State board had policy against medical assistants injecting as long as six months ago, email reveals

Monday, Sept. 21, 2009 | 12:49 p.m.

In an email exchange with the attorney general's office on Feb. 17, Medical Examiners Board Executive Director Louis Ling, who has lamented the confusion caused by the media on who can inject, made the board's position clear: "Because the administration of Botox (or any other dangerous drug) requires licensure per NRS 454.213, a medical assistant could not render the injection AT ALL. (his emphasis)." And in the same email, which I have posted at right, Ling told a deputy AG that the board "has been stating publicly through its staff that only people recognized in NRS 454.213 (which lists who can inject) can administer dangerous drugs, including Botox, and that this cannot be delegated to people not on the list...." And this: "Our position has been consistent for years that medical assistants cannot perform injections..."

(My producer, Dana Gentry, obtained the email exchange after a conference call we had last week with the attorney general. The AG's office, which clearly also is frustrated with the medical board's behavior, provided Gentry with the damning email.)

So where has the confusion been? And why, if the board has stated this publicly, as Ling said, would a member, Dr. Benjamin Rodriguez, have been using a medical assistant to inject?

Maybe instead of charging a medical assistant who had been injecting and suturing -- as dozens or more have been across the valley -- the AG would be better served by investigating the medical board.

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As a refresher, here are some of the more recent newspaper reports featuring Ling, who has blamed the media for the confusion while the board's disparate treatment and his own statements have contradicted and confused the clarity of what he wrote six months ago:

Sun, 9/18

Ling said he saw no reason to discipline doctors or medical assistants engaged in the practice.

"They didn't know it was wrong," said Ling, who added he is in the process of crafting further regulations to make it more clear to physicians who can administer the drug.

Review-Journal, 9/19:

To Louis Ling, the medical board executive director who actually wrote the new regulations, the answer is simple: "We have to do the right thing when we find out something is wrong."

How could it be that a law which made it illegal for medical assistants to give shots of any kind was either unknown to the medical community -- or ignored -- for 30 years?

Ling won't even speculate.

"I don't know," he said.

To RGJ, 9/18:

Louis Ling, the board's executive director, said new rules are needed because of uncertainty and confusion generated by news reports concerning Botox injections by medical assistants in Southern Nevada, a practice he described as "fairly common," and which has resulted in "uncertainty and disruption in patient care."

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So how does all of this jibe with Ling's statement in February that the board had been stating publicly that medical assistants can't render injections AT ALL?

Simple: It doesn't.