6836613

Allegations and Plea

The College alleged that the Member intended to perform a controlled act (administering an injection) without a physician’s order or proper delegation; failed to ensure the Client was assessed by a physician before agreeing to provide treatment; failed to retain records; and failed to abide by the terms of her undertaking with the College. The College also alleged that this conduct would be regarded as disgraceful, dishonourable or unprofessional.

The Member admitted to the allegations, and the College and the Member jointly submitted the following facts.

Agreed Facts

In 2008, the Discipline Committee found that the Member committed professional misconduct in respect of the administration of Botox, including performing unauthorized controlled acts, providing treatment without the required consent, failing to advise clients to obtain services elsewhere when their conditions were outside her scope of practice and falsifying records. As a result of the findings, the Member received a suspension and restrictions. In addition, the Member signed an undertaking agreeing that she would only practise nursing within the controlled acts authorized to nursing and only perform a controlled act if permitted by regulation or ordered by a member of specific professions.

Dr. A, the medical director of the clinic where the Member worked, was authorized to inject Botox and delegate the injection of Botox via an order or written medical directive. Clinic policy and the medical directive outlined the procedure for new and returning clients. New clients had to be seen by Dr. A in person or by video before Botox could be administered. Returning clients could have Botox injected by the nurses, unless there was a change in health history or other reason for a follow-up consultation with Dr. A.

The Client was a television producer who went undercover as a potential client for a television segment on Botox. She met the Member twice. At the initial meeting, the Client and the Member discussed the nature, cost and risks of Botox treatment. The Client did not fill out any health assessment or medical forms or a consent form. The Member asked no medical questions. The Member said that Dr. A would have seen the Client by video, but he was out of the country. Despite the unavailability of a physician to assess the Client and no order from Dr. A, the Member would have been prepared to inject the Botox, provided that the Client’s health questionnaire would not have revealed information to render the treatment inappropriate or unsafe. The Member did not inject the Client as the Client stated she was looking only for a consultation at that time. The Member retained no records from this visit.

The second appointment, approximately one month later, took place in a consulting area in the Member’s home. The Member began an initial assessment by touching the Client’s face and making notes. The Member did not review the potential risks or side effects of Botox with the Client, ask the Client any medical questions, or ask the Client to complete any consent or health history. If the Member were to testify, she would say she would have taken these steps after her assessment if the Client were a good candidate for Botox. 

The Member told the Client that they would normally have a video consult, but that Dr. A was gone for the day and that they would use video next time the Member saw the Client. Again, the Member would have been prepared to inject Botox without Dr. A’s assessment or delegation. The Client spontaneously disclosed that she was pregnant, at which time the Member immediately advised her that the Member could not proceed with the assessment. The Member did not inject any Botox. The Member kept no records from this visit. If the Client were to testify, she would say she was certain the Member intended to complete Botox injections without completing a therapeutic assessment.

Finding

The Panel found that the evidence clearly supported findings of professional misconduct as alleged. The fact that the Member had been disciplined in the recent past for similar issues, combined with her admission that she would have injected Botox without authority and that she breached her undertaking to the College, made her misconduct disgraceful, dishonourable and unprofessional.

Submissions on Order

The College and the Member jointly sought an oral reprimand and a four-month suspension. The Member would be required to complete specified remediation activities in preparation for a series of meetings with a nursing expert. For 12 months from the date the suspension ends, the Member would not be able to practise independently in the community, and she would be required to advise the College of her employers, provide employers with a copy of the Panel’s decision and reasons, and only practise for an employer who agreed to advise the College if the Member breached the standards of practice of the profession. 

Panel Order

The Panel accepted the joint submission as reasonable and in the public interest. The Member accepted responsibility for her actions and cooperated with the College by agreeing to the facts and proposed penalty.

The order provides specific and general deterrence, and protection of the public. The Member has resigned her certificate of registration and will need to meet entry requirements before obtaining another certificate, in which case this penalty will take effect. Engaging in controlled acts without appropriate authorization will not be tolerated.

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