Registrar's message

Guard against the risk of creating an impression that you are facilitating the unauthorized practice of medicine

On March 19, 2015, the BC Supreme Court granted an Order prohibiting Ms. Anita Fofie of Dermix Institute of Aesthetic Medicine located in downtown Vancouver from injecting medication including, abobotulinumtoxin A (Dysport®) and Restylane® (containing hyaluronic acid), which as an unlicensed practitioner she is not authorized to inject. Under BC law, the injection of such medication is a medical service that only physicians, dental surgeons, naturopaths who have been granted certification in esthetic procedures – cosmetic Botox®, and registered nurses and licensed practical nurses under the order of a physician are allowed to perform. Fortunately, in this instance, no public health or infection control concerns were identified.

While this was the first time the College has gone to court to obtain an injunction against an individual posing as a physician for the purpose of injecting medication for cosmetic enhancement, it may not be the last as injectable product becomes increasingly available, and stories of botched procedures continue to make headlines. 

Registrants may have heard of another recent seizure in Vancouver by Health Canada of a product being injected for cosmetic purposes that was not labelled, inspected, nor deemed safe for human beings; or the shocking incident in Toronto where an unlicensed practitioner was found guilty of criminal negligence causing bodily harm after a woman was hospitalized following injections of industrial silicone in her buttocks.

In hearing these stories it might be tempting to conclude that it is solely the unlicensed practitioners who put patients at risk by misrepresenting themselves, and injecting medication and other products into innocent patients looking for low-cost cosmetic enhancements.

Unfortunately, the College has encountered a number of cases of late where registrants are either directly or indirectly involved in unauthorized practice. In some instances, during the course of investigating allegations of unauthorized practice by non-registrants, the College has found that registrants have knowingly allowed themselves to be identified as the “medical director” of a spa or other personal service establishment (PSE) offering Botox® or dermal filler treatments. To make matters worse, these medical directors may be physically absent from the premises, and may never have met with the patients/clients of the PSE, even though they were fully aware that an unregulated individual was providing an injectable treatment.

Registrants who are involved in the injection of medication for cosmetic purposes should be aware that the following circumstances or arrangements are not acceptable and may be deemed unprofessional conduct:

  1. Registrants must not sign documentation agreeing to be the “medical director” of a spa or PSE, where that agreement includes providing oversight to unauthorized practitioners who inject medication.
  2. Registrants must not allow unauthorized practitioners to purchase injectable prescription medication using their name and CPSID number.
  3. Registrants must not train unauthorized individuals to inject medication, and must not issue “certificates” which could be used by those individuals to mislead patients.  
  4. Registrants should not establish a business association with individuals who may misrepresent that association to the public (e.g. use the registrant’s name and status as a physician to legitimize their business and the treatments they provide). Registrants must take extreme measures to guard against the risk of creating an impression that they are facilitating the unauthorized practice of medicine.

The College will continue to do whatever it can to stop unauthorized practitioners from putting the public at risk. In collaboration with British Columbia’s 26 regulated health professionals, the College is also actively involved in a public awareness campaign, which focuses on the importance of seeing a regulated health professional and verifying credentials before agreeing to any treatment.

Registrants also have an important role to play in educating patients and ensuring that their business associations don’t inadvertently put patients at risk. Situations as described above may be investigated by the Inquiry Committee, and may result in findings of unprofessional conduct.

Registrants should familiarize themselves with the professional standard: Injection of Botulinum Toxin, Dermal Fillers and Venous Sclerotherapy

H.M. Oetter, MD

We welcome your feedback on any article contained in the College Connector.