The Arkansas State Medical Board will consider new guidelines for doctors overseeing minor cosmetic surgical procedures, including chemical peels and injectable treatments such as Botox and fillers.
The proposed rule clarifies training and other requirements for doctors who supervise staff that perform “aesthetic” procedures.
It’s drawn support from some physicians, who describe it as a matter of patient safety. It’s opposed by some industry professionals, including those at clinics known as med spas, as akin to a turf war initiated by plastic surgeons.
As written, the rule’s provisions include:Requiring doctors to show they have training in the procedures — including, but not limited to, board certification in certain specialties — before delegating them to others.
Requiring doctors to “personally diagnose and document” a patient’s condition before prescribing the treatments.
Requiring that doctors employ or have a written agreement with staff members performing such procedures.
Rules around laser treatments, which are also used for cosmetic purposes, were addressed in earlier guidelines, a draft of the proposed rule said. Its full text is online: armedicalboard.org.
At a public hearing Thursday that did not include a vote, about a half-dozen people appeared to add to hundreds of written comments the board received about the proposed guidelines with most who spoke in person expressing opposition.
They included John Burris, a lobbyist and former Republican state representative from Harrison, who once chaired the House Committee on Public Health, Welfare and Labor. Burris said he represented a group of practitioners, including some advanced practice registered nurses, who object to the regulation.
“I think all would agree that there’s room for improvement on what we require in terms of training for people who are putting needles into skin,” he said, but “requiring a personal diagnosis by a core specialty physician for a Botox injection is overreach, intended to bottleneck the system into a few core specialty providers.”
Dr. Melanie Prince, a Little Rock plastic surgeon, disagreed. She spoke to support the guidelines, adding that she thinks problems from cosmetic procedures are underreported.
“If you talk to the majority of plastic surgeons in town, we have seen these complications; we have cared for these complications,” she said. “When something bad happens, you need to be able to care for that patient afterward.”
State Medical Board members have commented on that issue at previous meetings, noting that if administered improperly, procedures covered by the proposed rule can cause serious complications such as necrosis (death of tissue cells) or blindness.
Board attorney Kevin O’Dwyer said in an interview Thursday that the rule came out of nearly five years of conversation between the group and state boards governing cosmetology and nursing “to deal with this issue,” including increasing complaints surrounding aesthetic procedures.
In June 2019, the State Medical Board scolded a doctor who was serving as the medical director for two Northwest Arkansas med spas despite having no training in cosmetic procedures and who was infrequently on-site. In August, board members rebuked another med spa for a promotion advertising free beer with Botox injections and laser hair removal.
Nonetheless, the group received numerous written comments objecting to increased oversight, according to documents released under the state’s public-records law.
One doctor who owns an El Dorado med spa said the rules would deprive many parts of the state, especially rural Arkansas, from receiving affordable cosmetic procedures.
“Patients will be forced to drive long distances and pay much higher costs for services. … The need for a physician to personally diagnose wrinkles adds to the overall cost of the procedure,” Dr. Donya Watson wrote in a May 26 letter.
A plastic surgeon whose name was not included in documents reviewed by the newspaper lauded the rule, saying patients in Arkansas deserve a higher standard of care.
“Major complications of fillers are rare,” the letter said. “However, for the patient experiencing the complication, it is catastrophic, leaving them permanently scarred or worse.”
Board members viewed Thursday’s hearing remotely, so there was little feedback from the group that oversees the practice of medicine in the state. They will discuss the rule and vote at a future full board meeting, the next of which is scheduled for Aug. 6-7.
If approved by the board, the rule will then go to the Arkansas Legislative Council’s Administrative Rules Committee for final endorsement. The state’s nursing board will consider a companion rule, O’Dwyer said.