Following an incident at a medical spa showcasing the dangers of the unlicensed practice of medicine in nontraditional medical settings, Texas has enacted a bill that will place the first set of regulatory requirements on elective intravenous (IV) therapy. Prescription and administration of elective IV therapy will be limited to particular healthcare professionals and solely when acting under the oversight of a physician in accordance with an executed prescriptive authority agreement. The heighted regulations are scheduled to take effect on Sept. 1, 2025, and they will ultimately set forth more stringent guidelines for provision and oversight of elective IV therapy when performed outside the bounds of a traditional medical setting, as well as add to the current regulations regarding physician oversight and prescriptive authority agreements.
Need for Heightened Medical Spa State Regulations
In the aftermath of the medical spa incident, Rep. Angelia Orr (R-District 13) sponsored the bill, colloquially termed "Jenifer's Law," which Gov. Greg Abbott signed into law June 20, 2025, with strong support from both the House and Senate. Nearly two years earlier, on July 10, 2023, a visitor to a medical spa in Wortham, Texas, received an elective IV infusion containing a vitamin B complex solution that can have potential for complications and requires a prescription for administration. Shortly following insertion of the IV, the visitor lost consciousness and went into cardiac arrest, was unresponsive to CPR by local emergency medical services technicians and died thereafter in the hospital.
Though the visitor had signed consent forms prior to treatment indicating that she was not under the care of a physician, had no known chronic conditions and was not taking any medication, the acting medical director for the medical spa was more than 100 miles away from the spa at the time of the IV administration by the spa's unlicensed owner. Arguably, the medical spa failed to comply with requirements for appropriate physician supervision, leading the Texas Medical Board to temporarily suspend the medical director's medical license.
Scope of the Increased State Regulations on Elective IV Therapy
Due to the minimal regulations on medical spas and their rapid growth over recent years, the Texas Legislature decided that additional measures were needed regarding elective IV therapy. Specifically, Jenifer's Law establishes delegatory requirements for elective IV therapy if administered outside of a hospital, physician's office, licensed mental hospital or other licensed health facility (i.e., if administered in a "Non-Facility"), including the following:
- Limited Practitioners Permitted Delegatory Authority for Prescription. The bill limits delegation of the act of prescribing or ordering such therapy to only a physician assistant (PA) or advanced practice registered nurse (APRN) acting under appropriate physician supervision.
- Limited Practitioners Permitted Delegatory Authority for Administration. The bill has similarly limited delegation of the act of administering such therapy to a PA, an APRN or a registered nurse (RN) acting under appropriate physician supervision.
- Prescriptive Authority Agreement Limitations. A prescriptive authority agreement will be required for prescription and/or administration of elective IV therapy through the above specified individuals, and the agreement will count toward the maximum total authority agreements authorized under the law of seven PAs and APRNs combined or full-time equivalent thereof.
Looking Ahead
The new regulations will place additional restrictions on facilities such as medical spas, with the aim of protecting citizen welfare following the unfortunate death that led to Jenifer's Law. With the increase in oversight, there will likewise be heightened scrutiny regarding the adequacy of appropriate physician supervision. Non-facility providers such as medical spas should be aware of the increased regulation and scrutiny and consider adopting policies and procedures regarding physician supervision of PAs, APRNs and/or RNs administering elective IV therapy and documenting the provision of appropriate supervision in patient or client records.
Stay tuned for updates as the regulations on elective IV therapy evolve and their impact on healthcare personnel responsible for oversight of non-healthcare entities continues to unfold.
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