California landlord guide: RN/NP/PA violations, reporting obligations, premises liability, and enforcement strategies
Landlords and medical facility operators who lease space to med-spas, IV therapy clinics, aesthetic injectors, or other healthcare providers face unique patient safety and liability exposures. When tenants operate outside their scope of practice—RNs performing procedures that require physician oversight, NPs exceeding their standardized procedures, or unlicensed persons posing as medical professionals—patients are at risk and landlords face premises liability.
California law imposes a duty on property owners to maintain safe premises and, in some circumstances, to prevent third parties (tenants) from causing foreseeable harm to others (patients). Understanding scope-of-practice rules, recognizing red flags, and knowing when to intervene are critical to protecting your facility and avoiding liability.
| Safety Issue | Landlord Liability Risk | Prevention Strategy |
|---|---|---|
| RN performing procedures beyond scope | High—if landlord knew RN lacked physician supervision and did nothing, liable for patient injuries | Require proof of physician supervision agreements; inspect for compliance; terminate if violations found |
| Unsanitary conditions / infection risk | Moderate—landlord liable if failure to maintain premises (e.g., mold, vermin, unsanitary common areas) contributes to infections | Regular facility inspections; require tenant to maintain infection control; OSHA compliance audits |
| Lack of emergency equipment / protocols | Low—generally tenant's responsibility, but landlord may be liable if emergency access blocked or facility lacks required exits | Verify tenant has AED, oxygen, emergency medications; ensure clear egress paths; test fire alarms |
| Controlled substance diversion | Moderate—DEA may investigate facility; landlord liable if aware of illegal drug activity and did not report or evict | Require tenants with DEA licenses to provide copies; report suspicious activity (e.g., high volume of opioid prescriptions) |
| Unlicensed practitioners | High—landlord may face "aiding and abetting" claims if knew tenant was unlicensed and continued to rent space | Verify all tenant licenses via state boards; surprise inspections to confirm personnel match licensed individuals |
Landlords are generally not liable for tenant malpractice unless they have actual knowledge of unsafe conditions and fail to act reasonably to prevent harm. Key concepts:
Actual Knowledge: You must have real awareness of the problem—not just constructive knowledge ("should have known"). Sources of actual knowledge:
Reasonable Action: Once you have knowledge, you must take reasonable steps to prevent harm:
Authorized Activities (B&P §§ 2725-2727):
Medical Functions Requiring Physician Supervision (CCR § 1379):
RNs may perform the following only under written standardized procedures created and supervised by a physician:
Prohibited Activities (cannot do even with supervision):
Authorized Activities (CCR §§ 1399.540-.546):
Supervision Requirement: NPs must practice under standardized procedures developed in collaboration with a physician. Standardized procedures must specify:
Aesthetic Procedures: NPs can perform Botox, fillers, and lasers IF authorized in standardized procedures. Many NPs exceed their scope by offering procedures not listed in their standardized procedures or by operating without any standardized procedures.
Authorized Activities (CCR §§ 1399.530-.540):
Supervision Requirement: PAs must have a written delegation of services agreement with a supervising physician specifying:
Red Flag: PA performing aesthetic injections in a med-spa setting without a delegation agreement or without supervising physician ever visiting the facility.
Esthetician Scope (B&P §§ 7316-7320):
Medical Assistant Scope (B&P §§ 2069-2070):
Observation: You've leased space to a med-spa that advertises Botox, fillers, and laser services. Over 6 months, you've never seen a physician enter the suite. RN staff arrive daily and perform treatments.
Legal Issue: For RNs to perform medical procedures, California requires physician supervision, which typically means the physician must be:
If the physician never visits, "supervision" is likely a sham. The RN is effectively practicing medicine without a license.
Your Action: Request copies of the supervising physician's visit logs, chart review documentation, and standardized procedures. If tenant cannot produce these, demand they cease operations until compliant.
Observation: Your tenant's IV therapy lounge has 10-15 patients daily, all receiving IV infusions. You've observed only one RN on-site, with no physician ever present.
Legal Issue: High patient volume with minimal physician oversight suggests inadequate supervision. Standardized procedures for IV therapy typically require physician availability during treatment hours and chart review of a percentage of patients (e.g., 10% monthly).
If RN is treating 300 patients/month with physician reviewing 0% of charts, supervision is non-existent.
Your Action: Demand proof of physician chart review (e.g., signed chart review logs showing dates and number of charts reviewed). If tenant cannot provide, this is a material lease breach.
Observation: During a walk-through, you notice:
Legal Issue: Facilities performing aesthetic injections (Botox, fillers) must have emergency equipment for allergic reactions, anaphylaxis, and cardiovascular events. OSHA and standardized procedures typically require:
Your Action: This is a life-threatening deficiency. Demand immediate correction (within 48 hours) or prohibit patient treatments until equipment is in place.
Observation: Tenant's website lists "Jane Doe, Lead Injector" with no credentials (RN, NP, PA, MD). You Google Jane Doe and find she's an esthetician, not a nurse or physician.
Legal Issue: Estheticians cannot perform injections (Botox, fillers) or operate medical lasers. This is unlicensed practice of medicine (B&P § 2052) and is a crime.
Your Action: Verify licenses of all clinical staff via state board websites (Medical Board, Board of Registered Nursing, Physician Assistant Board, Board of Barbering and Cosmetology). If tenant employs unlicensed persons to perform medical procedures, this is grounds for immediate lease termination and potentially a duty to report to Medical Board.
Observation: Tenant advertises "weight loss clinic" with prescriptions for phentermine (Schedule IV controlled substance). Tenant's NP does not have a DEA registration.
Legal Issue: Prescribing controlled substances requires a valid DEA registration (federal) in addition to state prescribing authority. Prescribing without DEA registration is a federal crime (21 U.S.C. § 841) and exposes your facility to DEA investigation and asset forfeiture.
Your Action: Verify tenant's DEA registration at www.deadiversion.usdoj.gov (limited public search). If no DEA registration, prohibit controlled substance prescribing and consider reporting to DEA.
Observation: One tenant (licensed physician) appears to be providing "medical director services" to multiple other tenants (estheticians, wellness coaches) in your co-working space. The physician charges a flat monthly fee and signs charts but never actually supervises procedures.
Legal Issue: This is likely Corporate Practice of Medicine (CPOM) violation and/or aiding and abetting unlicensed practice (B&P § 2053). It also exposes you (landlord) to claims that you're facilitating CPOM by providing the space for this arrangement.
Your Action: Prohibit "medical director for hire" arrangements where physician does not actually supervise. Require each medical tenant to have their own bona fide supervision agreement with documented oversight.
California law generally does not require landlords to report tenant scope-of-practice violations to regulatory agencies. However, several doctrines create quasi-duties:
1. Premises Liability Duty to Prevent Harm: If you have actual knowledge of tenant's dangerous practices and foresee patient harm, you have a tort duty to take reasonable steps to prevent harm (Civ. Code § 1714). This may include reporting to regulators if eviction alone is insufficient to stop ongoing harm (e.g., tenant continues operating during unlawful detainer proceedings).
2. "Aiding and Abetting" Exposure: If you knowingly provide space for unlicensed medical practice and take no action, you could face claims of aiding and abetting (B&P § 2053). Reporting to authorities may be necessary to avoid criminal liability.
3. OSHA Violations: Cal-OSHA requires employers to report serious injuries and fatalities. If you're aware of OSHA violations (bloodborne pathogen risks) and an employee or patient is injured, your failure to report or correct could trigger OSHA penalties against you as facility owner.
4. Controlled Substance Diversion: Federal law imposes reporting duties on persons with knowledge of controlled substance diversion or illegal drug activity. Failure to report can result in DEA investigation and potential accessory-after-the-fact charges.
| Scenario | Report? | To Whom? | Why? |
|---|---|---|---|
| RN performing Botox with no physician supervision; no patient injuries yet | Optional (after demand letter) | Medical Board; Board of Registered Nursing | Unlicensed practice; reporting protects you from "aiding" liability if tenant continues |
| Patient injured due to tenant's scope violation; patient threatens to sue landlord | Yes | Medical Board; your insurer | Demonstrates you took reasonable action upon learning of violations; supports premises liability defense |
| Tenant refuses to correct OSHA violations (sharps, PPE); continues operating | Yes | Cal-OSHA | OSHA can issue citations and shut down tenant; protects you from "controlling employer" liability |
| Esthetician performing surgical procedures (deep laser, fat removal) without license | Yes (urgent) | Medical Board; possibly DA | Extreme patient safety risk; potential criminal activity; landlord must act to avoid facilitation claims |
| Tenant prescribing controlled substances without DEA registration | Yes | DEA; Medical Board | Federal crime; landlord at risk of DEA asset forfeiture if facility used for illegal drug activity |
| Tenant misrepresenting physician credentials (false advertising) but no patient harm | Optional | Medical Board; AG (false advertising) | Business fraud; reporting is discretionary but may support lease termination |
When reporting tenant violations to regulators, frame your report carefully to avoid extortion or interference claims:
Reports must be motivated by patient safety, not financial disputes. Tenant can argue your report was retaliatory or extortionate if it appears tied to lease negotiations.
Medical Board of California:
Board of Registered Nursing:
Cal-OSHA:
DEA (Drug Enforcement Administration):
Date: [Current Date]
To: [Tenant Med-Spa Name]
[Suite Address]
From: [Landlord Name / Property Management]
[Address]
RE: NOTICE OF PATIENT SAFETY VIOLATIONS – DEMAND FOR IMMEDIATE CORRECTIVE ACTION
Dear [Tenant]:
This letter documents serious patient-safety concerns regarding your operations and demands immediate corrective action to bring your practice into compliance with California law.
Observations During Facility Inspection ([Date]):
Legal Violations:
Landlord Liability Exposure: Your violations expose our facility to premises liability under Civil Code § 1714. If patients are injured due to inadequate supervision or lack of emergency equipment, we may be held liable for knowingly permitting unsafe medical practice on our premises.
IMMEDIATE CORRECTIVE ACTIONS REQUIRED (within 72 hours):
Consequences of Non-Compliance: If you fail to complete these actions within 72 hours, we will:
This is an urgent patient-safety matter. Contact me immediately at [phone/email] to confirm corrective actions.
Sincerely,
[Your Name]
[Title]
Enclosures: Inspection photos (dated [Date]); CCR Title 16, § 1379 (Standardized Procedures requirement); Lease Section [X]
Date: [Current Date]
To: [Tenant Business Name]
[Suite Address]
From: [Landlord]
[Address]
RE: NOTICE OF UNLICENSED MEDICAL PRACTICE – IMMEDIATE CESSATION REQUIRED
Dear [Tenant]:
We have discovered that your business is engaging in unlicensed practice of medicine in violation of California law. You must immediately cease all medical procedures or face lease termination and regulatory reporting.
Discovery of Unlicensed Practice: Your business website and marketing materials advertise "Jane Doe, Lead Injector" performing Botox and dermal filler treatments. We verified Jane Doe's credentials via the Board of Barbering and Cosmetology website and confirmed she holds an esthetician license only—she is not a registered nurse, nurse practitioner, physician assistant, or physician.
California law (Business & Professions Code §§ 7316-7320) strictly prohibits estheticians from:
Ms. Doe's performance of Botox injections constitutes unlicensed practice of medicine under B&P § 2052, which is a crime punishable by imprisonment and fines.
Landlord Liability: By leasing space for unlicensed medical practice, we face:
IMMEDIATE DEMANDS:
If You Do Not Comply Within 24 Hours:
This is a non-negotiable patient-safety and legal compliance issue. Unlicensed practice of medicine exposes patients to serious harm and exposes us to catastrophic liability. We will not tolerate it.
Confirm cessation of medical procedures in writing within 24 hours to the address above.
Sincerely,
[Your Name]
[Title]
Enclosures: Esthetician license verification (Ms. Doe); screenshot of website advertising "Jane Doe, Lead Injector"; B&P §§ 2052, 7316-7320
Patient safety and scope-of-practice violations require urgent legal action to protect landlords from premises liability, regulatory enforcement, and criminal exposure. These disputes involve complex healthcare licensing law, tort duty analysis, and regulatory reporting strategy—areas where general landlord-tenant attorneys lack expertise.
I represent California landlords, medical facility owners, and property managers in patient-safety disputes involving med-spa tenants, IV therapy clinics, and aesthetic providers. My practice focuses on rapid intervention, regulatory coordination, and premises liability defense.
Patient safety disputes are time-sensitive and require healthcare regulatory expertise:
Patient safety violations create liability that extends beyond typical landlord-tenant disputes. If your medical tenant is operating outside their scope, lacking proper supervision, or engaging in unlicensed practice, every day you wait increases your exposure.
Send me your lease agreement, tenant's license documentation (or lack thereof), and photos or observations of violations. I'll assess your duty to act, liability exposure, and immediate steps to protect your facility.
Flat-fee patient safety audits ($2,500-$5,000). Urgent injunctions on hourly basis (expedited). Eviction litigation flat-fee or hourly. Premises liability defense typically through your insurance carrier.