Doctor criticised for use of unqualified staff to provide Botox

“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”

Deputy health and disability commissioner Deborah James says a doctor was ultimately responsible for allowing an unqualified employee to administer Botox injections to a woman who suffered adverse side effects.  

According to the decision released on Monday, the staff member wasn’t registered to practise as a nurse and didn’t hold a practising certificate. 

The employee was a clinical practice manager at the medical centre and told the HDC that, in addition to administration work, she also helped the doctor, who owned the practice, with clinical activities when they were short-staffed.

The doctor was away when the woman visited the practice for Botox on 5 September 2020. But, according to the HDC decision, when the patient arrived, she was asked to sign a consent form for the clinician to provide the treatment. The Botox was, in fact, administered by the staff member, who signed the papers as the “doctor”. 

The consent form listed some of the minor risks and side effects that she could experience from Botox. That included temporary drooping of the eyebrow or eyelid and swelling or bruising. But, according to the HDC, there was no discussion about other potential risks. 

The employee called the doctor for advice on how to deal with the woman, who was getting Botox for the first time. He told her to conduct an initial assessment and, if there weren’t any contraindications, proceed with treatment. 

Ms James found the doctor breached the code for directing an 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 says the woman wasn’t given adequate information as part of the informed consent process, and the employee failed to discuss the potential risks and side effects before treatment was provided. As a result, the doctor was found to have breached the code.  

“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,” she says.

The following day, the complainant said she felt tired, had a raised heart rate, and was sweating and shaking, and said her “body felt like it was on fire”. 

On 7 September, she continued to experience symptoms and had what she described as severe brain fog and was struggling to concentrate. She also had a loss of feeling in her cheeks, trouble with her balance, dry eyes, heavy eyelids, blurred vision and an aching face. 

She emailed the medical centre that day, and the employee who administered the treatment told her to come in for an assessment. 

On 8 September, a GP at the medical centre noted that the patient had multiple symptoms following her treatment but was feeling better than she had felt two days before. The GP found she was clinically stable, and the results from a neurological examination were normal. The doctor described her symptoms as a mild reaction to Botox, with an “overlay of severe anxiety”.

According to the HDC decision, the medical centre has since reviewed and updated its consent form and its policy and procedures relating to Botox treatment.  

The employee told the HDC her work no longer includes any clinical or cosmetic procedures, while the doctor at the heart of the complaint is no longer practising. 

Ms James recommended the doctor undertake a competency review with the Medical Council of New Zealand if he returns to medical practice. She called on the medical centre to ensure that only a doctor or registered nurse provided Botox treatment, not a physician assistant, if it decided to continue to offer cosmetic services. Ms James also said the employee must ensure that she did not sign any documentation or consent forms as a “doctor” in future.