Yes, if the procedure is one that California’s unlicensed-practice statute covers and the person has neither a valid physician’s certificate nor another license that authorizes that act. The offense can be charged as a felony or a misdemeanor, it reaches cosmetic treatment of a “blemish” or “disfigurement,” not only disease, and anyone who conspires with or aids or abets the unlicensed person faces the same punishment.

The core rule

Business and Professions Code section 2052(a) makes it a public offense to practice or attempt to practice, or to advertise or hold yourself out as practicing, “any system or mode of treating the sick or afflicted,” or to diagnose, treat, operate for, or prescribe for “any ailment, blemish, deformity, disease, disfigurement, disorder, injury, or other physical or mental condition” of any person. Because the list includes “blemish” and “disfigurement,” cosmetic work can fall within it, not only surgery or diagnosis. Two kinds of authorization take a person outside the statute: a valid, unrevoked, or unsuspended physician’s certificate, or authorization to perform the act under a certificate obtained under some other provision of law. The second is why, for a nurse or physician assistant, the question is whether their own license authorized what they did.

The punishment is a fine of up to $10,000, a felony term under Penal Code section 1170(h), up to one year in county jail, or the fine plus either kind of confinement. Section 2052 does not specify the felony term, so section 1170(h) makes it 16 months, two years, or three years, ordinarily served in county jail. Since the statute offers both a felony term and county jail, the offense is a “wobbler” that becomes a misdemeanor in the situations Penal Code section 17(b) lists.

Helping can carry the same punishment

Under section 2052(b), any person who “conspires with or aids or abets another” to commit an act described in subdivision (a) is guilty of a public offense subject to the same punishment. Depending on what they knew and did, that can include a spa owner, manager, or anyone else who hires or directs an unlicensed person to perform procedures, not only the person who performed them.

What the Medical Board says about medical spas and injectables

The Medical Board of California still posts a January 2007 newsletter article on medical spas. It says that when a “medical spa” offers medical procedures, the label is marketing and the work is, in reality, the practice of medicine, and that “it is illegal for unlicensed personnel to provide these types of treatments.” It adds that cosmetologists, though licensed for superficial treatments such as facials and microdermabrasion, “may never inject the skin, use lasers, or perform medical-level dermabrasion or skin peels,” and that in California those treatments must be performed by a physician, or by a registered nurse or physician assistant under a physician’s supervision. The article is Board guidance, not a statute, and it does not list every rule that applies to nurses or physician assistants.

A narrow exception that does not cover injections

Section 2053.5 shields a person who complies with section 2053.6 from violating section 2052. Compliance means giving the client, before any service, a plain-language written statement that the provider is not a licensed physician, that the treatment is alternative or complementary to state-licensed healing arts services, and that the services are not licensed by the state, among other points, and getting the client’s written acknowledgment. The shield is lost for anyone who performs a procedure that “punctures the skin or harmfully invades the body,” prescribes or administers legend drugs or controlled substances, holds out as a physician or surgeon, or willfully diagnoses and treats a condition under circumstances that create a risk of great bodily harm, serious physical or mental illness, or death, among other listed acts. Injections fall outside it.

Section 2054 separately makes it a misdemeanor to use “doctor,” “physician,” “Dr.,” “M.D.,” “D.O.,” or other terms implying you are a physician, surgeon, or practitioner on a sign, business card, letterhead, or advertisement, or to hold yourself out as one, without a valid, unrevoked, and unsuspended physician’s and surgeon’s certificate. The same section bars using those titles in a health care setting in a way that would lead a reasonable patient to believe the person is a licensed M.D. or D.O. Both rules have listed exceptions, including a holder of a current and active license in another healing arts profession, to the extent the title is consistent with the law governing that license.

What actually decides these cases

Because both the elements and the aiding-and-abetting exposure are fact-specific, what usually matters is:

  • Whether the person who performed the procedure held a valid physician’s certificate at the time, or another license that authorized that specific act.
  • If a registered nurse or physician assistant performed it, whether a physician was actually supervising. The Board’s article warns about a “paper-only supervisor” and says the physician need not be onsite but “must be immediately reachable.”
  • Who hired, directed, marketed, or paid the person who performed the procedure, and what they knew about that person’s license.
  • What was actually done: the Board lists injections, lasers, and medical-level dermabrasion or skin peels as work a cosmetologist may never do, and any procedure that punctures the skin is outside the section 2053.5 exception.
  • Any advertising, business cards, or signage describing the person or business as a doctor, physician, or medical practice.

If you or your business is facing an accusation involving unlicensed medical or cosmetic procedures, Law Offices of David S. Chesley can sort through the licensing facts and supervision arrangement with you. Speak with the firm at (800) 755-5174.