Safety cited in new scope-of-practice policies

New Orleans -- The American Medical Association enacted several scope-of-practice policies addressing care provided at medical spas and during invasive procedures and anesthesia services.

A resolution adopted by the AMA House of Delegates during its Interim Meeting in November states that safeguards are needed to protect patients during cosmetic medical procedures performed at medical spas. The Association will advocate that these procedures, such as botulinum toxin injections and procedures involving laser and intense pulsed light, be considered within the practice of medicine.

Delegates directed the AMA to increase awareness about the dangers medical spa treatments can cause when they do not adhere to patient safety standards. For instance, an improper injection of Botox above the eye could seep down and injure the eyelid, said Sean Figy, a Medical Student Section alternate delegate from Holland, Ohio.

The new policy calls for the creation of a formal complaint process to report such injuries in order to increase transparency.

Health spas can play a positive role in patient care, but treatments by untrained or unsupervised workers can lead to severe injuries, Figy said. "We want to make sure that patients that are going to these medical spas are safe and have persons who have been trained in the practice of medicine."

The AMA said it will join interested state and medical specialty societies in continuing to study new treatments provided at medical spas to ensure patient safety.

Physician-led health care teams

House testimony was overwhelmingly in support of a new AMA Board of Trustees report that addressed physician scope-of-practice issues regarding invasive procedures. Delegates adopted policies calling for the AMA to advocate that interventional chronic pain management employing radiation, such as fluoroscopy, should be performed only by physicians.

Delegates also adopted policy calling on the AMA to convene a task force to develop guidelines for advocacy efforts regarding the appropriate level of supervision, education, training and provision of other invasive procedures by nonphysicians -- including those employing radiologic imaging.

The report was considered timely, as doctors have seen some states allow nurse practitioners to supervise fluoroscopies. For instance, an Iowa rule had permitted advanced registered nurse practitioners to provide direct supervision for fluoroscopy until a judge overturned it in October.

Delegates instructed the Association to create model legislation prohibiting nonphysicians from performing fluoroscopy.

The house also directed the AMA to identify and review states whose governors have opted out of the federal Medicare physician supervision requirements for anesthesia services. Delegates adopted a separate Board of Trustees report calling on the AMA to analyze data to determine whether there has been an increase in patient access to services in those states. An analysis would include data on the type and complexity of care by all nonphysicians compared with care provided by physicians and anesthesia care teams.

While several delegates agreed with the initial trustees report, others said it should contain stronger language. The report's recommendations should be broadened so that they apply to all medical care, said James Hay, MD, a family physician in Del Mar, Calif., and a delegate for the California Medical Assn. "We would like to see this go much further," he said.

The AMA later adopted policies stating that physicians are best qualified to lead the health care team, but also recognizing nonphysician practitioners as valuable components.