any of the following:
(a) A licensed physician.
(b) A licensed physician's assistant who performs such a procedure in a health care facility.
(c) A certified nurse practitioner who performs such a procedure in a health care facility.
(4) The department may promulgate rules to further prohibit or otherwise restrict the use of lasers for
dermatological purposes.
(5) As used in this section:
(a) “Dermatological” means of or relating to the practice of dermatology.
(b) “Practice of dermatology” means the diagnosis and treatment of medically necessary and
cosmetic conditions of the skin, hair, and nails by various surgical, reconstructive, cosmetic, and
nonsurgical methods.
(c) “Supervision” means the overseeing of or participation in the work of another individual by a health
professional licensed under this article in circumstances where at least all of the following conditions
exist:
(i) The continuous availability of direct communication in person or by radio, telephone, or
telecommunication between the supervised individual and a licensed health professional.
(ii) The availability of a licensed health professional on a regularly scheduled basis to review the
practice of the supervised individual, to provide consultation to the supervised individual, to review
records, and to further educate the supervised individual in the performance of the individual's
functions.
(iii) The provision by the licensed supervising health professional of predetermined procedures and
drug protocol.
History: Add. 2004, Act 144, Imd. Eff. June 15, 2004
Popular Name: Act 368
333.17548 Limitation on number of physician's assistants supervised; prohibiting or
restricting delegation of medical care service or requiring higher levels of supervision;
delegation of ultimate responsibility prohibited; rules as to drugs; ordering, receiving, and
dispensing complimentary starter dose drugs.
Sec. 17548.
(1) Except as otherwise provided in this subsection and section 17549(5), a physician who is a sole
practitioner or who practices in a group of physicians and treats patients on an outpatient basis shall
not supervise more than 4 physician's assistants. If a physician described in this subsection
supervises physician's assistants at more than 1 practice site, the physician shall not supervise more
than 2 physician's assistants by a method other than the physician's actual physical presence at the
practice site.
(2) A physician who is employed by or under contract or subcontract to or has privileges at a health
facility licensed under article 17 or a state correctional facility may supervise more than 4 physician's
assistants at the health facility or agency or state correctional facility.
(3) To the extent that a particular selected medical care service requires extensive medical training,
education, or ability or pose serious risks to the health and safety of patients, the board may prohibit
or otherwise restrict the delegation of that medical care service or may require higher levels of
supervision.
(4) A physician shall not delegate ultimate responsibility for the quality of medical care services, even
if the medical care services are provided by a physician's assistant.
(5) The board may promulgate rules for the delegation by a supervising physician to a physician's
assistant of the function of prescription of drugs. The rules may define the drugs or classes of drugs
the prescription of which shall not be delegated and other procedures and protocols necessary to
promote consistency with federal and state drug control and enforcement laws. Until the rules are
promulgated, a supervising physician may delegate the prescription of drugs other than controlled
substances as defined by article 7 or federal law. When delegated prescription occurs, both the
physician's assistant's name and the supervising physician's name shall be used, recorded, or
otherwise indicated in connection with each individual prescription.
(6) A supervising physician may delegate in writing to a physician's assistant the ordering, receipt,
and dispensing of complimentary starter dose drugs other than controlled substances as defined by
article 7 or federal law. When the delegated ordering, receipt, or dispensing of complimentary starter
dose drugs occurs, both the physician's assistant's name and the supervising physician's name shall
be used, recorded, or otherwise indicated in connection with each order, receipt, or dispensing. As
used in this subsection, “complimentary starter dose” means that term as defined in section 17745. It
is the intent of the legislature in enacting this subsection to allow a pharmaceutical manufacturer or
wholesale distributor, as those terms are defined in part 177, to distribute complimentary starter dose
drugs to a physician's assistant, as described in this subsection, in compliance with section 503(d) of
the federal food, drug, and cosmetic act, chapter 675, 52 Stat. 1051, 21 U.S.C. 353.
History: 1978, Act 368, Eff. Sept. 30, 1978 ;-- Am. 1988, Act 462, Eff. Sept. 1, 1989 ;-- Am. 1990, Act
247, Imd. Eff. Oct. 12, 1990 ;-- Am. 1996, Act 355, Imd. Eff. July 1, 1996
Popular Name: Act 368
Admin Rule: R 338.6101 et seq. of the Michigan Administrative Code.
Truth in Advertising
333.16221 Investigation of licensee, registrant, or applicant for licensure or registration; hearings,
oaths, and testimony; report; grounds for proceeding under MCL 333.16226.
Sec. 16221.
The department may investigate activities related to the practice of a health profession by a licensee,
a registrant, or an applicant for licensure or registration. The department may hold hearings,
administer oaths, and order relevant testimony to be taken and shall report its findings to the
appropriate disciplinary subcommittee. The disciplinary subcommittee shall proceed under section
16226 if it finds that 1 or more of the following grounds exist:
(i) False or misleading advertising.
Mich. Comp. Laws §333.16265. Use of terms “doctor” or “dr.”
333.16265. Use of terms “doctor” or “dr.”
Sec. 16265. (1) An individual licensed under this article to engage in the practice of chiropractic,
dentistry, medicine, optometry, osteopathic medicine and surgery, podiatric medicine and surgery,
psychology, or veterinary medicine shall not use the terms “doctor” or “dr.” in any written or printed
matter or display without adding thereto “of chiropractic”, “of dentistry”, “of medicine”, “of optometry”,
“of osteopathic medicine and surgery”, “of podiatric medicine and surgery”, “of psychology”, “of
veterinary medicine” or a similar term, respectively.
(2) An individual licensed under part 182 shall not use the terms “doctor” or “dr.” without having been
granted a doctoral degree in psychology from a regionally or nationally accredited college or
university.
Corporate Practice of Medicine
State law appears to only allow non-profit corporations to employ physicians to provide medical
services.
A general business corporation may not practice a learned profession, because the Professional
Service Corporation Act and Limited Liability Company Act specifically govern the formation of an
entity to practice a learned profession. See Mich. Comp. Laws § 450.1251 (2006). Non-profit
corporations (including hospitals) may employ physicians to provide medical services. See MI Op.
Att'y Gen. No. 6770 (Sept. 17, 1993).
Minnesota
147.081 Practicing without license; penalty.
Subdivision 1. Unlawful practice of medicine. It is unlawful for any person to practice medicine
as defined in subdivision 3 in this state unless:
(1) the person holds a valid license issued according to this chapter; or
(2) the person is registered to provide interstate telemedicine services according to section
147.032.
Subd. 2. Penalty. Any person violating the provisions of subdivision 1 is guilty of a gross
misdemeanor.
Subd. 3. Practice of medicine defined. For purposes of this chapter, a person not exempted
under section 147.09 is "practicing medicine" or engaged in the "practice of medicine" if the person
does any of the following:
(1) advertises, holds out to the public, or represents in any manner that the person is authorized to
practice medicine in this state;
(2) offers or undertakes to prescribe, give, or administer any drug or medicine for the use of
another;
(3) offers or undertakes to prevent or to diagnose, correct, or treat in any manner or by any means,
methods, devices, or instrumentalities, any disease, illness, pain, wound, fracture, infirmity, deformity
or defect of any person;
(4) offers or undertakes to perform any surgical operation including any invasive or noninvasive
procedures involving the use of a laser or laser assisted device, upon any person;
(5) offers to undertake to use hypnosis for the treatment or relief of any wound, fracture, or bodily
injury, infirmity, or disease; or
(6) uses in the conduct of any occupation or profession pertaining to the diagnosis of human
disease or conditions, the designation "doctor of medicine," "medical doctor," "doctor of
osteopathy," "osteopath," "osteopathic physician," "physician," "surgeon," "M.D.," "D.O.," or any
combination of these designations.
HIST: (5717) RL s 2300; 1927 c 188 s 4; 1963 c 45 s 6; 1971 c485 s 5; 1974 c 43 s 1; 1985 c 247
s 13,25; 1986 c 444; 1993 c 121 s 1; 2002 c 361 s 2
146A.01 Definitions.
Subdivision 1.
them.
Terms. As used in this chapter, the following terms have the meanings given
(b) Complementary and alternative health care practices do not include surgery, x-ray radiation,
administering or dispensing legend drugs and controlled substances, practices that invade the human
body by puncture of the skin, setting fractures, the use of medical devices as defined in section
147A.01, any practice included in the practice of dentistry as defined in section 150A.05, subdivision
1, or the manipulation or adjustment of articulations of joints or the spine as described in section
146.23 or 148.01.
Truth in Advertising
147.091 Grounds for disciplinary action.
Subdivision 1. Grounds listed. The board may refuse to grant a license, may refuse to grant
registration to perform interstate telemedicine services, or may impose disciplinary action as
described in section 147.141 against any physician. The following conduct is prohibited and is
grounds for disciplinary action:
(e) Advertising which is false or misleading, which violates any rule of the board, or which
claims without substantiation the positive cure of any disease, or professional superiority to or greater
skill than that possessed by another physician.
Minn. Stat. §144.6585 Identification Of Health Care Providers.
Any health care provider who is licensed, credentialed, or registered by a health-related licensing
board as defined under section 214.01, subdivision 2, must wear a name tag that indicates by words,
letters, abbreviations, or insignia the profession or occupation of the individual.
The name tag must be worn whenever the health care provider is rendering health services to a
patient, unless wearing the name tag would create a safety or health risk to the patient. The failure to
wear a name tag is not reportable under chapter 214.
Corporate Practice of Medicine
State statutes and regulations do not address CPOM.
An Attorney General Opinion appears to only allow nonprofit corporations to employ physicians to
provide medical services.
The Attorney General has reinforced the long-standing position that a for-profit corporation may not
employ a physician in Minnesota. See MN Op. Att'y Gen. No. 92-B-11 (Oct. 5, 1955).
Mississippi
Definitions
200
For the purpose of Chapter 14 only, the following terms have the meanings indicated:
1. “Auxiliary” or “Auxiliaries” shall include, but is not limited to, registered nurses, licensed practical
nurses, certified nursing assistants, physical therapists, nurse practitioners and optometrists.
2. “Under the supervision” means to critically watch, direct, advise and oversee, and to inspect and
examine the actions of another health care practitioner.
3. “Physician” means any person licensed to practice medicine, osteopathic medicine or podiatric
medicine in the state of Mississippi.
4. “Surgery” means any invasive procedure which results in the projection into (i.e. laser surgery),
entering, cutting or suturing of tissue or any body organ.
Chapter 15 Office Based Surgery
Scope
100 This regulation sets forth the policies of the Mississippi State Board of Medical
Licensure regarding office based surgery rendered by individuals licensed to practice
medicine, osteopathic medicine and podiatric medicine in the state of Mississippi.
Definitions
200 For the purpose of Chapter 15 only, the following terms have the meanings indicated:
1. “Surgery” is defined as any operative procedure, including the use of lasers, performed upon the
body of a living human being for the purposes of preserving health, diagnosing or curing disease,
repairing injury, correcting deformity or defects, prolonging life, relieving suffering or any elective
procedure for aesthetic, reconstructive or cosmetic purposes, to include, but not be limited to: incision
or curettage of tissue or organ; suture or other repair of tissue or organ, including a closed as well as
an open reduction of a fracture; extraction of tissue including premature extraction of the products of
conception from the uterus; insertion of natural or artificial implants; or an endoscopic procedure. The
use of local, general or topical anesthesia and/or intravenous sedation is the prerogative of the
surgeon.
2. “Surgeon” is defined as a licensed physician performing any procedure included
within the definition of surgery.
Chapter 16 Laser Devices
100 The use of laser, pulsed light or similar devices, either for invasive or cosmetic procedures, is
considered to be the practice of medicine in the state of Mississippi and therefore such use shall be
limited to physicians and those directly supervised by physicians, such that a physician is on the
premises and would be directly involved in the treatment if required.
Supervising Physician Limited
700 No physician shall be authorized to supervise a physician assistant unless that physician
holds an unrestricted license to practice medicine in the state of Mississippi.
701 Supervision means overseeing activities of, and accepting responsibility for, all medical
services rendered by the physician assistant. Except as described in Section 702, supervision
must be continuous, but shall not be construed as necessarily requiring the physical presence
of the supervising physician.
702 New graduate physician assistants and all physician assistants newly practicing in
Mississippi, except those licensed under Section 300, require the on-site presence of a
supervising physician for one hundred twenty (120) days.
703 The physician assistant’s practice shall be confined to the primary office or clinic of the
supervising physician or any hospital(s) or clinic or other health care facility within the same
community where the primary office is located, wherein the supervising physician holds
medical staff privileges. Exceptions to this requirement may be granted on an individual
basis, provided the location(s) of practice are set forth in the protocol.
704 The supervising physician must provide adequate means for communication with the
physician assistant. Communication may occur through the use of technology which may
include, but is not limited to, radio, telephone, fax, modem, or other telecommunication
device.
705 The supervising physician shall, on at least a monthly basis, conduct a review of the
records/charts of at least ten percent (10%) of the patients treated by the physician assistant,
said records/charts selected on a random basis. During said review, the supervising
physician shall note the medical and family histories taken, results of any and all
examinations and tests, all diagnoses, orders given, medications prescribed, and treatments
rendered. The review shall be evidenced by the supervising physician placing his or her
signature or initials next to each of the above areas of review, and shall submit proof of said
review to the Board upon request.
Number of Physician Assistants Supervised
800 No physician shall supervise more than two (2) physician assistants at any one time. A
physician supervising two (2) nurse practitioners may not supervise a physician assistant.
Truth in Advertising
Definitions
200
For the purpose of Chapter 24 only, the following terms have the meanings indicated:
1. “Board” means the Mississippi State Board of Medical Licensure.
2. “Physician” means any individual licensed to practice medicine, osteopathic
medicine or podiatric medicine in the state of Mississippi.
3. “Advertisement” or “Advertising” means any form of public communication, such
as newspaper, magazine, telephone directory, medical directory, radio, television,
direct mail, billboard, sign, computer, business card, billing statement, letterhead or
any other means by which physicians may communicate with the public or patients.
Requirements
300 Subject to the requirements set forth herein below, any advertisement by a physician may
include:
1. The educational background or specialty of the physician.
2. The basis on which fees are determined, including charges for specific services.
3. Available credit or other methods of payment.
4. Any other non-deceptive information.
301 A physician may publicize himself or herself as a physician through any form of
advertisement, provided the communication, (i) shall not be misleading because of the
omission of necessary information, (ii) shall not contain any false or misleading statement,
or (iii) shall not otherwise operate to deceive.
302 Because the public can sometimes be deceived by the use of medical terms or illustrations
that are difficult to understand, physicians should design the advertisement to communicate
the information contained therein to the public in a readily comprehensible manner.
303
It is unethical to advertise in such a manner as to create unjustified medical expectations by
the public. The key issue is whether advertising or publicity, regardless of format or content,
is true and not materially misleading.
304
In addition to the above general requirements, any advertisement or other form of public
communication shall comply with the following specific requirements:
1. All advertisements and written communications pursuant to these rules shall include
the name of at least one (1) physician responsible for its content.
2. Whenever a physician is identified in an advertisement or other written
communication, the physician should not be identified solely as “Doctor” or “Dr.”
but shall be identified as M.D. for medical doctors, D.O. for osteopathic physicians
and D.P.M. for podiatric physicians.
3. A physician who advertises a specific fee for a particular service or procedure shall
honor the advertised fee for at least ninety (90) days unless the advertisement
specifies a longer period; provided that for advertisements in the yellow pages of a
telephone directory or other media not published more frequently than annually, the
advertised fee shall be honored for no less than one (1) year following publication.
4. A physician shall not make statements which are merely self-laudatory or statements
describing or characterizing the quality of the physician's services.
5. No physician shall advertise or otherwise hold himself or herself out to the public as
being “Board Certified” without, (i) a complete disclosure in the advertisement of
the specialty board by which the physician was certified, and (ii) can submit proof
of current certification by a specialty board recognized by the American Board of
Medical Specialties or the American Osteopathic Association. The term “Board
Certified” frequently appears in conjunction with a list of services that the physician
or clinic provides. The general public could easily be misled into thinking that the
physician is certified in all of those services.
6. No physician shall hold himself or herself out as a specialist in a particular field
unless that physician has either, (i) completed a “board approved” residency
program, which provides specific training in the specialized field and can submit
proof that such training was completed, or (ii) can submit proof that while not
completing a residency, was “grandfathered” into a specialty by successful
completion of board examinations followed by board certification by the American
Board of Medical Specialties or the American Osteopathic Association. A “board
approved” residency program shall be limited to residency programs recognized by
the American Medical Association, by the American Osteopathic Association, and
by the American Podiatric Medical Association.
7. No physician shall compare his or her service with other physicians' services, unless
the comparison can be factually substantiated; this precludes the use of terms such
as “the best,” “one of the best,” or “one of the most experienced” or the like.
8. Where an advertisement includes a consumer-endorser's experience (i.e., patient
testimonials), the advertisement must contain an appropriately worded, clear and
prominent disclosure of (a) what the generally expected performance would be in the
depicted circumstances, and (b) the limited applicability of the endorser's experience.
Although testimonials and endorsements are authorized under this rule, compliance
will be strictly monitored as endorsements and testimonials are inherently misleading
to the lay public and to those untrained in medicine.
9. Any claims of success, efficacy or result (i.e., cure) must have scientific evidence in
substantiation of such claims.
10. Any claims that purport to represent “typical” results (results that consumers will
generally achieve) must be based on a study of a sample of all patients who entered
the program, or, if the claim refers to a subset of those patients, a sample of that
subset.
11. Any claim made regarding the safety of a medical procedure or drug must also
disclose the risk of adverse medical complications.
12. No physician shall claim to have any new drug or medication or new use of a drug
or medication for a specific ailment or condition unless such drug or medication has
an F.D.A. approved indication for such purpose.
13. Any claim that improvements can be achieved through surgery in a specified time
period must also include disclosure of the typical recovery time.
305 Consistent with federal regulatory standards which apply to commercial advertising, a
physician who is considering the placement of an advertisement or publicity release, whether
in print, radio or television, should determine in advance that the communication or message
is explicitly and implicitly truthful and not misleading. These standards require the
advertiser to have a reasonable basis for claims before they are used in advertising. The
reasonable basis must be established by those facts known to the advertiser, and those which
a reasonable, prudent advertiser should have discovered.
306
The above rules do not prohibit physicians or clinics from authorizing the use of the
physician's name or clinic name in medical directories, HMO directories, preferred provider
agreements or other communications intended primarily for referral purposes.
Corporate Practice of Medicine
State statutes and regulations do not address CPOM.
A physician licensing body opinion appears to allow a corporation to employ a physician to provide
medical services if the corporation does not interfere with the physician's independent medical
judgment.
Mississippi abandoned the CPOM doctrine and now adheres to the position that as long as there is
no interference with the physician-patient relationship, then various forms of business relationships
with physicians are permissible. See Mississippi State Board of Medical Licensure, "Internal Policy
Regarding Corporate Practice of Medicine," revised May 16, 1996, and September 20, 2001.
Missouri
Unauthorized practice of medicine and surgery prohibited--practice of medicine across state
lines, definition.
334.010. 1. It shall be unlawful for any person not now a registered physician within the meaning of
the law to practice medicine or surgery in any of its departments, to engage in the practice of
medicine across state lines or to profess to cure and attempt to treat the sick and others afflicted with
bodily or mental infirmities, or engage in the practice of midwifery in this state, except as herein
provided.
2. For the purposes of this chapter, the "practice of medicine across state lines" shall mean:
(1) The rendering of a written or otherwise documented medical opinion concerning the diagnosis or
treatment of a patient within this state by a physician located outside this state as a result of
transmission of individual patient data by electronic or other means from within this state to such
physician or physician's agent; or
(2) The rendering of treatment to a patient within this state by a physician located outside this state as
a result of transmission of individual patient data by electronic or other means from within this state to
such physician or physician's agent.
3. A physician located outside of this state shall not be required to obtain a license when:
(1) In consultation with a physician licensed to practice medicine in this state; and
(2) The physician licensed in this state retains ultimate authority and responsibility for the diagnosis or
diagnoses and treatment in the care of the patient located within this state; or
(3) Evaluating a patient or rendering an oral, written or otherwise documented medical opinion, or
when providing testimony or records for the purpose of any civil or criminal action before any judicial
or administrative proceeding of this state or other forum in this state; or
Missouri
(4) Participating in a utilization review pursuant to section 376.1350.
Truth in Advertising
Denial, revocation or suspension of license, alternatives, grounds for--reinstatement
provisions.
334.100. 1. The board may refuse to issue or renew any certificate of registration or authority, permit
or license required pursuant to this chapter for one or any combination of causes stated in subsection
2 of this section.
2. The board may cause a complaint to be filed with the administrative hearing commission as
provided by chapter 621 against any holder of any certificate of registration or authority, permit or
license required by this chapter or any person who has failed to renew or has surrendered the
person's certificate of registration or authority, permit or license for any one or any combination of the
following causes:
(q) Advertising by an applicant or licensee which is false or misleading, or which violates any rule of
the board, or which claims without substantiation the positive cure of any disease, or professional
superiority to or greater skill than that possessed by any other physician. An applicant or licensee
shall also be in violation of this provision if the applicant or licensee has a financial interest in any
organization, corporation or association which issues or conducts such advertising;
Corporate Practice of Medicine
State statutes and regulations do not address CPOM.
An Attorney General Opinion appears to allow a corporation to employ a physician to provide medical
services.
The Attorney General has stated that it is allowable for a corporation to contract with a licensed
physician to furnish medical services. See Mo. Op. Att'y Gen. No. 8 (Mar. 15, 1962).
Montana
Mont. Code Ann. §37-3-101 et seq.
37-3-102 Definitions.
"Practice of medicine" means the diagnosis, treatment, or correction of or the attempt to or the
holding of oneself out as being able to diagnose, treat, or correct human conditions, ailments,
diseases, injuries, or infirmities, whether physical or mental, by any means, methods, devices, or
instrumentalities. If a person who does not possess a license to practice medicine in this state under
this chapter and who is not exempt from the licensing requirements of this chapter performs acts
constituting the practice of medicine, the person is practicing medicine in violation of this chapter.
24.156.501
DEFINITIONS
(11) "Surgery" means any procedure in which human tissue is cut or altered by mechanical or
energy forms, including electrical or laser energy or ionizing radiation.
24.121.1517 DEPARTMENT OF LABOR AND INDUSTRY
24.121.1517 SALON PREPARATION STORAGE AND HANDLING
(1) All salon and shop preparations must be:
(a) stored, handled and applied to protect against contamination; and
(b) dispensed from containers to prevent contamination of the unused portion, either by use of
pump, spray, or single-service spatulas.
(2) Use of the following items is prohibited:
(a) pumice stones;
(b) natural sponges;
(c) styptic pencils or lump alum;
(d) methyl methacrylate monomers for artificial nails; and
(e) for chemical exfoliation:
(i) phenol;
(ii) resorcinol;
(iii) trichloroacetic acid (TCA); and
(iv) Jessner's solution.
(3) Liquid or powder astringent must be stored and applied with a separate clean sterilized
gauze or cotton pad.
(4) All acids for use in chemical exfoliation must be used in concentrations of 30 percent or
less, a pH level of not less than 3.0 and shall be applied in a manner and for a duration as
recommended by the manufacturer.
(5) Only commercially available products may be used for chemical exfoliation purposes. The
mixing or combining of skin exfoliation products or services is strictly prohibited.
(6) When using bulk products poured into another or smaller storage container, the new
storage container must be labeled with the same product name, ingredients and warnings as the
original container.
(7) Dermaplane procedures, dermabrasion procedures, blades, knives, lancets and any tools
that invade the skin or living cells are prohibited.
(8) The use of laser energy, as prescribed in ARM 24.156.501, as "any procedure in which
human tissue is cut or altered by mechanical or energy forms, including electrical or laser energy or
ionizing radiation", constitutes the practice of medicine and is prohibited for all individuals licensed
under this chapter. (History: 37-1-131 , 37-31-203 , 37-31-204 , MCA; IMP, 37-31-204 , MCA; NEW,
2004 MAR p. 2813, Eff. 11/19/04.)
24.159.1006 DEPARTMENT OF LABOR AND INDUSTRY
24.159.1006 STANDARDS RELATED TO THE PRACTICAL NURSE'S ROLE IN COSMETIC
PROCEDURES (1) A practical nurse who has the proper training and on-going competency may
perform the following tasks and procedures only under the on-site supervision of a physician:
(a) procedures using lasers;
(b) procedures using intense pulsed light sources;
(c) procedures using microwave energy;
(d) procedures using radio frequency;
(e) procedures using electrical impulse;
(f) dermatologic procedures employing technologies that cut or alter living tissue; and
(g) injections or insertions of the following:
(i) botulism toxins, commonly referred to as "botox";
(ii) natural and synthetic collagens;
(iii) silicone;
(iv) sclerotherapy agents; or
(v) natural or synthetic filler materials. (History: 37-8-202 , MCA; IMP, 37-8-102 , MCA; NEW,
2004 MAR p. 641, Eff. 3/26/04; TRANS, from Commerce, & AMD, 2006 MAR p. 2035, Eff. 8/25/06.)
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24.156.625
UNPROFESSIONAL CONDUCT
(1) In addition to those forms of unprofessional conduct defined in 37-1-316 , MCA, the
following is unprofessional conduct for a licensee or license applicant under Title 37,
chapter 3, MCA:
(d) making a false or misleading statement regarding the licensee's skill or the effectiveness or
value of the medicine, treatment, or remedy prescribed by the licensee or at the licensee's direction in
the treatment of a disease or other condition of the body or mind;
Corporate Practice of Medicine
State statutes and regulations do not address CPOM.
Nebraska
Neb.Rev.St. §38-2024 Practice of medicine and surgery, defined
The following classes of persons shall be deemed to be engaged in the practice of medicine and
surgery:
(1) Persons who publicly profess to be physicians or surgeons or publicly profess to assume the
duties incident to the practice of medicine, surgery, or any of their branches;
(2) Persons who prescribe and furnish medicine for some illness, disease, ailment, injury, pain,
deformity, or any physical or mental condition, or treat the same by surgery;
(3) Persons holding themselves out to the public as being qualified in the diagnosis or treatment of
diseases, ailments, pain, deformity, or any physical or mental condition, or injuries of human beings;
(4) Persons who suggest, recommend, or prescribe any form of treatment for the intended palliation,
relief, or cure of any physical or mental ailment of any person;
(5) Persons who maintain an office for the examination or treatment of persons afflicted with ailments,
diseases, injuries, pain, deformity, or any physical or mental condition of human beings;
(6) Persons who attach to their name the title of M.D., surgeon,
physician, physician and surgeon, or any word or abbreviation and who indicate that they are
engaged in the treatment or diagnosis of ailments, diseases, injuries, pain, deformity, infirmity, or any
physical or mental condition of human beings; and
(7) Persons who are physically located in another state but who, through the use of any medium,
including an electronic medium, perform for compensation any service which constitutes the healing
arts that would affect the diagnosis or treatment of an individual located in this state.
§38-2029. Practice as osteopathic physicians, defined
(1) For purposes of the Uniform Credentialing Act, the following classes of persons shall be deemed
to be engaged in practice as osteopathic physicians:
(a) Persons publicly professing to be osteopathic physicians or publicly professing to assume the
duties incident to the practice of osteopathic physicians; and
(b) Persons who are graduates of a school or college of osteopathic medicine and who treat human
ailments by that system of the healing art which was advocated and taught by the school or college of
osteopathic medicine from which such person graduated at the time of his or her graduation as
determined by the department, with the recommendation of the board.
(2) No license issued to osteopathic physicians under the Medicine and Surgery Practice Act shall
authorize the person so licensed to perform surgical procedures except those usually performed by
general practitioners, as determined by the department, with the recommendation of the board.
(3) Nothing in this section shall be construed to prohibit an osteopathic physician licensed in
accordance with the act from serving as an assistant in surgery more complex than that usually
performed by general practitioners, as determined by the department, with the recommendation of the
board, when such surgery is performed by an osteopathic physician licensed pursuant to section 382032 or by an osteopathic physician or doctor of medicine licensed pursuant to section 38-2026. In no
event shall this section or section 38-2032 be construed as authorizing any physician to engage in
any procedure which he or she is not qualified by training to perform according to the standards
prevailing in the State of Nebraska at the time.
(4) Persons who are licensed to practice as osteopathic physicians who have demonstrated to the
department, with the recommendation of the board, that they have acquired adequate training and
knowledge for such purpose and have been so authorized by the department, with the
recommendation of the board, may prescribe and administer drugs and medicines.
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88-012 GROUNDS ON WHICH THE DEPARTMENT MAY LIMIT, PLACE ON PROBATION,
DENY, REFUSE RENEWAL OF, OR DISCIPLINE A LICENSE OR PERMIT:
88-012.03 The Department may deny, refuse renewal or reinstatement of, limit, suspend, place on probation,
discipline or revoke licenses or permits for any of the following grounds.
11. Use of untruthful or improbable statements, or flamboyant, exaggerated, or extravagant claims
concerning such licensee’s professional excellence or abilities, in advertisements.
12. Conviction of fraudulent or misleading advertising or conviction of a violation
of the Uniform Deceptive Trade Practices Act.
88-013 UNPROFESSIONAL CONDUCT: This section defines the following acts as
unprofessional conduct, pursuant to Neb. Rev. Stat. §71-148(22), and where applicable, further
construes the unlawful or unprofessional acts listed in Neb. Rev. Stat. §§71-147 and 71-148.
4. The use of any false or deceptive statement in any advertisement;
24. Lack of or inappropriate direction, collaboration or direct supervision of a licensed,certified or
registered health care provider employed by, supervised by or assigned to the physician;
Corporate Practice of Medicine
State statutes and regulations do not address CPOM.
Case law indicates that a corporation employing a physician to provide medical services is not
practicing medicine.
A corporation contracting with a physician did not constitute the practice of medicine or violate the law
or public policy of Nebraska. See State Electro-Med. Inst. v. Platner, 103 N.W.
1079, 1082 (Neb. 1905).
Nevada
NRS 630.0122 “Healing art” defined. “Healing art” means any system, treatment, operation,
diagnosis, prescription or practice for the ascertainment, cure, relief, palliation, adjustment or
correction of any human disease, ailment, deformity, injury, or unhealthy or abnormal physical or
mental condition for the practice of which long periods of specialized education and training and a
degree of specialized knowledge of an intellectual as well as physical nature are required
NRS 630.020 “Practice of medicine” defined. “Practice of medicine” means:
1. To diagnose, treat, correct, prevent or prescribe for any human disease, ailment, injury,
infirmity, deformity or other condition, physical or mental, by any means or instrumentality, including,
but not limited to, the performance of an autopsy.
2. To apply principles or techniques of medical science in the diagnosis or the prevention of any
such conditions.
3. To perform any of the acts described in subsections 1 and 2 by using equipment that transfers
information concerning the medical condition of the patient electronically, telephonically or by fiber
optics.
4. To offer, undertake, attempt to do or hold oneself out as able to do any of the acts described in
subsections 1 and 2.
[Part 17:169:1949; 1943 NCL § 4107.17]—(NRS A 1973, 504; 1975, 415; 1985, 1036, 2225;
1995, 1734; 2003, 438, 1886, 3430; 2009, 2946)
NEVADA ADMINISTRATIVE CODE
CHAPTER 644 – COSMETOLOGY
NAC 644.368 Prohibited invasive procedures. ( 644.110)
1. Except as otherwise provided in this section, a licensee shall not perform any invasive
procedure that includes, without limitation:
(a) The application of electricity for the sole purpose of contracting a muscle;
(b) The application of a topical lotion, cream or other substance which affects anything other than
the uppermost layers of the skin;
(c) The penetration of the skin by metal needles; or
(d) The abrasion of the skin below the uppermost layers of the skin.
2. The provisions of paragraph (c) of subsection 1 do not apply to the use of electrolysis needles
by a licensed electrologist.
3. As used in this section, “invasive procedure” means an act that affects the structure or function
of the skin other than the uppermost layers of the skin.
(Added to NAC by Bd. of Cosmetology by R029-02, eff. 7-19-2002)
NRS 631.215 Persons deemed to be practicing dentistry.
1. Any person shall be deemed to be practicing dentistry who:
(a) Uses words or any letters or title in connection with his name which in any way represents him
as engaged in the practice of dentistry, or any branch thereof;
(b) Advertises or permits to be advertised by any medium that he can or will attempt to perform
dental operations of any kind;
(c) Diagnoses, professes to diagnose or treats or professes to treat any of the diseases or lesions
of the oral cavity, teeth, gingiva or the supporting structures thereof;
(d) Extracts teeth;
(e) Corrects malpositions of the teeth or jaws;
(f) Takes impressions of the teeth, mouth or gums, unless the person is authorized by the
regulations of the Board to engage in such activities without being a licensed dentist;
(g) Examines a person for, or supplies artificial teeth as substitutes for natural teeth;
(h) Places in the mouth and adjusts or alters artificial teeth;
(i) Does any practice included in the clinical dental curricula of accredited dental colleges or a
residency program for those colleges;
(j) Administers or prescribes such remedies, medicinal or otherwise, as are needed in the
treatment of dental or oral diseases;
(k) Uses X-ray radiation or laser radiation for dental treatment or dental diagnostic purposes,
unless the person is authorized by the regulations of the Board to engage in such activities without
being a licensed dentist;
(l) Determines:
(1) Whether a particular treatment is necessary or advisable; or
(2) Which particular treatment is necessary or advisable; or
(m) Dispenses tooth whitening agents or undertakes to whiten or bleach teeth by any means or
method, unless the person is:
(1) Dispensing or using a product that may be purchased over the counter for a person’s own
use; or
(2) Authorized by the regulations of the Board to engage in such activities without being a
licensed dentist.
2. Nothing in this section:
(a) Prevents a dental assistant, dental hygienist or qualified technician from making radiograms or
X-ray exposures or using X-ray radiation or laser radiation for dental treatment or dental diagnostic
purposes upon the direction of a licensed dentist.
(b) Prohibits the performance of mechanical work, on inanimate objects only, by any person
employed in or operating a dental laboratory upon the written work authorization of a licensed dentist.
(c) Prevents students from performing dental procedures that are part of the curricula of an
accredited dental school or college or an accredited school of dental hygiene or an accredited school
of dental assisting.
(d) Prevents a licensed dentist or dental hygienist from another state or country from appearing as
a clinician for demonstrating certain methods of technical procedures before a dental society or
organization, convention or dental college or an accredited school of dental hygiene or an accredited
school of dental assisting.
(e) Prohibits the manufacturing of artificial teeth upon receipt of a written authorization from a
licensed dentist if the manufacturing does not require direct contact with the patient.
[Part 2:152:1951]—(NRS A 1967, 864; 1971, 532; 1981, 1971; 1983, 1111; 1987, 858; 1995, 275;
, 271)
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§630.400. Penalty for certain violations.
A person who, except as otherwise provided by specific statute, practices medicine or respiratory
care without being licensed under this chapter; holds himself out as a physician assistant or uses any
other term indicating or implying that he is a physician assistant without being licensed by the Board;
or holds himself out as a practitioner of respiratory care or uses any other term indicating or implying
that he is a practitioner of respiratory care without being licensed by the Board, is guilty of a category
D felony and shall be punished as provided in NRS 193.130.
NAC 630.190 Prohibited advertising. (NRS 630.130, 630.304)
1. A physician shall not advertise the practice of medicine in such a manner that the advertising:
(a) Claims that a manifestly incurable disease can be permanently cured;
(b) Includes any false claim of a licensee’s medical skill, or the efficacy or value of his medicine or
treatment;
(c) Claims or implies professional superiority of the performance of any professional service in a
manner superior to that of other practitioners;
(d) Guarantees any professional service or the results of any course of treatment or surgical
procedure, or the performance of any operation painlessly;
(e) Includes any statement which is known to be false, or through the exercise of reasonable care
should be known to be false, deceptive, misleading or harmful, in order to induce any person to
purchase, utilize or acquire any professional services or to enter into any obligation or transaction
relating thereto;
(f) Includes any extravagant claim, aggrandizement of abilities or self-laudatory statement
calculated to attract patients, and which has a tendency to mislead the public or produce unrealistic
expectations in particular cases; or
(g) Is false, deceptive or misleading in regard to the price, cost, charge, fee or terms of credit or
services performed or to be performed.
2. It is sufficient for disciplinary purposes that any statement or other advertising described in
paragraph (e), (f) or (g) has a tendency to:
(a) Deceive, mislead or harm the public because of its false, deceptive, misleading or harmful
character; or
(b) Produce unrealistic expectations in particular cases, even though no member of the public is
actually deceived, misled or harmed, or no unrealistic expectations are actually produced by the
statement or other advertising.
[Bd. of Medical Exam’rs, § 630.190, eff. 12-20-79]—(NAC A 6-23-86)
Corporate Practice of Medicine
State statutes and regulations do not address CPOM.
An Attorney General Opinion appears to only allow nonprofit corporations to employ physicians to
provide medical services.
The Attorney General has stated that only a professional corporation or association may practice
medicine. No general, for-profit corporation may practice medicine. See Nev. Op. Att'y Gen. No. 77219 (Oct. 3, 1977).
New Hampshire
329:1 Practice. – Any person shall be regarded as practicing medicine under the meaning of this
chapter who shall diagnose, treat, perform surgery, or prescribe any treatment of medicine for any
disease or human ailment. ""Surgery'' means any procedure, including but not limited to laser, in
which human tissue is cut, shaped, burned, vaporized, or otherwise structurally altered, except that
this section shall not apply to any person to whom authority is given by any other statute to perform
acts which might otherwise be deemed the practice of medicine. ""Laser'' means light amplification by
stimulated emission of radiation.
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329:17 Disciplinary Action; Remedial Proceedings. –
VI. The board, after hearing, may take disciplinary action against any person licensed by it upon
finding that the person:
(g) Has included in advertising any statement of a character tending to deceive or mislead the
public or any statement claiming professional superiority.
N.H. Rev. Stat. Ann. §151:3-b
151:3-b Identification Required.
I. Except as provided in paragraph II, facilities licensed under this chapter shall require all persons,
including volunteers, consulting doctors, and students and including home health care providers and
hospice staff, in contact with clients and residents to wear a form of identification which readily
discloses the name, licensure status, if any, and staff position.
II. Paragraph I shall not apply to persons working in a facility which provides services to clients and
residents with mental illness or developmental disabilities when such persons are working with such
clients and residents outside of the facility.
Corporate Practice of Medicine
State statutes and regulations do not address CPOM.
New Jersey
13:3S-4A.3 Definitions
The following words and terms, when used in this subchapter, shall have the following meanings,
unless the context clearly indicates otherwise,
"Minor surgery" means surgery which can safely and comfortably be performed on a patient who has
received no more than the maximum manufacturer recommended dose of local or topical anesthesia,
without more than minimal pre-operative medication or minimal intra-operative tranquilization
and where the likelihood of complications requiring hospitalization is remote. Minor surgery
specifically excludes all procedures performed utilizing anesthesia services as defined in this section.
Minor surgery also specifically excludes procedures which may be performed under local anesthesia,
but which involve extensive manipulation or removal of tissue such as liposuction or lipo-injection,
breast augmentation or reduction, and removal of breast implants. Minor surgery includes the
excision of moles, warts, cysts, lipomas, skin biopsies, the repair of simple lacerations, or other
surgery limited to the skin and subcutaneous tissue. Additional examples of minor surgery include
closed reduction of a fracture, the incision and drainage of abscesses, certain simple ophthalmologic
surgical procedures, such as treatment of chalazions and non-invasive ophthalmologic laser
procedures performed with topical anesthesia, limited endoscopies such as flexible sigmoidoscopies,
anoscopies, proctoscopies, arthrocenteses, thoracenteses and paracenteses. Minor surgery shall not
include any procedure identified as "major surgery" within the meaning of N.J.A.C. 13:35-4.1.
"Surgery" means a manual or operative procedure, including the use of lasers, performed upon the
body for the purpose of preserving health, diagnosing or treating disease, repairing injury, correcting
deformity or defects, prolonging life or relieving suffering. Surgery includes, but is not limited to:
incision or curettage of tissue or an organ; suture or other repair of tissue or an organ; a closed or
open reduction of a fracture or extraction of tissue from the uterus.
(c) A practitioner who seeks to perform surgery (other than minor surgery) or special procedures in an
office, but does not hold privileges at a licensed hospital to perform these procedures shall submit to
the Board an application for these privileges, including a completed privilege request form appropriate
to the privileges requested. To be eligible to apply for this privilege, an applicant shall meet the
following criteria and submit an application that documents the applicant's fulfillment of these criteria:
2. Anyone of the following:
(d) A practitioner who seeks to utilize laser surgery techniques in an office, but does not hold
privileges at a licensed hospital to do so, shall submit to the Board an application, which shall include:
1. Certification of successful completion of an accredited laser training program, in which the
curriculum includes instruction in laser care, physics and clinical indications for utilization of the
specific laser; or
2. Documentation from the program director of an accredited residency training program which the
applicant has successfully completed, attesting to the inclusion of training in the specific laser therapy
for which privileges are being sought during residency training.
SUBCHAPTER 12. ELECTROLOGISTS ADVISORY COMMITTEE; LICENSURE OF
ELECTROLOGISTS AND ELECTROLOGY INSTRUCTORS; ELECTROLOGY
STANDARDS OF PRACTICE
13:35-12.2 Definitions
"Electrology" means the removal of hair permanently through the utilizaiion of solid probe electrodetype epilation, including thermolysis, being of a short wave, high frequency type, and including
electrolysis, being of a galvanic type, or a combination of both, which is accomplished by a
superimposed or sequential blend. This definition specifically excludes laser and other intense light
source hair removal from the definition of electrology.
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N.J. Stat. Ann. §45:9-5.1 Definitions
The phrase “the practice of medicine or surgery” and the phrase “the practice of medicine and
surgery” shall include the practice of any branch of medicine and/or surgery, and any method of
treatment of human ailment, disease, pain, injury, deformity, mental or physical condition, and the
term “physician and surgeon” or “physician or surgeon” shall be deemed to include practitioners in
any branch of medicine and/or surgery or method of treatment of human ailment, disease, pain,
injury, deformity, mental or physical condition. Within the meaning of this act, except as herein
otherwise specifically provided, and except for the purposes of the exemptions hereinafter contained
in sections 45:9-14.1 to 45:9-14.10, inclusive, the practice of medicine and/or surgery shall be
deemed to include, inter alia, the practice of osteopathy, and nothing herein contained shall be
construed to exempt the holder of a license issued under or validated by the provisions contained in
sections 45:9-14.1 to 45:9-14.10, inclusive, from the operation of the provisions contained in section
45:9-16 of this Title.
Corporate Practice of Medicine
State regulations appear to prohibit corporations from employing physicians to provide medical
services, with limited exceptions.
A physician may offer health care services as an employee of a general business corporation only in
one of the following situations:
(1) the corporation is licensed by the New Jersey Department of Health as an HMO, hospital, long or
short-term care facility, ambulatory care facility or other type of health care facility or health care
provider;
(2) the corporation is not in the business of offering treatment services but maintains a medical clinic
for the purpose of providing first aid;
(3) the corporation is a non-profit corporation sponsored by a union, social or religious or fraternal
organization providing health care services to members only;
(4) the corporation is an accredited educational institution that maintains a medical clinic for services
for students and faculty; or
(5) the corporation is licensed by the State Department of Insurance as an insurance carrier. See N.J.
Admin. Code 13, § 35-6.16(f) (2006).
New Mexico
TITLE 16
OCCUPATIONAL AND PROFESSIONAL LICENSING
CHAPTER 10 MEDICINE AND SURGERY PRACTITIONERS
PART 13 DELEGATED USE OF DEVICES AND PROCEDURES BY MEDICAL ASSISTANTS;
COSMETIC INJECTIONS
16.10.13.1 ISSUING AGENCY: New Mexico Medical Board, hereafter called the board.
[16.10.13.1 NMAC – Rp 16 NMAC 10.13.1, 4/18/02; A, 12/30/05]
16.10.13.2 SCOPE: This part governs the delegated use of procedures and use of certain medical
devices by medical assistants under the supervision of the physician.
[16.10.13.2 NMAC – Rp 16 NMAC 10.13.2, 4/18/02, A, 12/30/05]
16.10.13.3 STATUTORY AUTHORITY: These rules of practice and procedure govern the use of
medical devices and procedures by unlicensed medical assistants under the supervision of a
physician in New Mexico. These rules are promulgated pursuant to and in accordance with the
Medical Practice Act, sections 61-6-1 through 61-6-35 NMSA 1978.
[16.10.13.3 NMAC – Rp 16 NMAC 10.13.3, 4/18/02; A, 12/30/05]
16.10.13.4 DURATION: Permanent
[16.10.13.4 NMAC – Rp 16 NMAC 10.13.4, 4/18/02]
16.10.13.5 EFFECTIVE DATE: April 18, 2002, unless a different date is cited at the end of a
section.
[16.10.13.5 NMAC – Rp 16 NMAC 10.13.5, 4/18/02]
16.10.13.6 OBJECTIVE: This part establishes the procedures whereby physicians licensed in New
Mexico can delegate responsibility for certain medical procedures generally considered to be the
practice of medicine to medical assistants with appropriate training and supervision, pursuant to
section 61-6-17 (I) NMSA 1978.
[16.10.13.6 NMAC – Rp 16 NMAC 10.13.6, 4/18/02; A, 12/30/05]
16.10.13.7 DEFINITIONS:
A.
“Supervising physician” means a physician licensed to practice in New Mexico who is
responsible for the patient's care and will provide oversight and guidance of the medical assistant.
B.
“Medical assistant” means any individual who is not licensed as a healthcare
practitioner in New Mexico and is working under the direction and supervision of a licensed physician.
Licensed practitioners, including registered nurses and physician assistants, are not considered to be
medical assistants pursuant to this rule.
C.
“Medical therapeutic or cosmetic medical procedure, device, or treatment” means
a treatment or procedure that uses any of the following, if the procedure or treatment alters or
damages or is capable of altering or damaging living tissue, to improve the patient’s appearance or to
achieve an enhanced aesthetic result:
(1) injection or insertion of a biologic or synthetic substance for soft tissue
augmentation;
(2) application of a chemical substance;
(3) application of microwave energy; or
(4) application of a federal food and drug administration approved prescription device
that uses waveform energy of any kind, including, but not limited to lasers or intense pulsed light.
D.
"Certified" means the medical assistant has been awarded a certificate of completion
of training by a physician trained to use the equipment, by a certified representative of the medical
equipment company, or by another entity qualified to offer the required training.
[16.10.13.7 NMAC – Rp 16 NMAC 10.13.7, 4/18/02; A, 12/30/05; A, 7/22/08]
16.10.13.8 USE OF MEDICAL THERAPEUTIC AND COSMETIC DEVICES. Medical therapeutic
or cosmetic devices penetrate and alter human tissue and can result in complications such as visual
impairment, blindness, inflammation, burns, scarring, hypo-pigmentation and hyper-pigmentation.
The use of medical therapeutic and cosmetic devices is the practice of medicine as defined in Section
61-6-1 NMSA 1978.
A.
Limitations.
(1) Medical assistants are limited to using medical therapeutic and cosmetic devices
that are non-incisive and non-ablative.
(2) Medical therapeutic and cosmetic devices may only be used by a medical assistant
who is certified pursuant to Subsection D of 16.10.13.7 NMAC and when the supervising physician is
immediately available on the premises.
B.
Responsibility of the supervising physician. A physician who is trained in the safety
and use of medical therapeutic or cosmetic devices may supervise medical assistants who perform
hair removal and other therapeutic or cosmetic procedures using devices that use waveform energy
consistent with the following requirements.
(1) The supervising physician must provide the following services before treatment by
a medical assistant is initiated: patient history, physical examination, diagnosis, treatment protocol,
and preparation of medical record.
(2) The supervising physician shall review any adverse outcomes or changes in the
treatment protocol.
(3) The supervising physician shall assure the patient is informed and aware that the
individual performing the procedure is a medical assistant and is under the physician's supervision.
(4) The supervising physician shall provide the patient instructions for emergency and
follow-up care.
(5) The supervising physician shall prepare a written protocol for the medical assistant
to follow when using the medical therapeutic or cosmetic device. The protocol may include pre and
post care treatment related to the procedure as long as the treatment is topical and non-injectable.
The physician is responsible for ensuring that the medical assistant uses the medical therapeutic or
cosmetic device only in accordance with the written protocol and does not exercise independent
medical judgment when using the device.
(6) The supervising physician shall assure compliance with the training and reporting
requirements of this rule.
(7) The supervising physician is ultimately responsible for the safety of the patient,
regardless of who performs the treatment using the medical therapeutic or cosmetic device or
procedure.
C.
Training requirements. Medical assistants who use medical therapeutic or cosmetic
devices must have training and be certified on each device they will use. The training on each device
must include the following:
(1) physics and safety of the medical therapeutic or cosmetic device;
(2) basic principle of the planned procedure;
(3) clinical application of the medical therapeutic or cosmetic device, including
wavelengths to be used;
(4) indications and contraindications for the use of the medical therapeutic or cosmetic
device;
(5) pre-operative and post-operative care;
(6) recognition and acute management of complications that may result from the
procedure; and
(7) infectious disease control procedures required for each procedure.
D.
Reporting requirements. The supervising physician shall complete a "certificate of
training" form and submit it to the board prior to the use of a medical therapeutic or cosmetic device
by the medical assistant. The form will be device-specific and document training for each medical
therapeutic or cosmetic device used by the medical assistant.
E.
Public communication. Any public communication offering the performance or
administration of a cosmetic medical procedure or treatment shall identify the physician or surgeon
responsible for the provision of, or the direct supervision of the procedure or treatment.
[16.10.13.8 NMAC – Rp 16 NMAC 10.13.8, 4/18/02; A, 12/30/05; A, 7/22/08]
16.10.13.9 INJECTION OF COSMETIC OR AESTHETIC SUBSTANCES
The injection of cosmetic or aesthetic substances is considered to be the practice of medicine and
shall not be delegated to medical assistants.
[16.10.13.8 NMAC – Rp 16 NMAC 10.13.8, 4/18/02; N, 12/30/05]
History of 16.10.13 NMAC:
History of Repealed Material:
16 NMAC 10.13, Devices and Procedures; Use by Medical and Non-Medical Personnel – Repealed
4/18/02
Truth in Advertising
N.M. Stat. §61-6-6. Definitions
“licensed physician” means a medical doctor licensed under the Medical Practice Act to practice
medicine in New Mexico;
“the practice of medicine” consists of:
(1) advertising, holding out to the public or representing in any manner that one is authorized to
practice medicine in this state;
(2) offering or undertaking to administer, dispense or prescribe a drug or medicine for the use of
another person, except as authorized pursuant to a professional or occupational licensing statute set
forth in Chapter 61 NMSA 1978;
(3) offering or undertaking to give or administer, dispense or prescribe a drug or medicine for the use
of another person, except as directed by a licensed physician;
(4) offering or undertaking to perform an operation or procedure upon a person;
(5) offering or undertaking to diagnose, correct or treat in any manner or by any means, methods,
devices or instrumentalities any disease, illness, pain, wound, fracture, infirmity, deformity, defect or
abnormal physical or mental condition of a person;
(6) offering medical peer review, utilization review or diagnostic service of any kind that directly
influences patient care, except as authorized pursuant to a professional or occupational licensing
statute set forth in Chapter 61 NMSA 1978; or
(7) acting as the representative or agent of a person in doing any of the things listed in this
subsection;
Corporate Practice of Medicine
State statutes and regulations do not address CPOM.
An Attorney General Opinion appears to allow a corporation to employ a physician to provide medical
services if the corporation does not interfere with the physician's independent medical judgment.
Corporations organized and controlled by non-physicians may provide medical services to the public
through employed physicians, unless laypeople control medical decisions. See New Mexico Att'y
Gen. Op. No. 97-39 (July 30, 1987).
New York
N.Y. [Educ.] Law §6512; §6521; §6522
§ 6521. Definition of practice of medicine
The practice of the profession of medicine is defined as diagnosing, treating, operating or prescribing
for any human disease, pain, injury, deformity or physical condition.
§ 6512. Unauthorized practice a crime
1. Anyone not authorized to practice under this title who practices or offers to practice or holds
himself out as being able to practice in any profession in which a license is a prerequisite to the
practice of the acts, or who practices any profession as an exempt person during the time when his
professional license is suspended, revoked or annulled, or who aids or abets an unlicensed person to
practice a profession, or who fraudulently sells, files, furnishes, obtains, or who attempts fraudulently
to sell, file, furnish or obtain any diploma, license, record or permit purporting to authorize the practice
of a profession, shall be guilty of a class E felony.
2. Anyone who knowingly aids or abets three or more unlicensed persons to practice a profession or
employs or holds such unlicensed persons out as being able to practice in any profession in which a
license is a prerequisite to the practice of the acts, or who knowingly aids or abets three or more
persons to practice any profession as exempt persons during the time when the professional licenses
of such persons are suspended, revoked or annulled, shall be guilty of a class E felony.
-Only those who may practice Medicine (physicians, RN’s, PA’s and NP’s) may use lasers, with the
exception of laser hair removal. Hair removal by any means is not considered the practice of
medicine.
Truth in Advertising
27. Advertising or soliciting for patronage that is not in the public interest.
a. Advertising or soliciting not in the public interest shall include, but not be limited to,
advertising or soliciting that:
i.
is false, fraudulent, deceptive, misleading, sensational, or flamboyant;
ii.
represents intimidation or undue pressure;
iii.
iv.
v.
uses testimonials;
guarantees any service;
makes any claim relating to professional services or products or the costs or
price therefor which cannot be substantiated by the licensee, who shall have the
burden of proof;
vi.
makes claims of professional superiority which cannot be substantiated by the
licensee, who shall have the burden of proof; or
vii.
offers bonuses or inducements in any form other than a discount or reduction in
an established fee or price for a professional service or product.
b. The following shall be deemed appropriate means of informing the public of the
availability of professional services:
i.
informational advertising not contrary to the foregoing prohibitions; and
ii.
the advertising in a newspaper, periodical or professional directory or on radio or
television of fixed prices, or a stated range of prices, for specified routine
professional services, provided that if there is an additional charge for related
services which are an integral part of the overall service being provided by the
licensee, the advertisement shall so state, and provided further that the
advertisement indicates the period of time for which the advertised prices shall
be in effect.
c.
i.
All licensees placing advertisements shall maintain, or cause to be maintained,
an exact copy of each advertisement, transcript, tape or video tape thereof as
appropriate for the medium used, for a period of one year after its last
appearance. This copy shall be made available for inspection upon demand of
the department of health;
ii.
A licensee shall not compensate or give anything of value to representatives of
the press, radio, television or other communications media in anticipation of or in
return for professional publicity in a news item;
d. No demonstrations, dramatizations or other portrayals of professional practice shall be
permitted in advertising on radio or television;
§ 6522. Practice of medicine and use of title “physician”
Only a person licensed or otherwise authorized under this article shall practice medicine or use the
title “physician”.
Corporate Practice of Medicine
State laws appear to prohibit corporations from employing physicians to provide medical services,
with limited exceptions.
Only a person licensed or otherwise authorized under this article shall practice medicine. See N.Y.
Educ. Law § 6522 (2006). A non-profit medical or dental expense indemnity corporation or a hospital
service corporation may employ licensed physicians. See N.Y. Educ. Law § 6527 (2006). The use of
the word "person" in the physician licensing statute means that a corporation may not practice
medicine. Corporations may not employ licensed professionals to practice medicine. See People v.
John H. Woodbury Dermatological Inst., 85 N.E. 697 (N.Y. 1908).
North Carolina
§ 90-18. Practicing without license; practicing defined; penalties
Any person shall be regarded as practicing medicine or surgery within the meaning of this Article who
shall diagnose or attempt to diagnose, treat or attempt to treat, operate or attempt to operate on, or
prescribe for or administer to, or profess to treat any human ailment, physical or mental, or any
physical injury to or deformity of another person.
A person who resides in any state or foreign country and who, by use of any electronic or other
mediums, performs any of the acts described in this subsection, including prescribing medication by
use of the Internet or a toll-free telephone number, shall be regarded as practicing medicine or
surgery and shall be subject to the provisions of this Article and appropriate regulation by the North
Carolina Medical Board.
The following shall not constitute practicing medicine or surgery as defined in this section:
(1) The administration of domestic or family remedies in cases of emergency.
(2) The practice of dentistry by any legally licensed dentist engaged in the practice of dentistry and
dental surgery.
(3) The practice of pharmacy by any legally licensed pharmacist engaged in the practice of pharmacy.
(3a) The provision of drug therapy management by a licensed pharmacist engaged in the practice of
pharmacy pursuant to an agreement that is physician, pharmacist, patient, and disease specific when
performed in accordance with rules and rules developed by a joint subcommittee of the North
Carolina Medical Board and the North Carolina Board of Pharmacy and approved by both Boards.
(4) The practice of medicine and surgery by any surgeon or physician of the United States army,
navy, or public health service in the discharge of his official duties.
(5) The treatment of the sick or suffering by mental or spiritual means without the use of any drugs or
other material means.
(6) The practice of optometry by any legally licensed optometrist engaged in the practice of
optometry.
(7) The practice of midwifery as defined in G.S. 90-178.2.
(8) The practice of chiropody by any legally licensed chiropodist when engaged in the practice of
chiropody, and without the use of any drug.
(9) The practice of osteopathy by any legally licensed osteopath when engaged in the practice of
osteopathy as defined by law, and especially G.S. 90-129.
(10) The practice of chiropractic by any legally licensed chiropractor when engaged in the practice of
chiropractic as defined by law, and without the use of any drug or surgery.
(11) The practice of medicine or surgery by any nonregistered reputable physician or surgeon who
comes into this State, either in person or by use of any electronic or other mediums, on an irregular
basis, to consult with a resident registered physician or to consult with personnel at a medical school
about educational or medical training. This proviso shall not apply to physicians resident in a
neighboring state and regularly practicing in this State.
(12) Any person practicing radiology as hereinafter defined shall be deemed to be engaged in the
practice of medicine within the meaning of this Article.
(13) The performance of any medical acts, tasks, and functions by a licensed physician assistant at
the direction or under the supervision of a physician in accordance with rules adopted by the Board.
(14) The practice of nursing by a registered nurse engaged in the practice of nursing and the
performance of acts otherwise constituting medical practice by a registered nurse when performed in
accordance with rules and regulations developed by a joint subcommittee of the North Carolina
Medical Board and the Board of Nursing and adopted by both boards.
(15) The practice of dietetics/nutrition by a licensed dietitian/nutritionist under the provisions of Article
25 of this Chapter.
(16) The practice of acupuncture by a licensed acupuncturist in accordance with the provisions of
Article 30 of this Chapter.
(17) The use of an automated external defibrillator as provided in G.S. 90-21.15.
(18) The practice of medicine by any nonregistered physician residing in another state or foreign
country who is contacted by one of the physician's regular patients for treatment by use of the Internet
or a toll-free telephone number while the physician's patient is temporarily in this State.
(19) The practice of medicine or surgery by any physician who comes into this State to practice
medicine or surgery at a camp that specializes in providing therapeutic recreation for individuals with
chronic illnesses, as long as all the following conditions are satisfied:
a. The physician provides documentation to the medical director of the camp that the physician is
licensed and in good standing to practice medicine in another state.
b. The physician provides services only at the camp or in connection with camp events or camp
activities that occur off the grounds of the camp.
c. The physician receives no compensation for the services.
d. The physician provides those services within this State for no more than 30 days per calendar
year.
e. The camp has a medical director who holds an unrestricted license to practice medicine and
surgery issued under this Article.
Chapter 88A. Electrolysis Practice Act.
§ 88A-11.1. Requirements for licensure as a laser hair practitioner; limitations on licensed
laser hair practitioners.
(a)
Any person seeking licensure by the Board as a laser hair practitioner shall have met the
following requirements at the time the license is requested:
(1)
Be an electrologist licensed under this Chapter.
(2)
Completed a minimum 30-hour laser, light source, or pulsed-light treatment
certification course approved by the Board and in accordance with rules adopted by
the Board.
(3)
Be currently using or anticipate using laser, light source, or pulsed-light devices that
the person has been certified by a Board-approved school to operate.
(b)
When the Board determines that an applicant has met all the requirements for licensure,
and has submitted the initial license fee required in G.S. 88A-9(b), the Board shall issue a license to
the applicant.
(c)
Each laser hair practitioner shall practice laser, light source, or pulsed-light treatments
under the supervision of a physician licensed under Article 1 of Chapter 90 of the General Statutes.
The physician shall be readily available, but not required to be on site when the laser, light source, or
pulsed-light treatments are being performed. However, the authority to regulate laser clinicians shall
remain with the Board.
(d)
A laser hair practitioner shall not dispense or administer medication or provide advice
regarding the use of medication, whether prescription or over-the-counter, in connection with laser,
light source, or pulsed-light treatments.
(e)
All laser hair practitioners shall use laser, light source, or pulsed-light devices approved by
the federal Food and Drug Administration and comply with all applicable federal and State
regulations, rules, and laws. Any licensed laser hair practitioner violating this subsection shall have
his or her license revoked by the Board.
(f)
Only a licensed physician may use laser, light source, or pulsed-light devices for ablative
procedures. (2007-489, s. 6.)
§ 88A-15. Exemptions from licensure.
The following individuals shall be permitted to practice electrology without a license:
(1)
Any physician licensed in accordance with Article 1 and Article 11 of Chapter 90 of
the General Statutes.
(2)
A student at an approved school of electrology when electrolysis is performed in the
course of study.
(3)
A person demonstrating on behalf of a manufacturer or distributor any electrolysis
equipment or supplies, if such demonstration is performed without charge.
(4)
An employee of a hospital licensed under Chapter 131E of the General Statutes and
working under the supervision of a physician licensed under Article 1 of Chapter 90
of the General Statutes who is certified by the American Board of Dermatology.
(1989 (Reg. Sess., 1990), c. 1033, s. 1; 1993 (Reg. Sess., 1994), c. 755, s. 4.)
§ 88A-15.1. Persons and practices not affected.
The requirements of this Chapter shall not apply to any person licensed or approved by the North
Carolina Medical Board to practice medicine or perform medical acts, tasks, or functions pursuant to
Article 1 of Chapter 90 of the General Statutes or any person employed and working under the direct
supervision of a physician licensed to practice medicine pursuant to Article 1 of Chapter 90 of the
General Statutes. (2007-489, s. 9.)
North Carolina Medical Board Position Statement
LASER SURGERY
It is the position of the North Carolina Medical Board that the revision, destruction, incision, or
other structural alteration of human tissue using laser technology is surgery.* Laser surgery
should be performed only by a physician or by a licensed health care practitioner working within
his or her professional scope of practice and with appropriate medical training functioning under
the supervision, preferably on-site, of a physician or by those categories of practitioners currently
licensed by this state to perform surgical services.
Licensees should use only devices approved by the U.S. Food and Drug Administration unless
functioning under protocols approved by institutional review boards. As with all new procedures,
it is the licensee’s responsibility to obtain adequate training and to make documentation of this
training available to the North Carolina Medical Board on request.
Laser Hair Removal
Lasers are employed in certain hair-removal procedures, as are various devices that (1)
manipulate and/or pulse light causing it to penetrate human tissue and (2) are classified as
“prescription” by the U.S. Fowl and Drug Administration.. Hair-removal procedures using such
technologies should be performed only by a physician or by an individual designated as having
adequate training and experience by a physician who bears full responsibility for the procedure.
The physician who provides medical supervision is expected to provide adequate oversight of
licensed and non-licensed personnel both before and after the procedure is performed. The Board
believes that the guidelines set forth in this Position Statement are applicalle to every licensee of
the Board involved in laser hair removal, whether as an owner, medical director, consultant or
otherwise.
It is the position of the Board that good medical practice requires that each patient be examined
by a physician, physician assistant or nurse practitiofler licensed or approved by this Board prior
to receiving the first laser hair removal treatment and at other times as medically indicated. The
examination should include a history and a focused physical examination. Where prescription
medication such as topical anesthetics are used, the Board expects physicians to follow the
guidelines set forth in the Board’s Position Statement titled “Contact with Patients Before
Prescribing.” When medication is prescribed or dispensed In connection with laser hair removal,
the supervising physician shall assure the patient receives thorough instructions on the safe use or
application of said medication.
The responsible supervising physician should be on site or readily available to the person actually
performing the procedure. What constitutes “readily available” will depend on a variety of
factors. Those factors include the specific types of procedures and equipment used; the level of
training of the persons performing the procedure; the level and type of licensure, if any, of the
persons performing the procedure; the use of topical anesthetics; the quality of written protocols
for the performance of the procedure; the frequency, quality and type of ongoing education of
those performing the procedures; and any other quality assurance measures in place. In all cases,
the Board expects the physician to be able to respond quickly to patient cmergencies and questions
by those performing the procedures.
http://www.ncmedboard.org/Clients/N CBOMJPub1Ic/NewsandForurnilaser.htm 10/10/2006
*definition of surgery as adopted by the NCMB,November 1998: Surgery, which involves the revision,
destruction, incision, or structural alteration of human tissue performed using a
variety of methods and instruments, isa discipline that includes the operative and non-operative care
of individuals in need of such intervention, and demands pre-operative assessment, judgment,
technical skills, post-operative management, and follow up.
(Adopted July 1999)
(Amended January 2000, March 2002, August 2002, July 2005)
Truth in Advertising
Advertising and publicity
Created: Nov 1, 1999
Modified: March 2001, Reviewed September 2005, Amended November 2010
It is the position of the North Carolina Medical Board that advertising or publicity that is deceptive,
false, or misleading constitutes unprofessional conduct under the Medical Practice Act.*
The term “advertising” includes oral, written and other types of communication disseminated by or at
the direction of a licensee for the purpose of encouraging or soliciting the use of the licensee’s
services. At issue is whether a member of the general public would be confused or deceived by the
advertising in question. The following general principles are intended to assist licensees in meeting
the Board’s expectations: (1) advertisements should not contain false claims or misrepresentations of
fact, either expressly or by implication; (2) advertisements should not omit material facts; and (3)
licensees should be prepared to substantiate claims made in advertisements.
Licensees should avoid advertising and publicity that creates unjustified medical expectations, that
are accompanied by deceptive claims, or that imply exclusive or unique skills or remedies. Similarly,
a statement that a licensee has cured or successfully treated a large number of patients suffering a
particular ailment is deceptive if it implies a certainty of results and/or creates unjustified or
misleading expectations. When using patient photographs, they should be of the licensee’s own
patients and demonstrate realistic outcomes. Likewise, when a change of circumstances renders
advertising inaccurate or misleading, the licensee is expected to make reasonable efforts to correct
the advertising within a reasonable time frame.
The advent of the Internet and the proliferation of websites purporting to “rate” healthcare providers
mean that licensees cannot always control information about themselves in the public domain.
However, a licensee is expected to exercise reasonable efforts to bring about the correction or
elimination of false or misleading information when he or she becomes aware of it.
Physicians Advertising Board Certification
The term “board certified” is publicly regarded as evidence of the skill and training of a physician
carrying this designation. Accordingly, in order to avoid misleading or deceptive advertising
concerning board certification, physicians are expected to meet the following guidelines.
No physician should advertise or otherwise hold himself or herself out to the public as being “board
certified” without proof of current certification by a specialty board approved by the (1) American
Board of Medical Specialties (ABMS); (2) the Bureau of Osteopathic Specialists of the American
Osteopathic Association (AOA-BOS); (3) the Royal College of Physicians and Surgeons of Canada
(RCPSC); or (4) a board that meets the following requirements:
1. the organization requires satisfactory completion of a training program with training,
documentation and clinical requirements similar in scope and complexity to ACGME- or AOAapproved programs, in the specialty or subspecialty field of medicine in which the physician
seeks certification. Solely experiential or on-the-job training is not sufficient;
2. the organization requires all physicians seeking certification to successfully pass a written or
oral examination or both, which tests the applicant’s knowledge and skill in the specialty or
subspecialty area of medicine. All examinations require a psychometric evaluation for
validation;
3. the organization requires diplomates to recertify every ten years or less, and the recertification
requires, at a minimum, passage of a written examination;
4. the organization prohibits all certification and recertification candidates from attempting more
than three times in three years to pass the examination;
5. the organization has written by-laws and a code of ethics to guide the practice of its members
and an internal review and control process including budgetary practices to ensure effective
utilization of resources;
6. the organization has written proof of a determination by the Internal Revenue Service that the
certifying organization is tax-exempt under Section 501(c) of the Internal Revenue Code; and
7. the organization has a permanent headquarters and staff sufficient to respond to consumer
and regulatory inquiries.
Any physician advertising or otherwise holding himself or herself out to the public as “board certified”
should disclose in the advertisement the specialty board by which the physician was certified. A
physician is expected to maintain and provide to the Board upon request evidence of current board
certification. In the case of physicians who have been certified by non-ABMS, non-AOA and nonRCPSC boards, the physician is expected to maintain and provide to the Board upon request
evidence that the certifying board meets the criteria listed above.
The above limitations are only intended to apply to physicians who advertise or otherwise hold
themselves out to the public as being “board certified.” The above criteria are not applicable in other
instances, such as employment determinations, privileging or credentialing decisions, membership on
insurance panels, or setting reimbursement rates.
*Business letterheads, envelopes, cards, and similar materials are understood to be forms of
advertising and publicity for the purpose of this Position Statement.
Corporate Practice of Medicine
State statutes and regulations do not address CPOM.
An Attorney General Opinion prohibits corporations from employing physicians to provide medical
services, with limited exceptions.
North Carolina prohibits a private corporation from practicing medicine and from employing
physicians. CPOM prohibition does not extend to non-profit or public hospitals. See 33 N.C. Att'y
Gen. Rep. 43 (1955).
North Dakota
43-17-01. Definitions
3. "Practice of Medicine" includes the practice of medicine, surgery, and obstetrics. The following
persons must be regarded as practicing medicine:
a. One who holds out to the public as being engaged within this state in the diagnosis or
treatment of diseases or injuries of human beings.
b. One who suggests, recommends, or prescribes any form of treatment for the intended relief
or cure of any physicial or mental ailment of any person, with the intention of receiving, directly
or indirectly, any fee, gift, or compensation.
c. One who maintains an office for the examination or treatment of persons afflicted with
disease or injury of the body or mind.
d. One who attaches the title M.D., surgeon, doctor, D.O., osteopathic physician and surgeon,
or any other similar word or words or abbreviation to the person's name, indicating that the
person is engaged in the treatment or diagnosis of the diseases or injuries of human beings
shall be held to be engaged in the practice of medicine
CHAPTER 43-11
COSMETOLOGISTS
43-11-01. Definitions. In this chapter, unless the context or subject matter otherwise
requires:
2. "Cosmetology" means any one or combination of practices generally and usually performed by and
known as the occupation of beauty culturists or cosmeticians or cosmetologists or hairdressers, or of
any other person holding out as practicing cosmetology by whatever designation and within the
meaning of this chapter and in and upon whatever place or premises; and in particular cosmetology
includes the following or any one or a combination of practices: arranging, dressing, curling,
waving, cleansing, cutting, singeing, bleaching, coloring, or similar work, upon the hair of any person
by any means or with hands or mechanical or electrical apparatus or appliances, or by the use of
cosmetic preparations, antiseptics, tonics, lotions, creams, or otherwise, massaging, cleansing,
stimulating, manipulating, exercising, waxing to remove hair, beautifying, or similar work on the body,
or manicuring the nails of any person.
3. "Cosmetology salon" includes that part of any building in which the occupation of a cosmetologist is
practiced.
4. "Esthetician" means a person who is licensed by the board to engage in the practice of skin care.
An esthetician does not include a professional make-up artist trained in facial make-up application by
a cosmetics company.
7. "Invasive care" means any procedure that invades the live tissue of the dermis,
including:
a. Laser use, except the use of cold laser technology using nonlinear, pulsed light
application for the purpose of biostimulation without the generation of heat; and
b. Chemical peels, except for chemical peels using:
(1) Thirty percent alpha hydroxy acid, which includes glycolic acid with a pH
of 3.0 or higher;
(2) Twenty percent beta hydroxy acid, which includes salicylic acid with a pH
of 3.0 or higher; or
(3) Two percent resorcinol with a pH of 3.0 or higher.
13. "Skin care" means the use of cosmetic preparations, antiseptics, tonics, lotions,
creams, or otherwise, massaging, cleansing, stimulating, manipulating, waxing to
remove hair, beautifying, or similar work on the body of any person. The term does
not include invasive care.
Truth in Advertising
43-17-31. Grounds for disciplinary action.
Disciplinary action may be imposed against a physician upon any of the following grounds:
1. The use of any false, fraudulent, or forged statement or document, or the use of any fraudulent,
deceitful, dishonest, or immoral practice, in connection with any of the licensing requirements.
2. The making of false or misleading statements about the physician's skill or the efficacy of any
medicine, treatment, or remedy.
10. The practice of medicine under a false or assumed name.
11. The advertising for the practice of medicine in an untrue or deceptive manner.
12. The representation to a patient that a manifestly incurable condition, sickness, disease, or injury
can be cured.
13. The willful or negligent violation of the confidentiality between physician and patient, except as
required by law.
14. The failure of a doctor of osteopathy to designate that person's school of practice in the
professional use of that person's name by such terms as "osteopathic physician and surgeon",
"doctor of osteopathy", "D.O.", or similar terms.
43-17-02.2 Use of certain words or initials prohibited.
The terms "physician assistant" and "certified physician assistant" and the initials "PA-C" may only be
used to identify a person who has been issued a certificate of qualification by the board of medical
examiners. A person who uses those terms or initials as identification without having received a
certificate of qualification is engaging in the practice of medicine without a license.
Corporate Practice of Medicine
State statutes and regulations do not address CPOM.
An Attorney General Advisory Letter appears to prohibit a non-professional corporation from
practicing medicine or employing physicians to provide medical care.
A corporation is not qualified to be licensed to practice medicine. The rule appears to prevent the
practice of a learned profession by a non-professional corporation. See N.D. Att'y Gen. Adv. Ltr.
(October 23, 1990).
Ohio
4731-18-02 Use of light based medical devices.
(A) For purposes of this rule, light based medical device shall mean any device that can be made to
produce or amplify electromagnetic radiation at wavelengths equal to or greater than one hundred
eighty nm but less than or equal to 1.0 X 10 6nm [ten to the sixth power] and that is manufactured,
designed, intended or promoted for in vivo irradiation of any part of the human body for the purpose
of affecting the structure or function of the body.
(B) The application of light based medical devices to the human body is the practice of medicine and
surgery, osteopathic medicine and surgery and podiatric medicine and surgery.
(C) Except as provided in rule 4731-18-03 and rule 4731-18-04 of the Administrative Code, no
physician licensed pursuant to Chapter 4731. of the Revised Code shall delegate the application of
light based medical devices to the human body to any person not authorized to practice medicine and
surgery, osteopathic medicine and surgery or podiatric medicine and surgery pursuant to Chapter
4731. of the Revised Code.
(D) A violation of paragraph (C) of this rule shall constitute “a departure from, or the failure to conform
to, minimal standards of care of similar practitioners under the same or similar circumstances,
whether or not actual injury to a patient is established,” as that clause is used in division (B)(6) of
section 4731.22 of the Revised Code and “violating or attempting to violate, directly or indirectly, or
assisting in or abetting the violation of, or conspiring to violate, any provisions of this chapter or any
rule promulgated by the board,” as that clause is used in division (B)(20) of section 4731.22 of the
Revised Code, to wit: section 4731.41 of the Revised Code.
Chapter 4731-18 Surgery Standards
4731-18-01 Standards for surgery.
(A) The surgeon of record in an operative case shall personally:
(1) Evaluate the patient sufficiently to formulate an appropriate preoperative diagnosis; and
(2) Select the operation to be performed in consultation with the patient or with a person authorized to
act on his behalf; and
(3) Determine, based on his own evaluation, and, as necessary, on consultation with other physicians
involved in the patient’s care, that the patient is a fit candidate for the operation to be performed; and
(4) Assure that the patient or a person authorized to act on his behalf gives informed consent before
the surgery begins; and
(5) Comply with division (B)(6) of section 4731.22 of the Revised Code; and
(6) Perform or personally supervise the surgery, except those portions of the surgery, if any, which
are performed or supervised by another qualified surgeon with the informed consent of the patient.
(B) Management of postoperative medical care is the responsibility of the surgeon of record. The
surgeon of record shall fulfill this responsibility by:
(1) Personally performing the postoperative medical care; or
(2) Delegating postoperative medical care to another physician or physicians who are qualified by
training and experience to provide the level of care required, provided that the surgeon of record shall
remain primarily responsible for the patient’s overall care unless the patient and the other physician
have agreed in advance to shift that responsibility to the other physician; or
(3) Delegating defined aspects of the postoperative medical care to appropriately trained and
supervised allied health care personnel in compliance with applicable standards, provided that the
surgeon of record shall retain personal responsibility for the quality of the care rendered by personnel
who are under his supervision and control. The surgeon of record shall obtain the patient’s fully
informed consent, or the consent of a person authorized to act on the patient’s behalf, in advance of
surgery, before delegating aspects of patient care to allied health care personnel under this
paragraph. The surgeon of record need not obtain the patient’s informed consent for aspects of care
to which the patient has already consented, such as consent to treatment and care by hospital
personnel under an informed consent form signed upon the patient’s admission to the hospital; or
(4) Delegating defined aspects of the postoperative medical care to licensees of other health
regulatory boards who are licensed to independently provide the scope of practice and the level of
care required, provided that the surgeon of record shall remain primarily responsible for the patient’s
overall care and must examine the patient during the postoperative period.
(C) This rule shall not be read to transfer any responsibility which currently rests with any other
physician, allied health care provider, or institution to the surgeon of record.
(D) This rule shall not be read to prohibit or interfere with the appropriate training of medical students
and physicians in post-graduate training programs, or other personnel.
(E) The provisions of this rule requiring consultation with or obtaining the informed consent of the
patient or a person legally authorized to act on his behalf do not apply to the extent they would
prevent the performance of surgery or other procedures under emergency circumstances.
4731-23-02 Delegation of medical tasks.
(A) A physician shall not delegate the performance of a medical task unless that physician has
complied with all of the requirements of this chapter of the Administrative Code and the delegation
otherwise conforms to minimal standards of care of similar physicians under the same or similar
circumstances.
(B) Prior to a physician’s delegation of the performance of a medical task, that physician shall
determine each of the following:
(1) That the task is within that physician’s authority;
(2) That the task is indicated for the patient;
(3) The appropriate level of supervision;
(4) That no law prohibits the delegation;
(5) That the person to whom the task will be delegated is competent to perform that task; and,
(6) That the task itself is one that should be appropriately delegated when considering the following
factors:
(a) That the task can be performed without requiring the exercise of judgment based on medical
knowledge;
(b) That results of the task are reasonably predictable;
(c) That the task can safely be performed according to exact, unchanging directions;
(d) That the task can be performed without a need for complex observations or critical decisions;
(e) That the task can be performed without repeated medical assessments; and,
(f) That the task, if performed improperly, would not present life threatening consequences or the
danger of immediate and serious harm to the patient.
(C) When a physician delegates the administration of drugs, that physician shall provide on-site
supervision, except in the following situations:
(1) When the physician has transferred responsibility for the on-site supervision of the unlicensed
person who is administering the drug to another physician and that physician has knowingly accepted
that responsibility on a patient-by-patient basis; or
(2) In the routine administration of a topical drug, such as a medicated shampoo.
(3) When delegation occurs pursuant to section 5126.356 of the Revised Code within the programs
and services offered by a county board of mental retardation and developmental disabilities.
(4) When delegation occurs pursuant to section 5123.193 of the Revised Code.
(5) When written policies and procedures have been adopted for the distribution of drugs by an
unlicensed person to individuals incarcerated in state correctional institutions as defined in division
(A) of section 2796.01 of the Revised Code, other correctional facilities including county and
municipal jails, workhouses, minimum security jails, halfway houses, community residential centers,
regional jails and multi-county jails, or any other detention facility as defined in division (F) of section
2921.01 of the Revised Code.
(D) This chapter of the Administrative Code shall not apply if the rules contained herein:
(1) Prevent an individual from engaging in an activity performed for a handicapped child as a service
needed to meet the educational needs of the child, as identified in the individualized education
program developed for the child under Chapter 3323. of the Revised Code;
(2) Prevent delegation from occurring pursuant to section 5126.356 of the Revised Code within the
programs and services offered by a county board of mental retardation and developmental
disabilities;
(3) Conflict with any provision of the Revised Code that specifically authorizes an individual to
perform a particular task;
(4) Conflict with any rule adopted pursuant to the Revised Code that is in effect on the effective date
of this section, as long as the rule remains in effect, specifically authorizing an individual to perform a
particular task;
(5) Prohibit a perfusionist from administering drugs intravenously while practicing as a perfusionist.
Truth in Advertising
§ 4731.34. Unauthorized practice of medicine, surgery or podiatry.
(A) A person shall be regarded as practicing medicine and surgery, osteopathic medicine and
surgery, or podiatric medicine and surgery, within the meaning of this chapter, who does any of the
following:
(1) Uses the words or letters, "Dr.," "Doctor," "M.D.," "physician," "D.O.," "D.P.M.," or any other title in
connection with the person's name in any way that represents the person as engaged in the practice
of medicine and surgery, osteopathic medicine and surgery, or podiatric medicine and surgery, in any
of its branches;
(2) Advertises, solicits, or represents in any way that the person is practicing medicine and surgery,
osteopathic medicine and surgery, or podiatric medicine and surgery, in any of its branches
§ 4731.41. Practice of medicine or surgery without certificate.
No person shall practice medicine and surgery, or any of its branches, without the appropriate
certificate from the state medical board to engage in the practice. No person shall advertise or claim
to the public to be a practitioner of medicine and surgery, or any of its branches, without a certificate
from the board. No person shall open or conduct an office or other place for such practice without a
certificate from the board. No person shall conduct an office in the name of some person who has a
certificate to practice medicine and surgery, or any of its branches. No person shall practice medicine
and surgery, or any of its branches, after the person's certificate has been revoked, or, if suspended,
during the time of such suspension.
Corporate Practice of Medicine
State regulations appear to allow corporations to practice a profession if the corporation does not
interfere with the professional's independent judgment.
An Attorney General Opinion prohibits corporations from employing physicians to provide medical
services.
A corporation can practice a profession, but cannot control the professional clinical judgment
exercised by a physician. See Ohio Rev. Code Ann. § 1701 (2005).
Attorney General stated that any corporation that charges and collects a fee from patients for medical
treatment performed by licensed physicians as employees of the corporation is unlawfully engaged in
the practice of medicine. See Ohio Op. Att'y Gen. No. 52-1751 (1952).
Oklahoma
Oklahoma State Board of Medical Licensure and Supervision
Policy and Guidelines for Medical Spas & Aesthetic Procedures
Definitions (Oklahoma Law & Rules)
Practice of Medicine
Every person shall be regarded as practicing allopathic medicine within the meaning and provisions
of this act, who shall append to his or her name the letters "M.D.", "Physician" or any other title, letters
or designation which represent that such person is a physician, or who shall for a fee or any form of
compensation diagnose and/or treat disease, injury or deformity of persons in this state by any
allopathic legend drugs, surgery, manual, or mechanical treatment unless otherwise authorized by
law.
Doctor/Patient Relationship
Means a person has a medical complaint/issue, which has been addressed by the doctor and there is
a correlation between the complaint/issue and the treatment/procedure performed or drug
given/prescribed/dispensed.
Surgery
The ablation or alteration of any human tissue by any means including but not limited to the use of
sharp surgery, heat, cold, abrasion, laser, chemicals, injection/placement of substances
subcutaneous, or the use of FDA approved devices that can only be initially purchased by physicians
is the practice of medicine as defined in Title 59 O.S. Section 492. Lasers are instruments of surgery.
No matter what type of laser is being utilized, if a physician is involved in the process the following
guidelines apply.
GUIDELINES
The practice of medicine and surgery as defined above is grounded upon the doctor/patient
relationship which at a minimum requires a face-to-face evaluation of the patient by the physician or
physician assistant prior to the determined treatment or procedure, development of a patient chart,
patient informed consent and the process for follow up care.
There are several important guidelines to follow when supervising other practitioners.
•
If the physician is utilizing unlicensed, trained assistants under their control and supervision,
the physician must be on-site (premise) before, during and after the medical treatment or
procedure.
•
If the physician is utilizing Oklahoma licensed PA’s, the physician can delegate any of the
defined medical services to that licensed PA under general supervision, which does not require
the physician to necessarily be on-site.
•
If the physician is utilizing an Oklahoma licensed nurse, (RN, LPN, APN (advance practice
nurse), and/or APN w/ Rx) and IF they are functioning within the scope of their practice act,
then the physician may delegate any of the defined medical services to that licensed nurse
under general supervision, which may not require the physician to necessarily be on-site. It is
imperative that the physician contact the Oklahoma Board of Nursing (405-962-1800) to find
out the nurse designation’s scope of practice and level of physician supervision.
•
If the physician is utilizing any other Oklahoma recognized practitioner such as a certified
micropigmentologist or licensed aesthetist, the physician must contact the Oklahoma
Department of Health or the Board of Cosmetology respectively and find out the scope of their
practice act and level of medical supervision required.
•
In no instance may a physician allow one of the aforementioned practitioners to further
delegate the medical service to another practitioner.
•
Physicians who are medical directors for one or multiple medical facilities are included in these
guidelines.
When in doubt of a specific medical procedure/treatment and the corresponding level of supervision,
the physician should contact the Oklahoma Board of Medical Licensure and Supervision or
appropriate regulatory agency before potentially placing their medical license in jeopardy.
Oklahoma Board of Medical Licensure and Supervision
5104 North Francis Avenue
Oklahoma City, Oklahoma 73118
405-848-6841
www.okmedicalboard.org
Truth in Advertising
509. Unprofessional Conduct - Definition
The words "unprofessional conduct" as used in Sections 481 through 514 of this title are hereby
declared to include, but shall not be limited to, the following:
6. All advertising of medical business in which statements are made which are grossly untrue or
improbable and calculated to mislead the public;
Okla. Stat. tit. 59 §492. Designation of physicians--Employment by hospitals--Practice of
medicine defined--Services rendered by trained assistants--Persons practicing nonallopathic
healing
§492. Designation of physicians--Employment by hospitals--Practice of medicine defined-Services rendered by trained assistants--Persons practicing non-allopathic healing
Every person shall be regarded as practicing allopathic medicine within the meaning and provisions
of this act, who shall append to his or her name the letters “M.D.”, “Physician” or any other title, letters
or designation which represent that such person is a physician, or who shall for a fee or any form of
compensation diagnose and/or treat disease, injury or deformity of persons in this state by any
allopathic legend drugs, surgery, manual, or mechanical treatment unless otherwise authorized by
law.
The definition of the practice of medicine and surgery shall include, but is not limited to:
1. Advertising, holding out to the public, or representing in any manner that one is authorized to
practice medicine and surgery in this state;
2. Any offer or attempt to prescribe, order, give, or administer any drug or medicine and surgery for
the use of any other person, except as otherwise authorized by law;
3. a. Any offer or attempt, except as otherwise authorized by law, to prevent, diagnose, correct, or
treat in any manner or by any means, methods, devises, or instrumentalities except for manual
manipulation any disease, illness, pain, wound, fracture, infirmity, defect, or abnormal physical or
mental condition of any person, including the management of pregnancy and parturition, except as
otherwise authorized by law.
Corporate Practice of Medicine
State statutes appear to allow hospitals to employ physicians to practice medicine without being
regarded as itself practicing medicine.
A hospital or related institution organized and operated for such purpose may employ one or more
persons who are licensed to practice medicine in this state without being regarded as itself practicing
medicine. See Okla. St. Ann. tit. 59, § 492 (2005).
Oregon
677.085 What constitutes practice of medicine. A person is practicing medicine if the person does
one or more of the following:
(1) Advertise, hold out to the public or represent in any manner that the person is authorized to
practice medicine in this state.
(2) For compensation directly or indirectly received or to be received, offer or undertake to
prescribe, give or administer any drug or medicine for the use of any other person.
(3) Offer or undertake to perform any surgical operation upon any person.
(4) Offer or undertake to diagnose, cure or treat in any manner, or by any means, methods,
devices or instrumentalities, any disease, illness, pain, wound, fracture, infirmity, deformity, defect or
abnormal physical or mental condition of any person.
(5) Except as provided in ORS 677.060, append the letters "M.D." or "D.O." to the name of the
person, or use the words "Doctor," "Physician," "Surgeon," or any abbreviation or combination
thereof, or any letters or words of similar import in connection with the name of the person, or any
trade name in which the person is interested, in the conduct of any occupation or profession
pertaining to the diagnosis or treatment of human diseases or conditions mentioned in this section.
[Formerly 677.030; 1989 c.830 §3]
818-012-0005
Scope of Practice
(1) The Board determines that the practice of dentistry includes the following procedures which the
Board finds are included in the curricula of dental schools accredited by the American Dental
Association, Commission on Dental Accreditation, post-graduate training programs or continuing
education courses:
(a) Rhinoplasty;
(b) Blepharoplasty;
(c) Rhydidectomy;
(e) Submental liposuction;
(f) Laser resurfacing;
(g) Browlift, either open or endoscopic technique;
(h) Platysmal muscle plication;
(i) Dermabrasion;
(j) Otoplasty;
(k) Lip augmentation;
(l) Hair transplantation, not as an isolated procedure for male pattern baldness; and
(m) Harvesting bone extra orally for dental procedures, including oral and maxillofacial procedures.
(2) No licensee may perform any of the procedures listed in subsection (1) unless the licensee:
(a) Has successfully completed a residency in Oral and Maxillofacial Surgery accredited by the
American Dental Association, Commission on Dental Accreditation (CODA); and
(b) Has successfully completed a clinical fellowship, of at least one continuous year in duration, in
esthetic (cosmetic) surgery recognized by the American Association of Oral and Maxillofacial
Surgeons or by the American Dental Association Commission on Dental Accreditation; or
(c) Holds privileges either:
(A) Issued by a credentialing committee of a hospital accredited by the Joint Commission on
Accreditation of Healthcare Organizations (JCAHO) to perform these procedures in a hospital setting;
or
(B) Issued by a credentialing committee for an ambulatory surgical center licensed by the State of
Oregon and accredited by either the JCAHO or the American Association for Ambulatory Health Care
(AAAHC).
Stat. Auth.: ORS 679 & ORS 680
Stats. Implemented: ORS 679.010(2), ORS 679.140(1)(c), ORS 679.140(2), ORS 679.170(6) & ORS
680.100
Hist.: OBD 6-2001, f. & cert. ef. 1-8-01
818-012-0010
818-042-0040
Prohibited Acts
No licensee may authorize any dental assistant to perform the following acts:
(1) Diagnose or plan treatment.
(2) Cut hard or soft tissue.
(3) Any Expanded Function duty (818-042-0070 and 818-042-0090) or Expanded Orthodontic
Function duty (818-042-0100) without holding the appropriate certification.
(4) Correct or attempt to correct the malposition or malocclusion of teeth or take any action related to
the movement of teeth except as provided by OAR 818-042-0100.
(5) Adjust or attempt to adjust any orthodontic wire, fixed or removable appliance or other structure
while it is in the patient's mouth.
(6) Administer or dispense any drug except fluoride, topical anesthetic, desensitizing agents or drugs
administered pursuant to OAR 818-026-0060(11), 818-026-0070(11) and as provided in 818-0420070 and 818-042-0115.
(7) Prescribe any drug.
(8) Place periodontal packs.
(9) Start nitrous oxide.
(10) Remove stains or deposits except as provided in OAR 818-042-0070.
(11) Use ultrasonic equipment intra-orally except as provided in OAR 818-042-0100.
(12) Use a high-speed handpiece or any device that is operated by a high-speed handpiece intraorally.
(13) Use lasers, except laser-curing lights.
(14) Use air abrasion or air polishing.
(15) Remove teeth or parts of tooth structure.
(16) Cement or bond any fixed prosthetic or orthodontic appliance including bands, brackets,
retainers, tooth moving devices, or orthopedic appliances except as provided in 818-042-0100.
(17) Condense and carve permanent restorative material except as provided in OAR 818-042-0095.
(18) Place any type of cord subgingivally.
(19) Take jaw registrations or oral impressions for supplying artificial teeth as substitutes for natural
teeth, except diagnostic or opposing models or for the fabrication of temporary or provisional
restorations or appliances.
(20) Apply denture relines except as provided in OAR 818-042-0090(2).
(21) Expose radiographs without holding a current Certificate of Radiologic Proficiency issued by the
Board (818-042-0050 and 818-042-0060) except while taking a course of instruction approved by the
Oregon Department of Human Services, Oregon Public Health Division, and Radiation Protection
Services (RPS), or the Oregon Board of Dentistry.
(22) Use the behavior management techniques known as Hand Over Mouth (HOM) or Hand Over
Mouth Airway Restriction (HOMAR) on any patient.
(23) Perform periodontal probing.
(24) Any act in violation of Board statute or rules.
Stat. Auth.: ORS 679 & 680
Stats. Implemented: ORS 679.020, 679.025 & 679.250
Hist.: OBD 9-1999, f. 8-10-99, cert. ef. 1-1-00; OBD 2-2000(Temp), f. 5-22-00, cert. ef. 5-22-00 thru
11-18-00; OBD 1-2001, f. & cert. ef. 1-8-01; OBD 15-2001, f. 12-7-01, cert. ef. 1-1-02; OBD 3-2OBD
1-2010, f. 6-22-10, cert. ef. 7-1-10005, f. 10-26-05, cert. ef. 11-1-05; OBD 3-2007, f. & cert. ef. 11-3007; OBD 1-2010, f. 6-22-10, cert. ef. 7-1-10
Truth in Advertising
677.188 Definitions for ORS 677.190. As used in ORS 677.190, unless the context requires
otherwise:
(1) "Fraud or misrepresentation" means the intentional misrepresentation or misstatement of a
material fact, concealment of or failure to make known any material fact, or any other means by which
misinformation or a false impression knowingly is given.
677.190 Grounds for suspending, revoking or refusing to grant license, registration or
certification; alternative medicine not unprofessional conduct. The Oregon Medical Board may
refuse to grant, or may suspend or revoke a license to practice for any of the following reasons:
9) Making statements that the licensee knows, or with the exercise of reasonable care should know,
are false or misleading, regarding skill or the efficacy or value of the medicine, treatment or remedy
prescribed or administered by the licensee or at the direction of the licensee in the treatment of any
disease or other condition of the human body or mind.
(12) Using the name of the licensee under the designation "doctor," "Dr.," "D.O." or "M.D.," "D.P.M.,"
"Acupuncturist," "P.A." or any similar designation in any form of advertising that is untruthful or is
intended to deceive or mislead the public.
677.184 License to show degree held; display of license; use of degree on stationery and in
displays. (1) On each license issued by it, the Oregon Medical Board shall enter after the name of
the person holding the license the degree to which the person is entitled by reason of the diploma of
graduation from a school of medicine which, at the time of the graduation of such person, was
approved by the board for purposes of ORS 677.100.
(2) The license shall be displayed in a prominent place in the licensee's office.
(3) In every letter, business card, advertisement, prescription blank, sign, public listing or display
in connection with the profession of the person, each person licensed to practice medicine in this
state shall designate the degree appearing on the license of the person pursuant to subsection (1) of
this section. Action taken by the board under ORS 677.190 for failure to comply with this subsection
does not relieve a person from criminal prosecution for violation of ORS 676.110 and 676.120. [1967
c.470 §28; 1983 c.486 §20; 1989 c.830 §9]
Corporate Practice of Medicine
State statutes and regulations do not address CPOM.
An Attorney General Opinion appears to allow hospitals to employ physicians to provide medical
services because hospitals are licensed to provide medical services and may therefore employ
professionals to provide such services.
It is settled law in Oregon that a corporation cannot practice a profession, except to the extent that
"professional corporations" or hospital corporations are authorized to do so. See Op. Or. Att'y. Gen.
No. 5689 (1984).
Attorney General stated that a hospital corporation may lawfully employ a physical therapist to
perform the medical services that he or she is trained and licensed provide, just as it may employ
physicians and nurses. See Op. Or. Att'y. Gen. No 7230 (Oct. 28, 1975).
Pennsylvania
63 Pa. Cons. Stat. §422.2
422.2. Definitions
The following words and phrases when used in this act shall have the meanings given to them in this
section unless the context clearly indicates otherwise:
“Board.” The State Board of Medicine.
“Board regulated practitioner.” A medical doctor, midwife, physician assistant, respiratory therapist,
certified athletic trainer or drugless therapist or an applicant for a license or certificate the board may
issue.
“Doctor of osteopathy or osteopathic doctor.” An individual licensed to practice osteopathic medicine
and surgery by the State Board of Osteopathic Medical Examiners.
“Healing arts.” The science and skill of diagnosis and treatment in any manner whatsoever of disease
or any ailment of the human body.
“Health care practitioner.” An individual, other than a physician assistant, who is authorized to
practice some component of the healing arts by a license, permit, certificate or registration issued by
a Commonwealth licensing agency or board.
“Legend drug.” A drug:
(1) limited by the Federal Food, Drug and Cosmetic Act (52 Stat. 1040, 21 U.S.C. § 301 et
seq.) to being dispensed by prescription; and
(2) the product label of which is required to contain the following statement: “CAUTION:
FEDERAL LAW PROHIBITS DISPENSING WITHOUT A PRESCRIPTION.”
“Medical doctor.” An individual who has acquired one of the following licenses to practice medicine
and surgery issued by the board:
(1) License without restriction.
(2) Interim limited license.
(3) Graduate license.
(4) Institutional license.
(5) Temporary license.
(6) Extraterritorial license.
“Medical service.” Activity which lies within the scope of the practice of medicine and surgery.
“Medicine and surgery.” The art and science of which the objectives are the cure of diseases and the
preservation of the health of man, including the practice of the healing art with or without drugs,
except healing by spiritual means or prayer.
“Midwife or nurse-midwife.” An individual who is licensed as a midwife by the board.
“Physician.” A medical doctor or doctor of osteopathy.
“Physician assistant.” An individual who is licensed as a physician assistant by the board.
“Referral.” An order from a licensed physician, dentist or podiatrist to a certified athletic trainer for
athletic training services. An order may be written or oral, except that an oral order must be reduced
to writing within 72 hours of issuance.
“Written protocol.” A written agreement developed in conjunction with one or more supervising
physicians which identifies and is signed by the supervising physician and the certified athletic trainer.
It describes the manner and frequency in which the certified athletic trainer regularly communicates
with the supervising physician. It includes standard operating procedures developed in agreement
with the supervising physician and certified athletic trainer that the certified athletic trainer follows
when not directly supervised on site by the supervising physician.
§ 33.215. Use of lasers in the dental office—statement of policy.
(a) Background and purpose. The use of lasers in experimental and institutional settings has
raised questions with regard to using this technology in the dental office. In addressing this issue, the
Board has been mindful of its principal mandate: protection of the public. Section 4.1(a)(8) and (9) of
the act (63 P. S. § 123.1(a)(8) and (9)) authorizes the Board to take disciplinary action against
licensees who engage in unprofessional conduct or who commit acts of negligence, incompetence or
malpractice. The use of lasers may implicate both provisions by, for example, generating complaints
of incompetent treatment or treatment that fails to conform to acceptable standards of practice. The
Board offers the following guidelines to assist its licensees in conforming their behavior to the act. In a
disciplinary action brought against a dentist for treatment involving a laser, the Board will consider
whether these guidelines were followed.
(b) Guidelines. A dentist who uses a laser in private practice shall:
(1) Be familiar with and conform to regulations on lasers promulgated by the Food and Drug
Administration.
(2) Possess clinical competency in the use of lasers. The Board recommends a minimum of
6 hours of instruction given by an accredited institution or by a manufacturer of lasers sponsored by
such an institution. The instruction should include hands-on training and should cover all known risks
to paitents, staff and the practitioner.
Source
The provisions of this § 33.215 adopted June 23, 1995, effective June 24, 1995, 25 Pa.B.
2492.
Truth in Advertising
§ 16.61. Unprofessional and immoral conduct.
(a) A Board-regulated practitioner who engages in unprofessional or immoral conduct is
subject to disciplinary action under section 41 of the act (63 P. S. § 422.41). Unprofessional conduct
includes, but is not limited to, the following:
(4) Unconditionally guaranteeing that a cure will result from the performance of medical services or
treatment regimen.
(5) Advertising of a medical business which is intended to or has a tendency to deceive the public.
(10) Impersonating another health-care practitioner.
AN ACT
Amending the act of July 19, 1979 (P.L.130, No.48), entitled "An act relating to health care;
prescribing the powers and providing the powers and duties of the State Health Coordinating Council,
health systems agencies and Health Care Policy Board in the Department of Health, and State Health
Facility Hearing Board in the Department of Justice; providing for certification of need of health care
providers and prescribing penalties," providing for photo identification tag regulations.
The General Assembly of the Commonwealth of Pennsylvania hereby enacts as follows:Section 1.
The act of July 19, 1979 (P.L.130, No.48), known as the Health Care Facilities Act, is amended by
adding a section to read:
Section 809.2. Photo identification tag regulations.
(a) Regulations.--Except as provided under subsection (c), the department shall promulgate
regulations under subsection (b) to require employees to wear a photo identification tag when the
employee is working. The following shall apply:
(1) The photo identification tag shall include a recent photograph of the employee, the employee's
name, the employee's title and the name of the health care facility or employment agency.
(2) The title of the employee shall be as large as possible in block type and shall occupy a one-half
inch tall strip as close as practicable to the bottom edge of the badge.
(3) Titles shall be as follows:
(i) A Medical Doctor shall have the title "Physician."
(ii) A Doctor of Osteopathy shall have the title "Physician."
(iii) A Registered Nurse shall have the title "Registered Nurse."
(iv) A Licensed Practical Nurse shall have the title "Licensed Practical Nurse."
(v) All other titles shall be determined by the department. Abbreviated titles may be used when the
title indicates licensure or certification by a Commonwealth agency.
(b) Interim regulations.--The department, upon the conclusion of at least one public hearing, shall
publish interim regulations regarding implementation of this section in the Pennsylvania Bulletin within
90 days of the effective date of this section. The interim regulations shall not be subject to sections
201 and 202 of the act of July 31, 1968 (P.L.769, No.240), referred to as the Commonwealth
Documents Law, and the act of June 25, 1982 (P.L.633, No.181), known as the "Regulatory Review
Act." The interim regulations shall expire 18 months following the effective date of this section or
when final regulations are promulgated by the department, whichever occurs first. Final regulations
shall be promulgated no later than 18 months following the effective date of this section.
(c) Exceptions.--Notwithstanding subsection (a), the following shall apply:
(1) An employee shall not be required to wear an identification badge while delivering direct care to a
consumer if not clinically feasible.
(2) The last name of the employee may be omitted or concealed when delivering direct care to a
consumer who exhibits symptoms of irrationality or violence.
(d) Applicability.--Except for subsection (a)(2) and (3), this section shall apply to an employee that
delivers direct care to a consumer outside of the health care facility or employment agency. On June
1, 2015, this section shall apply to an employee that delivers direct care to a consumer at or outside
of the health care facility or employment agency.
(e) Definitions.--As used in this section, the following words and phrases shall have the meanings
given to them in this subsection unless the context clearly indicates otherwise:
"Employee." An employee or a physician of any of the following that delivers direct care to a
consumer:
(1) A health care facility.
(2) A health care provider.
(3) The private practice of a physician.
(4) An employment agency.
"Employment agency." A public or private organization that provides employment services for
persons seeking employment and for potential employers seeking employees.
"Title." A license, certification or registration held by the employee.
Section 2. This act shall take effect as follows:
(1) The addition of section 809.2(a)(2) and (3) of the act shall take effect June 1, 2015.
(2) The remainder of this act shall take effect in 60 days.
20090HB1482PN4370
Corporate Practice of Medicine
A recently passed state statute appears to allow health care facilities, which includes hospices, to
employ physicians to provide medical services.
Case law appears to prohibit corporations from employing physicians to provide medical services.
A health care practitioner may practice the healing arts as an employee or independent contractor of
a health care facility or health care provider or an affiliate of a health care facility
or health care provider established to provide health care. See 35 P.S. § 448.817a (2006). A health
care facility is defined as any health care facility providing clinically related health services, including
a hospice. See 35 P.S. § 448.103.
A court held that a licensed practitioner may not practice among the public as a servant of an
unlicensed person or a corporation. See Neill v. Gimbel Bros., Inc., 199 A. 178, 182 (Pa. 1938).
Rhode Island
Board of Medical Licensure and Discipline
Rhode Island Board of Medical Licensure and Discipline Positions
12/15/2003 - Policy statement on office based esthetic procedures:
It is the position of the Board that office based cosmetic or esthetic procedures that require the use of
medical lasers, high-frequency radio waves, or injection of sclerosing chemicals or biologically active
compounds [e.g. Botulinum toxin A, Botox] are medical procedures.
Therefore, prior to undergoing such procedures patients must receive a medical evaluation for
appropriateness by a licensed and qualified physician or other practitioner acting within his/her scope
of practice. Although these procedures may be performed by an appropriately trained nonphysician
working under the supervision and direction of a physician or other practitioner acting within his/her
scope of practice, it is the supervising physician's [or other practitioner acting within his/her scope of
practice] responsibility to assure that procedures are conducted appropriately; with appropriate
assessment, consent and follow-up; and upon appropriate patients; and that all patient records are
maintained according to standards applicable for medical records; and that patient privacy is
protected. The supervising physician or other practitioner acting within his/her scope of practice is
responsible for any procedures carried out by nonphysicians under his/her direction.
Physicians [or other practitioner acting within his/her scope of practice] who perform and supervise
such procedures must be able to demonstrate appropriate training and experience. Such training and
experience may include, but is not limited to, residency or fellowship. The physician or other
practitioner acting within his/her scope of practice is responsible to assure and document adequate
training for individuals under his/her supervision.
Additionally, other cosmetic procedures such as dermabrasion or the application of potentially
scarring chemical treatments [e.g. so-called chemical peels] should also meet this same standard.
TITLE 5
Businesses and Professions
CHAPTER 5-37
Board of Medical Licensure and Discipline
SECTION 5-37-1
(13) "Physician" means a person with a license to practice allopathic or osteopathic medicine in this
state under the provisions of this chapter.
(14) "Practice of medicine" includes the practice of allopathic and osteopathic medicine. Any person
is regarded as practicing medicine within the meaning of this chapter who holds himself or herself out
as being able to diagnose, treat, operate, or prescribe for any person ill or alleged to be ill with
disease, pain, injury, deformity or abnormal physical or mental condition, or who either professes to
heal, offer or undertake, by any means or method to diagnose, treat, operate, or prescribe for any
person for disease, pain, injury, deformity or physical or mental condition. In addition, one who
attaches the title, M.D., physician, surgeon, D.O., osteopathic physician and surgeon, or any other
similar word or words or abbreviation to his or her name indicating that he or she is engaged in the
treatment or diagnosis of the diseases, injuries or conditions of persons shall be held to be engaged
in the practice of medicine.
Truth in Advertising
TITLE 5
Businesses and Professions
CHAPTER 5-37
Board of Medical Licensure and Discipline
SECTION 5-37-5.1
§ 5-37-5.1 Unprofessional conduct. – The term "unprofessional conduct" as used in this
chapter includes, but is not limited to, the following items or any combination of these items and may
be further defined by regulations established by the board with the prior approval of the director:
(2) All advertising of medical business, which is intended or has a tendency to deceive the
public;
§ 5-37-12. Unauthorized practice of medicine
Any person who is not lawfully authorized to practice medicine within this state, and registered
according to law, who practices medicine or surgery or attempts to practice medicine or surgery, or
any of the branches of medicine or surgery, after having received or with the intent of receiving, either
directly or indirectly, any bonus, gift or compensation, or who opens an office with intent to practice
medicine, or holds himself or herself out to the public as a practitioner of medicine, whether by
appending to his or her name the title of doctor or any abbreviation, or M.D., or any other title or
designation implying a practitioner of medicine, or in any other way, shall be imprisoned not more
than three (3) years, or fined not more than one thousand dollars ($1,000), or shall suffer both fine
and imprisonment; and in no case when any provision of this chapter has been violated shall the
person violating these provisions be entitled to receive compensation for services rendered.
Corporate Practice of Medicine
State statutes and regulations do not address CPOM.
South Carolina
Title 40 - Professions and Occupations
CHAPTER 47.
PHYSICIANS, SURGEONS AND OSTEOPATHS
ARTICLE 1.
GENERAL PROVISIONS
SECTION 40-47-20. Definitions.
(3) "Adverse disciplinary action" means a final decision by a United States or foreign licensing
jurisdiction, a peer review group, a health care institution, a professional or medical society or
association, or a court, which action was not resolved completely in the licensee's favor.
(4) "Agreed to jointly" means the agreement by the Board of Nursing and Board of Medical Examiners
on delegated medical acts that nurses perform and that are promulgated by the Board of Nursing in
regulation.
(5) "Approved written protocols" means specific statements developed collaboratively by the
physician or the medical staff and the advanced practice registered nurse (NP, CNM, or CNS) that
establish physician delegation for medical aspects of care, including the prescription of medications.
(6) "Approved written scope of practice guidelines" means specific statements developed by a
physician or the medical staff and a physician assistant that establish physician delegation for
medical aspects of care, including the prescription of medications.
(13) "Delegated medical acts" means additional acts delegated by a physician or dentist to a
physician assistant, respiratory care practitioner, anesthesiologist's assistant, or other practitioner
authorized by law under approved written scope of practice guidelines or approved written protocols
as provided by law in accordance with the applicable scope of professional practice. Delegated
medical acts must be performed under the supervision of a physician or dentist who must be readily
or immediately available for consultation in accordance with the applicable scope of professional
practice.
(14) "Delegated medical acts to the APRN" means additional acts delegated by a physician or dentist
to the Advanced Practice Registered Nurse (NP, CNM, or CNS) which may include formulating a
medical diagnosis and initiating, continuing, and modifying therapies, including prescribing drug
therapy, under approved written protocols as provided in Section 40-33-34 and Section 40-47-195.
Delegated medical acts to the APRN (NP, CNM, or CNS) must be agreed to jointly by both the Board
of Nursing and the Board of Medical Examiners. Delegated medical acts to the APRN (NP, CNM, or
CNS) must be performed under the general supervision of a physician or dentist who must be readily
available for consultation.
(20) "Immediately available" for the purpose of supervising unlicensed personnel means being
located within the office and ready for immediate utilization when needed.
(31) "Misconduct" means violation of any of the provisions of this chapter or regulations promulgated
by the board pursuant to this chapter or violation of any of the principles of ethics as adopted by the
board or incompetence or unprofessional conduct.
(32) "Osteopathic medicine" means a complete school of medicine and surgery utilizing all methods
of diagnosis and treatment in health and disease and placing special emphasis on the
interrelationship of the musculo-skeletal system to all other body systems.
(35) "Physician" means a doctor of medicine or doctor of osteopathic medicine licensed by the South
Carolina Board of Medical Examiners.
(36) "Practice of Medicine" means:
(a) advertising, holding out to the public or representing in any manner that one is authorized
to practice medicine in this State;
(b) offering or undertaking to prescribe, order, give, or administer any drug or medicine for the
use of any other person;
(c) offering or undertaking to prevent or to diagnose, correct or treat in any manner, or by any
means, methods, or devices, disease, illness, pain, wound, fracture, infirmity, defect, or abnormal
physical or mental condition of a person, including the management or pregnancy and parturition;
(d) offering or undertaking to perform any surgical operation upon a person;
(e) rendering a written or otherwise documented medical opinion concerning the diagnosis or
treatment of a patient or the actual rendering of treatment to a patient within this State by a physician
located outside the State as a result of transmission of individual patient data by electronic or other
means from within a state to such physician or his or her agent;
(f) rendering a determination of medical necessity or a decision affecting the diagnosis and/or
treatment of a patient is the practice of medicine subject to all of the powers provided to the Board of
Medical Examiners, except as provided in Section 38-59-25;
(g) using the designation Doctor, Doctor of Medicine, Doctor of Osteopathic Medicine,
Physician, Surgeon, Physician and Surgeon, Dr., M.D., D.O., or any combination of these in the
conduct of any occupation or profession pertaining to the prevention, diagnosis, or treatment of
human disease or condition unless such a designation additionally contains the description of another
branch of the healing arts for which one holds a valid license in this State that is applicable to the
clinical setting; and
(h) testifying as a physician in an administrative, civil, or criminal proceeding in this State by
expressing an expert medical opinion.
(37) "Practitioner" means a person who has been issued an authorization to practice in this
State. The term does not include persons who have not been issued a
license, registration,
certification, or other authorization to practice in this State, except as provided by law for persons
licensed in another state or jurisdiction.
(43) "Readily available" means the physician must be in near proximity and is able to be contacted
either in person or by telecommunications or other electronic means to provide consultation and
advice to the practitioner performing delegated medical acts. When application is made for more than
the equivalent of three full-time NPs, CNMs, or CNSs to practice with one physician, or when a NP,
CNM, or CNS is performing delegated medical acts in a practice site greater than forty-five miles from
the physician, the Board of Nursing and the Board of Medical Examiners shall review the application
to determine if adequate supervision exists.
(50) "Supervision" means the process of critically observing, directing, and evaluating another
person's performance, unless otherwise provided by law.
(53) "Unprofessional conduct" means acts or behavior that fail to meet the minimally acceptable
standard expected of similarly situated professionals including, but not limited to, conduct that may be
harmful to the health, safety, and welfare of the public, conduct that may reflect negatively on one's
fitness to practice, or conduct that may violate any provision of the code of ethics adopted by the
board or a specialty.
South Carolina Board of Medical Examiners
LLR-BOARD OF MEDICAL EXAMINERS
Approved by the Board: October 18-19, 1999 Board meeting
Amended at the: February 6-8, 2005 Board meeting
February 5-7, 2007 Board meeting
November 3-5, 2007 Board meeting
Service Area: Medical
Subject: Laser and Other Devices
MEDICAL DEVICES/DELEGATABLE MEDICAL ACT
SCOPE OF PRACTICE
Purpose
•
To provide model legislative and regulatory language upon which the state medical board can
develop or improve their regulations governing the scope of practice. The goal is to protect
patient safety, and ensure that the physicians' manner commensurates with their education
and training.
Definitions
•
•
•
•
•
•
•
"Adverse incident" means any patient complication or any unforeseen unintended outcome, or
perception by the patient of complications.
"Board certified physician" means an ABMS/ABOMS board-certified or board eligible physician
licensed by the state to practice medicine.
"Cutaneous medicine" means performing any act or procedure that, by its use, can alter or
damage living tissue. This includes, but is not limited to, the use of all lasers, light sources,
microwave energy, electrical impulses, chemical applications, particle sanding, the injection or
insertion of foreign or natural substances, or soft tissue augmentation.
"Light-based medical device" means any device such as lasers, light sources, intense pulsed
light and microwave energy that has the ability to alter or damage living human tissue.
"Non-physician" means any person that may work under the supervision of a licensed
physician.
"Patient" means any member of the public who is provided access to a procedure performed
by a licensed physician or under the supervision of a licensed physician.
"Training" means acceptable training programs such as those that conform to ABMS/ABOMS
or specialty society standards; or training that pertains to cutaneous medicine, and the physics
and safety of light-based devices.
Physician Responsibilities
•
•
•
•
If advertising as board-certified, a physician must specify which ABMS/ABOMS board (s) they
are certified by.
The physician must examine each patient prior to any initial treatment or prior to authorizing
treatment by a non-physician.
The physician should examine any significant new problems existing with the patient.
The physician must only perform procedures that are within his/her scope of practice based on
his/her education and training.
•
•
•
•
•
•
When performing or providing supervision for cutaneous medical procedure, a physician must
have adequate training in the procedure and the devices used for performing the procedure.
The physician must only delegate procedures to non-physicians that are working within their
scope of practice based on their education and training.
The physician shall develop written office protocols for non-physicians under his/her
supervision for non-physicians to follow when using all devices, including light-based medical
devices. The written office protocols must be compliant with existing state law. The written
protocol should include:
o The physician (and back-up physician if applicable) responsible for supervision of the
non-physician.
o A statement of activities, decision criteria, and plan the supervised non-physician must
follow when performing the light-based procedure.
o Identification of all devices and settings, including light-based devices, to be used for
patients who meet selection criteria.
o Methods by which all devices, including light-based devices are to be operated and
maintained.
o A description of appropriate care and follow-up for common complications, serious
injury, or emergencies.
The physician shall provide on-site supervision for all non-physicians under his/her supervision
performing cutaneous medical procedures. The physician must be immediately available at all
times in the event of complication or emergency.
The physician shall notify the patient if the procedure will be performed by a non-physician,
and obtain their consent.
The physician shall maintain profession and legal responsibility for the patient’s care and
treatment at all times.
Non-physician Responsibilities
•
•
•
•
•
•
•
Non-physician must only perform procedures under direct supervision that are within their
scope of practice, based on their education and training.
Non-physicians must have documentation of their training.
Non-physicians must be properly licensed (if applicable) by the appropriate state board.
Non-physicians must follow written office protocols when performing procedures using all
medical devices, including light-based medical devices.
Non-physicians must report all adverse incidents to the supervising physician and document
them in the patient’s chart.
Non-physician must satisfactorily complete a documented special education and training
program on applicable: laser physics, safety, techniques, and pre and post operative care and
laser safety, which includes supervised practice and clinical skill competency.
Continuing education for these procedures is ongoing and documented.
Truth in Advertising
SECTION 40-47-110. Misconduct constituting grounds for disciplinary action; temporary suspensions;
review of final actions; conduct subverting security or integrity of medical licensing examination
process.
(A) In addition to the grounds provided in Section 40-1-110, upon finding misconduct that constitutes
one or more of the grounds for disciplinary action the board may cancel, fine, suspend, revoke, issue
a public reprimand or a private reprimand, or restrict, including probation or other reasonable action
such as requiring additional education or training or limitation on practice, the authorization to practice
of a person who has engaged in misconduct.
(B) "Misconduct" that constitutes grounds for disciplinary action is a showing to the board by the
preponderance of evidence that a licensee has:
(1) used a false, fraudulent, or forged statement or document or practiced a fraudulent, deceitful, or
dishonest act in connection with a licensing requirement;
(7) knowingly performed an act that in any way assists an unlicensed person to practice;
(9) engaged in dishonorable, unethical or unprofessional conduct that is likely either to deceive,
defraud, or harm the public;
(10) used a false or fraudulent statement in a document connected with the licensee's practice;
(11) obtained fees or assisted in obtaining fees under dishonorable, false, or fraudulent
circumstances;
Corporate Practice of Medicine
State statutes and regulations do not address CPOM.
Case law appears to prohibit corporations from employing physicians to provide medical services.
South Carolina has a common law prohibition against the CPOM. See Baird v. Charleston County,
511 S.E.2d 69, 78 (S.C. 1999).
A corporation may not engage in the practice of medicine even through licensed employees. See
Wadsworth v. McRae Drug Co., 28 S.E.2d 417, 419 (S.C. 1943).
South Dakota
§36-4-8.2. Surgery constituting practice of medicine
Surgery constituting the practice of medicine includes the use of a laser or ionizing radiation for the
purpose of cutting or otherwise altering human tissue for diagnostic, palliative, or therapeutic
purposes.
South Dakota Administrative Rules
20: 42 Cosmetologists, Estheticians, and Nail Technicians
20:42:04:04.03. Prohibited equipment and procedures. The following equipment and
procedures are prohibited:
(1) Dermaplane procedures, dermabrasion procedures, ultrasound equipment, blades, knives,
and any tools, except for lancets used specifically for extraction of impurities, that invade the skin or
living cells; and
(2) Any procedure in which human tissue is cut or altered by mechanical or energy form,
including electrical or laser energy or ionizing radiation.
Source: 29 SDR 176, effective July 1, 2003.
Truth in Advertising
§36-4-30. Acts considered unprofessional conduct--Criminal prosecution. The term,
unprofessional or dishonorable conduct, as used in this chapter includes:
(5)
All advertising of medical business in which untruthful or improbable statements are
made or which are calculated to mislead or deceive the public;
§36-2-3. Use of word “doctor” as evidence of practice--Basic science certificate required
If any person appends to his name the word “doctor” or any contraction thereof, any other word,
abbreviation, or designation indicating that he is qualified to make diagnosis or treatment, such shall
constitute prima facie evidence that such person is holding himself out as qualified to engage in such
diagnosis or treatment.
§36-4-9. Use of title and other acts constituting practice of medicine.
For the purpose of this chapter, "practice of medicine or osteopathy" includes, but not by way of
limitation, to append or prefix the letters M.D., or D.O. or the title of Doctor or Dr. or Specialist or
Osteopath or any other sign or appellation in a medical sense to one's name or to profess publicly to
be a physician or surgeon or to recommend, prescribe or direct for the use of any person any drug,
medicine, apparatus, or other agency for the cure, relief or palliation of any ailment or disease of the
mind or body or the cure or relief of any wound, fracture or bodily injury or deformity.
§36-4-23. Advertising and printed material to show type of practice for which licensed-Violation as misdemeanor
No person practicing any of the healing arts shall use the title “doctor” or any contraction thereof, in
connection with his business or profession, or any written or printed material, or in connection with
any advertising, unless he add after his name the recognized abbreviation or specification of the
branch of the healing art in which he is licensed to practice and is engaged. A violation of this section
is a Class 1 misdemeanor.
Corporate Practice of Medicine
State law appears to prohibit a corporation from practicing medicine through employed physicians if
the corporation gains profit from the physician's practice of medicine.
§36-4-8.1. Corporation prohibited from practice of medicine or osteopathy.
Except as provided in chapter 47-11, it is the public policy of this state that a corporation may not
practice medicine or osteopathy. A corporation is not engaged in the practice of medicine or
osteopathy and is not in violation of § 36-4-8 by entering into an employment agreement with a
physician licensed pursuant to this chapter if the agreement or the relationship it creates does not:
(1)
In any manner, directly or indirectly, supplant, diminish or regulate the physician's
independent judgment concerning the practice of medicine or the diagnosis and treatment of any
patient;
(2)
Result in profit to the corporation from the practice of medicine itself, such as by the
corporation charging a greater fee for the physician's services than that which he would otherwise
reasonably charge as an independent practitioner, except that the corporation may make additional
charges reasonably associated with the services rendered, such as facility, equipment or
administrative charges; and
(3)
Remain effective for a period of more than three years, after which it may be renewed
by both parties annually.
Source: SL 1993, ch 271, § 1.
Public policy prohibits corporations from practicing medicine. Nonetheless, a corporation is not
practicing medicine when it hires a physician if the corporation does not, in any manner, influence or
diminish the physician's independent judgment, or gain profit from the practice of medicine itself. See
S.D. Codified Laws Ann. § 36-4-8.1 (2006).
Tennessee
63-6-204. “Practice of medicine” defined. —
(a) (1) Any person shall be regarded as practicing medicine within the meaning of this chapter who
treats, or professes to diagnose, treat, operates on or prescribes for any physical ailment or any
physical injury to or deformity of another.
0880-02-.14 SPECIALLY REGULATED AREAS AND ASPECTS OF MEDICAL PRACTICE.
(10) Use of Laser Equipment - Any procedure encompassed within the definition of the practice of
medicine contained in T.C.A. § 63-6-204 that is to be performed by use of a laser shall be
considered, except as provided in T.C.A. §§ 63-26-102 (5) and 63-9-106, to be the practice of
medicine and any person performing such procedure must be under the supervision of a
licensed physician.
0880-02-.21 OFFICE BASED SURGERY. A license to practice medicine issued pursuant to T.C.A. §
63-6-204 authorizes the holder to perform surgery. To the extent that any licensee performs surgery
in his or her office rather than a hospital, abortion clinic, or ASTC, that licensee, or the governing
body of the entity lawfully authorized to practice medicine wherein the surgery is to be performed,
shall comply with these rules.
(3) Definitions
(o) Surgery - The excision or resection, partial or complete, destruction, incision or other
structural alteration of human tissue by any means (including through the use of lasers)
performed upon the body of a living human for purposes of preserving health,
diagnosing or curing disease, repairing injury, correcting deformity or defects,
prolonging life, relieving suffering, or for aesthetic, reconstructive or cosmetic purposes,
to include, but not limited to: incision or curettage of tissue or an organ; suture or other
repair of tissue or organ, including a closed or an open reduction of a fracture;
extraction of tissue, including premature extraction of products of conception from the
uterus; and insertion of natural or artificial implants. For the purpose of this rule, certain
diagnostic and therapeutic procedures requiring medication to immobilize the patient
are contained within the definition of surgery.
(8) Procedure Specific Restrictions
(b) Laser surgery - Laser surgeries performed pursuant to these rules require written policies
and procedures that include, but are not limited to, laser safety, education, training, and the
supervision of other licensed health care practitioners who are performing laser treatments. A
safe environment shall be maintained for laser surgery.
(10) Use of Laser Equipment - Any procedure encompassed within the definition of the practice of
medicine contained in T.C.A. § 63-6-204 that is to be performed by use of a laser shall be considered,
except as provided in T.C.A. §§ 63-26-102 (5) and 63-9-106, to be the practice of medicine and any
person performing such procedure must be under the supervision of a licensed physician.
Truth in Advertising
63-6-214. Grounds for license denial, suspension or revocation — Reporting misconduct. —
(a) The board has the power to:
(1) Deny an application for a license to any applicant who applies for the same through reciprocity
or otherwise;
(2) Permanently or temporarily withhold issuance of a license;
(3) Suspend, or limit or restrict a previously issued license for such time and in such manner as
the board may determine;
(4) Reprimand or take such action in relation to disciplining an applicant or licensee, including, but
not limited to, informal settlements, private censures and warnings, as the board in its discretion may
deem proper; or
(5) Permanently revoke a license.
(b) The grounds upon which the board shall exercise such power include, but are not limited to:
(3) Making false statements or representations, being guilty of fraud or deceit in obtaining
admission to practice or being guilty of fraud or deceit in the practice of medicine;
(8) The advertising of medical business in which untrue or misleading statements are made or
causing
the publication or circulation of fraudulent advertising relative to any disease, human
ailment or conditions;
63-6-215. Advertising. —
(a) The board shall adopt rules and regulations to regulate the nature, manner, content and extent of
advertising by practitioners who are under the jurisdiction of such board.
(b) If advertising is permitted, all methods must be allowed: newspaper, radio and television.
0880-02-.14 SPECIALLY REGULATED AREAS AND ASPECTS OF MEDICAL PRACTICE.
(11) Use of Titles - Any person who possesses a valid, current and active license issued by the Board
that has not been suspended or revoked has the right to use the title “Medical Doctor” or “M.D.” and
to practice medicine, as defined in T.C.A. §§ 63-6-204. Any person licensed by the Board to whom
this rule applies must use one of the titles authorized by this rule in every “advertisement” [as that
term is defined in rule 0880-02-.13(2)(a)] he or she publishes or the failure to do so will constitute an
omission of a material fact which makes the advertisement misleading and deceptive and subjects
the physician to disciplinary action pursuant to T.C.A. § 63-6-214(b)(1), (b)(3), (b)(8) and (b)(9).
Corporate Practice of Medicine
State regulations appear to allow a corporation to employ a physician to provide medical services if
the corporation does not interfere with the physician's independent medical judgment.
The practice of medicine by non-professional corporations is allowed if the employment relationship
between the physician and the corporation is evidenced by a written contract with a job description
and with language that does not restrict the physician from exercising independent medical judgment
in diagnosing and treating patients. If so, then the corporation shall not be deemed to be engaged in
the practice of medicine. See Tenn. Code Ann. § 63-6-204(c) (2006).
Texas
Sec. 151.002. DEFINITIONS. (a) In this subtitle:
(12) "Physician" means a person licensed to practice medicine in this state.
(13) "Practicing medicine" means the diagnosis, treatment, or offer to treat a mental or
physical disease or disorder or a physical deformity or injury by any system or method, or the attempt
to effect cures of those conditions, by a person who:
(A) publicly professes to be a physician or surgeon; or
(B) directly or indirectly charges money or other compensation for those
services.
(14) "Surgery" includes:
(A) surgical services, procedures, and operations; and
(B) the procedures described in the surgery section of the common procedure
coding system as adopted by the Health Care Financing Administration of the United States
Department of Health and Human Services.
(b) The terms "physician" and "surgeon" are synonyms. As used in this subtitle, the terms
"practitioner" and "practitioner of medicine" include physicians and surgeons.
SUBCHAPTER M. LASER HAIR REMOVAL
Sec. 401.501. DEFINITIONS. In this subchapter:
(1) "Department" means the Department of State Health Services.
(2) "Executive commissioner" means the executive commissioner of the Health and
Human Services Commission.
(3) "Laser hair removal" means the use of a laser or pulsed light device for nonablative
hair removal procedures.
(4) "Laser hair removal facility" means a business location that provides laser hair
removal.
(5) "Laser or pulsed light device" means a device approved by the department and the
United States Food and Drug Administration for laser hair removal.
(6) "Nonablative hair removal procedure" means a hair removal procedure using a laser
or pulsed light device that does not remove the epidermis.
(7) "Operator" means the owner of a laser hair removal facility, an agent of an owner,
or an independent contractor of a laser hair removal facility.
Sec. 401.502. EXAMINATION. The executive commissioner may adopt rules to govern the
development and administration of an examination for an applicant under this subchapter.
Sec. 401.503. APPLICATION PROCESS. (a) An application for a certificate or license under
this subchapter must be made on a form prescribed and provided by the department.
(b) The application must require an applicant to provide sworn statements relating to the
applicant's education and to provide other information required by the department.
Sec. 401.504. CERTIFICATE FOR INDIVIDUALS REQUIRED. (a) A person may not perform
or attempt to perform laser hair removal unless the person holds the appropriate certificate under this
subchapter.
(b) A certificate issued under this subchapter only authorizes a person to perform nonablative
cosmetic laser hair removal. The certificate does not authorize the person to diagnose, treat, or offer
to treat any client for any illness, disease, injury, defect, or deformity of the human body. The
certificate holder shall specifically disclose this limitation in writing to all clients and prospective
clients.
(c) This subchapter does not require a health professional licensed under another law to hold
a certificate under this subchapter to perform laser hair removal if the performance of laser hair
removal is within the scope of that professional's practice as determined by the professional's
licensing board.
(d) This subchapter does not apply to a physician or to a physician's employee or delegate
acting under Chapter 157, Occupations Code.
Sec. 401.505. CERTIFIED LASER HAIR REMOVAL PROFESSIONAL. (a) An applicant for a
laser hair removal professional certificate must:
(1) be certified by a recognized certifying agency, including the Society for Clinical and
Medical Hair Removal or another certification entity approved by the department;
(2) meet the requirements for a senior laser hair removal technician certificate under
Section 401.506; and
(3) pass an examination administered by the department.
(b) A certified laser hair removal professional acting under the protocol established with a
consulting physician may perform laser hair removal without supervision.
Sec. 401.506. SENIOR LASER HAIR REMOVAL TECHNICIAN. (a) Except as provided by
Subsection (b), an applicant for a senior laser hair removal technician certificate must:
(1) meet the requirements for a laser hair removal technician certificate under Section
401.507; and
(2) have supervised at least 100 laser hair removal procedures, as audited by a
certified laser hair removal professional.
(b) The qualifications for eligibility for an applicant for a senior laser hair removal technician
certificate who is a licensed health professional shall be established by the entity that issues licenses
for that health profession.
Sec. 401.507. LASER HAIR REMOVAL TECHNICIAN. An applicant for a laser hair removal
technician certificate must:
(1) meet the requirements for a laser hair removal apprentice-in-training certificate
under Section 401.508; and
(2) have performed at least 100 laser hair removal procedures under the direct
supervision of a senior laser hair removal technician or a certified laser hair removal professional.
Sec. 401.508. LASER HAIR REMOVAL APPRENTICE-IN-TRAINING. (a) An applicant for a
laser hair removal apprentice-in-training certificate must have at least 24 hours of training in safety,
laser physics, skin typing, skin reactions, treatment protocols, burns, eye protection, emergencies,
and posttreatment protocols.
(b) A laser hair removal apprentice-in-training must work directly under the supervision of a
senior laser hair removal technician or a certified laser hair removal professional.
(c) A person must be at least 18 years of age to qualify to be a laser hair removal apprenticein-training.
Sec. 401.509. CONTINUING EDUCATION.
The department shall recognize, prepare, or
administer continuing education programs for certificate holders. A certificate holder must participate
in the programs to the extent required by department rule to renew the person's certificate.
Sec. 401.510. FACILITY LICENSE REQUIRED. (a) A person may not operate a laser hair
removal facility unless the person holds a license issued under this subchapter to operate the facility.
(b) A separate license is required for each laser hair removal facility.
(c) This section does not apply to:
(1) a facility owned or operated by a physician for the practice of medicine;
(2) a licensed hospital; or
(3) a clinic owned or operated by a licensed hospital.
Sec. 401.511. EXPIRATION OF CERTIFICATE OR LICENSE. The executive commissioner
by rule may adopt a system under which certificates and licenses expire on various dates during the
year.
Sec. 401.512. RENEWAL OF CERTIFICATE OR LICENSE.
(a)
A certificate or license
expires on the second anniversary of the date of issuance.
(b) A person must renew the person's certificate or license on or before the expiration date.
(c) The department shall issue a renewal certificate or license on receipt of a renewal
application in the form prescribed by the department, accompanied by a renewal fee in an amount
equal to the original certificate or license fee.
Sec. 401.513. DISPLAY OF LICENSE OR CERTIFICATE.
A person holding a license or
certificate under this subchapter shall display the person's license or certificate in an open public area
of the laser hair removal facility.
Sec. 401.514. LASER OR PULSED LIGHT DEVICE. (a) A laser or pulsed light device used
for laser hair removal in a laser hair removal facility must comply with all applicable federal and state
laws and regulations.
(b) A person who adulterates or misbrands a laser or pulsed light device violates Chapter 431.
The department may investigate a person accused of adulterating or misbranding a laser or pulsed
light device.
(c) A person may only use a laser or pulsed light device approved for laser hair removal by the
federal Food and Drug Administration for that purpose and may only use the device at the settings
expected to safely remove hair.
Sec. 401.515. CUSTOMER NOTICE; LIABILITY. (a) A laser hair removal facility shall give
each customer a written statement outlining the relevant risks associated with laser hair removal,
including a warning that failure to use the eye protection provided to the customer by the laser hair
removal facility may result in damage to the eyes.
(b) The executive commissioner shall adopt rules relating to the customer notice.
(c) Compliance with the notice requirement does not affect the liability of the laser hair
removal facility operator or a manufacturer of a laser or pulsed light device.
Sec. 401.516. WARNING SIGNS. (a) A laser hair removal facility shall post a warning sign
as prescribed by the department in a conspicuous location readily visible to a person entering the
facility.
The sign must provide a toll-free telephone number for the department and inform the
customer that the customer may call the department.
(b) The executive commissioner shall adopt rules specifying the size, content, and design of
the sign, with wording listing the potential dangers involved.
(c) The department shall include with a license application and an application for renewal of a
license a description of the design standards required for a sign under this section.
Sec. 401.517. OPERATIONAL REQUIREMENTS. (a) Except as provided by Subsection (b),
a laser hair removal facility shall have a certified laser hair removal professional or a licensed health
professional described by Section 401.504(c) present to supervise the laser hair removal procedures
performed at the facility during the facility's operating hours.
(b) A laser hair removal facility may continue to perform laser hair removal procedures after
the facility's certified laser hair removal professional leaves the facility if a senior laser hair removal
technician is present to perform or supervise each procedure. Not later than the 45th day after the
date the facility's certified laser hair removal professional leaves the facility:
(1) the facility's senior laser hair removal technician must become certified as a laser
hair removal professional under Section 401.505; or
(2) the facility must hire a new certified laser hair removal professional.
Sec. 401.518. SAFETY.
(a)
A laser hair removal facility operator is responsible for
maintaining the laser hair removal facility's compliance with the requirements of this subchapter and
department rules relating to laser and pulsed light devices.
(b) A laser hair removal facility operator may not claim, advertise, or distribute promotional
materials that claim that laser hair removal is free from risk or provides any medical benefit.
(c) A laser hair removal facility operator may not produce false or misleading advertising
regarding the services offered at the facility.
Sec. 401.519. CONSULTING PHYSICIAN.
(a)
A laser hair removal facility must have a
written contract with a consulting physician to:
(1) establish proper protocols for the services provided at the facility; and
(2) audit the laser hair removal facility's protocols and operations.
(b) Under the rules of the department, a laser hair removal facility must document with the
department the facility's contractual relationship with the consulting physician.
(c) The consulting physician must be available for emergency consultation with the facility as
appropriate to the circumstances, including, if the physician considers it necessary, an emergency
appointment with the client. If the consulting physician is unavailable for an emergency consultation,
another designated physician must be available for the consultation with the facility relating to care for
the client.
(d) This subchapter does not relieve a consulting physician or another health care
professional from complying with applicable regulations prescribed by a state or federal agency.
Sec. 401.520. DISCLOSURE OF RECORD PROHIBITED; EXCEPTION.
(a)
Except as
provided by Subsection (b), an operator or other person may not disclose a customer record required
to be kept by the department.
(b) An operator or other person may disclose a customer record if:
(1) the customer or a person authorized to act on behalf of the customer requests the
record;
(2) the department, the Texas Medical Board, a health authority, or an authorized agent
requests the record;
(3) the customer consents in writing to disclosure of the record to another person;
(4) the customer is a victim, witness, or defendant in a criminal proceeding and the
record is relevant to that proceeding;
(5) the record is requested in a criminal or civil proceeding by court order or subpoena;
or
(6) disclosure is otherwise required by law.
Sec. 401.521. PROHIBITED PRACTICE. (a) A person may not operate a laser or pulsed light
device with the intent to treat an illness, disease, injury, or physical defect or deformity unless the
person is:
(1) a physician;
(2) acting under a physician's order; or
(3) authorized under other law to treat the illness, disease, injury, or physical defect or
deformity in that manner.
(b) A person who violates Subsection (a) is practicing medicine in violation of Subtitle B, Title
3, Occupations Code, and is subject to the penalties under that subtitle and under Section 401.522.
Sec. 401.522. ENFORCEMENT;
PENALTIES.
(a)
The
department
may
impose
an
administrative penalty on a person who violates this subchapter or a rule adopted under this
subchapter. The amount of the penalty may not exceed $5,000 for each violation.
(b) The department may suspend or revoke a license or certificate issued under this
subchapter in addition to or instead of imposing a penalty under Subsection (a).
(c) The executive commissioner shall adopt rules as necessary to implement this section.
SECTION 2. Section 483.041(c), Health and Safety Code, is amended to read as follows:
(c) Subsection (a) does not apply to the possession of a dangerous drug in the usual course
of business or practice or in the performance of official duties by the following persons or an agent or
employee of the person:
(1) a pharmacy licensed by the board;
(2) a practitioner;
(3) a person who obtains a dangerous drug for lawful research, teaching, or testing, but
not for resale;
(4) a hospital that obtains a dangerous drug for lawful administration by a practitioner;
(5) an officer or employee of the federal, state, or local government;
(6) a manufacturer or wholesaler licensed by the Department of State Health Services
under Chapter 431 (Texas Food, Drug, and Cosmetic Act);
(7) a carrier or warehouseman;
(8) a home and community support services agency licensed under and acting in
accordance with Chapter 142;
(9) a licensed midwife who obtains oxygen for administration to a mother or newborn or
who obtains a dangerous drug for the administration of prophylaxis to a newborn for the prevention of
ophthalmia neonatorum in accordance with Section 203.353, Occupations Code; [or]
(10) a salvage broker or salvage operator licensed under Chapter 432; or
(11) a certified laser hair removal professional under Subchapter M, Chapter 401, who
possesses and uses a laser or pulsed light device approved by and registered with the department
and in compliance with department rules for the sole purpose of cosmetic nonablative hair removal.
SECTION 3. (a) Not later than September 1, 2010, a laser hair removal facility in operation on
the effective date of this Act must obtain licenses and certificates required by Subchapter M, Chapter
401, Health and Safety Code, as added by this Act.
(b) Not later than March 1, 2010, the executive commissioner of the Health and Human
Services Commission shall adopt rules as required by Subchapter M, Chapter 401, Health and Safety
Code, as added by this Act.
SECTION 4. (a) Except as provided by Subsection (b) of this section, this Act takes effect
September 1, 2009.
(b) Sections 401.504, 401.510, 401.517, 401.521, and 401.522, Health and Safety Code, as
added by this Act, and Section 483.041(c), Health and Safety Code, as amended by this Act, take
effect September 1, 2010.
Truth in Advertising
Sec. 164.052. PROHIBITED PRACTICES BY PHYSICIAN OR LICENSE
APPLICANT. (a) A physician or an applicant for a license to practice medicine commits a prohibited
practice if that person:
(6) uses an advertising statement that is false, misleading, or deceptive;
(7) advertises professional superiority or the performance of professional service in a
superior manner if that advertising is not readily subject to verification;
Chapter 164, Physician Advertising
§164.6. Required Disclosures on Websites.
(a) Disclosure. A licensee that maintains a website in relation to the license’s professional practice
must clearly disclose:
(1) ownership of the website;
(2) specific services provided;
(3) office address and contact information;
(4) licensure and qualifications of physician(s) and associated health care providers;
(5) fees for online consultation and services and how payment is to be made;
(6) financial interest in any information, products, or services;
(7) appropriate uses and limitations of the site, including
providing health advice and emergency health situations;
(8) uses and response times for e-mails, electronic messages, and other communications transmitted
via the site;
(9) to whom patient health information may be disclosed and for what purpose;
(10) rights of patients with respect to patient health information;
and
(11) information collected and any passive tracking mechanisms utilized.
(b) Accountability. Licensees must provide patients with a clear mechanism to:
(1) access, supplement, and amend patient-provided personal health information;
(2) provide feedback regarding the site and the quality of information and services; and
(3) register complaints, including information regarding filing a complaint with the Texas Medical
Board as provided for in Chapter 178 of this title (relating to Complaints).
(c) Advertising/Promotion of Goods or Products. Advertising or promotion of goods or products that a
licensee sells outside the normal course of business from which the physician receives direct
remuneration or incentives is prohibited.
Corporate Practice of Medicine
State statutes and regulations do not address CPOM.
Case law appears to prohibit corporations from employing physicians to provide medical services.
It is a violation of the doctrine for a corporation comprised of lay persons to hire licensed physicians to
treat patients and receive fees for these services. See Gupta v. E. Idaho Tumor Institute, Inc., 140
S.W.3d 747, 752 (Tex. App. 2004).
Utah
UTAH MEDICAL PRACTICE ACT
Part 1 - General Provisions
58-67-102. Definitions.
(8) "Practice of medicine" means:
(a) to diagnose, treat, correct, administer anesthesia or prescribe for any human disease,
ailment, injury, infirmity, deformity, pain or other condition, physical or mental, real or
imaginary, or to attempt to do so, by any means or instrumentality, and by an individual in Utah
or outside the state upon or for any human within the state, except that conduct described in
this Subsection (8)(a) that is performed by a person legally and in accordance with a license
issued under another chapter of this title does not constitute the practice of medicine;
(b) when a person not licensed as a physician directs a licensee under this chapter to withhold
or alter the health care services that the licensee has ordered, but practice of medicine does
not include any conduct under Subsection 58-67-501(2);
(c) to maintain an office or place of business for the purpose of doing any of the acts described
in Subsection (8)(a) whether or not for compensation; or
(d) to use, in the conduct of any occupation or profession pertaining to the diagnosis or
treatment of human diseases or conditions in any printed material, stationery, letterhead,
envelopes, signs, or advertisements, the designation "doctor", "doctor of medicine",
"physician", "surgeon", "physician and surgeon", "Dr.," "M.D.," or any combination of these
designations in any manner which might cause a reasonable person to believe the individual
using the designation is a licensed physician and surgeon, and if the party using the
designation is not a licensed physician and surgeon, the designation must additionally contain
the description of the branch of the healing arts for which the person has a license.
58-11a-102. Definitions.
As used in this chapter:
(10) "Direct supervision" means that the supervisor of an apprentice or the instructor of a student is
immediately available for consultation, advice, instruction, and evaluation.
(11) "Electrologist" means a person who is licensed under this chapter to engage in the practice of
electrology.
(13) "Esthetician" means a person who is licensed under this chapter to engage in the practice of
esthetics.
(20) "Master esthetician" means an individual who is licensed under this chapter to engage in the
practice of master-level esthetics.
(25) "Practice of basic esthetics" means any one of the following skin care procedures done on the
head, face, neck, arms, hands, legs, feet, eyebrows, or eyelashes for cosmetic purposes and not for
the treatment of medical, physical, or mental ailments:
(a) cleansing, stimulating, manipulating, exercising, applying oils, antiseptics, clays, or masks,
manual extraction, including a comodone extractor, depilatories, waxes, tweezing, natural nail
manicures or pedicures, or callous removal by buffing or filing;
(b) limited chemical exfoliation as defined by rule;
(c) removing superfluous hair by means other than electrolysis;
(d) other esthetic preparations or procedures with the use of the hands, a high-frequency or
galvanic electrical apparatus, or a heat lamp for cosmetic purposes and not for the treatment of
medical, physical, or mental ailments; or
(e) cosmetic laser procedures under direct supervision of a licensed health care practitioner as
defined by rule, limited to the following:
(i) superfluous hair removal;
(ii) anti-aging resurfacing enhancements;
(iii) photo rejuvenation; or
(iv) tattoo removal.
(28) "Practice of electrology" means:
(a) the removal of superfluous hair from the body of a person by the use of electricity, waxing,
shaving, or tweezing; or
(b) cosmetic laser procedures under the general supervision of a licensed health care
practitioner as defined by rule, limited to superfluous hair removal.
(31) (a) "Practice of master-level esthetics" means:
(i) any of the following when done for cosmetic purposes on the head, face, neck, torso,
abdomen, back, arms, hands, legs, feet, eyebrows, or eyelashes and not for the treatment of
medical, physical, or mental ailments:
(A) body wraps as defined by rule;
(B) hydrotherapy as defined by rule;
(C) chemical exfoliation as defined by rule;
(D) advanced pedicures as defined by rule;
(E) sanding, including microdermabrasion;
(F) advanced extraction;
(G) other esthetic preparations or procedures with the use of:
(I) the hands; or
(II) a mechanical or electrical apparatus which is approved for use by division
rule for beautifying or similar work performed on the body for cosmetic purposes
and not for the treatment of a medical, physical, or mental ailment; or
(H) cosmetic laser procedures under the general supervision of a licensed health care
practitioner as defined by rule, with a physician's evaluation before the procedure, as
needed, and limited to the following:
(I) superfluous hair removal;
(II) anti-aging resurfacing enhancements;
(III) photo rejuvenation; or
(IV) tattoo removal with a physician's evaluation before the tattoo removal procedure;
and
(ii) lymphatic massage by manual or other means as defined by rule.
(b) Notwithstanding the provisions of Subsection (31)(a), a master-level esthetician may perform
procedures listed in Subsection (31)(a)(i) for noncosmetic purposes if done under the supervision of a
licensed health care practitioner acting within the scope of the licensed health care practitioner’s
license as defined by rule.
(c) The term "practice of master-level esthetics" includes the practice of esthetics.
Truth in Advertising
§ 58-1-501. Unlawful and unprofessional conduct
“Unprofessional conduct” means conduct, by a licensee or applicant, that is defined as unprofessional
conduct under this title or under any rule adopted under this title and includes:
•
practicing or attempting to practice an occupation or profession requiring licensure under this
title by any form of action or communication which is false, misleading, deceptive, or
fraudulent;
•
practicing or attempting to practice an occupation or profession regulated under this title
beyond the scope of the licensee's competency, abilities, or education;
•
practicing or attempting to practice an occupation or profession regulated under this title
beyond the scope of the licensee's license;
Corporate Practice of Medicine
State regulations appear to allow a corporation to employ a physician to provide medical services if
the corporation does not interfere with the physician's independent medical judgment.
An individual licensed physician may be employed by another person. See Utah Code Ann. § 58-67802(1)(b) (2006).
Any person who manages and has a financial interest in a licensed physician's professional practice
may not substantially interfere with a licensee's practice of medicine. See Utah Code Ann.§ 58-67501(1)(c) (2006).
Vermont
Title 26: Professions and Occupations
Chapter 23: MEDICINE AND SURGERY
26 V.S.A. § 1311. Definitions
§ 1311. Definitions
For the purposes of this chapter:
(1) A person who advertises or holds himself or herself out to the public as a physician or surgeon, or
who assumes the title or uses the words or letters "Dr.," "Doctor," "Professor," "M.D.," or "M.B.," in
connection with his or her name, or any other title implying or designating that he or she is a
practitioner of medicine or surgery in any of its branches, or shall advertise or hold himself or herself
out to the public as one skilled in the art of curing or alleviating disease, pain, bodily injuries, or
physical or nervous ailments, or shall prescribe, direct, recommend, or advise, give or sell for the use
of any person, any drug, medicine or other agency or application for the treatment, cure, or relief of
any bodily injury, pain, infirmity, or disease, or who follows the occupation of treating diseases by any
system or method, shall be deemed a physician, or practitioner of medicine or surgery.
(2) "Board" means the state board of medical practice established under section 1351 of this title.
(3) "License" means license to practice medicine and surgery in the state as defined in subchapter 3
of this chapter. "Licensee" includes individuals licensed under this chapter and chapter 7 of this title
and registrants and holders of certificates issued by the board.
(4) "Medical director" means, for purposes of this chapter, a physician who is board-certified or boardeligible in his or her field of specialty, as determined by the American Board of Medical Specialties
(ABMS), and who is charged by a health maintenance organization with responsibility for overseeing
all clinical activities of the plan in this state, or his or her designee.
(5) "Health maintenance organization", as used in this section, shall have the same meaning as
defined in subdivision 9402(10) of Title 18.
(6) "Members" means members of the board.
(7) "Secretary" means the secretary of the board. (Amended 1975, No. 249 (Adj. Sess.), § 1; 1999,
No. 133 (Adj. Sess.), § 49; 2001, No. 129 (Adj. Sess.), § 20, eff. June 13, 2002; 2003, No. 34, § 4, eff.
May 23, 2003; 2009, No. 25, § 10.)
Chapter 86: ELECTROLOGISTS
26 V.S.A. § 4402. Definitions
§ 4402. Definitions
As used in this chapter:
(1) "Director" means the director of the office of professional regulation.
(2) "Disciplinary action" means any action taken by an administrative law officer established under
subsection 129(j) of Title 3 against a certified electrologist or an applicant. It includes all sanctions of
any kind, including obtaining injunctions, refusal to grant or renew certification, suspension or
revocation of certification, issuing warnings and other similar sanctions.
(3) "Electrology" means the removal of hair by electrical current using needle/probe electrode-type
epilation which would include electrolysis (direct current/DC), thermolysis (alternating current/AC), or
a combination of both (superimposed or sequential blend). "Electrology" includes the use by properly
trained licensed electrologists of lasers approved by the United States Food and Drug Administration
for electrology and as otherwise permitted by Vermont law.
(4) "Electrology office" means a facility regularly used to offer or to perform the practice of electrology.
(5) "Practice of electrology" or "practicing electrology" means engaging in the performance of
electrology. (Added 1999, No. 133 (Adj. Sess.), § 46, eff. Jan. 1, 2001; amended 2001, No. 129 (Adj.
Sess.), § 37, eff. June 13, 2002; 2005, No. 148 (Adj. Sess.), § 49; 2009, No. 103 (Adj. Sess.), § 51.)
Truth in Advertising
Title 26: Professions and Occupations
Chapter 23: MEDICINE AND SURGERY
26 V.S.A. § 1314. Illegal practice
§ 1314. Illegal practice
(a) A person who, not being licensed, advertises or holds himself out to the public as described in
section 1311 of this title, or who, not being licensed, practices medicine or surgery as defined in
section 1311 of this title, or who practices medicine or surgery under a fictitious or assumed name, or
who impersonates another practitioner or signs a certificate of death for the purpose of burial or
removal, shall be imprisoned not more than three months or fined not more than $200.00 nor less
than $50.00, or both.
(b) An action shall not be maintained by such person for the recovery of compensation for such
services.
Corporate Practice of Medicine
State statutes and regulations do not address CPOM.
Title 26: Professions and Occupations
Chapter 23: MEDICINE AND SURGERY
26 V.S.A. § 1403. Professional corporations; medicine and surgery
§ 1403. Professional corporations; medicine and surgery
A person licensed to practice medicine and surgery under this chapter may own shares in a
professional corporation created under chapter 4 of Title 11 which provides professional services in
the medical and nursing professions. (Added 2007, No. 14, § 1, eff. May 2, 2007.)
Virginia
Section 54.1-2900
Practice of medicine or osteopathic medicine" means the prevention, diagnosis and treatment of
human physical or mental ailments, conditions, diseases, pain or infirmities by any means or method.
Va. Code Ann §54.1-2903.
§ 54.1-2903. What constitutes practice
Any person shall be regarded as practicing the healing arts who actually engages in such practice as
defined in this chapter, or who opens an office for such purpose, or who advertises or announces to
the public in any manner a readiness to practice or who uses in connection with his name the words
or letters "Doctor," "Dr.," "M.D.," "D.O.," "D.P.M.," "D.C.," "Healer," or any other title, word, letter or
designation intending to designate or imply that he is a practitioner of the healing arts or that he is
able to heal, cure or relieve those suffering from any injury, deformity or disease.
Section 54.1-2901(4) and (6).
4. Any registered professional nurse, licensed nurse practitioner, graduate laboratory technician or
other technical personnel who have been properly trained from rendering care or services within the
scope of their usual professional activities which shall include the taking of blood, the giving of
intravenous infusions and intravenous injections, and the insertion of tubes when performed under
the orders of a person licensed to practice medicine;
6. Any practitioner licensed or certified by the Board from delegating to personnel supervised by him,
such activities or functions as are nondiscretionary and do not require the exercise of professional
judgment for their performance and which are usually or customarily delegated to such persons by
practitioners of the healing arts, if such activities or functions are authorized by and performed for
such practitioners of the healing arts and responsibility for such activities or functions is assumed by
such practitioners of the healing arts;
The Board of Pharmacy Section 54.1-3455(3)
3. Any drug, not included in Schedules I, II, III, IV or V, required by federal law to bear on its label
prior to dispensing, at a minimum, the symbol "Rx only," or which bears the legend "Caution: Federal
Law Prohibits Dispensing Without Prescription" or "Caution: Federal Law Restricts This Drug To Use
By Or On The Order Of A Veterinarian" or any device which bears the legend "Caution: Federal Law
Restricts This Device To Sales By Or On The Order Of A __________________ ." (The blank should
be completed with the word "Physician," "Dentist," "Veterinarian," or with the professional designation
of any other practitioner licensed to use or order such device.)
Section 54.1-2400.01.
As used in this subtitle, "laser surgery" means treatment through revision, destruction, incision or
other structural alteration of human tissue using laser technology. Under this definition, the continued
use of laser technology solely for nonsurgical purposes of examination and diagnosis shall be
permitted for those professions whose licenses permit such use.
Truth in Advertising
§ 54.1-2915. Unprofessional conduct; grounds for refusal or disciplinary action.
A. The Board may refuse to admit a candidate to any examination; refuse to issue a certificate or
license to any applicant; reprimand any person; place any person on probation for such time as it may
designate; suspend any license for a stated period of time or indefinitely; or revoke any license for
any of the following acts of unprofessional conduct:
1. False statements or representations or fraud or deceit in obtaining admission to the practice,
or fraud or deceit in the practice of any branch of the healing arts;
7. Engaging in the practice of any of the healing arts under a false or assumed name, or
impersonating another practitioner of a like, similar, or different name
15. Publishing in any manner an advertisement relating to his professional practice that
contains a claim of superiority or violates Board regulations governing advertising;
Va. Code Ann §54.1-2903.
§ 54.1-2903
No person regulated under this chapter shall use the title "Doctor" or the abbreviation "Dr." in writing
or in advertising in connection with his practice unless he simultaneously uses a clarifying title, initials,
abbreviation or designation or language that identifies the type of practice for which he is licensed.
Corporate Practice of Medicine
State statutes and regulations do not address CPOM.
An Attorney General Opinion indicates that a corporation may employ a physician to provide medical
services.
There is no court decision or statute in Virginia adopting the "corporate practice of medicine" doctrine.
See 1992 Va. Op. Att'y. Gen. 147.
Washington
WAC 246-919-606 Nonsurgical medical cosmetic procedures (medical physicians) and 246918-126 Nonsurgical medical cosmetic procedures (medical physician assistants) defines the area of
medicine and sets minimum standards for the performance and the delegation of nonsurgical medical
cosmetic procedures by physicians and physician assistants in this state. The adopted new sections
will protect the public from potential harm or risk of harm.
WAC 246-918-126 Nonsurgical medical cosmetic procedures. (1) The purpose of this
rule is to establish the duties and responsibilities of a physician assistant who injects medication or
substances for cosmetic purposes or uses prescription devices for cosmetic purposes. These
procedures can result in complications such as visual impairment, blindness, inflammation, burns,
scarring, disfiguration, hypopigmentation and hyperpigmentation. The performance of these
procedures is the practice of medicine under RCW 18.71.011.
(2) This section does not apply to:
(a) Surgery;
(b) The use of prescription lasers, noncoherent light, intense pulsed light, radiofrequency, or
plasma as applied to the skin; this is covered in WAC 246-919-605 and 246-918-125;
(c) The practice of a profession by a licensed health care professional under methods or
means within the scope of practice permitted by such license;
(d) The use of nonprescription devices; and
(e) Intravenous therapy.
(3) Definitions. These definitions apply throughout this section unless the context clearly
requires otherwise.
(a) "Nonsurgical medical cosmetic procedure" means a procedure or treatment that
involves the injection of a medication or substance for cosmetic purposes, or the use of a prescription
device for cosmetic purposes. Laser, light, radiofrequency and plasma devices that are used to
topically penetrate the skin are devices used for cosmetic purposes, but are excluded under
subsection (2)(b) of this section, and are covered by WAC 246-919-605 and 246-918-125.
(b) "Physician" means an individual licensed under chapter 18.71 RCW.
(c) "Physician assistant" means an individual licensed under chapter 18.71A RCW.
(d) "Prescription device" means a device that the federal Food and Drug Administration has
designated as a prescription device, and can be sold only to persons with prescriptive authority in the
state in which they reside.
PHYSICIAN ASSISTANT RESPONSIBILITIES
(4) A physician assistant may perform a nonsurgical medical cosmetic procedure only after the
commission approves a practice plan permitting the physician assistant to perform such procedures.
A physician assistant must ensure that the supervising or sponsoring physician is in full compliance
with WAC 246-919-606.
(5) A physician assistant may not perform a nonsurgical cosmetic procedure unless his or
her supervising or sponsoring physician is fully and appropriately trained to perform that same
procedure.
(6) Prior to performing a nonsurgical medical cosmetic procedure, a physician assistant
must have appropriate training in, at a minimum:
(a) Techniques for each procedure;
(b) Cutaneous medicine;
(c) Indications and contraindications for each procedure;
(d) Preprocedural and postprocedural care;
(e) Recognition and acute management of potential complications that may result from the
procedure; and
(f) Infectious disease control involved with each treatment.
(7) The physician assistant must keep a record of his or her training in the office and
available for review upon request by a patient or a representative of the commission.
(8) Prior to performing a nonsurgical medical cosmetic procedure, either the physician
assistant or the delegating physician must:
(a) Take a history;
(b) Perform an appropriate physical examination;
(c) Make an appropriate diagnosis;
(d) Recommend appropriate treatment;
(e) Obtain the patient's informed consent including disclosing the credentials of the person
who will perform the procedure;
(f) Provide instructions for emergency and follow-up care; and
(g) Prepare an appropriate medical record.
(9) The physician assistant must ensure that there is a written office protocol for performing
the nonsurgical medical cosmetic procedure. A written office protocol must include, at a minimum, the
following:
(a) A statement of the activities, decision criteria, and plan the physician assistant must
follow when performing procedures under this rule;
(b) Selection criteria to screen patients for the appropriateness of treatment;
(c) A description of appropriate care and follow-up for common complications, serious
injury, or emergencies; and
(d) A statement of the activities, decision criteria, and plan the physician assistant must
follow if performing a procedure delegated by a physician pursuant to WAC 246-919-606, including
the method for documenting decisions made and a plan for communication or feedback to the
authorizing physician concerning specific decisions made.
(10) A physician assistant may not delegate the performance of a nonsurgical medical
cosmetic procedure to another individual.
(11) A physician assistant may perform a nonsurgical medical cosmetic procedure that uses
a medication or substance that the federal Food and Drug Administration has not approved, or that
the federal Food and Drug Administration has not approved for the particular purpose for which it is
used, so long as the physician assistant's sponsoring or supervising physician is on-site during the
entire procedure.
(12) A physician assistant may perform a nonsurgical medical cosmetic procedure at a
remote site. A physician assistant must comply with the established regulations governing physician
assistants working in remote sites, including obtaining commission approval to work in a remote site
under WAC 246-918-120.
(13) A physician assistant must ensure that each treatment is documented in the patient's
medical record.
(14) A physician assistant may not sell or give a prescription device to an individual who
does not possess prescriptive authority in the state in which the individual resides or practices.
(15) A physician assistant must ensure that all equipment used for procedures covered by
this section is inspected, calibrated, and certified as safe according to the manufacturer's
specifications.
(16) A physician assistant must participate in a quality assurance program required of the
supervising or sponsoring physician under WAC 246-919-606.
WAC 246-919-606 Nonsurgical medical cosmetic procedures. (1) The purpose of this rule is to
establish the duties and responsibilities of a physician who delegates the injection of medication or
substances for cosmetic purposes or the use of prescription devices for cosmetic purposes. These
procedures can result in complications such as visual impairment, blindness, inflammation, burns,
scarring, disfiguration, hypopigmentation and hyperpigmentation. The performance of these
procedures is the practice of medicine under RCW 18.71.011(3).
(2) This rule does not apply to:
(a) Surgery;
(b) The use of prescription lasers, noncoherent light, intense pulsed light, radiofrequency, or
plasma as applied to the skin; this is covered in WAC 246-919-605 and 246-918-125;
(c) The practice of a profession by a licensed health care professional under methods or
means within the scope of practice permitted by such license;
(d) The use of nonprescription devices; and
(e) Intravenous therapy.
(3) Definitions. These definitions apply throughout this section unless the context clearly
requires otherwise.
(a) "Nonsurgical medical cosmetic procedure" means a procedure or treatment that
involves the injection of a medication or substance for cosmetic purposes, or the use of a prescription
device for cosmetic purposes. Laser, light, radiofrequency and plasma devices that are used to
topically penetrate the skin are devices used for cosmetic purposes, but are excluded under
subsection (2)(b) of this section, and are covered by WAC 246-919-605 and 246-918-125.
(b) "Physician" means an individual licensed under chapter 18.71 RCW.
(c) "Prescription device" means a device that the federal Food and Drug Administration has
designated as a prescription device, and can be sold only to persons with prescriptive authority in the
state in which they reside.
PHYSICIAN RESPONSIBILITIES
(4) A physician must be fully and appropriately trained in a nonsurgical medical cosmetic
procedure prior to performing the procedure or delegating the procedure. The physician must keep a
record of his or her training in the office and available for review upon request by a patient or a
representative of the commission.
(5) Prior to authorizing a nonsurgical medical cosmetic procedure, a physician must:
(a) Take a history;
(b) Perform an appropriate physical examination;
(c) Make an appropriate diagnosis;
(d) Recommend appropriate treatment;
(e) Obtain the patient's informed consent;
(f) Provide instructions for emergency and follow-up care; and
(g) Prepare an appropriate medical record.
(6) Regardless of who performs the nonsurgical medical cosmetic procedure, the physician
is ultimately responsible for the safety of the patient.
(7) Regardless of who performs the nonsurgical medical cosmetic procedure, the physician is
responsible for ensuring that each treatment is documented in the patient's medical record.
(8) The physician must ensure that there is a quality assurance program for the facility at which
nonsurgical medical cosmetic procedures are performed regarding the selection and treatment of
patients. An appropriate quality assurance program must include the following:
(a) A mechanism to identify complications and untoward effects of treatment and to determine
their cause;
(b) A mechanism to review the adherence of supervised health care professionals to written
protocols;
(c) A mechanism to monitor the quality of treatments;
(d) A mechanism by which the findings of the quality assurance program are reviewed and
incorporated into future protocols required by subsection (10)(d) of this section and physician
supervising practices; and
(e) Ongoing training to maintain and improve the quality of treatment and performance of
supervised health care professionals.
(9) A physician may not sell or give a prescription device to an individual who does not possess
prescriptive authority in the state in which the individual resides or practices.
(10) The physician must ensure that all equipment used for procedures covered by this section is
inspected, calibrated, and certified as safe according to the manufacturer's specifications.
PHYSICIAN DELEGATION
(11) A physician who meets the above requirements may delegate a nonsurgical medical cosmetic
procedure to a properly trained physician assistant, registered nurse or licensed practical nurse,
provided all the following conditions are met:
(a) The treatment in no way involves surgery as that term is understood in the practice of
medicine;
(b) The physician delegates procedures that are within the delegate's lawful scope of practice;
(c) The delegate has appropriate training in, at a minimum:
(i) Techniques for each procedure;
(ii) Cutaneous medicine;
(iii) Indications and contraindications for each procedure;
(iv) Preprocedural and postprocedural care;
(v) Recognition and acute management of potential complications that may result from the
procedure; and
(vi) Infectious disease control involved with each treatment.
(d) The physician has a written office protocol for the delegate to follow in performing the
nonsurgical medical cosmetic procedure. A written office protocol must include, at a minimum, the
following:
(i) The identity of the physician responsible for the delegation of the procedure;
(ii) Selection criteria to screen patients for the appropriateness of treatment;
(iii) A description of appropriate care and follow-up for common complications, serious injury, or
emergencies; and
(iv) A statement of the activities, decision criteria, and plan the delegate shall follow when
performing delegated procedures, including the method for documenting decisions made and a plan
for communication or feedback to the authorizing physician concerning specific decisions made.
(e) The physician ensures that the delegate performs each procedure in accordance with the
written office protocol;
(f) Each patient signs a consent form prior to treatment that lists foreseeable side effects and
complications, and the identity and license of the delegate or delegates who will perform the
procedure; and
(g) Each delegate performing a procedure covered by this section must be readily identified by a
name tag or similar means so that the patient understands the identity and license of the treating
delegate.
(12) If a physician delegates the performance of a procedure that uses a medication or substance
that the federal Food and Drug Administration has not approved, or that the federal Food and Drug
Administration has not approved for the particular purpose for which it is used, the physician must be
on-site during the entire duration of the procedure.
(13) If a physician delegates the performance of a procedure that uses a medication or substance
that is approved by the federal Food and Drug Administration for the particular purpose for which it is
used, the physician need not be on-site during the procedure, but must be reachable by phone and
able to respond within thirty minutes to treat complications.
(14) If the physician is unavailable to supervise a delegate as required by this section, the
physician must make arrangements for an alternate physician to provide the necessary supervision.
The alternate supervisor must be familiar with the protocols in use at the site, will be accountable for
adequately supervising the treatment under the protocols, and must have comparable training as the
primary supervising physician.
(15) A physician performing or delegating nonsurgical cosmetic procedures may not sponsor more
than three physician assistants at any one time.
(16) A physician may not permit a delegate to further delegate the performance of a nonsurgical
medical cosmetic procedure to another individual.
18.71.011. Definition of practice of medicine--Engaging in practice of chiropractic prohibited, when
A person is practicing medicine if he does one or more of the following:
(1) Offers or undertakes to diagnose, cure, advise or prescribe for any human disease, ailment, injury,
infirmity, deformity, pain or other condition, physical or mental, real or imaginary, by any means or
instrumentality;
(2) Administers or prescribes drugs or medicinal preparations to be used by any other person;
(3) Severs or penetrates the tissues of human beings;
(4) Uses on cards, books, papers, signs or other written or printed means of giving information to the
public, in the conduct of any occupation or profession pertaining to the diagnosis or treatment of
human disease or conditions the designation “doctor of medicine”, “physician”, “surgeon”, “m.d.” or
any combination thereof unless such designation additionally contains the description of another
branch of the healing arts for which a person has a license: PROVIDED HOWEVER, That a person
licensed under this chapter shall not engage in the practice of chiropractic as defined in RCW
18.25.005.
WAC 246-853-630 Use of laser, light, radiofrequency, and plasma devices as applied to
the skin. (1) For the purposes of this section, laser, light, radiofrequency, and plasma (LLRP)
devices are medical devices that:
(a) Use a laser, noncoherent light, intense pulsed light, radiofrequency, or plasma to
topically penetrate skin and alter human tissue; and
(b) Are classified by the federal Food and Drug Administration as prescriptive devices.
(2) Because an LLRP device is used to treat disease, injuries, deformities, and other
physical conditions in human beings, the use of an LLRP device is the practice of osteopathic
medicine under RCW 18.57.001. The use of an LLRP device can result in complications such as
visual
impairment,
blindness,
inflammation,
burns,
scarring,
hypopigmentation
and
hyperpigmentation.
(3) Use of medical devices using any form of energy to penetrate or alter human tissue for a
purpose other than those in subsection (1) of this section constitutes surgery and is outside the scope
of this section.
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18.71.190 False personation.
Every person filing for record, or attempting to file for record, the certificate issued to another, falsely
claiming himself or herself to be the person named in such certificate, or falsely claiming himself or
herself to be the person entitled to the same, is guilty of forgery under RCW 9A.60.020.
Corporate Practice of Medicine
State statutes and regulations do not address CPOM.
Case law appears to prohibit corporations from employing physicians to provide medical services.
Neither a corporation nor any unlicensed person or entity may engage, through licensed employees,
in the practice of the learned professions. See Morelli v. Ehsan, 756 P.2d 129, 131 (1988).
West Virginia
Article 3. West Virginia Medical Practice Act
§30-3-4. Definitions.
As used in this article:
(3) "Practice of medicine and surgery" means the diagnosis or treatment of, or operation or
prescription for, any human disease, pain, injury, deformity or other physical or mental condition.
"Surgery" includes the use on humans of lasers, ionizing radiation, pulsed light and radiofrequency
devices. The provisions of this section do not apply to any person who is a duly licensed health care
provider under other pertinent provisions of this code and who is acting within the scope of his or her
license.
W. Va. Code §30-3-13
§ 30-3-13 Unauthorized practice of medicine and surgery or podiatry; criminal penalties; limitations
(a) A person shall not engage in the practice of medicine and surgery or podiatry, hold himself or
herself out as qualified to practice medicine and surgery or podiatry or use any title, word or
abbreviation to indicate to or induce others to believe that he or she is licensed to practice medicine
and surgery or podiatry in this state unless he or she is actually licensed under the provisions of this
article.
(b) The provisions of this section do not apply to:
(1) Persons who are duly licensed health care providers under other pertinent provisions of this
code and are acting within the scope of their license;
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(c) The Board may deny an application for license or other authorization to practice medicine and
surgery or podiatry in this state and may discipline a physician or podiatrist licensed or otherwise
lawfully practicing in this state who, after a hearing, has been adjudged by the Board as unqualified
due to any of the following reasons:
(3) False or deceptive advertising;
Corporate Practice of Medicine
State statutes and regulations do not address CPOM.
An Attorney General Opinion appears to prohibit corporations from employing physicians to provide
medical services.
A corporation cannot, under any circumstances, employ a licensed physician to practice medicine on
its behalf without violating the law. See 46 Op. W. Va. Att'y Gen. 202 (1955).
Wisconsin
Sis. Stat. §448.01 Definitions
“Physician” means an individual possessing the degree of doctor of medicine or doctor of osteopathy
or an equivalent degree as determined by the medical examining board, and holding a license
granted by the medical examining board.
“Practice of medicine and surgery” means:
(a) To examine into the fact, condition or cause of human health or disease, or to treat,
operate, prescribe or advise for the same, by any means or instrumentality.
(b) To apply principles or techniques of medical sciences in the diagnosis or prevention of any
of the conditions described in par. (a) and in sub. (2).
(c) To penetrate, pierce or sever the tissues of a human being.
(d) To offer, undertake, attempt or do or hold oneself out in any manner as able to do any of
the acts described in this subsection.
Board of Cosmetology
BC 2.025 Delegated medical procedures.
(1) Licensees may provide client services constituting medical procedures only as directed,
supervised and inspected by a physician who has the power to direct, decide and oversee the
implementation of the client services provided in licensed establishments.
(2) Delegated medical procedures include the following:
(a) Laser hair removal services. Prior to providing any laser hair removal procedures, a licensee shall
complete advanced training in the use of laser devices in a training program of not less than 6 hours.
If the training program is provided in a setting other than a licensed school of cosmetology or
barbering, the program shall incorporate all of the following:
1. The training shall be conducted by a trainer who has been a practicing aesthetician, a barbering or
cosmetology instructor, an aesthetics instructor, or a barbering or cosmetology manager for a
minimum of one year, and who has completed a course in laser training provided by a licensed
school of cosmetology or barbering, or provided by a licensed school of aesthetics. A licensed
physician may also provide the training.
2. Trainees receive hands−on training which includes actual use of the laser device under the
supervision and guidance of the trainer.
3. The training is documented by a certificate of completion which sets forth the length of the training
and the type of device and which is signed by the trainer and includes the trainer’s license
number.
4. The licensee posts in a conspicuous location in the immediate area where the procedure is carried
out the certificate of completion of the training required in subd. 3.
5. Licensees providing laser hair removal procedures shall complete each biennium at least 6
continuing education credit hours acceptable to the board in laser hair removal. This coursework shall
be in addition to any other continuing education requirements required by the board for license
renewal. Licensees shall maintain records of continuing education hours for at least 5 years from the
date the coursework is completed.
(b) Microdermabrasion services, except as specified under sub. (2r).
(c) Chemical exfoliation, except for application of commercially available exfoliation products utilized
in accordance with the manufacturers’ instructions, limited to the following:
1. Alpha hydroxyl acids of 30% or less, with a ph of not less than 3.0.
2. Salicylic acids of 20% or less, with a ph of not less than 3.0. (2g) Licensees providing chemical
exfoliation shall complete at least 6 continuing education credit hours acceptable to the board
in chemical exfoliation each biennium. This coursework shall be in addition to any other continuing
education requirements required by the board for license renewal. Licensees shall maintain records
of continuing education hours for at least 5 years from the date the coursework is completed. (2r) A
licensee may utilize microdermabrasion devices in his or her practice without medical supervision if
all of the following conditions are met:
(a) The device shall be of an aesthetic grade and not labeled as a prescription device by the United
States Food and Drug Administration. Only FDA approved Class I machines may be used pursuant to
this subsection.
(b) The device utilizes a closed loop negative pressure system that incorporates a tissue retention
device.
(c) The normal and customary use of the device results in the removal of only the surface epidermal
cells of the skin.
(d) Eye protection is provided to the client and protective gloves are worn by the operator.
(e) Microdermabrasion services are not provided within 48 hours before or after a chemical
exfoliation.
(f) The licensee has performed a pretreatment assessment on the client and reviewed the results with
the client.
(g) The client has given written consent prior to the administration of the services.
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MEDICAL EXAMINING BOARD
Chapter Med 10
UNPROFESSIONAL CONDUCT
Med 10.02 Definitions. (1) For the purposes of these rules:
(2) The term “unprofessional conduct” is defined to mean and include but not be limited to the
following, or aiding or abetting the same:
(c) Knowingly making or presenting or causing to be made or presented any false, fraudulent, or
forged statement, writing, certificate, diploma, or other thing in connection with any application for
license.
Corporate Practice of Medicine
State statutes prohibit corporations from splitting fees with physicians and require that bills for
physician services be separate from bills for any other services.
An Attorney General Opinion focusing on for-profit corporations states that such corporations may not
employ physicians to provide medical services.
Except as authorized under Title 18 or 19, an individual statement or account of charges for
physicians services that is being sent to a patient directly must be "distinct and separate from any
statement or account by any physician or other person, who has rendered or who may render any
medical surgical or any similar service whatsoever, or who has given or may give any medical,
surgical or similar advice or assistance to such patient, physician, corporation, or to any other
institution or organization of any kind". See Wis. Stat. 448.08(2).
For-profit general business corporations are prohibited from practicing medicine through employed
licensed professionals because: (1) state statutes only permit individuals, not corporations, to obtain
licenses to practice medicine; (2) medical professionals cannot split fees with a corporation in
exchange for referrals; and (3) CPOM raises public policy concerns. See 75 Op. Wis. Att'y Gen 200
(1986).
Wyoming
WYOMING BOARD OF MEDICINE RULES
CHAPTER 1
LICENSE ELIGIBILITY, APPLICATION AND INTERVIEWS
Section 3. Definitions.
The definitions contained in W.S. 33-26-102 and those contained in the APA are incorporated herein
by this reference. In addition, the following definitions apply to this chapter:
(n) “Practicing medicine” means any person who in any manner:
(i) Advertises, holds out or represents to the public that he is authorized to practice
medicine in this state;
(ii) Offers or undertakes to prevent, diagnose, correct or treat, in any manner, by any
means, method or device, including, but not limited to, the internet or other electronic or
telephonic means any human disease, illness, pain, wound, fracture, infirmity, defect or
abnormal physical or mental condition, injury, deformity or ailment, including the
management of pregnancy and parturition;
(iii) Attaches the title of M.D., D.O., physician, surgeon, osteopathic physician or
osteopathic surgeon, doctor, or any other words, letters or abbreviations or any
combination thereof when used in the conduct of any occupation or profession
pertaining to the prevention, diagnosis or treatment of human disease or condition
unless the designation additionally contains the description of another branch of the
healing arts for which one holds a valid license in this state;
(iv) Practices osteopathy;
(v) Offers or undertakes to prescribe, orders, give or administer drugs which can only be
obtained by prescription according to law;
(vi) Renders a determination of medical necessity or appropriateness of proposed
treatment; or
(vii) Operates or delegates the responsibility to operate a medical device classified as a
Class II or Class III medical device by the U.S. Food and Drug Administration unless
operation or authorization for operation occurs in a site under the supervision of a
person licensed under this chapter.
W
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33-26-402. Grounds for suspension; revocation; restriction; imposition of conditions; refusal to renew
or other disciplinary action.
(a) The board may refuse to renew, and may revoke, suspend or restrict a license or take other
disciplinary action, including the imposition of conditions or restrictions upon a license on one (1) or
more of the following grounds:
(iii) Making false or misleading statements regarding the licensee's skill or the efficacy or value of his
treatment or remedy for a human disease, injury, deformity, ailment, pregnancy or delivery of infants;
(v) Advertising the practice of medicine in a misleading, false or deceptive manner;
Corporate Practice of Medicine
State statutes and regulations do not address CPOM.