A whirlwind and emotional couple of days results in a totally different bill... and a major win for med spas; the impact on IV clinics remains to be seen.

By Alex Thiersch, Founder and CEO, AmSpa

Boy, that escalated quickly.

A couple weeks ago, I wrote a blog about the newly filed Texas med spa legislation, HB 3749, that was... well, a little critical. That proposed bill, which was filed in response to the unbearably sad events surrounding Jenifer Cleveland's death due to an IV infusion at a Texas med spa, took aim at Texas medical spas, nurse practitioners (NPs) and physician assistants (PAs). It would have devastated the medical spa industry in Texas without solving the problem it wanted to solve. It wasn't a good bill, and I, along with many of you, let our feelings be known to the bill's author, Representative Angelia Orr.

Even though I really liked the letter we sent to Rep. Orr (it was professional and educational but pointed and persuasive—very well edited by my team), I honestly didn't think anything major would be changed in the bill. Maybe I'm becoming cynical as I get older, or maybe I'm just beaten down by the current political climate, but I figured we'd have some hard choices to make, given the circumstances surrounding the legislation.

Well, when you're wrong, you're wrong, and it's important to step up and admit it. And I was definitely wrong. Not only did Rep. Orr seemingly listen to what we and many others said about the bill, but she also acted sensibly and pragmatically by amending the bill so it attempted to solve the problem at hand.

Not everyone will agree with the new version of the bill, but I must give credit where credit is due. Kudos to Rep. Orr. She took in the arguments of the stakeholders, researched and understood realities of the industry, and tried to draft a smart bill that attacked the problem. She used a scalpel, not an atom bomb. She deserves thanks and credit for doing so.

Now, let's talk about the new bill.

The amended HB 3749—only IV therapy

All mentions of "cosmetic medical treatments" or "medical spas" were removed from the bill. All requirements that a physician—and only a physician—be on site at all times at all medical spas were removed. And all restrictions on NPs’ and PAs' ability to perform good faith exams at medical spas were stripped away.

Regardless of what happens, that's a huge win for the industry. The original bill was problematic because it attacked safe and compliant med spas, even though the real culprits were unsafe, non-compliant IV therapy practices. I'm relieved to report that all the anti-med spa and anti-NP/PA language is now gone from the bill. We can all breathe a collective sigh of relief.

What remains is a proposed bill that attempts to regulate elective IV therapy—and only IV therapy—in Texas. It does so first by firmly defining elective IV therapy as a medical treatment, thereby reinforcing the requirement that IV patients be seen by a physician, NP or PA prior to treatment and that proper delegation and supervision protocols be in place.

But the main weight of the bill is in its restrictions on who can administer the IV treatment—i.e., who can physically stick a needle in a patient's arm after examination by a physician, PA or NP.

The new version of HB 3749 allows the "administration" of IV treatments to be performed only by registered nurses (RNs), PAs, NPs or physicians. So, to perform elective IV treatments in Texas, a clinic must have at least a trained RN on site to place the IV in the patient's arm. Licensed vocational nurses (LVNs), paramedics and medical assistants cannot provide that function.

To many, this is logical. Having at least an RN insert an IV into a vein in your arm seems normal. But, in many states, Texas included, the delegation of medical treatment is at the discretion of the physician in charge. If the physician believes that a particular provider is trained and capable of administering a treatment—including an IV—the physician can delegate that treatment to anyone, including a tech or medical assistant. That's the current law in Texas.

The result is that elective IV therapy would be held to a different standard than other areas of medicine in Texas. If HB 3749 becomes law, a medical assistant could insert a prescribed IV at a doctor's office or hospital, but that same medical assistant, no matter how highly trained, could not do this for elective treatments outside of a doctor's office.

I know for a fact that some IV therapy clinics use non-RNs to administer IVs. Those providers—typically paramedics, LVNs or medical assistants—are typically well-trained and supervised by physicians or NPs/PAs, and often become quite proficient at safely administering IVs.

Physicians who run these clinics will argue, quite passionately and convincingly, that most serious adverse events happen because of IV dosage, drug mixture, patient selection and supervision—not because of who administers the IV. There are complications from IV placement to be sure, but those can happen anywhere, even at the best hospitals, and they can come at the hands of the most experienced RNs or physicians.

In other words, according to this argument, it is not the licensure of the person doing the needle-stick that is the root of the problem—it is the training, experience and supervisory protocols of the clinic that matter, as they do in all medical settings. And, therefore, there is no reason for elective IV therapy clinics to be treated differently than anyone else.

The emotional committee hearing and the current status of HB 3749

On Monday, April 28, 2025, the House Public Health Committee held a hearing on HB 3749—the new version—at the Texas capital in Austin. I was lucky enough to testify on the general background on the industry, its regulatory framework and the legal impact of the new bill. Special thanks also go to the Chair of AmSpa's Texas State Chapter, S. Alexis Gordon, MD, FACS, of Renew MD Facial Aesthetics, for testifying on the clinical and practice elements of IV therapy.

 

 

The hearing was an eye-opening, heart-wrenching, and informative snapshot into how a segment of the community views our industry. It also provided a glimpse of one version of the industry's possible future.

There were a couple of super-important takeaways: One, the campaign to restrict and over-regulate med spas is just getting started, and the industry will no doubt see further attempts to capture market share across the country; and, two, the legislatures, regulators and rule-makers have no idea how the medical spa industry works or even what it is, and, if left uninformed, will enact laws that bear no relationship to the problems we face and will do nothing to enhance patient safety.

I was left more convinced than ever that the med spa industry must act immediately on a nationwide basis to educate on and advocate for its own rights to ensure its continued existence. And we must always put patient safety and professional medical care first.

First, one of the most emotional moments of the day was when Brian Cleveland, Jenifer Cleveland's husband, testified on behalf of his late wife and his family. This was very difficult to watch, and it was impossible not to feel deeply for him and his family. As I've said before, he deserves answers and he deserves action. His wife should be alive today. And, while almost all of us are practicing safely, we cannot brush aside the fact that a wife and mother was killed because parts of our industry have operated recklessly and openly for years, without consequence.

Until this industry collectively decides to regulate and police itself, what happened to Jenifer Cleveland will continue to happen, and legislation like HB 3479 will continue to be introduced. But, the next time, we cannot count on someone like Rep. Orr listening—the regulation will be swift, harsh and overreaching, and it will be entirely deserved.

Second, we cannot allow regulators and legislators to decide our fate, because they do not understand health care in general, let alone cash-pay aesthetic treatments. The level of education we provided to the committee was on the kindergarten level. We didn’t discuss scope of practice for particular treatments and particular providers, general versus onsite supervision or training requirements. The information the committee needed was elementary—the difference between an RN and an NP, how a PA is allowed to prescribe a drug and order a treatment, and why injecting drugs intravenously is even possible outside of a hospital setting.

To be clear, this is not the fault of the legislators at all. They aren't doctors, RNs or PAs, and, for most of them, this was the first time they'd learned about medical protocols and standard operating procedures in any health care setting. But that's the point—the legislators on the committee should not be the individuals making the final decision on who should be doing what and what type of training is needed in a medical spa. That would be like me, an English major who couldn't muster higher than a C in math my entire life, drafting safety standards for rocket propulsion in interspace travel. It's beyond my comprehension and I shouldn't be involved.

The current bill and the path forward

So, where do we go from here? As mentioned, the current draft of the bill* is much better than what it was before, but it is still inconsistent with Texas law as a whole and subjects IV therapy clinics to stricter standards than other health practices. Whether this is acceptable to IV clinics and med spas with significant IV practices needs to be determined. AmSpa is open to feedback on this question.

To be transparent, AmSpa has requested that the language be amended so that it's consistent with the general delegation standards of Texas law. Under those standards, it is up to the physician to determine who is qualified to administer a treatment or deliver a drug, provided proper diagnoses, treatment plans and supervisory protocols are in place. If Texas wishes to change its delegation standards, I think a fulsome review of the rules across all medical disciplines is in order.

That said, I believe that AmSpa and the industry should be supportive of this bill whether the language is changed or not. Something needs to be done to alter the current dynamic. The industry must change, or we risk having the entire structure of it collapse on itself. And the current bill, while not perfect, at least rattles the cages of non-compliant actors so that they know that laws do, in fact, exist. This would be only an incremental change—not a wholesale revision like its first iteration. If we show ourselves unwilling to accept even incremental change, my fear is that next time, we will be forced to accept something even more drastic.

Regardless of what happens with HB 3749, the industry must band together now to ensure we are ready for future bills that will undoubtedly come. More importantly, we must take this opportunity to determine for ourselves what kind of industry we want moving forward. We have the ability to fix this, but only if we move forward together as one industry.

*Note that as of May 6, 2025 the website for the Texas state legislature still carries the original text of HB 3749. AmSpa received this revised text directly from the office of the bill's sponsor, Texas state representative Angelia Orr, and this was the text that was voted on and approved by the Committee on Public Health.