Medispas Face More Scrutiny

Laser hair removal, microdermabrasion facials and skin “fillers” such as Botox are part of the beauty vernacular in Southern California, and day spas across the San Fernando Valley have tried to meet demand for these services in recent years by expanding their menu of medical offerings. But recently enacted legislation takes aim at medical spas that some professional associations and lawmakers say may not have staff properly trained to perform the services. Businesses that fail to follow the state requirements for operating a medical spa now will face major fines for non-compliance. While it’s unclear how many medical spas are located within the greater San Fernando Valley area, as they are not licensed by any state agency, signs for such businesses are prevalent throughout the region in retail strip centers and standalone facilities. Yelp.com lists reviews of more than 200 area businesses that perform spa and medical services. Medical spas are required to operate under the eye of a licensed doctor, but health advocates say that isn’t always the case, and patients often are left vulnerable. “It’s not that you went in for surgery and they left a sponge in. At a hospital, there are protocols, a whole set of safeguards. That’s not so in some medispas,” said Tom Riley, director of government relations for the California Society of Dermatology & Dermatologic Surgery, whose organization co-sponsored the bill. Penalties will also increase for doctors who lend their name to a spa, but aren’t involved in day-to-day operations of the practice, the so-called “rent-a-license” option. Under AB 1548, fines for practicing unlicensed medicine can be up to $20,000 per offense, or double the cost of the procedure, whichever is greater; and up to two years in prison. These replace minor fines of $200 that health advocates say were routinely ignored. Shaidy Hosseini, office manager at Norris Cosmetic Physician Center in Tarzana, recalled one horror story she heard from a patient about an experience at another medispa. “She put several thousand dollars down up front for a package … but when she went back, they weren’t there. The whole place was closed up. Now she doesn’t know what to do about her money,” Hosseini said. She also noted that the patient had been burned on her arms during a treatment at the other facility. Calls to several other Valley area facilities for this story went unreturned. Hosseini said other area facilities are reportedly closing because they don’t have a doctor on staff. Regulation by fine The medical spa industry goes largely unregulated because of a lack of a distinct governing body to track the businesses. The California Medical Board can discipline doctors, but if a spa is allowing someone who isn’t a doctor to perform services, then it becomes a matter for law enforcement. “A lot of it is ignorance and some of it is willful disregard,” said Dan Wood, spokesman for the California Medical Board. “If the doctor isn’t doing what he is supposed to do, we can have a complaint against him and investigate the matter. If the investigation turns up something that he wasn’t doing properly, then we can revoke or suspend his license, but as far as anyone who is performing the procedures, it becomes a matter for criminal courts.” This confusion seems to give consumers little recourse when things go wrong. “Often, someone comes home from the medispa, then has a reaction, or the redness or pain doesn’t go away. They call the spa; they (spa operators) tell them to go to the emergency room, (and) they do, and once it’s better, no one reports it,” Riley said. The increased fines and penalties are designed to solve such problems — and make enforcement agencies more likely to go after doctors who are allowing spas to use their name to mask unlicensed work or unlicensed medical practitioners, Riley said. Despite the lack of data on how widespread the problem is, he and others say more enforcement and oversight is needed. “When we first tried to get these penalties increased two years ago, I gathered up some testimonies, some were given to me from the Osteopathic Medical Board, and some were really painful to read,” he said. Consumer rights Lynne McNees, president of the International Spa Association, said medical offerings are increasing at spas worldwide, and laws such as this one are needed to protect consumers and keep them from looking at price alone when determining whether to proceed with procedures that may be invasive. According to the 2011 U.S. ISPA Industry Study, there are an estimated 19,800 spas in the United States, and medically supervised services are offered by 14 percent of them, or just less than 2,800. And the services aren’t going anywhere. According to McNees, the medical offerings in spas are on the rise globally. “We’re seeing this growth, and it is really being driven by the consumer,” she said. “They want real results.” Despite the focus on the negative possibilities for medical spa visits, there are ways to maintain the services, which offer a boost to the spa’s bottom line, while putting customer’s safety first. Existing law in California prohibits the “corporate practice of medicine,” which means that a company cannot bill a client for medical services when a physician was not present for the procedure, among other regulations. “A lay person can arrange scheduling and staffing, but they cannot decide what the setting should be for a laser,” said Michael Cohen, an attorney in Beverly Hills who specializes in health care regulatory compliance. “They cannot be involved in diagnosis, operations or prescriptions.” Cohen noted that from a legal perspective, however, there are ways to set up a medical spa and use the guidelines to create a positive experience and a truly integrated practice. “We don’t want to put medispas out of business,” Riley said. “We want medispas — and the people who perform these services — to have the knowledge, training and experience to ensure patient safety.” Experts say that patients should conduct research before visiting any health facility including medical spas, and be wary of choosing one based on online deals such as those offered by Groupon or Living Social. Norris Cosmetic Physician Center, where Hosseini has worked for the last seven years, is overseen by Dr. Kamran Safvati. The MediSpa has been in its Tarzana location since 2007. “It’s very important that you have a doctor on staff,” Hosseini said. “It’s a medical spa. It says it right there in the name.” Hosseini said she thinks the changes to the law are important. “It’s not a friendly environment out there.”