Flu shots OK, but no Botox

RENO -- Medical assistants will be allowed to give flu shots but prevented from administering injections of Botox, other cosmetic drugs and chemotherapy, the state Board of Medical Examiners ruled Friday on a 5-0 vote.

The regulation goes into effect immediately. Gov. Jim Gibbons had authorized the board to conduct an emergency meeting out of concern that medical assistants may be needed to administer thousands of vaccinations as flu season approaches.

A vaccination for H1N1, or swine flu, likely will be ready within weeks and long lines of residents may want the shots.

"We need medical assistants to be able to work with our physicians to provide medical care during this flu season," Gibbons said.

Under the 120-day temporary regulation, the medical assistants can perform the vaccinations but a supervising physician must be able to get to the site where they are working within five minutes.

Current regulations required them to always work under the direct supervision of doctors. Physicians also had been required to see any patient first before a medical assistant was allowed to work on them. These requirements, however, were being ignored.

Board Chairman Charles Held said the practice has been for doctors to allow medical assistants to do any work for which they had given them training, including giving shots.

"My job is to make sure doctors do their jobs," added Held, a Reno physician. "Some don't take the time to do the job. They take the money and run."

As soon as the temporary regulation was adopted, Las Vegas lawyer Jacob Hafter vowed to seek a restraining order to block its implementation.

Hafter, who said he represented doctors and medical assistants, maintained the board broke state law by not allowing three citizens in the audience to give their opinions.

He contended the law requires all people be allowed to testify before a state board adopts temporary or permanent regulations.

In a phone interview Friday afternoon, Hafter said he had yet to file anything in court.

But he maintained it is "all hype and propaganda" that medical assistants, under a 30-year-old law, could not give flu and other shots before the regulation was adopted. That law states who can give shots, not who can't, according to Hafter.

If there was a real need for an emergency regulation, then he questioned why the board of osteopathic doctors was not convened to enact a similar regulation.

Attempts to reach the osteopathic board for comment late Friday were unsuccessful.

Held originally had planned to let all citizens speak for five minutes each before adopting the regulation.

But Board members Van Heffner and Dr. Javaid Anwar said they had to leave for noon engagements. Without their presence, the nine-member board would not have a quorum of at least five members needed to pass the regulation.

That forced Held to move rapidly to make amendments to the temporary regulation and pass it before they left.

Before then, member Renee West had left the meeting for another engagement. Two other members, Dr. Beverly Neyland and Dr. Theodore Berndt, did not attend the meeting.

Dr. Benjamin Rodriguez, the board's vice chairman, abstained from voting. He used medical assistants in his office to administer Botox, the anti-wrinkle drug, to his patients.

His daughter and public relations manager, Noelle Rodriguez, said Wednesday that her father allowed medical assistants to inject the cosmetic medication because of a newsletter sent out by the board's former executive director Tony Clark. In the 2006 newsletter, Clark said medical assistants could give shots if the physician "has verified the type and dosage and the injection is intramuscular, intradermal or subcutaneous."

But according to Louis Ling, the current board executive director, medical assistants are prohibited by the 1979 law from administering Botox and other drugs.

Despite that law, Ling said schools that train medical assistants still charge students $10,000 tuition and teach them that any injections they make are "perfectly legal."

Changes were made in the regulation Friday after Reno medical assistant Michelle Smythe pointed out that the law, as proposed, still would have blocked her from giving flu shots because of a requirement that a doctor has to first see the patient.

So, the board put in the stipulation that a physician had to be available within five minutes of the patient and didn't have to first make an evaluation.

Ling said earlier that plastic surgeons throughout the state have been using medical assistants to give shots to their patients.

In a statement Gibbons said had the change not been made, the current law potentially could put many medical assistants out of work.

The temporary regulation expires Jan. 15.

In the meantime, the board will hold numerous public meetings and workshops on a permanent regulation that will spell out exactly what duties can be performed by medical assistants.

Contact Capital Bureau Chief Ed Vogel at evogel@reviewjournal.com or 775-687-3901.