By Patrick O'Brien, JD, legal coordinator, American Med Spa Association

In response to the COVID-19 pandemic, some medical spas have begun offering in-car injectable services like Botox and other neuromodulators, but is this legal or beneficial for medical aesthetic practices?

Unless you have been living on a deserted island or in a remote mountain cave, you are well aware that the coronavirus pandemic has brought major and far-reaching changes to our daily lives. Medical spas and the aesthetic industry have not been immune to these changes. As businesses have been permitted to re-open, they have had to face new challenges brought by these circumstances.

Some innovative practitioners have begun offering drive-thru injectable services to meet these issues. For these appointments, the patient completes their intake documents and initial screening remotely, and then is met by the practitioner in full personal protective equipment (PPE) in front of the spa for treatment. As some spas find success with this model, others are looking to expand the types of procedures they can offer. Will this become a medical spa mainstay or a curiosity of the times? No one knows for sure, but if you want to start offering services like this, there are a few issues you will want to consider.

What Are the Benefits of Drive-Thru Injectables?

Before we jump into the issues, let's explore why you might want to consider this type of service. Even though many states and cities have lifted restrictions on business or stay-at-home requirements, many people are justifiably reluctant to venture out. Since COVID-19 spreads by aerosol and contact with an infected person, you can limit your risk of infection by limiting your interactions with people. Every doorknob you touch or room you stand in is a place where you can catch it. In this regard, in-car or drive-thru service is attractive to a patient because they don't have to leave the safety of their vehicle and they have to interact with the minimum number of people. Due to this mentality, they are much more likely to use services that make them feel safer and are more convenient.

For medical spa practitioners and owners, drive-thru service is nice because it limits the number of people entering the office, thus reducing the need to sterilize rooms multiple times per day and shortening each appointment. (Ideally, rooms should be cleaned between every patient and at the beginning or end of each day.) It also limits the contact your employees have with potentially infectious patients. While you will still pre-screen and take other precautions for each patient, they only interact with one provider instead of several staff members; this has the side benefit of reducing your PPE costs. While each employee will still need to wear appropriate PPE in the office, the use of heightened PPE—such as gloves, gowns, eye protection and N95 respirators—can be limited to the one provider.

Are Drive-Thru Injectables Legal for Medical Spas?

Generally speaking, most states do not restrict where a physician may practice, provided they are able to maintain the appropriate standard of care for their patients. Therefore, treating a person in their car would generally be permitted, provided it is done in a safe and clean way. There are a few states that have location-based restrictions on procedures, including Nevada, which limits the administration of Botox and other injectables to physician offices and other specified locations. We previously covered the topic of concierge or house-call medical aesthetics, which you can read here. Many of those issues would also apply to a drive-thru type of service.

While this is generally permitted for physicians, states will often have rules and requirements for non-physician providers and appropriate practice settings. These can run the gamut of complications from minor inconvenience to strict prohibition.

On the one hand, we see this in supervisor agreements for physician assistants (PAs) and advanced practice registered nurses (APRNs). Often, these agreements will need to authorize the settings in which they may practice. In this case, addressing the issue may be as simple as amending or executing a new agreement.

On the other hand, the practice requirements for PAs, APRNs or registered nurses (RNs) may include specific approved practice locations, such as licensed facilities or clinics; they probably do not explicitly authorize a parking lot. If this is the case, contacting the medical or nursing board may be helpful in getting more information about what is allowed. And finally, as a reminder, you will need to adopt new office protocols to account for these types of services. Typically, nurses are required to practice under appropriate office protocols for the services they provide.

Should My Medical Spa Offer Drive-Thru Injectables?

Clearly, there is more to offering drive-thru treatments than just performing the treatment. But for the most part, the legal issues, policies, procedures and standard of care can all be met with some due diligence and groundwork. The benefits to patient satisfaction and safety certainly make it an attractive path.

However, there is one final concern that will need to be addressed before these services can truly be successful—public perception. You will notice that I have used "drive-thru" in this post. This is primarily because this is the phrase used in other media. Obviously, this is meant to create an implication that these treatments are the "fast food" of the medical aesthetic world, with the attendant implication that they are low-quality or cheap. This is similar to how medical spas were first viewed against traditional medical practices.

Just as medical spas have gained legitimacy by providing high-quality services in a non-traditional setting, so will these new modes of service need to do the same. "Concierge," "mobile" and in-vehicle services have the potential to provide high-quality and safe services in new settings, but they will need to convince the public of that. Food trucks have made the transformation from "roach coaches" to gourmet dining; we will see if in-car aesthetic care can do the same. The long-term success of these procedures will depend on medical spa owners and operators' ability to navigate and overcome these challenges.

AmSpa offers resources (see here and here) that can help you re-open and get running again. We also have online training resources in our Virtual Boot Camp and our AmSpa Masters classes. Finally, on July 1, AmSpa will present a live webinar on re-opening, presented by Brad Adatto, founding partner with the law firm ByrdAdatto.