Texas Bill Introduced to Restrict Non-Physician Practice in Certain Medical Spas

In July 2023, Jenifer Cleveland passed away after receiving an intravenous (IV) infusion containing vitamin B complex, ascorbic acid, B12, and total parenteral nutrition (TPN) electrolytes at a Wortham, Texas medical spa. An investigation by the Texas Medical Board found that the spa’s medical director—a physician based over 100 miles away—rarely visited the spa, failed to implement protocols or standard operating procedures for IV services, and had an informal (and unsigned) “medical director agreement” documenting his relationship with the spa. The spa’s owner, who performed the IV treatment, did not hold a medical license, and no other licensed medical professionals were present at the spa at the time.^[1]

As a direct result of this tragedy, on March 4, 2025, Texas State Representative Angelia Orr introduced Texas House Bill 3749 (H.B. No. 3749 or the “Bill”), “An Act relating to the regulation of the practice of medicine, including the performance of cosmetic medical procedures and the provision of elective IV therapy.” The Bill seeks to impose greater physician oversight of “medical spas,” defined as facilities outside a physician’s primary office location where cosmetic medical procedures are performed, with the goal of improving patient safety. The term “cosmetic medical procedure” covers a range of cosmetic medical treatments such as or dermal filler injections, dermatological laser procedures, and energy-based aesthetic devices.^[2] The Bill also regulates “elective IV therapy.”^[3]

Key Provisions

H.B. 3749 would require medical spas to have a director (i.e., a physician trained in the performance of cosmetic medical procedures or the use of particular medical devices who assumes the role of directing the spa’s operations) in order to be able to perform cosmetic medical procedures.^[4] The Bill would also require the medical spa director to implement policies promoting quality patient care, including providing for physician delegation, supervision, and training of cosmetic medical procedure providers.^[5] Additionally, H.B. 3749 would classify medical spas as a “medical practice setting” and force medical spas to post a notice whenever a physician is not present at the spa.^[6] Notably, the bill would also require a physician to perform an initial assessment of a patient and prepare a written treatment plan for each patient.^[7] 

Industry Backlash

The American Med Spa Association (AmSpa) criticized H.B. 3749 as an unnecessary regulatory overreach that will increase compliance costs, diminish the roles of physician assistants and nurse practitioners, and divert physicians’ attention away from more complex patients. Individuals associated with AmSpa and Vitalyc Medspa have argued that it was a lack of operating procedures—not a lack of physician oversight—that led to Ms. Cleveland’s death.^[8]

May Not Be a Significant Change for Some Business Models

Depending on the ownership structure of a medical spa, the Bill may not have significant impact on existing operations. Some medical spas are structured to be part of a plastic surgery, dermatology, or other physician specialty practices, which are owned and operated by licensed physicians. Depending on the physical location of these medical spas, they may not constitute “Medical spas” under the current version of H.B. 3749. Notwithstanding the foregoing, the authority of a physician to delegate medical acts is and will continue to be subject to applicable Texas law, including the Texas Medical Board rules.  

Notable Dates

H.B. No. 3749 was referred to the Public Health Committee of the Texas House of Representatives on March 26, 2025. If passed in its current form, applicable medical spas would need to comply with the Bill’s requirements by September 1, 2025.

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[1] , The Texas Med Spa IV Therapy Death: What You Need to Know (Oct. 19, 2023, updated Dec. 21, 2023), https://americanmedspa.org/blog/the-texas-med-spa-iv-therapy-death-what-you-need-to-know.

[2] H.B. 3749, 89th Leg., R.S., 2024, § 172.001.

[3] Id. § 173.001 (a term used to describe procedures to administer fluids, nutrients, medications, or blood directly into a patient’s bloodstream through a vein, that is sought by the patient to alleviate symptoms of temporary discomfort or improve temporary wellness, but that is not administered in a physician office, licensed health facility, or hospital).

[4] Id. §§ 173.051, 173.052.

[5] Id. § 173.053.

[6] Id. §§ 172.002, 172.003.

[7] Id. § 172.102(c).

[8] See, e.g., , New Texas Bill Would Impact Med Spas, and (Mar. 6, 2025), https://americanmedspa.org/blog/new-texas-bill-would-impact-med-spas-pas-and-nps; , Recap: Texas HB 3749 Restricts and in Medical Spas (Mar. 14, 2025), https://americanmedspa.org/blog/webinar-recap-texas-hb-3749-restricts-nps-and-pas-in-medical-spas.