In a significant move to enhance patient safety, Texas Governor Greg Abbott signed House Bill 3749—known as Jenifer’s Law—on June 20, 2025. This legislation introduces comprehensive regulations for elective intravenous (IV) therapy administered outside traditional healthcare settings, following the tragic death of Jennifer Cleveland in 2023.
A Tragedy Spurs Reform
Jenifer Cleveland, a 47-year-old radio station employee from Fairfield, Texas, lost her life after receiving an IV infusion containing a vitamin B complex and electrolytes at a local spa. The Texas Medical Board’s subsequent investigation revealed that the spa’s supervising physician failed to properly oversee an unlicensed individual who administered the IV treatment. The staff was unprepared to manage complications, ultimately leading to Cleveland’s death. This incident highlighted the dangers of unregulated IV therapy and prompted swift legislative action.
Defining Elective IV Therapy
Jenifer’s Law amends the Texas Occupations Code by adding Chapter 172, which specifically addresses elective IV therapy. Under the new law, elective IV therapy is defined as the administration of fluids, nutrients, medications, or blood directly into a patient’s bloodstream for temporary symptom relief or wellness improvement, when requested by the patient. Importantly, the law applies only to IV therapy provided outside a physician’s office, licensed health facility, mental hospital, or state-operated hospital.
Scope of Practice and Delegation
The law sets clear boundaries on who may prescribe, order, and administer elective IV therapy:
- Prescribing/Ordering: In order to obtain elective IV therapy, patients must have an order or prescription from a physician, licensed by the Texas Medical Board. However, the physician may delegate this authority to physician assistants (PAs) or advanced practice registered nurses (APRNs), provided there is adequate physician supervision.
- Administration: The actual administration of elective IV therapy may be delegated to PAs, APRNs, or registered nurses (RNs), again under adequate physician supervision.
Adequate supervision is defined as what a reasonable, prudent physician would consider consistent with sound medical judgment, taking into account the education and experience of the PA or APRN. Continuous supervision is required, but the physician does not need to be physically present at all times.
Prescriptive Authority Agreements
For PAs and APRNs to prescribe or order elective IV therapy, a written prescriptive authority agreement with the physician must be in place. These agreements must:
- Be reviewed, signed, and dated annually by all parties
- Include the names, addresses, and professional license numbers of all parties
- Specify the nature of the practice and practice locations
- Identify which drugs or devices may or may not be prescribed
- Outline plans for consultation, referral, and patient emergencies
- Describe communication processes and quality assurance measures, including chart reviews and periodic meetings
A physician may only delegate prescriptive authority for elective IV therapy to a maximum of seven PAs or APRNs (or their full-time equivalent), and all such agreements must be registered with the Texas Medical Board before the delegate begins work.
Implications for IV Therapy Clinics and Wellness Spas
Effective September 1, 2025, all elective IV therapy services offered outside traditional healthcare settings in Texas must comply with the new law. This means:
- Every elective IV therapy session must be ordered or prescribed by a physician, PA, or APRN under a valid prescriptive authority agreement and adequate physician supervision.
- Only physicians, PAs, APRNs, or RNs may administer elective IV therapy, and only under adequate physician supervision.
- Supervising physicians are responsible for ensuring that all delegated providers are properly qualified and that protocols and standard operating procedures are in place.
A New Standard for Patient Safety
Jenifer’s Law represents a major step forward in regulating elective IV therapy in Texas. By establishing clear requirements for delegation, supervision, and prescriptive authority, the state aims to prevent future tragedies and ensure that patients seeking wellness treatments receive safe, professional care. The law serves as a reminder that even seemingly routine wellness services carry risks—and that proper medical oversight is essential.
