Doctor Directs Unqualified Employee To Administer Botox

A doctor has breached the Code of Health and Disability
Services Consumers’ Rights (the Code) for directing an
unqualified employee to administer Botox to a woman who then
suffered adverse reactions and for not ensuring that
appropriate informed consent was obtained.

The
employee 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 that, in addition to 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.

Deputy Health
and Disability Commissioner, Deborah James, found the doctor
breached Right 4(2) of the Code (which gives consumers the
right to 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.”

Ms 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.

“Ultimate responsibility to ensure that
the risks were discussed, and that appropriate informed
consent was obtained, rested with the doctor as the medical
professional who remained responsible for the treatment,” Ms
James said.

Ms James also found the doctor breached
Right 6(1) of the Code by failing to ensure such information
was provided, and Right 7(1) 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”.

Ms 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, Ms 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.

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