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LEGAL ISSUES cleared by the Food and Drug Administration (FDA) for dermatologic use. This guideline can be problematic because many cos- metic practices are owned by non-core physicians. This is not to say that non-core physicians cannot supervise Nurse Practitioners (NPs) and Physician Assistants (PAs) who are engaged in aesthetic medicine. It does mean that greater care in training and documentation is called for. It would also be prudent for the non-core supervising physician to attend training courses in aesthetic medicine and retain documen- tation of that training. To ensure patient safety and minimize legal risks, every aesthetic medical practice should have the "Three P's" in place. These are practice "policies, procedures and proto- cols." The supervising physician should develop, implement and review the "Three P's" at least once every six months. Ancillary medical staff should review them regularly as well. Supervising Someone Else's Employees A more complicated and often misunderstood scenario oc- curs when a physician is hired to supervise staff performing medical aesthetic treatments at a facility not owned by the supervising physician. Many physicians believe that they have more fl exibility and less responsibility when they are super- vising employees or contractors of another facility. Nothing could be further from the truth. This aspect of physician supervision must be broken down into two elements: A situation in which a physician is supervising aesthetic medical providers in a facility owned by another physician; and a scenario in which the physician is supervising aesthetic providers who are performing medical treatments and the owner of the facility is not a physician. Under the fi rst scenario, it can be argued that the em- ployees and contractors of the other facility are performing medical aesthetic procedures under the delegation of the owner-physician. In this case, the supervising physician would be providing his or her aesthetic medicine expertise as a form of advanced training. This is a sound argument, and the respective documents and agreements between the physicians should refl ect this scenario. If new treatments are being intro- duced as part of this training and supervision, the supervising physician and owner-physi- cian can develop the "Three P's" together with the owner-physician ensuring that all protocols and procedures are appropriately followed and implemented. Both physicians should carry appropriate insurance to protect each other and their respective corporate entities. It would be prudent to create an agreement between the supervising physician and the owner-phy- sician that spells out the terms of the training, supervision and ongoing involvement with staff members. The situation becomes much riskier if the physician is supervising medical and non-medical person- nel who perform medical treatments at a facility that is not physician owned. (For example, many non-physicians own medical spas that perform medical treatments.) This scenario is not legally supportable. There is no distinction between aesthetic medicine and traditional medicine when it comes to inappropriate person- nel performing medical procedures. Accordingly, there are Unauthorized Practice of Medicine (UPM) issues as well as Corporate Practice of Medicine (CPOM) issues. These topics have been covered in prior issues and it is well worth the time to review these issues. As you deviate from these basic concepts, you are taking a risk. 32 MAY/JUNE 2014 | Med Esthetics It would be prudent to create an agreement between the supervising physician and the owner-physician that spells out the terms of the training, supervision and ongoing involvement. Physicians who supervise employees who perform medical treatments at a non-physician-owned facility expose themselves to signifi cant risk. © ISTOCKPHOTO.COM continued on page 78 L e g a l I s s u e s M E D 5 - 6 1 4 . i n d d 3 2 Legal Issues MED5-614.indd 32 4 / 1 6 / 1 4 4 : 3 8 P M 4/16/14 4:38 PM