March 25, 2025 • 22 mins
The aesthetic medicine landscape in Texas has undergone significant regulatory restructuring, and practitioners need to take notice. Tony Bertolino, managing partner at the Bertolino Law Firm, joins us to dissect the Texas Medical Board's reorganized rules governing non-surgical cosmetic procedures like Botox and dermal fillers.
While these changes don't revolutionize what's permitted, they provide crucial clarification by explicitly classifying these treatments as medical procedures requiring proper delegation and supervision. Tony walks us through the new regulatory framework section by section, explaining how physicians must ensure delegates have proper training, establish written protocols, maintain comprehensive patient records, and guarantee emergency support is readily available. A physician delegating aesthetic procedures must themselves be trained in those procedures—no more pediatricians overseeing Botox injections from 200 miles away.
This increased scrutiny comes amid concerning incidents like the recent case in Dublin, Texas, where an allegedly unlicensed practitioner's Botox "lip flip" procedure triggered seizures and vomiting in a patient, requiring emergency intervention. The stakes couldn't be higher for professionals in this field—violations may result in fines, license suspension, cease and desist orders, or even third-degree felony charges for practicing medicine without a license. The TMB's jurisdiction extends beyond just physicians to anyone performing these procedures without proper authorization.
Whether you're a physician, nurse practitioner, physician assistant, nurse, esthetician, or cosmetologist working in cosmetic medicine, these changes affect your daily practice. Learn the steps you need to take now to ensure compliance and protect both your patients and your professional license.
______________________________
Visit the Texas Medical Board's website!
https://www.tmb.state.tx.us/
Get more information, details and resources on Know Your Regulator - https://www.belolaw.com/know-your-regulator
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
This podcast is for educational purposes only, does
not constitute legal advice anddoes not create an
attorney-client relationship.
If you need legal assistanceabout a legal problem, contact
an attorney.
Welcome back to Know yourRegulator, the podcast that
inspires you to engage.
I am your host, simone Murphree, and co-hosting with me today
(00:22):
is Melissa Hooper Howdy.
Speaker 2 (00:24):
Today we are going to cover a very important topic.
This one covers a wide range ofprofessionals across Texas.
The Texas Medical Board, orcommonly referred to as TMB, has
made significant changes to therules governing non-surgical
cosmetic procedures, includingBotox and other aesthetic
(00:48):
treatments.
Speaker 1 (00:49):
Joining us.
To break it all down, is TonyBertolino, managing partner at
the Bertolino Law Firm.
Tony, thanks for joining us.
Speaker 3 (00:57):
Well, thank you.
Thank you for having me.
You guys, I'm, you know, happyI'm brought back on again.
I've done several of thesepodcasts with you.
I've always enjoyed them andI'm really looking forward to
covering a very important topicand helping our listeners out
there.
This is going to be aninteresting topic to cover.
Speaker 1 (01:18):
I think so.
So let's get started with thebasics, tony, the Texas Medical
Board recently reorganized andclarified its regulations around
non-surgical medical cosmeticprocedures.
Can you talk to us about someof these key changes?
Speaker 3 (01:34):
Absolutely.
You know, and you know the wayyou address that as key changes.
I think that a lot of whatthese, this new law, really does
is it really hasn't changed awhole lot.
What it's done is it hasoffered some clarification and,
(01:54):
more importantly, reorganizingthese laws to make it simpler to
understand and, of course,helping people, you know, making
sure that they're in morecompliance with Texas law.
But what really what this lawhas done and it took effect in
January of this year is that itultimately repealed the old rule
, the Section 193.17, where therule, the law, addressed the
(02:20):
what's called other delegatedacts.
And now these new rules and newlaw that's in place again has
offered some structure to theold law and has reorganized it
in a sense.
So really, what's happened inthese changes is and then what I
want to do is go down the line,addressing each section one by
(02:43):
one for the listeners out thereto help them understand what
that current law is versussection 169.25.
And that new provision says thatnon-surgical medical cosmetic
procedures, such as Botox andfillers, is considered the
practice of medicine andtherefore must be properly
(03:04):
delegated and supervised.
So it's clarifying again whatthose cosmetic procedures are.
And then the next section169.26,.
Under that new rule, what thephysicians must ensure is that
the licensees that they delegateto you know whether they're
nurses or advanced nursepractitioners or physician
(03:27):
assistants.
They need to have the propertraining and there is also the
necessity of having a signedwritten protocol, sort of
directions or rules on whatneeds to be followed as to these
cosmetic procedures Also underthat section.
Under that new rule, thephysicians must also be trained
in the procedures that theydelegate to.
(03:48):
For example, you can't have apediatrician delegating these
procedures.
It's got to be someone aphysician who is actually
trained in that procedure him orherself.
Of course, under section 169.26,before a procedure can be
delegated, a physician assistantor PA or an advanced practice
(04:11):
registered nurse must actuallydo five things under that
section.
The first thing is that theremust be an established
practitioner and patientrelationship.
The second thing is there mustbe a maintaining and a creation
of the medical records for thatparticular patient.
There's also a necessity todisclose the identity of the
(04:32):
professionals who will beperforming these delegated acts,
and also they have a duty todisclose their credentials,
whether they're a nurse or aphysician's assistant.
And of course, finally, theyhave to make sure that at least
one person with basic lifesupport training is available on
site in case there's any kindof emergency while performing
(04:56):
these kinds of procedures.
Under that same section 169.26,it also addresses the
supervision that is, that thephysician, the PA or the
advanced practicing registerednurse must be on site now or
immediately be available foremergency consultations in case
(05:18):
those emergencies do arise, andthen the physician must be able
to also be available to conductan emergency appointment if
necessary.
Next section that has that hasalso changed the laws is 169.27.
And that one addresses theresponsibilities of a delegating
physician to develop writtentreatment orders, or they must
(05:40):
review and approve any existingtreatment orders, and that
includes any medical orders thatare in place.
And then, finally, 169.28 isthe law, the new rule that
requires that the names of thedelegating physicians and the
mandatory complaintnotifications must be posted in
public areas, of course, thesecomplaint notifications you may
(06:03):
have seen these.
For example, when you go toyour you know your local
pharmacy, you see thesecomplaint notices and frames up
on the walls where it you knowlists the address and the phone
numbers where you can file yourcomplaints against people who
are in these offices.
Also, all the persons whoperform delegated medical acts
(06:25):
must now have name tags thatidentify not just their name but
also what specific license theypossess and what their
credentials may be.
So that's another importantchange as well as part of
Section 169.
Speaker 2 (06:42):
Wow, that does sound like a lot of changes.
Thank you, tony.
What do you think the drivingforce is behind these changes?
Speaker 3 (06:50):
Well, you know the changes that came about, you
know, really come from an effort, an overall effort, to improve
oversight and patient safety.
You know, that's really thebiggest factor.
And that actually brings me toyou know a recent case that came
about that you know the viewersmay be aware of in the media,
(07:14):
which is this increased scrutinyof what's called these Botox
parties.
One particular case is actuallyhappened in a city north of
Austin called Dublin, texas, inwhich a lady went into a
facility and she was given, orreceived, a Botox procedure for
(07:34):
her lips it's called a lip flip,I believe and apparently it was
done by an alleged unlicensedpractitioner and, as a result,
she suffered a severe reactionto the Botox and she actually
began vomiting and she went intoseizures and it, you know, ems
(07:55):
had to be called and she was.
I mean, it became a trueemergency and of course, under
the new rules, you've got adoctor that's supposed to be on
site, or at least someone youknow that's available on site
that can provide these kinds ofmedical emergency procedures.
But in this case there was adelegating pediatrician almost
200 miles away in Tyler, texas.
So these are the kinds ofthings you know local, I mean
(08:19):
media is really picking up onthese stories now, which is
making this, this area, very,very topical.
So, at the end of the day, theTexas Medical Board wants to
ensure that only properlytrained professionals are
performing these procedures andit's very likely that, as a
result of this case up in Dublin, texas, that this practitioner
(08:44):
may be prosecuted for a felonyThird degree felony, I believe,
is what it is for that.
So not only that, but you alsothere's a possibility of the
attorney general's officeimposing civil kind of penalties
, let alone the fact, again,they could be facing, you know,
(09:05):
criminal charges.
So overall, it really has a lotto do with the safety of the
public, the safety of patients.
Speaker 1 (09:12):
Yeah, and that makes a lot of sense.
I mean, like you said, fromthat story it sounds like you
know that safety was notprioritized there at all, and so
I think that's you know reallygood.
I'm glad that we're kind oflooking at these, that the Texas
Medical Board is looking atthese issues and doing what they
(09:33):
can to protect the public.
Now we know that these rulechanges don't just affect
doctors.
They have many implications forother professionals.
Who else needs to be payingattention to this?
Speaker 3 (09:49):
You know it's really widespread.
I mean it's really, you know,of course I'll get into more
specifics in a moment but it'sreally, you know, anybody who
thinks that they could sort ofhave these back alley kind of
Botox parties, whether you're alicensed professional or not.
I mean that's just improper andunlawful.
(10:11):
But, more specifically, itseems like the ones you know,
the professionals that should bepaying attention, of course are
the physicians.
The professionals that shouldbe paying attention, of course
are the physicians and thephysician assistants and these
advanced practice registerednurses who are in the job of
delegating these procedures.
I mean, at the end of the day,they're going to be on the hook
for if they're not complyingwith current laws.
(10:33):
Of course, another sector ofprofessionals that should be
concerned and paying closeattention are nurses and other
medical professionals who areworking in these med spots, and
you know they're certainly goingto have to comply with the new
laws and make the proper changesand making sure the proper
protocols are in place to ensurecompliance with these TMB rules
(10:55):
.
And then, of course, you've got, you know, these estheticians
and cosmetologists and otherswho may have previously offered
cosmetic treatments withoutdirect physician oversight, and
they're going to certainly needto make sure they're in
compliance with the new laws,because you know you've got
issues of not just the TexasMedical Board coming down on you
(11:16):
in the form of a possible ceaseand desist letter, but these
estheticians and cosmetologistscould ultimately be facing board
complaints from their ownapplicable board, like the Texas
Department of Licensing andRegulations that regulate these
particular types of licenseholders.
So those are specific, you know, professionals that should be
(11:37):
paying attention, but really, asI mentioned before, overall you
know it's really anybody andeverybody who believes that
they're, you know they're goingto be able to inject, you know,
botox and fillers in patientsand when they're, you know just
unlawfully doing so and and andreally have, you know, little or
(11:57):
no compliance with with thelaws.
Speaker 2 (12:02):
Okay.
So to recap, if you're amedical professional working in
aesthetics, what does this meanfor their day-to-day practice?
Tony?
Speaker 3 (12:11):
Well, I think what'll need to happen and, of course,
what the change is is makingsure that proper protocols are
followed and updated and alsoensuring that there's proper
supervision made by asupervising professional,
whether it be a physician, youknow, an advanced nurse
(12:35):
practitioner or a physician'sassistant.
In addition, there's also theneed that you know these
facilities out there, these spas, these medical facilities.
They must now display properphysician information, as I
mentioned before.
You know it's all about.
(12:55):
You know the new transparencyreally is what this is and
making sure that these you knowthese physicians are properly
identified to the patient.
And then, of course, thewritten orders and emergency
plans must be in place as partof these delegated procedures as
well.
I mean, you've got to, you know,follow written orders and have
(13:19):
them documented, which is one ofthe you know, the big key
things that the Texas MedicalBoard is trying to correct is
making sure that everything isin proper writing and, of course
, signed off by the physician asneeded.
You know, if you are, you know,an esthetician or a
cosmetologist or someone workingin these kinds of fields and
(13:43):
you operate a med spa or afacility like this, you know,
you've got to be aware that ifyou're operating in these sort
of gray areas.
You know, now it's no longergray with these clarifications
that are that are made, or thisreorganization, as I talked
about earlier, has been made.
You know it's now clear.
(14:04):
The law is somewhat unambiguousnow, and now it's time to make
sure that you're in compliantwith the laws and the rules, and
you know there really isn'tgoing to be any excuses if
you're not.
Speaker 2 (14:17):
Well, thank you for that clarification, Tony.
Now that we have a betterunderstanding of these changes,
let's talk about action steps.
What should a licensedprofessional do to stay
compliant?
Speaker 3 (14:31):
in these updated Texas Medical Board rules.
You know and there's, you know,certainly going straight to the
Texas Medical Board websiteitself you know it'll provide a
lot of updates to these rules.
(14:51):
You know there's differentresources online that you know
can better educate you.
You know the other thing thatis important to be in compliance
, particularly if you're aphysician.
You know making sure that youknow you're properly delegating
this, you know these proceduresand or delegating to the proper
(15:15):
licensed professionals that areexperienced and that you do have
, you know, have properprotocols in place.
If you're the actual providerwho's performing these
procedures, you need to, ofcourse, confirm that you're
being properly supervised by aphysician because, again, that
physician oversight is reallykey to these rules that there's
(15:38):
a need to have a supervisingprofessional overseeing these
procedures and then, of course,the you know the requirement now
that these clinics shouldupdate their signage and, of
course, their patientnotifications that need to be
posted at these facilities aswell.
(15:59):
All of that needs to be updated.
Speaker 1 (16:01):
Are there penalties for noncompliance.
I think that those are allthings that license holders
should absolutely or even youknow, like you said, those
estheticians, cosmetologiststhey definitely need to be aware
of.
You know what happens if aprovider is caught violating
these rules.
Speaker 3 (16:20):
Mm-hmm.
Well, the medical board, theTexas Medical Board and a lot of
people are not aware of this,but the Texas Medical Board has
jurisdiction over folks thatviolate the law, particularly if
you're unlicensed to practice,and this vast jurisdiction
(16:42):
really applies to everybody andanybody who violates the law and
they're practicing medicinewithout a license.
So it really doesn't matter.
You know who you are.
You don't have to necessarilybe a physician to be under
investigation by the TexasMedical Board and as part of the
penalties for noncompliance,specifically, the medical board
(17:02):
can issue fines, they cansuspend a license holder or even
revoke a license if you happento have a license with the board
.
As to the unlicensedpractitioner, those individuals
will very likely receive a ceaseand desist letter from the
(17:23):
Texas Medical Board.
And, again, as I said earlier,the Texas Medical Board has
jurisdiction to step in andissue these cease and desist,
even if you happen to not be alicensed physician.
And another thing that couldalso happen as a result is that
the medical board can not onlysend a cease and desist letter
out to you telling you hey, stopthe behavior.
(17:45):
You're not authorized topractice medicine without a
license, you're not authorizedto be injecting patients with
Botox and fillers.
And in doing so, what theycould also do is refer the
matter to a local lawenforcement or a district
attorney's office for possibleprosecution for felony of an
unlicensed practice of medicine.
(18:07):
You know, if you're not alreadyaware, you know it is a third
degree felony if you arepracticing medicine without a
license.
So it's of course it's under thediscretion of the local DAs to
bring charges if it gets to thatpoint, which is, as I mentioned
before, these penalties thatare imposed against these, uh,
(18:43):
these folks that are violatingthe current rules and laws.
You know, one of the things toavoid this kind of thing is
really to, you know, as needed,consult with attorney, um, if
you have issues, um, withcompliance, or you're just not
sure of what the law is, or ifyour practice you know, your new
practice is trying to, you know, go through the long laundry
(19:07):
list of the laws that you haveto comply with.
Sometimes it requires theinterpretation and counsel by an
attorney.
You know, to avoid all of thesepenalties for noncompliance, I
mean, you, you know, if you'rein a position to invest a short
amount of money at the front endto avoid all these headaches on
the back end, it's probablygoing to be the best for you if
(19:29):
you're you know, if you're apractitioner, interested in
going into this field.
Speaker 2 (19:35):
So any final advice for professionals navigating
these type of changes, Tony?
Speaker 3 (19:41):
First is stay informed, Understand what the
laws and the rules are.
If you are going through ChatGPTor you're Google searching
these rules and laws, you know,make sure double make sure that
you're you know you're followingthe right rules and you're
understanding what you'rereading, and you know there's a
(20:01):
lot of misinformation out there.
I would suggest that as part ofstaying informed and following
the rules is that you go to theTexas Medical Board website.
It's got a lot of really goodresources to help you really
understand what the the currentlaws and rules are.
And, of course, if you're stillunsure about compliance and
(20:23):
understanding these new rules,as I mentioned before, consult
an attorney and make sure thatthat attorney is also
well-versed and understands whatcurrent laws are.
You know, don't you know?
Make sure you hire a properlawyer who's experienced in
these areas and understand thechanges.
(20:43):
You know, at the end of the day, these changes are really meant
to protect the public, toprotect patients, but they also,
you know, serve as a warningand to not to cut corners, and
the Texas Medical Board iscertainly watching out for that
kind of thing.
They're cracking down now morethan ever and, as these new news
(21:06):
stories blossom, Texas MedicalBoard is going to, you know,
become more and more aggressive,you know, with these kinds of
matters and, as I said, reallythey're looking to protect the
patients, protect the publicfrom being harmed.
Speaker 2 (21:22):
That's great advice.
Thank you very much for yourtime and breaking all this down
for us today, Tony.
Speaker 1 (21:29):
Yes.
Thank you so much, tony, forcarving some time out of your
schedule to join us on Know yourRegulator again and to our
viewers.
If you would like to learn moreabout this topic and this
change, you can check out theTexas Medical Board's website at
tmbstatetxus.
Be sure to subscribe and followKnow your Regulator as we
(21:52):
continue to follow changes inyour professional landscape.
Until next time, stay inspiredand continue engaging with your
regulatory agency.
Know your Regulator the podcastthat inspires you to engage.
This podcast is for educational purposes only, does
not constitute legal advice anddoes not create an
attorney-client relationship.
If you need legal assistanceabout a legal problem, contact
an attorney.
Welcome back to Know yourRegulator, the podcast that
inspires you to engage.
I am your host, simone Murphree, and co-hosting with me today
(00:22):
is Melissa Hooper Howdy.
Speaker 2 (00:24):
Today we are going to cover a very important topic.
This one covers a wide range ofprofessionals across Texas.
The Texas Medical Board, orcommonly referred to as TMB, has
made significant changes to therules governing non-surgical
cosmetic procedures, includingBotox and other aesthetic
(00:48):
treatments.
Speaker 1 (00:49):
Joining us.
To break it all down, is TonyBertolino, managing partner at
the Bertolino Law Firm.
Tony, thanks for joining us.
Speaker 3 (00:57):
Well, thank you.
Thank you for having me.
You guys, I'm, you know, happyI'm brought back on again.
I've done several of thesepodcasts with you.
I've always enjoyed them andI'm really looking forward to
covering a very important topicand helping our listeners out
there.
This is going to be aninteresting topic to cover.
Speaker 1 (01:18):
I think so.
So let's get started with thebasics, tony, the Texas Medical
Board recently reorganized andclarified its regulations around
non-surgical medical cosmeticprocedures.
Can you talk to us about someof these key changes?
Speaker 3 (01:34):
Absolutely.
You know, and you know the wayyou address that as key changes.
I think that a lot of whatthese, this new law, really does
is it really hasn't changed awhole lot.
What it's done is it hasoffered some clarification and,
(01:54):
more importantly, reorganizingthese laws to make it simpler to
understand and, of course,helping people, you know, making
sure that they're in morecompliance with Texas law.
But what really what this lawhas done and it took effect in
January of this year is that itultimately repealed the old rule
, the Section 193.17, where therule, the law, addressed the
(02:20):
what's called other delegatedacts.
And now these new rules and newlaw that's in place again has
offered some structure to theold law and has reorganized it
in a sense.
So really, what's happened inthese changes is and then what I
want to do is go down the line,addressing each section one by
(02:43):
one for the listeners out thereto help them understand what
that current law is versussection 169.25.
And that new provision says thatnon-surgical medical cosmetic
procedures, such as Botox andfillers, is considered the
practice of medicine andtherefore must be properly
(03:04):
delegated and supervised.
So it's clarifying again whatthose cosmetic procedures are.
And then the next section169.26,.
Under that new rule, what thephysicians must ensure is that
the licensees that they delegateto you know whether they're
nurses or advanced nursepractitioners or physician
(03:27):
assistants.
They need to have the propertraining and there is also the
necessity of having a signedwritten protocol, sort of
directions or rules on whatneeds to be followed as to these
cosmetic procedures Also underthat section.
Under that new rule, thephysicians must also be trained
in the procedures that theydelegate to.
(03:48):
For example, you can't have apediatrician delegating these
procedures.
It's got to be someone aphysician who is actually
trained in that procedure him orherself.
Of course, under section 169.26,before a procedure can be
delegated, a physician assistantor PA or an advanced practice
(04:11):
registered nurse must actuallydo five things under that
section.
The first thing is that theremust be an established
practitioner and patientrelationship.
The second thing is there mustbe a maintaining and a creation
of the medical records for thatparticular patient.
There's also a necessity todisclose the identity of the
(04:32):
professionals who will beperforming these delegated acts,
and also they have a duty todisclose their credentials,
whether they're a nurse or aphysician's assistant.
And of course, finally, theyhave to make sure that at least
one person with basic lifesupport training is available on
site in case there's any kindof emergency while performing
(04:56):
these kinds of procedures.
Under that same section 169.26,it also addresses the
supervision that is, that thephysician, the PA or the
advanced practicing registerednurse must be on site now or
immediately be available foremergency consultations in case
(05:18):
those emergencies do arise, andthen the physician must be able
to also be available to conductan emergency appointment if
necessary.
Next section that has that hasalso changed the laws is 169.27.
And that one addresses theresponsibilities of a delegating
physician to develop writtentreatment orders, or they must
(05:40):
review and approve any existingtreatment orders, and that
includes any medical orders thatare in place.
And then, finally, 169.28 isthe law, the new rule that
requires that the names of thedelegating physicians and the
mandatory complaintnotifications must be posted in
public areas, of course, thesecomplaint notifications you may
(06:03):
have seen these.
For example, when you go toyour you know your local
pharmacy, you see thesecomplaint notices and frames up
on the walls where it you knowlists the address and the phone
numbers where you can file yourcomplaints against people who
are in these offices.
Also, all the persons whoperform delegated medical acts
(06:25):
must now have name tags thatidentify not just their name but
also what specific license theypossess and what their
credentials may be.
So that's another importantchange as well as part of
Section 169.
Speaker 2 (06:42):
Wow, that does sound like a lot of changes.
Thank you, tony.
What do you think the drivingforce is behind these changes?
Speaker 3 (06:50):
Well, you know the changes that came about, you
know, really come from an effort, an overall effort, to improve
oversight and patient safety.
You know, that's really thebiggest factor.
And that actually brings me toyou know a recent case that came
about that you know the viewersmay be aware of in the media,
(07:14):
which is this increased scrutinyof what's called these Botox
parties.
One particular case is actuallyhappened in a city north of
Austin called Dublin, texas, inwhich a lady went into a
facility and she was given, orreceived, a Botox procedure for
(07:34):
her lips it's called a lip flip,I believe and apparently it was
done by an alleged unlicensedpractitioner and, as a result,
she suffered a severe reactionto the Botox and she actually
began vomiting and she went intoseizures and it, you know, ems
(07:55):
had to be called and she was.
I mean, it became a trueemergency and of course, under
the new rules, you've got adoctor that's supposed to be on
site, or at least someone youknow that's available on site
that can provide these kinds ofmedical emergency procedures.
But in this case there was adelegating pediatrician almost
200 miles away in Tyler, texas.
So these are the kinds ofthings you know local, I mean
(08:19):
media is really picking up onthese stories now, which is
making this, this area, very,very topical.
So, at the end of the day, theTexas Medical Board wants to
ensure that only properlytrained professionals are
performing these procedures andit's very likely that, as a
result of this case up in Dublin, texas, that this practitioner
(08:44):
may be prosecuted for a felonyThird degree felony, I believe,
is what it is for that.
So not only that, but you alsothere's a possibility of the
attorney general's officeimposing civil kind of penalties
, let alone the fact, again,they could be facing, you know,
(09:05):
criminal charges.
So overall, it really has a lotto do with the safety of the
public, the safety of patients.
Speaker 1 (09:12):
Yeah, and that makes a lot of sense.
I mean, like you said, fromthat story it sounds like you
know that safety was notprioritized there at all, and so
I think that's you know reallygood.
I'm glad that we're kind oflooking at these, that the Texas
Medical Board is looking atthese issues and doing what they
(09:33):
can to protect the public.
Now we know that these rulechanges don't just affect
doctors.
They have many implications forother professionals.
Who else needs to be payingattention to this?
Speaker 3 (09:49):
You know it's really widespread.
I mean it's really, you know,of course I'll get into more
specifics in a moment but it'sreally, you know, anybody who
thinks that they could sort ofhave these back alley kind of
Botox parties, whether you're alicensed professional or not.
I mean that's just improper andunlawful.
(10:11):
But, more specifically, itseems like the ones you know,
the professionals that should bepaying attention, of course are
the physicians.
The professionals that shouldbe paying attention, of course
are the physicians and thephysician assistants and these
advanced practice registerednurses who are in the job of
delegating these procedures.
I mean, at the end of the day,they're going to be on the hook
for if they're not complyingwith current laws.
(10:33):
Of course, another sector ofprofessionals that should be
concerned and paying closeattention are nurses and other
medical professionals who areworking in these med spots, and
you know they're certainly goingto have to comply with the new
laws and make the proper changesand making sure the proper
protocols are in place to ensurecompliance with these TMB rules
(10:55):
.
And then, of course, you've got, you know, these estheticians
and cosmetologists and otherswho may have previously offered
cosmetic treatments withoutdirect physician oversight, and
they're going to certainly needto make sure they're in
compliance with the new laws,because you know you've got
issues of not just the TexasMedical Board coming down on you
(11:16):
in the form of a possible ceaseand desist letter, but these
estheticians and cosmetologistscould ultimately be facing board
complaints from their ownapplicable board, like the Texas
Department of Licensing andRegulations that regulate these
particular types of licenseholders.
So those are specific, you know, professionals that should be
(11:37):
paying attention, but really, asI mentioned before, overall you
know it's really anybody andeverybody who believes that
they're, you know they're goingto be able to inject, you know,
botox and fillers in patientsand when they're, you know just
unlawfully doing so and and andreally have, you know, little or
(11:57):
no compliance with with thelaws.
Speaker 2 (12:02):
Okay.
So to recap, if you're amedical professional working in
aesthetics, what does this meanfor their day-to-day practice?
Tony?
Speaker 3 (12:11):
Well, I think what'll need to happen and, of course,
what the change is is makingsure that proper protocols are
followed and updated and alsoensuring that there's proper
supervision made by asupervising professional,
whether it be a physician, youknow, an advanced nurse
(12:35):
practitioner or a physician'sassistant.
In addition, there's also theneed that you know these
facilities out there, these spas, these medical facilities.
They must now display properphysician information, as I
mentioned before.
You know it's all about.
(12:55):
You know the new transparencyreally is what this is and
making sure that these you knowthese physicians are properly
identified to the patient.
And then, of course, thewritten orders and emergency
plans must be in place as partof these delegated procedures as
well.
I mean, you've got to, you know,follow written orders and have
(13:19):
them documented, which is one ofthe you know, the big key
things that the Texas MedicalBoard is trying to correct is
making sure that everything isin proper writing and, of course
, signed off by the physician asneeded.
You know, if you are, you know,an esthetician or a
cosmetologist or someone workingin these kinds of fields and
(13:43):
you operate a med spa or afacility like this, you know,
you've got to be aware that ifyou're operating in these sort
of gray areas.
You know, now it's no longergray with these clarifications
that are that are made, or thisreorganization, as I talked
about earlier, has been made.
You know it's now clear.
(14:04):
The law is somewhat unambiguousnow, and now it's time to make
sure that you're in compliantwith the laws and the rules, and
you know there really isn'tgoing to be any excuses if
you're not.
Speaker 2 (14:17):
Well, thank you for that clarification, Tony.
Now that we have a betterunderstanding of these changes,
let's talk about action steps.
What should a licensedprofessional do to stay
compliant?
Speaker 3 (14:31):
in these updated Texas Medical Board rules.
You know and there's, you know,certainly going straight to the
Texas Medical Board websiteitself you know it'll provide a
lot of updates to these rules.
(14:51):
You know there's differentresources online that you know
can better educate you.
You know the other thing thatis important to be in compliance
, particularly if you're aphysician.
You know making sure that youknow you're properly delegating
this, you know these proceduresand or delegating to the proper
(15:15):
licensed professionals that areexperienced and that you do have
, you know, have properprotocols in place.
If you're the actual providerwho's performing these
procedures, you need to, ofcourse, confirm that you're
being properly supervised by aphysician because, again, that
physician oversight is reallykey to these rules that there's
(15:38):
a need to have a supervisingprofessional overseeing these
procedures and then, of course,the you know the requirement now
that these clinics shouldupdate their signage and, of
course, their patientnotifications that need to be
posted at these facilities aswell.
(15:59):
All of that needs to be updated.
Speaker 1 (16:01):
Are there penalties for noncompliance.
I think that those are allthings that license holders
should absolutely or even youknow, like you said, those
estheticians, cosmetologiststhey definitely need to be aware
of.
You know what happens if aprovider is caught violating
these rules.
Speaker 3 (16:20):
Mm-hmm.
Well, the medical board, theTexas Medical Board and a lot of
people are not aware of this,but the Texas Medical Board has
jurisdiction over folks thatviolate the law, particularly if
you're unlicensed to practice,and this vast jurisdiction
(16:42):
really applies to everybody andanybody who violates the law and
they're practicing medicinewithout a license.
So it really doesn't matter.
You know who you are.
You don't have to necessarilybe a physician to be under
investigation by the TexasMedical Board and as part of the
penalties for noncompliance,specifically, the medical board
(17:02):
can issue fines, they cansuspend a license holder or even
revoke a license if you happento have a license with the board
.
As to the unlicensedpractitioner, those individuals
will very likely receive a ceaseand desist letter from the
(17:23):
Texas Medical Board.
And, again, as I said earlier,the Texas Medical Board has
jurisdiction to step in andissue these cease and desist,
even if you happen to not be alicensed physician.
And another thing that couldalso happen as a result is that
the medical board can not onlysend a cease and desist letter
out to you telling you hey, stopthe behavior.
(17:45):
You're not authorized topractice medicine without a
license, you're not authorizedto be injecting patients with
Botox and fillers.
And in doing so, what theycould also do is refer the
matter to a local lawenforcement or a district
attorney's office for possibleprosecution for felony of an
unlicensed practice of medicine.
(18:07):
You know, if you're not alreadyaware, you know it is a third
degree felony if you arepracticing medicine without a
license.
So it's of course it's under thediscretion of the local DAs to
bring charges if it gets to thatpoint, which is, as I mentioned
before, these penalties thatare imposed against these, uh,
(18:43):
these folks that are violatingthe current rules and laws.
You know, one of the things toavoid this kind of thing is
really to, you know, as needed,consult with attorney, um, if
you have issues, um, withcompliance, or you're just not
sure of what the law is, or ifyour practice you know, your new
practice is trying to, you know, go through the long laundry
(19:07):
list of the laws that you haveto comply with.
Sometimes it requires theinterpretation and counsel by an
attorney.
You know, to avoid all of thesepenalties for noncompliance, I
mean, you, you know, if you'rein a position to invest a short
amount of money at the front endto avoid all these headaches on
the back end, it's probablygoing to be the best for you if
(19:29):
you're you know, if you're apractitioner, interested in
going into this field.
Speaker 2 (19:35):
So any final advice for professionals navigating
these type of changes, Tony?
Speaker 3 (19:41):
First is stay informed, Understand what the
laws and the rules are.
If you are going through ChatGPTor you're Google searching
these rules and laws, you know,make sure double make sure that
you're you know you're followingthe right rules and you're
understanding what you'rereading, and you know there's a
(20:01):
lot of misinformation out there.
I would suggest that as part ofstaying informed and following
the rules is that you go to theTexas Medical Board website.
It's got a lot of really goodresources to help you really
understand what the the currentlaws and rules are.
And, of course, if you're stillunsure about compliance and
(20:23):
understanding these new rules,as I mentioned before, consult
an attorney and make sure thatthat attorney is also
well-versed and understands whatcurrent laws are.
You know, don't you know?
Make sure you hire a properlawyer who's experienced in
these areas and understand thechanges.
(20:43):
You know, at the end of the day, these changes are really meant
to protect the public, toprotect patients, but they also,
you know, serve as a warningand to not to cut corners, and
the Texas Medical Board iscertainly watching out for that
kind of thing.
They're cracking down now morethan ever and, as these new news
(21:06):
stories blossom, Texas MedicalBoard is going to, you know,
become more and more aggressive,you know, with these kinds of
matters and, as I said, reallythey're looking to protect the
patients, protect the publicfrom being harmed.
Speaker 2 (21:22):
That's great advice.
Thank you very much for yourtime and breaking all this down
for us today, Tony.
Speaker 1 (21:29):
Yes.
Thank you so much, tony, forcarving some time out of your
schedule to join us on Know yourRegulator again and to our
viewers.
If you would like to learn moreabout this topic and this
change, you can check out theTexas Medical Board's website at
tmbstatetxus.
Be sure to subscribe and followKnow your Regulator as we
(21:52):
continue to follow changes inyour professional landscape.
Until next time, stay inspiredand continue engaging with your
regulatory agency.
Know your Regulator the podcastthat inspires you to engage.
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