Shot in the dark

Still licking its collective wounds from one public health crisis, Nevada's medical community is on the verge of another -- and like last time, it has itself to blame.

The hepatitis outbreak caused by deliberately unsterile, corner- and cost-cutting procedures at a Las Vegas endoscopy center was a result of greed and a disturbing lack of conscience. The lives forever changed by that operation should have reminded every medical professional to make patient welfare their top priority.

Nevertheless, some physicians decided this year that thriving medical "spas," enterprises where medical assistants routinely inject customers with cosmetic fillers, were costing them too much business. So they went to the State Board of Medical Examiners seeking enforcement of a 30-year-old law that says medical assistants can't give injections.

Never mind that medical assistants for years have safely administered vaccinations and flu shots at doctor's offices across the valley, sparing their bosses from handling the time-consuming tasks.

So state officials reached a convenient compromise last month: They concocted emergency rules that allowed medical assistants to continue injecting vaccines, antibiotics and vitamins, but prohibited them from giving cosmetic injections.

But in a Sept. 18 emergency session of the Board of Medical Examiners, several members couldn't be troubled with public comment -- they had lunches planned. So they approved the new regulations before a quorum disappeared. End of discussion.

That violated the state's open meeting law. Medical spa owners, whose business model depends on having medical assistants handle injections, sued. District Judge Kathleen Delaney correctly ruled against the board and prevented the emergency regulations from taking effect.

That leaves in place the long-ignored state law that prohibits medical assistants from giving any injections.

Now flu season is approaching. Thousands of Nevadans will soon line up for H1N1 vaccines. Doctors and nurses alone can't possibly provide that many shots in the coming months. "It's going to be very hard to accommodate the masses without the (medical assistants') help," said Dr. Kim LaMotte-Malone, a valley pediatrician.

What's the bigger public health threat? Medical assistants in successful businesses that cater to those who want to improve their looks, or the likelihood that the valley's population won't be properly immunized against disease?

The Board of Medical Examiners can't reconsider the issue because the law allows it to take up a specific emergency regulation only once. The board, then, should consider a new emergency regulation: one that declares medical assistants won't face any sanctions for administering injections of any kind.