File photo.
Photo: 123RF
A woman experienced adverse reactions after a doctor told an unqualified person to do the Botox treatment.
A report by the Health and Disability Commissioner (HDC) says the doctor breached the Health and Disability Services Consumer Rights Code by telling an unqualified worker over the phone to proceed with treatment in 2020.
In the report, the doctor said he was away from the medical center on the day of the surgery.
“They were only supposed to make appointments for follow-up patients and not for new patients.”
He said when the employee, who was employed at the clinic as a health care assistant/administrative support worker, realized the woman was a new patient, he called him and asked what he should do.
“Then I made a misjudgment and advised her, given the circumstances, to do an initial assessment as I would normally do and if there are no contraindications, proceed with the treatment,” the doctor told HDC.
The woman was injected with a total of 30 units of Botox.
In the report, she told the HDC that she was not told about the risks and side effects before the treatment and was not given written information about it.
The doctor said the error came from pressure from the patient’s friends in the room, who came along for the procedure.
“Overwhelmed by an extended audience to watch her actions and enthusiastic encouragement to move forward, [the employee] made the wrong judgment to forgo most of the steps for an initial evaluation and proceed with treatment for [the patient].
“Check the medical questionnaire for any contraindications and explain the most common side effects.”
The report said the patient signed a consent form, but it was the unauthorized employee who signed as a “physician.”
“There was no pre-editing of the content of the consent form, and no discussion of potential risks, side effects or post-treatment protocols,” the woman told HDC.
“I wasn’t told how many units I was getting, the only question I was asked was ‘what I was hoping for’ (regarding my wrinkles) and I explained that I would rather have less the first time to see if I liked it. Then the Botox injection took place.”
The woman told the commissioner that a few days after the procedure, she started showing several symptoms.
“Increased heart rate, feeling shaky, shaking, sweating, unable to sleep (was up all night), body felt like it was on fire and had electrical surges in my arms and legs, heavy legs, feeling [off-balance].”
Deputy Health and Disability Commissioner Deborah James said the doctor breached the code which led to the unauthorized employee giving the woman Botox injections.
“As a registered health professional, the doctor was responsible for ensuring that 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 given adequate information and there was not a proper discussion about the risks and side effects.
“The ultimate responsibility for ensuring that risks are discussed and appropriate informed consent is obtained rests with the physician as the health professional who remained responsible for the treatment.”
The HDC report indicated that since the patient’s complaint, the medical center has reviewed and updated its consent form and Botox policy and procedure.
He said the doctor was no longer practicing and his practicing certificate expired in 2020.
“The employee told HDC that she now works in a job ‘that does not involve any type of clinical activities or cosmetic treatments,'” the report said.
In a list of recommendations, the Commissioner suggested the doctor undertake a competency check, with the help of the New Zealand Medical Council, if he decides to return to medical practice.
He also recommended that if the medical center reviews and updates its policy, it should ensure that only a doctor or registered nurse can provide Botox treatment, not a “physician assistant.”
“I recommend it [the employee] familiarize yourself with the requirements to practice as a registered nurse in New Zealand.
“I suggest it too [the employee] make sure he doesn’t sign any documents or consent forms as a ‘doctor’ in the future,” James said.
