Alert: Will Alabama’s New IV Therapy Enforcement Become the National Standard?

November 9, 2022

IV (intravenous) therapy services have been the growing rage in the elective medicine space for the past few years. Existing medical spas and wellness centers have moved to add the services and there has been an explosion of stand-alone IV bars opening around the country. Like most elective services in the space, IV therapy falls within the practice of medicine, and medical providers must place themselves in a compliant position to reduce the potential risks that come along with offering this therapy (See Update to the 123s of IV Therapy Providers).

As many IV therapy clinics have noted, few, if any states have published any direct rulings on the IV services. Consequently, IV therapy has been like the Wild West from a compliance perspective. Practitioners with different backgrounds and significant training on placing IVs have resisted the idea that IV therapy services would be treated as the practice of medicine.  Alabama has issued a definitive ruling that may provide the clarity needed in this space and could become the standard used by other states.

On July 21, 2022, the Alabama State Board of Medical Examiners (“BME”) issued a declaratory ruling to address the growing business of retail IV therapy. The BME conducted a statewide investigation on retail IV therapy businesses and found that a substantial number of these businesses were not compliant with Alabama law. The BME found that medically unqualified or underqualified individuals were administering IV treatments without the proper oversight of a physician. This declaratory ruling clarified the regulations on the administration of IV therapy and addressed whether providing IV therapy constitutes the practice of medicine under Alabama law.

The Ruling Answered the Following Questions:

Does administration of IV therapy constitute the practice of medicine in Alabama?

Yes. Under Alabama law, the diagnosis of a patient’s condition and the recommendation of IV therapy constitutes the practice of medicine.

Who can diagnose IV therapy in Alabama?

Only a licensed physician, or a physician assistant (“PA”), certified registered nurse practitioner (“CRNP”) or certified nurse-midwife (“CNM”) legally practicing with a physician, may diagnose a patient, assess their symptoms, and recommend an IV for the treatment of the patient’s condition. Often this is called the good faith exam (“GFE”) in the medical industry.

Can an RN diagnose IV therapy?

No. Medical diagnosing is outside the scope of practice for an RN. The issuance of “standing orders” by the physician for the RN to follow does not satisfy the physician’s legal duties to the patient.

Can a RN administer IV therapy?

Yes the RN can administer the IV therapy after the GFE has been conducted by the appropriate medical provider.

What steps must retail IV therapy businesses take to be in compliance?

To comply with Alabama law, retail IV therapy businesses must:

  1. Perform the GFE (this may occur in person or utilizing telemedicine)
  2. Create a medical record for the patient
  3. Issue a prescription* – prior to administering IV therapy

*Assuming that the physician, PA, CRNP, or CNM diagnosed the patient and is prescribing IV, he or she has determined it will benefit the patient.

Failing to meet these requirements could result in disciplinary action by the BME.  As often is the case, once a state or medical board issues a declaratory ruling on an expanding area of medicine, other states may take notice and follow. Will Alabama’s BME set the new national standard going forward?  If you are in the IV therapy business, it is important to pause and reflect on your process to determine if you are complaint based on this ruling in the event your state follows Alabama BME’s position.

Contact ByrdAdatto

At ByrdAdatto we are working hard to ensure our clients are apprised of constantly changing laws and well equipped for operating their business. If you have questions regarding this alert, reach out to or call 214.291.3200.

We are grateful for the significant research and drafting contribution to this article from our Law Clerk, Clint Nuckolls. Clint is a second year student at SMU Dedman School of Law.

ByrdAdatto Founding Partner Bradford E. Adatto

Bradford E. Adatto

Brad decided to become a lawyer during sixth-grade Career Day, when he promised to represent his best friend, a future doctor. A few decades later, he started his own law firm that focused on representing health care and corporate clients.