I have read the several articles, the Florida Statutes pertaining chapters and the Board of Nursing website re. ARNP's providing botox and dermal filler injections. It seems to be a very gray area. Could someone who understands this issue please help me out? Here are my questions:

ARNP has an S corp and rents office space in a spa (not a medi-spa, but a spa providing facials, pedicures, massages etc).
ARNP provides botox and dermal filler injectables to clients.
ARNP could, if necessary, have a protocol with a physician filed with the Board of Nursing.
This physician is not a dermatologist or plastic surgeon.
This physician does not own any part of the spa or of the ARNP's corporation.
The ARNP is not an employee of the physician.
The ARNP and the physician do not have any financial arrangement .
The physician is available by telephone and is not physically present in the spa or rented office space.
The physicians only office is 50 miles from the rented office space.

Is this permissible? If not, what would need to change with this scenario to make it acceptable?

I'm a PA in FL - what you suggest seems permissible.

The only law that I see that would pertain is the one the derms and plastics put into place where a physician who is not a derm or plastics cannot supervise a satellite office that does primarily derm medical aesthetics (botox/fillers). So if that is where you go to work every day and that is primarily what you do, and the supervising physician is not a derm or plastics, then that might be an issue.

Of course, you need the physician in order to order the product, so you'll have to be linked to some degree.

Since that law went into place, I have never heard of a case of strict enforcement, so I would say you would be fine.

You may have to register the office differently - obtain a biomedical waste license, etc.

prsleepy,

You will need to talk to a lawyer that is familiar with laser laws in your state. Every state treats things differently. I live and practice in South Dakota and an ARNP could do laser procedures and injections (I just helped get the laws changed). The issue is in South Dakota I do not think they treat a CRNA the same as an Nurse Practitioner. So in South Dakota you would not be able to perform any of the procedures.

Please spend the money to work with a good lawyer. He/She will save you money in the long haul. It sucks to buy a clinic or even a laser and then not be able to use it.

Lornell E. Hansen II, M.D.
www.LazaDerm.com

Dr. Hansen,

Thank you so much for your words of wisdom. I will do just that. In Florida, I am considered an ARNP as well, except that we are still a supervised state although it does not have to be specifically by an anesthesiologist. I just want to create my own business without giving part of my company to someone else.

Againg, thank you and happy holidays.

Sonia Negron, MS, MSHA, CRNA, ARNP

Sonia,

Make sure you find a lawyer that is well versed in medical contracts, state licensing laws as well as state practice laws. I initially tried to get by without the lawyers 8 years ago and it definitely cost me money. Now, if I have the slightest concern I check with my lawyer. He is the most well versed in the legal side of medicine around here for state and federal medical laws. Do not use someone new to medical law as they will not know all of the ins and outs.

Lornell E. Hansen II, M.D.
www.LazaDerm.com

Dr. Hansen,

Thank you for the advice. I already made contact with a well known health care lawyer in Miami. I surely do not any problems. I will keep you posted on what they say.

Sonia

Good to hear. It will be well worth it in the long haul.

Lornell E. Hansen II, M.D.
www.LazaDerm.com

Hello Dr. Hansen,

Reference to my questions of scope of practice, my attorney has informed me that there are no restrictions for me to practice. As long as I have MD protocols in place, that is all I need as an ARNP. PA always have to be supervised by an MD, but ARNPs do not.

Newcomer,

Glad you spent the money to get that figured out. I know that Florida has been a hotspot for "medspa" laws and they are changing at times. I would also recommend that you look to make sure there are no laws being presented to the state legislature. The plastics and derms in Florida are trying to legislate everyone else out of business.

Lornell E. Hansen II, M.D.
www.LazaDerm.com

Sonia,

I am impressed and inspired by your determination to open your own business.
I am also an ARNP in South Florida and looking into business similar to what you described on your tread above. Would you share with me your opinion as to the best training available for ARNPs on aesthetic techniques, i.e. Botox, etc.?

Thanks.

For a non-physician owned MedSpa in Florida, the Medical Director must be a board certified plastic surgeon or dermatologist. Best training in Florida for NP's or PA's is by Sasha Parker's Esthetic Skin Institute at http://www.esiw.com/esi/about-us/sasha-parker/

I have been asked to be a medical director of a spa that is opening in Miami. I will not be an owner and just salaried as contract employee. I am a plastic surgeon but that will not be my primary office but within about 25miles of it. They plan on doing only fillers and maybe Botox. I have looked and really cannot find concrete answers. They are:
1)Do I need to register with Florida Medical Board
2)Do I need to have liability insurance or just under med spa owner(not me) and is that necessary
3)Do I have to see every patient that is "treated" there prior to treatment
4)Do I need to be physically present
5)Can a trained lay person under my direct supervision do fillers or they have to be ?
Maybe someone could recommend a source or office that deals with these issues. I do not want to jeopardize my medical license in any way.