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.

Discussion: 9 comments so far…

By NNurse

9/16/09 at 9:22 a.m.

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"...injected by de la Cruz, who was erroneously labeled a nurse..,"

Thank you for publicizing the widespread practice of Las Vegas doctors falsly referring to unlicensed assistive personnel, such as medical assistants, as licensed nurses (registered nurses [RNs], practical nurses [LPNs]). Very, very few physicians here employ RNs, yet they refer to their usually female assistants in scrubs as "my nurse." Worse, some medical practices palm off physician assistants as doctors, by saying things like "The doctor will be with you shortly."

I suggest that patients/clients ask such people, "Are you an RN or LPN?" or "Where did you go to medical school?" This exposes the fraud immediately. Then complain to the physician about the inappropriate use of the word "nurse" or "doctor."
By confussed

9/16/09 at 3:47 p.m.

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Is the Special Meeting for the medical board on Friday open to the public, if so where is it and what time?
By Zulene

9/16/09 at 11:57 p.m.

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Betty Guerra, according to the Nevada Medical Board, is not a medical assistant. Betty Guerra is a foreign trained practitioner who has not been licensed in Nevada and was posing as a physician. That is why she was arrested. The medical assistance are in enough trouble now.
They don't need improper reporting to add to their problems. I know of no medical assistant who has been arrested. They all work for physicians. Doctor Rodriguez has had Monica working for him for years. She does much more than injections. Ask his patients who does their IV sedation during surgery. She has never been through the medical assistant course to learn injection technique. Doctor Rodriguez was told by another medical assistant that Monica shoud not be doing injections. This assistant quit because Monica was doing injections. Rodriguez was and is very awary of his infractions.
By NNurse

9/17/09 at 7:23 a.m.

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Zulene, de la Cruz is considered a UAP, unlicensed assistive personnel, as I wrote. I gave "medical assistant" as an example of a UAP. I am not comfortable having UAPs sticking me with needles and injecting medications, as there has been no impartial board reviewing their education and credentials. Buyer beware.
By Patrick_R_Gibbons

9/17/09 at 9:37 a.m.

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Government is really bad at protecting people. Especially when the protections come from regulations drafted by special interest groups looking to eliminate their competition and drive up their profits.

And what a horrible thing to say"I can't believe you would actually want fairly competing companies to be driven out of business.

And the state made this person a criminal by making an activity between two consenting adults illegal.
By itoldu

9/17/09 at 2:11 p.m.

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This is truly a "GOTCHA" moment. It shows he is DISHONEST and a LIAR because he knew better.

HE DID IT ON PURPOSE when he posted a picture of himself getting shot with BOTOX by Monica Delacruz, who he calls a "NURSE", but who is in fact only a MEDICAL ASSISTANT. This is WRONG and illegal. He INTENTIONALLY tried to get away with it because what plastic surgeon or doctor in their right mind would post a statement saying their "MEDICAL ASSISTANT" injects botox. He would get no business! HE'S A LIAR and he should face the firing squad. FALSE ADVERTISING. AND HE LIED AGAIN, when he said he stopped doing it august 7, but had Monica make appts with the investigators after that date.

Thank the Lord for the ANONYMOUS tip that found the photo online TO PROVE the FACTS, and BEFORE Rodriguez removed it in a cover up attempt to hide his DISGRACE. If it wasn't WRONG, it would still be up for all the world to see. Well we don't see it no more.

This really degrades all NURSES when Rodriguez tries to say medical assistants are like nurses, or even actually are nurses.

The attorney general's office should ARREST Monica Delacruz and put her in jail. Rodriguez should be removed from the board and his license suspended for FRAUD and DISHONESTY. WHAT A LIAR. Worse is he is trying to COVER UP his LIE!

OH, BUT LET ME SAY I DIDN'T KNOW I WASN'T SUPPOSED TO DO THAT, YEAH WRONG EXCUSE LIAR.

Zulene, you should make a complaint to the board and go on record with your info to bring him DOWN. You can even do it anonymously.
By Patrick_R_Gibbons

9/17/09 at 3:45 p.m.

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The restrictive law should be eliminated. All this does is continue the nasty fight between medical professionals over who is allowed to do what. This drives up the cost of medical care.
By NNurse

9/17/09 at 3:51 p.m.

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Hey Patrick, Mr. Desai is going to be offering cut-rate colonoscopies after all the lawsuits end; time for you to sign up because low price is your only consideration.
By itoldu

9/19/09 at 1:37 p.m.

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dr rod is like GI dr desai. desai was also on medical board and has discipline for false advertising. just like rod does false ads that he uses fake "nurse" monica to inject botox. this is such a lie. corrupt hypocrite board members. just like their practice. a liar is a liar. don't call your ma a nurse. it humiliates your nurse and deceives patients and shows you are dishonest doctor lying to make a dollar. unethical coothe.