Senate committee considers bill to limit delegation of elective IV therapy after med-spa death
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Summary
Lawmakers reviewed House Bill 37 49 to require physician delegation of elective intravenous therapies be limited to RNs, APRNs and PAs after a patient’s death at a med spa; paramedics and industry speakers urged inclusion or safeguards while physicians and family members pressed for tight clinical oversight.
Senators heard testimony on House Bill 37 49, a proposal to restrict physician delegation of elective IV therapy to registered nurses, advanced practice registered nurses and physician assistants, following the July 2023 death of a Austin-area woman after treatment at a med spa.
Sponsor Sen. Lois Kolkhorst said the bill, carried in the House by Rep. Orr, is intended to "reign in this unregulated or loosely regulated cottage industry" including mobile IV bars and med spas. She said the bill would set a clear statutory standard for who may administer elective IV infusions under physician delegation.
The family of the woman who died, Jennifer Cleveland, testified. Her husband said, "She walked into a med spa and she did not walk out of it. ... One was too many." Family members asked the committee for stricter limits and oversight.
Medical groups supported stricter limits. Dr. Zeke Silva of the Texas Medical Association said, "Placing an IV, infusing a medication into the bloodstream is a medical act as defined by the medical practice act," and that delegation options under state law are to APRNs, PAs and registered nurses. Physician witnesses and sponsor stressed the need for resuscitation equipment and physician oversight when procedures occur outside hospital settings.
Paramedics and mobile-IV providers testified that many paramedics working under physician protocols deliver safe elective IV therapy outside traditional EMS operations and asked the committee to allow licensed paramedics to continue those services under physician delegation. Dora Eatonburg, a licensed paramedic, said, "We fully support the intent of HB 37 49 ... We believe HB 37 49 can be made stronger by ensuring it protects patients without excluding the very professionals who were likely called to try and save her life, paramedics." Several paramedic witnesses described clinical training, standing orders and telehealth physician evaluations used before treatment.
Committee members questioned business practices described by mobile-IV providers, including telehealth examinations, use of third-party telemedicine companies, and company liability structures. Senators repeatedly noted the need to preserve patient safety, appropriate physician supervision, and clear oversight if elective infusions are allowed outside traditional clinical settings.
The committee closed public testimony and left HB 37 49 pending for further work.
Ending: The hearing underscored tension between patient-safety advocates and providers in an evolving market; senators asked for clearer operational safeguards, training and liability protections if the practice is allowed outside licensed clinical facilities.
