Medical Assistant's can not inject Botox!
I've seen and head about medical estheticians, medical assistants and even front desk staff administering Botox injections.
It's not legal, as this story on the prosicution of a medical assistant clearly shows.
Betty Guerra’s monthslong nightmare is over.
The 45-year-old former medical assistant learned today from her attorney that the 10 felony counts against her on allegations of “unlawful practice of medicine” will be dismissed, she said.
“I always believed things would work out the right way,” she said tearfully. “I cannot be punished for something I didn’t do.”
Guerra’s July arrest sparked controversy over what medical assistants can and cannot do. Specifically, there was confusion over whether they are able to give shots.
Guerra was accused of unlawfully administering cosmetic injections, an act commonly performed by medical assistants throughout Nevada.
The state attorney general’s office did not specifically say charges against Guerra would be dropped but indicated it won’t be pursuing the case.
“The complaint against Betty Guerra submitted to the Attorney General’s Office by the Board of Medical Examiners has been contradicted by the subsequent actions by the Board,” Attorney General Catherine Cortez Masto said in a statement. “Therefore, it is fair for us to conclude that it would be difficult to prosecute this case beyond a reasonable doubt.”
Guerra’s attorney, Jason Weiner, said this evening that the attorney general’s office had sent him a copy of an unfiled motion dismissing the case earlier in the day. He would not be able to provide the Review-Journal with a copy of that motion until Wednesday, he said.
After Guerra’s arrest, physicians became concerned about what duties their medical assistants could perform.
Former medical board director Louis Ling said that upon reading a 30-year-old law, he concluded that the assistants could not give shots. With flu season coming on, he then attempted to draft emergency regulations that would allow them to give flu shots, but not Botox or other cosmetic injections.
However, that effort was shot down when a judge recently ruled that the board, in considering the regulations, had violated the open meeting law.
The board later reversed its position, determining that state law allows medical assistants to administer everything from flu shots to Botox. Medical assistants could give shots as long as they are under the “direct supervision” of a physician. Most health officials and doctors take that to mean the physician is on premises.
Ling resigned on Friday.
Guerra, a mother of three who was a physician in her native Peru, said she has been under incredible stress since her arrest and lost her job because of the publicity surrounding her case.
“It was a nightmare. I could not even sleep or eat all this time, wondering what was going to happen.”
Still, she said she harbors no anger.
“Now, I start all over. But it’s just another experience in my life.”
Via Review Journal story.
Jeff, Medical Spa MD
Reader Comments (9)
I work as a medical esthetician in a well know medical spa and skin clinic in NYC. The doctor who runs our medical spa has trained myself and one other medical esthetician to give general shots (we offer flu shots) as well as Botox injections. While we never do Restylane or Juvederm or Sculptra, we have both performed Botox injections on patients. In every case that I'm aware of the doctor was in the medspa and instructed us to do so. All of the patients also knew that it wasn't a doctor that was giving them Botox and they were OK with that. (The received a discount on the Botox.)
Am I missing something? Isn't the doctor the one who 'decides' what we're allowed to do under his supervention?
I, as an aesthetician, can emphatically say that MONTHS (even years of advanced learning) of skin related learning does NOT qualify you to inject someone. I don't care what "training" you may have had. Hell, I don't care if you are the Botox messiah....you aren't legally medically schooled to inject anything into anyone. As an aesthetician who's "medically trained" I would never attempt (even as conformable and qualified as my MD thinks I am) injecting anything. The difference isn't simply if you are good at it or not at it. I work under a physician's license and She and I both respect the work we do, BUT we I know that I work under HER medical liability and out state's laws require the practice of medicine to exclude aestheticians. Let me ask you this....What makes you think that you as someone with non-medical training think that you can do something that otherwise requires a physician to sign off on. (i.e. Botox , Juvederm, must be purchased from someone with a medical license.) My advise to you is to investigate and question your legal boundaries for your own sake. You can (and WILL if the medical board investigates) have your aesthetic license taken away. It doesn't mean jack if there is an MD on site or even if he directed your hand. If HE/SHE isn't doing to cosmetic injectables than you are ALL risking at least license revocation, at worst, legal action. My advice is RUN!
I don't mean to be rude or disrespectful, but I have to agree with "Aesthetician" above. There is no way anyone without medical training should be sticking a needle in anyone for any reason in a physician's office or medical spa. I went to nursing school in NJ and I wasn't even allowed to stick a needle into a live human being until I graduated, passed my boards, and took a mandatory IV puncture course! "Botox Esthetician, you are going down a dangerous path.
And, no, it is not the physician's decision... it's State laws and it doesn't matter if the patient was "ok" with it or not. If that were the case, the physician can have a receptionist inject Botox at the counter as people are checking out. Botox, or any injectable product, should not be taken lightly. Remember it's botulinum toxin you're injecting into someone's face. You, as an aesthetician, should be aware of the fact that State laws mandate who can operate a laser as well.
Do you think it will hold up in a court of law if a patient ever sues you? What are you going to say? Well the patient said it was ok? Even worse, how will you feel ethicially if you have harmed someone? When they start teaching how to inject Botox in esthetician school, maybe you'll have a leg to stand on. But until then, drop the needle and run.
Thanks Paula! I don't mean to be insensitive. I can't lie and say I've never stuck a needle into someone, I've injected into my RN under her direct supervision (even then COMPLETELY violating our state laws and I shouldn't have done it and will NEVER do it to an patient) Again, You have no legal bearing when it comes to injecting someone. I myself as an aesthetician was very excited about the prospect of getting on the fast track into the medical field. One thig you MUST understand though is that you are an aesthetician transitioning into medical. That is very different than a medical person transitioning into aesthetics. There are many things I have schooled my RN and MD on when it comes to skin. Does that mean I am qualified to prescribe meds and preform injectables? NO. Don't take it as a slight when we "slam" your injecting, You need to realize that you don't have the medical training and schooling that is required by the state and medical boards to preform there services. There is a reason that they regulate these, and it's because when something goes wrong who are you to address these issues? You aren't medically inclined to deal with the potential issues and medical contraindications. Again, I'm not trying to slam you. You just need to realize that talent and aptitude isn't equivalent in the eyes of the law when it comes to medical procedures.
Aesthetician, you know it also goes the other way! Under PA State Law as a Nurse I cannot perform a facial for a patient unless it is deemed medically necessary and the physician has written an order for it. And, as a Dermatology Nurse, I know a lot about skin! Medical spas have been and always will continue to be a very controversial business aspect across the US. This is why we are seeing new legislation popping up all over the place.
And, Mark, the issue wasn't about a practitioner injecting Botox, it was about an Aesthetician injecting Botox.
Can we flip the coin over for a second - remove the word "Botox" from the dialog - and ask that the ones who are making arguments strictly on the basis of "sticking needles in skin" to likewise be as vigilant about the qualifications of the person sticking needles in their children who are being immunized? I can't speak for NYC, but many of the pediatric offices and PCP offices employ Certified Medical Assistants who ARE formally trained to stick needles into skin (http://aama-ntl.org/resources/library/OA.pdf). And the difference in our state between CMA's and nurses is that nurses can do so without the direct supervision of a physician (still requires oversight and orders). Again - we are NOT discussing Botox, but "sticking needles in skin".
The broader concern and argument should be made, not about technique of injection, reconstitution, etc., but the finer points of which muscles and how much. What is the desired outcome? How was the previous injection? What changes have occurred since last injection that inpact THIS series? If I were making an argument about why a physician or mid-level provider needs to do these injections - it would be based on the higher skills required to this... "practice of medicine". Sticking a needle into the skin is, IMO, not practicing medicine if the physician has already determined if, where, and how much.
(Sorry, this opinion DOES exclude estheticians who aren't formally trained in medical injections or vitals as part of their profession.)
And I'm sorry, but the title of this article - I think - is incongruous with the conclusion, with all due respect.
QUOTE:
"The board later reversed its position, determining that state law allows medical assistants to administer everything from flu shots to Botox. Medical assistants could give shots as long as they are under the “direct supervision” of a physician. Most health officials and doctors take that to mean the physician is on premises.
Ling [former medical board director who gave unfavorable interpretation] resigned on Friday."
END QUOTE.
Am I wrong here?
The difference between a flu shot and Botox as I see it is that Botox is a specific treatment, not the general administration of a product that can be stuck in any muscle mass. If I were to miss an injection site with a flu shot by an inch there's no problem. But if I'm injecting Botox and put the Botox in the wrong place and I'll be causing the patient harm, and getting my medical spa and supervising physician sued. (And rightly so.)
I'm betting that there's no malpractice insurer that would cover medical assistants injecting Botox...
Malpractice Insurance carriers do not insure Certified Medical Assistants. They insure the Physicians who employ them. The physician delegates procedures/tasks as permitted by law. And again, the article above concluded with the Nevada board reversing it's previous mis-interpretation of a 30 year old Nevada State Law when ..."The board later reversed its position, determining that state law allows medical assistants to administer everything from flu shots to Botox. Medical assistants could give shots as long as they are under the “direct supervision” of a physician. Most health officials and doctors take that to mean the physician is on premises." Everything that the Certified Medical Assistant does under the order and supervision of the physician makes him/her culpable. That's why it is in his/her - THE PHYSICIAN'S - best interest to make sure that whatever task is delegated is delegated to someone who is properly trained (either formally or personally) and delivered with the same high level of care he himslef would give. Period.
Ling resigned on Friday.