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June 4, 2012

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Botox, medical spas and flawed regulation

Wednesday, Sept. 16, 2009 | 2:01 a.m.

Betty Guerra, a medical assistant at a spa who is accused of illegally injecting Botox, was thrown in jail by the attorney general’s office after a patient complained to the state Board of Medical Examiners about a procedure done three years ago.

Monica de la Cruz, an assistant who works for medical board member Benjamin Rodriguez and has been injecting patients for years, has never felt the cold steel of handcuffs simply for doing her job. And neither have an unknown number of assistants at spas and doctor’s offices who routinely brandish syringes with potentially dangerous substances without a license to do so, behavior tacitly condoned by the Board of Medical Examiners.

Now, galvanized by the relentless reporting of “Face to Face” Executive Producer Dana Gentry and the program’s coverage of the disparate treatment and the gaping loophole that the medical board and lawmakers have failed to close, the governor’s office has sprung into action. The Gibbons administration has prodded the board to adopt an emergency regulation Friday that will spell out procedures that medical assistants cannot perform — including Botox injections — and allow them to perform others, including vaccinations.

The unintended (I hope) consequences will be to put some medical spas out of business — some proprietors have long said plastic surgeons see them as competitors. But the state’s role here, while it seems to have been to single out Guerra and protect a medical board member, should primarily be to protect patients. And thanks to Rodriguez’s tacit condoning of the illegal conduct as board member (he was reappointed last week by Gibbons) and as a doctor overseeing his own practice, the medical board once again seems not only to have ignored the pharmacy statutes but also the laws pertaining to regulatory incest.

This is exactly the perception the board — and by extension, the attorney general — does not want. Attorney General Catherine Cortez Masto, in an interview, obviously was frustrated by her lack of oversight of independent state boards — and I have heard rumbles that may change, too. Cortez Masto’s exasperation began with the Endoscopy Center crisis, when the same kind of careless, assembly-line medicine that doctors allege occurs at some spas was apparently going on.

If medical assistants are practicing medicine with no supervision at spas across the state, that is an outrage and a potential threat to patients. But it is also outrageous that the medical board has known this was occurring for years and has done nothing except talk at meetings and to lawmakers.

It is clear in the state law governing dangerous drugs that medical assistants are not permitted to administer them. But this law apparently was unknown to the state Board of Medical Examiners, whose slogan apparently is not “do no harm” but “see no evil, hear no evil, speak no evil.” Especially if it might hurt a doctor’s bottom line.

“The day Dr. Rodriguez learned about the statute at the Nevada State Medical Board of Examiners meeting on August 7, 2009, his office policy was established that no one other than the physician himself administers injections,” Rodriguez said in a statement. “It is fortunate that a member of the Medical Board (that means him on “Face to Face”) was highlighted regarding this matter so that the gross majority of the physicians of Nevada who are unaware of the statute and all of its 11 amendments (sic) can be informed and educated.” (For the record, Gentry called and made Botox appointments with de la Cruz weeks after Aug. 7.)

A medical assistant — defined only in the state’s administrative code — need only be employed by a physician or physician assistant, be supervised by someone and assist in the care of patients. He or she does not need a license. That is, I could do the job.

Rodriguez has been unwilling to speak about this, but when we asked him via e-mail why he had pictures on his Web site of himself being injected by de la Cruz, who was erroneously labeled a nurse, the doctor immediately removed the pictures. But I foretold his site-cleansing the night before we asked for an explanation of his advertising an illegal act, so we saved the original Web page. One of the pictures is here: lasvegassun.com/botoxpic.

Rodriguez may finally be complying with the law and de la Cruz may indeed have halted her injections. But Guerra still stands accused of 10 felony counts as the power of the state has been brought to bear against her by a medical board with unclean hands and an attorney general’s office that may have bagged a criminal, but one whose crime is as commonplace in Nevada as people looking for the Fountain of Youth in a syringe.

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