Enrolled nurse: Beauty salons + injectable substances

Bechara v Nursing and Midwifery Council of New South Wales [2018] NSWCATOD 181 is of interest as it concerns an enrolled nurse operating a beauty salon. The Tribunal was required to consider an appeal brought by the nurse against suspension of her registration.

Under a heading ‘ancillary matters’, the Tribunal commented as follows at [73] – [77]:

We were informed during the course of the hearing by counsel for the Council that the operation of beauty salons in which treatment occurs using injectable substances is unregulated, at least in New South Wales. We were also advised that there is no regulation of who may administer an injection. We find this surprising given the essential requirements that treatment of this kind be given in a sterile environment and that there be on hand procedures and equipment necessary to deal with emergencies of the kind described in the Manual of Renaissance Cosmetic Clinics which we have earlier referred to. Some of the possible emergency circumstances, involving matters such as anaphylaxis and vascular occlusion are obviously potentially life-threatening. Furthermore, it is essential that those performing such treatments be adequately and appropriately trained and, if not a medical practitioner, supervised.

On the basis of the information conveyed to us during the course of the hearing it would seem essential that a medical practitioner be involved in the circumstances of each of the clients of beauty salons providing this type of treatment, particularly as we understand that the injectable substances are Schedule 4 drugs so specified by the Therapeutic and Goods Administration Act. If these drugs can only be prescribed by a medical practitioner, then it follows that a medical practitioner must, consistent with his or her duty of care ensure that the drugs are only prescribed to a person who is a patient of the medical practitioner who has been appropriately assessed by way of physical examination and the taking of an appropriate history. It must also follow that the medical practitioner must ensure that the treatments are administered by someone competent to do so with adequate and proper supervision, including the ability to monitor and supervise the patient during the course of and subsequent to the administration of the treatment including any necessary follow-up. The evidence given to us in these proceedings calls into question whether these essential and basic requirements have been fulfilled.

There is evidence that the appellant ordered bulk supplies of medication through Dr Ho, who arranged for it to be delivered to her where it was stored on her premises. This medication was then used from time to time for clients of the beauty salon against prescriptions which were later issued through Dr Ho’s practice consequent upon consultations either with Dr Ho or someone else in his practice conducted by Skype, given that Dr Ho practices from Western Australia. As we understand the situation, each of the clients of the appellant would thereby become a patient of Dr Ho’s practice, and come under his care with respect to all of the treatments afforded to them by the appellant. The evidence in the proceedings is that if there was any supervision by Dr Ho or persons in his practice of the treatment afforded by the appellant consistent with what we understand to be a commercial arrangement between her and Dr Ho, such supervision was minimal. In the same way, our understanding of the evidence of the appellant is that she rarely communicated with Dr Ho or others in his practice concerning the circumstances of any of her clients. It was her specific evidence that she alone determined the injection sites for her clients.

We must emphasise that we are not suggesting that Dr Ho or anyone in his practice has engaged in any inappropriate conduct. We raise these matters because the circumstances as described by the appellant in her evidence are capable of suggesting that there might exist, in the aggregate, a situation which may call for investigation of all of the circumstances in which the appellant operated her beauty salon practice as part of a commercial relationship with Dr Ho. We take the view that it is appropriate that we draw these matters to the attention of the relevant authorities lest we be seen to have condoned circumstances which might potentially call for investigation.

Accordingly, we ask the Nursing and Midwifery Council of New South Wales to refer a copy of these reasons for decision to the Health Care Complaints Commission, to the Medical Board of Australia and the relevant Departments of Health in New South Wales and Western Australia.