Doctor directed unqualified employee to administer Botox - HDC

A doctor has been told to take a competency review if he wants to return to work after directing a woman be given Botox by an unqualified person.

The woman suffered extensive and severe reactions to the treatment, according to a finding by the Health and Disability Commission (HDC).

The doctor has been found to have breached the Code of Health and Disability Services Consumers’ Rights for directing the employee to administer the Botox and also did not ensure appropriate consent was obtained.

The employee who arranged the treatment was a member of an overseas nursing organisation, but she was not registered with the Nursing Council of New Zealand to practise as a nurse, and she did not hold a practising certificate in New Zealand.

She was not entitled to perform health services, including injecting prescribed medicines.

The employee was working as the clinical practice manager at the medical centre owned by the doctor.

She told HDC in addition to her administrative tasks, she also at the doctor’s request assisted the doctor with clinical activities when the medical centre was short-staffed.

The doctor was away on the day the employee administered Botox to the woman. The employee phoned the doctor and was advised to proceed with the treatment.

The woman signed a consent form for the doctor to provide her with Botox treatment, but the treatment was provided by the employee who signed the consent form as the "doctor".

The only risks and side effects listed on the consent form are a minor, temporary drooping of the eyebrow or eyelid, and slight swelling or bruising. No other discussion about potential risks or side-effects of the procedure occurred.

On the day following the treatment, the patient said she felt “very tired” and “slightly off”, and added she took great care to not rub her face, and she had not done any physical exercise.

She said around 10.30pm, she experienced several symptoms, which were described as a racing heart rate, feeling of dread, shaking, sweating and the inability to fall asleep.

“[My] body felt like it was on fire and I had electrical surges through my arms, legs, heavy legs, feeling [off-balance].”

Later symptoms included slightly blurred vision and an aching face, according to the report.

The patient was also examined by a GP at a medical centre. The GP noted she presented with multiple symptoms following her treatment but felt better than the two days previously.

Her neurological examination was normal, as were her ears, nose and throat. The GPs impression was one of a mild reaction to botox, with an overlay of "severe anxiety".

About one month later, the woman said she still “felt exhausted” and had dizziness, vertigo, a brief episode of an inability to swallow, followed by a lump sensation in her throat.

Deputy Health and Disability Commissioner, Deborah James, found the doctor breached the right to give customers services that comply with legal, professional, ethical, and other relevant standards for directing the unqualified employee to administer the woman’s Botox injections.

"As the registered health practitioner, the doctor was responsible for ensuring he delegated his clinical work to appropriately qualified and trained staff. I am concerned that the doctor also asked the employee to assist with Botox treatments for other consumers, when she was not qualified to do so."

James said the woman was not provided with adequate information, as part of the informed consent process, and there was not a proper discussion about the risks and side-effects before treatment was provided.

James also found the doctor breached the code by failing to ensure such information was provided, and for failing to ensure that the woman’s informed consent was obtained before treatment was provided.

Since the events, the medical centre has reviewed and updated its consent form and its policy and procedure on Botox. The doctor is no longer practising, and his practising certificate expired in 2020. The employee told HDC she now works in a job "which does not include any type of clinical activities or cosmetic treatments".

James recommended the doctor undertake a competence review, with the assistance of the Medical Council of New Zealand, should he return to medical practice.

She also recommended that if the medical centre decides to continue appearance medicine services, it review and update its policy to ensure that only a doctor or registered nurse can provide Botox treatment, and not a ‘physician assistant’.

Finally, James recommended the employee familiarise herself with the requirements to practise as a registered nurse in New Zealand and ensure that she does not sign any documentation or consent forms as a "doctor" in future.