AUSTIN (KXAN) The Texas Medical Board issued new rules when it comes to administering and overseeing certain treatments like Botox injections in response to consumers “demanding more transparency,” according to TMB president Dr. Sherif Zaafran in a February bulletin. More changes could come as lawmakers also push for additional oversight.

The TMB rules clarify that treatments or procedures including Botox, IV and hydration therapy are considered “medical” and must be administered by a Texas licensed physician or others qualified under a doctor’s supervision like a physician assistant or an advanced practice registered nurse. 

Facilities are now required to post the name and the board license number of the delegating physician in all public areas and treatment rooms. Additionally, all advertising must also feature that physician’s name, and all staff must wear identification showing their name and credentials.

“The new rules aim to increase transparency, helping patients make informed choices and avoid negative outcomes,” explained TMB Communications Officer Spencer Miller-Payne.

The change comes after a KXAN investigation uncovered how anyone across the state can become certified to do injections including Botox. 

Lawmaker pushes oversight

“It’s a great start,” said Dr. Kelly Green, co-founder of TX400, a grassroots group of doctors advocating for patient safety across the state. 

The ophthalmologist in Marble Falls explained another big step would be if Senate Bill 378 filed in November passes this legislative session. The legislation from State Sen. Charles Schwertner, R-Georgetown, would prevent barbers, cosmetologists and estheticians from administering Botox and other injectables unless they are licensed or authorized to give the shots.  

“Whenever you’re injecting something, speaking as a surgeon, it’s important that the person doing that injecting or doing that cutting knows what they’re doing,” Schwertner explained. “We need to make sure that injury and harm does not occur.”

The bill would also give the Texas Department of Licensing and Regulation authority to discipline those professionals if something goes wrong. 

“I have had patients who’ve had their eyelid come down from Botox done elsewhere,” Green said.

The bill has been referred to the Senate Business and Commerce Committee. It has not been scheduled for a hearing yet. Last session, the bill stalled after passing the Senate. 

In May, KXAN’s “Backroom Botox,” highlighted a medical emergency under investigation by the police department in Dublin, a small city north of Austin. A woman who wanted her privacy protected told KXAN investigators that she had fainted after getting a Botox treatment in the back room of a shop in town. 

“Everyone was just kind of panicking. It’s like, ‘oh, my gosh, like, you know, what’s going on?’ And then the EMS and police arrived,” recalled the woman. 

An EMS report detailed she had a five-minute seizure and was vomiting. The Dublin Police Department launched an investigation into whether or not the injector was “practicing medicine without a license.” Police would only confirm medical staff was not at the shop the day of the emergency and a medical director listed back then was a pediatrician in Tyler – more than three hours away – who never returned KXAN investigators’ repeated calls and emails.

A spokesperson with the police department explained in February that the investigation is ongoing and it’s now working with the U.S. Food and Drug Administration. 

Complaints and discipline

TMB can take action against doctors and other individuals for either improper supervision or the unauthorized practice of medicine. KXAN reviewed TMB disciplinary records from 2018 to March 2024 and found more than 60 actions taken against individuals and/or physicians specifically related to med spas and or non-surgical cosmetic procedures.

Since the KXAN investigation in May, TMB disciplinary records show more than 20 new similar actions have been taken against individuals and/or physicians. KXAN investigators have not found any action related to the Dublin case and Miller-Payne said the agency cannot confirm or deny any complaints or investigations until action has been taken. 

Miller-Payne added that TMB continues to receive complaints related to Med Spas and IV hydration clinics about “improper supervision,” and “delegation by the physician.” He explained the complaints include failure to see patients before treatment or ensure that the delegated providers evaluate the patient and review medical records before deciding if treatment is appropriate. 

“Given the concerns over the risks of these therapies pose, the focus of the rules is to ensure patients are properly medically evaluated prior to treatment, know what they are actually receiving, and who is providing the therapy to them,” Miller-Payne explained to KXAN. 

He said that a “significant” number of complaints include there being no physician delegation and supervision. In such cases the TMB issues a Cease and Desist order.

“Patients need to be aware that if they go to a medical place, they can get medical care. If they’re going to a med spa or something like that, cosmetology type of place, those places shouldn’t be doing medical care unless they’re really being supervised by a physician,” Dr. Green explained. 

Ultimately, she believes it’s about patient safety in an industry that continues to grow. She explained that her group will be pushing for any legislation this session that puts patients first. 

“Some of this is being done in hair salons. Boutiques will have, like, a little closet set up in the back where people are getting Botox,” she said. “I mean, it’s completely bonkers.”

Investigative Photojournalist Richie Bowes, Graphic Artist Wendy Gonzalez, Director of Investigations & Innovation Josh Hinkle, Investigative Photojournalist Chris Nelson and Digital Director Kate Winkle contributed to this report.