This story comes courtesy of California Watch.

By Anika Anand

Proposed legislation in California would increase penalties for illegally owning and operating medical spas, which in some cases are performing procedures without required medical supervision.

Medical spas provide services such as laser hair removal, Botox injections and microdermabrasion. The cosmetic treatments are considered medical procedures, but at some medical spas, medical professionals aren’t giving or supervising the treatments.

From 2002 to 2010, more than 1,500 medical spas opened in the U.S., according to the International SPA Association. There is no official count of medical spas operating in California because they aren't required to register with the state medical board or any other government agency. Under California law, medical businesses must be owned by a physician or owned at least 51 percent by a physician and the remainder by a licensed practitioner, such as a nurse.

Also, a physician or an advanced practitioner, like a physician assistant or nurse practitioner, needs to examine the patient before any treatments, such as Botox or dermal fillers, are administered or prescriptions are given. But advocates of AB 1548 say that when medical spas get caught operating illegally, the fines aren’t harsh enough to dissuade them from doing it again.

Assemblywoman Wilmer Amina Carter, D-Rialto, said she is sponsoring the bill because she is concerned about patient safety.

"Alternative patient treatment sites, often called 'medi-spas,' have and continue to be a major and often misleading presence in the medical cosmetic skin care field,” Carter said. “While the demand for cosmetic procedures is on the rise, the risk to patients resulting from inadequate supervision is unacceptable."

In April, the state Assembly approved the bill, which calls for increased fines and more jail time for illegal medical spa offenders. Last week, the Senate unanimously approved the bill, which is now awaiting approval from Gov. Jerry Brown.

Under current state law, any person found guilty of illegally operating or helping to illegally operate a medical business can be charged with a misdemeanor or felony. Penalties include a fine of $200 to $1,200, a 60- to 180-day jail sentence or both. AB 1548 proposes raising the maximum fine to $50,000 and instituting a maximum two- to five-year sentence in a state prison if the services exceeded $950 in cost to the patient. If costs are less than $950, the offender could receive a six-month jail sentence, maximum $1,000 fine or both.

“This legislation increases the penalty so much that it actually gives the state funding to enforce the law and it acts as an actual deterrent,” said Lisle Soukup, director of advocacy and public policy for the American Society for Dermatologic Surgery. “It’s not just a patient safety issue; it’s a consumer fraud issue. Patients are assuming the people in the white coats that are offering their treatments are appropriately trained and supervised – but unfortunately, that is frequently not the case.”

The group sponsored the bill along with the California Society of Dermatology & Dermatologic Surgery.

Dr. M. Christine Lee, a dermatologist and director of The East Bay Laser & Skin Care Center in Walnut Creek, is an advocate for tougher regulations. Since 2000, she has treated patients with minor to severe burns, nerve damage, eye damage, permanent keloids, and permanent scars from medical spa treatments.

In 2004, she said she treated a patient whose face was covered with black stripes, burn marks from attempted laser hair removal. Lee said she ended up seeing a dozen women burned the same way after visiting the same medical spa. Most of the botched procedures Lee has seen were done by nurses or non-nurses, she said.

Every month, Lee said she sees an average of five people who had treatments go wrong. AB 1548 would help cut down the number of medi-spas performing illegal procedures, she said.

"It's much needed because the penalties aren't stringent enough to actually deter this type of illegal activity," Lee said. "The problem is, if you don't have penalties that have any bite, then people don't care. They think it's just a minor fine."

Soukup said her group has been trying to get legislation passed for the last two years. In 2010, the Assembly and Senate passed AB 2566 [PDF], which was similar to the bill now before Brown. But then-Gov. Arnold Schwarzenegger vetoed the bill later that year. In his veto letter [PDF], Schwarzenegger said that rather than investigating medical spas, the medical board’s time was better spent investigating physicians accused of causing serious patient harm or death.

The medical board doesn’t regulate medical spas. But through its Operation Safe Medicine program, it regulates the unlicensed practice of medicine and investigates complaints.

Defense attorney Tracy Green, who has represented a number of medical spa owners and employees over the past 12 years, said she has seen a recent increase in the number of illegal medical spa cases the state is prosecuting.

“In the past 10 years or so, if it was suspected that a medical spa wasn't in compliance with the law, the Department of Consumer Affairs or the California Medical Board would just send them a letter asking them to comply,” Green said. “Now, in the past year, I've seen the state executing search warrants and treating this like a felony.”

Green is representing a nurse in a Beverly Hills case that also involves a medical spa owner, an employee and a physician. The four were arrested in June and charged with felonies by Los Angeles County District Attorney Steve Cooley. After receiving a complaint alleging that medical procedures and "inappropriate medical services" were being provided at Dana Elise Solutions, formerly known as Laser Solutions, in Beverly Hills, investigators from the California Medical Board "seized evidence of illegal ownership and illegal practice of medicine" in December 2011, according to an agency press release.

The undercover operation found that non-physicians were giving medical treatment and prescription medications were being sold without a physician's order or without the patient being seen by a doctor, the release says. The medi-spa’s services include electrolysis, microdermabrasion, and depigmentation and exfoliation peels, according to its website.

Dana Elise Payinda, owner of Dana Elise Solutions, is being charged with eight felony counts of practicing medicine without a license. Her colleague, Dr. Debra Beth Luftman, is charged with aiding and abetting the unlicensed practice of medicine. Nurse Kimberly Benner and employee Tracy Lynn Poire are charged with practicing medicine without a license.

Green said that although the state can prosecute the women for felonies, she thinks it’s too harsh.

“Everyone I've ever represented genuinely had no idea they were breaking the law,” Green said. “This isn't a bunch of organized crime operating medical spas. … It's just a matter of people not knowing what the laws are.”

So far this year, Green has handled four criminal cases related to illegal medical spa operation. She said it’s the first time she has had cases involving the unlicensed practice of medicine at a medical spa that were criminal cases. She also has worked with 10 spas this year to make sure they are fully compliant with the law.

While Green recognizes it’s necessary to make sure medi-spas are in compliance, she doesn’t think the criminal charges are necessary. "It's heavy-handed, in my opinion," she said. "They can send a cease-and-desist (order). I don't know if they need to file criminal actions. If these are repeat offenders or someone who's told that this is the law, then that's different."

But dermatologist Lee said she has seen enough harm caused by unlicensed medical spas. “If you make a point of not wanting to learn the law, ignorance isn’t an excuse,” she said.

Anika Anand is a student at the CUNY Graduate School of Journalism in New York City where she is studying business and economics reporting. To read more California Watch stories, click here.

Related on HuffPost:

Healthy spa trends for 2012:
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  • Family Fun

    In 2008, the International Spa Association reported that <a href="" target="_hplink">four million teens have been to a spa</a>, and that 17 percent of spas offer exercise programs for kids and teens. That number will only continue to grow, predicts. But before you denounce the necessity of a pedicure for a seven year old, consider the educational value: Over half of all spas offer <a href="" target="_hplink">educational sessions</a> on topics ranging from nutrition to cooking to fitness, and could help in the fight against childhood obesity.

  • Long-Term Accountability

    Support can be hard to come by for the spa-goer looking to learn something long-lasting about nutrition or exercise or stress relief. As a result, more guidance for those newly-learned lessons may be implemented in 2012. The healthy habits learned at a spa or resort can be hard to stick to after leaving that nurturing environment, which is why predicts more will offer coaching to help guests make healthy changes that last. Some, like Canyon Ranch, even offer <a href="" target="_hplink">follow-up coaching over the phone</a>.

  • Feet First

    <a href="" target="_hplink">High heels hurt</a> -- but that doesn't necessarily mean you'll stop wearing them. Spas know that too, and to care for your tired dogs they're focusing more treatments on preventing injuries and easing pain, according to, ranging from "gait analysis" to muscle-strengthening to pedicures overseen by podiatrists. Often called <a href="" target="_hplink">"medical pedicures"</a> or "medicures", these toe treatments are now often performed by a foot doctor, thereby guaranteeing <a href="" target="_hplink">safer removal of calluses and corns</a>.

  • Chill Out

    Many spa-goers are used to retreating to the sauna or steam room to "sweat it out," but in 2012 it's time to cool off, literally. Cold treatments like ice rubdowns, snow showers and even cryotherapy chambers are becoming more common, according to and can reduce inflammation and improve circulation. Plus, summer spa vacationers in particular will get a <a href="" target="_hplink">boost to their spirits</a> as they escape the heat, reports ABC. Take a bit of the cold trend home with you and try this ice massage tip from <em>Running Times</em>: <a href="" target="_hplink">Freeze a small paper cup of water</a>, then rub the ice over a painful spot (like shin splints).

  • Virtual Reality

    Over and over again, research shows that your social networks -- virtual and offline -- <a href="" target="_hplink">influence your health and happiness</a>. In the wake of these groundbreaking studies, healthy living niches have cropped up all over the Web, from social media initiatives like <a href="" target="_hplink">Tweet What You Eat</a> to recipe blogs to <a href="" target="_hplink">Meetups</a> for finding a fitness partner for just about any kind of exercise activity you can think of. In 2012, spa living will branch out virtually too, predicts. Integrative medicine guru and HuffPost blogger <a href="" target="_hplink">Deepak Chopra</a> entered this space early-on with the meditation game Leela, and Clarins has now created a beauty game called "Spa Life" for Facebook. Expect programs like these to support a spa-goer's newly-formed healthy habits after returning home.

  • All Senses Go

    Soothing music and low lights aren't just aesthetic finishing touches at spas and resorts. <a href="" target="_hplink">Ayurvedic medicine</a> has incorporated color, rhythm and certain scents into spa treatments for thousands of years. In 2012, predicts more spas will pick up on these ancient practices and give them a modern spin in saunas, steam baths, tubs, massage tables and even lounge chairs, like the one picture here.

  • Scientific Scrutiny

    Although treatments like acupuncture and massage are increasingly more commonplace in traditional medical practices, there isn't always a large <a href="" target="_hplink">body of evidence</a> backing up what are often considered "alternative" treatments. But many people -- spa-goers or not -- are examining things like reflexology and aromatherapy under a narrower lens, according to, which is why sites like <a href="" target="_hplink"></a> will become more heavily relied upon in 2012. There you'll find a one-stop hub for the science behind various treatments, information that will be used by both traditional medical professionals to add services to their practices and by spas and resorts to lend credibility to their offerings, predicts.

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