Compliance Planning and standards

Those of you who could not attend the meeting that was held August 23, 2012 at the law of offices of Call & Jensen, located in Newport Beach, missed a great presentation. Norman C. Davis, Esq. spoke about the issues concerning Aesthetic Compliance. Those of us that keep our ear to the ground are aware of the raids on medical spas in California leading to the arrest of nurses, spa owners, and in one case a physician. It appears that the Board of Nursing (BRN) has created a task force to investigate medical spas that are considered non-compliant. Unfortunately, the BRN did not communicate what the compliance issues were. If you are interested in protecting your license, the links below will provide updated information from the medical board regarding compliance issues.

WHY?

Notice:
http://www.mbc.ca.gov/laws/regs_physician_availability_notice.pdf
Text:
http://www.mbc.ca.gov/laws/regs_physician_availability_text.pdf
Initial Statement of Reasons:
http://www.mbc.ca.gov/laws/regs_physician_availability_isr.pdf

Areas of legal concern

1. Laser/RF Device purchase, ownership and use
2. Supervision of Laser/RF medical procedures
3. Cosmetic injectables
4. Corporate Practice of Medicine
5. Business Structure models
6. Working relationships
7. Risk Management

Laser/RF Device Purchase and ownership issues

State Regulatory Boards
1. Control who may use the device and under what circumstances, if you are not compliant, they will get you
2. Level of M.D. supervision over the practice, if you are not compliant, they will get you
3. RN’s cannot perform the first assessment, ONLY! An M.D,or D.O. Nurse Practitioner (NP) or Physician Assistant (PA), every state varies, check with the medical board or the board of nursing in your state, if you are not compliant, they will get you

Training/Certification/Competency

PHYSICIANS – NURSE PRACTIONERS-RNs-PAs

Do you think that your training is adequate from a laser rep that has no medical background; any one can teach you how to push buttons. Do you know the physiology behind the epidermis? In addition, do you understand the basic physics and laser safety? Were you trained in a hotel room by so-called “educators” from other states they do not have a clue about California’s laws if so, and you are not compliant, they will get you.

Do you want to be arrested for non-compliance? Many people are facing jail and prison time in the state of California. Several raids have been executed in the past several months. Nurses, physicians and medical spa owners have been the target. Criminal charges have been placed on several in Beverly Hills, Palm Springs, Newport Beach, and others. If you are not compliant, they will get you.

The College of Medical Aesthetics is the only institute of higher learning Approved by the Bureau of Education. In addition, has a strong relationship with top tier Universities. If you are serious and professional you will look at an institute that teaches not trains, if you want to be a true professional in the field of Aesthetic Dermatology Nursing
I would like to encourage you to take this seriously.

Julia Pettis, Bs, Hcm
President, CEO

Lack of regulation raises medical spa safety issues Lawmakers have yet to enact safeguards

When Daphne Carroll suffered permanent injuries from a botched cosmetic laser procedure, she tried to file a complaint with state regulatory boards but had nowhere to go.

Medical Aesthetic Training of California are advocates for regulating medicals spas

She said she felt like a ping pong ball. The Tennessee Department of Health, which has purview over doctors, sent her to the state Board of Cosmetology, which referred her back to Health. She learned that Tennessee allows medical spas to operate with less accountability than doctors’ offices. Carroll tried to change that and testified before the General Assembly this year, but it ended another session without establishing a consumer safeguard law.
“I cannot stand the thought of this happening to someone else” Carroll said.

The La Vergne woman says she is still suffering almost five years after an aesthetician-someone who typically does facials-used a laser on her. Carroll had walked into a medispa in Murfreesboro to buy makeup, agreed to a skin evaluation and heard a sales pitch for the laser procedure that cost $250. It was supposed to fix a red spot on her face.

“I went back for our wedding anniversary thinking it would be a day of pampering, good for my skin,” Carroll said.
She suffered a burned, swollen face and went home having trouble breathing. Carroll was injured at Rejuvenate Cosmetic Laser Surgery, according to the lawsuit she filed in Rutherford County Circuit Court. The superficial wounds have healed, but deeper damage to her trigeminal nerve is permanent. The Damage keeps her eyes from producing tears and cause facial pain.

She maintains a Facebook page and is the sponsor of a petition on change.org to advocate for better regulation, but the debate is not limited to Tennessee.

People got to medical spas for Botox injections, microdermabrasion, laser procedures and other treatments to look younger. The services typically are supervised by a heath care professional, supervised by a health care professional, but that person is not always a nurse or a doctor.

Medical Aesthetic Training of California are advocates for regulating medicals spas and establishing educational requirements for Aesthetic and Dermatology Nurses

Do Nurses In The Aesthetic Field Need Their Own Liability Insurance?

Over the past couple of months, a number of questions come up from nurses in the aesthetic field regarding professional liability insurance. I thought it might help to lay a few of them out for clarification:

Do Nurses In The Aesthetic Field Need Their Own Liability Insurance?

1) I AM A 1099 SO DO I NEED MY OWN INSURANCE OR AM I COVERED BY THE MEDISPA?
You do need your own insurance and cannot be covered by the Medispa unless you are an employee (W-2).

2) I HAVE INSURANCE THROUGH NSO FOR MY WORK AT HOSPITALS BUT ALSO DO WORK AT A MEDISPA. THE NSO INSURANCE PROTECTS ME AT THE MEDISPA RIGHT?
NO it does not! NSO does not provide any coverage for 1099 work in the aesthetic field for the state of California. To protect yourself for your potential liability at the medispa, you need a separate insurance policy for that work.

3) WHAT IS THE COST OF PROFESSIONAL LIABILITY INSURANCE FOR A 1099?
If the medispa has it’s own professional liability insurance (not just general liability which covers slip and falls), and, if you can provide a copy of the first page of the medispas professional liability insurance and the professional liability insurance of the Medical Director, then the cost runs in the area of $1250 a year.

If the medispa does not have professional liability insurance, or if the medical director does not have insurance to cover him/her at the medispa, then your insurance will cost more as you are the primary person who could get sued. The premium for you will run about $2900 a year.

Both of the above policies are for $1,000,000 in coverage.

As you can see, it is extremely important that you find out if the medispa has it’s own insurance so that you can better discuss your compensation.

4) DO I HAVE TO PAY FOR THE PREMIUM ALL AT ONCE OR CAN IT BE DONE OVER TIME?
There are payment plans available. They normally require 25-35% down and the rest over 9-10 payments.

5) ISN’T THE MEDICAL DIRECTOR COVERED UNDER HIS PROFESSIONAL LIABILITY INSURANCE FROM HIS NORMAL MEDICAL PRACTICE?
No, he is not covered. If he is acting as a Medical Director for a medispa, he would need a separate professional liability insurance to cover him. The medispa can add him to their policy or can get a stand alone policy. Interestingly, if he is added to the medispa policy, the premium is probably less than your policy (this is because of number of claims, primary responsibility, etc. which falls on you, the nurse who does the procedure).

6) IF I AM PROVIDED A COPY OF THE REQUESTED INSURANCE, THEN I AM FULLY COVERED, RIGHT?
Yes and no. You are may be covered for the work you do at the medispa, but not for any work done outside of the medispa. If you were to attend and work at a “botox party”, you would NOT BE COVERED by your insurance that you got for the medispa.

Additionally, it depends of you are an employee or a 1099 independent contractor. If you are a 1099 independent contractor, you are not covered by the policy of the medispa.

7) I AM AN EMPLOYEE (W-2) OF THE MEDICSPA. I AM INSURED RIGHT?
The only way to know if you are insured is to:

• See a copy of the medispas policy
• Look at the exclusion page and look to see if employees are not covered, what procedures are not covered, etc.
• Check to see if all employees are automatically covered or if you must be specifically added to the policy

8) OK, I AM COVERED BY THE MEDISPA INSURANCE SO I AM OK RIGHT?
Yes and no.

YES:
If you have a problem at the medispa, you are covered

NO:
If the policy is “claims made”, then when you leave the employ of the medispa, or if the medispa changes insurance companies and then a claim is made on a procedure done under the old policy, you will not be covered. To be covered, the insurance policy must be “Occurrence” form of insurance. With “occurrence” insurance, even if you leave the employ of the medispa and then a claim is made against you, you will be covered.

YES, BUT HOW MUCH:
If the amount of insurance coverage is “shared aggregate”, then the let’s say $1,000,000 of coverage is the total amount of protection that is shared by all parties being sued.
Recent lawsuits have included the nurse, the medispa, the medical director, the landlord and even the person who booked the appointment!

NO:
The insurance company of the Medispa may try to show that you were at fault for the cause of action and sue you!

9) SO IF I AM AN EMPLOYEE, SHOULD I GET MY OWN INSURANCE?
It depends on you. If you feel that insurance that costs about $100 a month is not worth the downside risk to you, your family, your assets, etc., then don’t get insurance. If on the other hand, you don’t want to run the risk of being in debt for the rest of your life, then $100 a month is a small price to pay for piece of mind.

10) I HAVE INSURANCE AT THE HOSPITAL WHERE I WORK FROM ANOTHER COMPANY, SO WHEN I DO SOME PROCEDURES AT A MEDISPA I AM COVERED BY THE INSURANCE FROM THE HOSPITAL, RIGHT?
No, the insurance from the hospital only covers you for actions at the hospital. Nowhere else.

I hope these points help clarify any questions you may have regarding insurance, your risk and how to protect yourself and your family.

Barry J Klazura

Experts in the Cosmetic World

Continue to support the increase in non-invasive treatments. Botox and other toxins are on the rise with laser skin re-skin resurfacing in second place. With new technology in lasers, the minimal down time is a selling factor for today’s consumers.

Recently Newport Aesthetics, located in Newport Beach, Ca offered Photo-Facial treatments with Living Social. 85% of new clients never had a basic facial, much less a laser treatment. 57% were in their late 20′s to early 40′s. Most discussed the desire to improve the appearance and texture of their skin. This opened doors to engage in conversation about skin products and other services that would benefit the client.

Extending Your Practice

According to DermatologyTimes.com February 2010 Vol.33, No2 Extending Your Practice. National report- Dermatologists are increasingly turning to “extenders”-nurse practitioners and nurses- to combat a shortage of doctors in the specialty. These mid-level providers and the physicians who hire them say teamwork, training and education are among the keys for successful collaborations.

UPDATE: College of Medical Aesthetics

College of Medical Aesthetics, formally Medical Aesthetic Training of Califonia, Inc will launch the first Aesthetic Nursing Certificate program in the USA.

The general purpose of the Aesthetic nursing program is to establish educational guidelines that provide the educational institution with direction for seeking approval of a new post-licensure nursing program. In accordance with Business and professions Code, Section 2786 (a), educational programs offered in institutions of higher education may apply for accreditation of new programs. These institutions such as the College of Medical Aesthetics will meet the requirements of certification and degree programs.

The specialty area of aesthetic nursing prepares the aesthetic nurse to provide competent care, educate the patient to what is scientifically proven, participate in research, develop best practices, and provide evidence based nursing care. Aesthetic nurse professionals are currently unregulated, leaving nurses susceptible to insufficient instruction regarding patient safety, laser safety, and direction of standardized procedures and protocols, and understanding the role of the medical director, while defining a full understanding of federal and state laws that vary from state to state. However the College of Medical Aesthetics has established a complete, comprehensive, and academically precise curriculum to meet this deficiency in aesthetic nursing education.

This comprehensive18 week educational program will launch March 5, 2012, accepting only 12 students that must meet requirements set by the college. The College of Medical Aesthetics will offer the program as a learning community in cyberspace and also traditional hands on skills labs that require the student to be present. This is known as a hybrid program that will allow working professionals to study at their
leisure while providing a synchronous and asynchronous environment.

Enrollment is now open: limited to 12 students

Coming soon in 2012:

The College of Medical Aesthetics

Medical Aesthetic Training will soon have a new comprehensive program with a myriad of innovative instruction and learning techniques including new and exciting instructors. Medical Aesthetic Training of California is currently in the application process of Accreditation by the Bureau of Private Postsecondary Education the only Aesthetic Nursing program that offers a nursing program approved by the state of California Bureau of Private Postsecondary Education. Our goal for 2012 is to incorporate a full educational facility along with externship programs for students that meet the requirements of completion of theory and skills lab. For more information call us at 949.759.1620