A report from Health and Disability Commissioner (HDC) says the doctor broke the Code of Health and Disability Services Consumers' Rights by telling an unqualified employee over the phone to proceed with the treatment in 2020.
In the report, the doctor said he was away from the medical centre on the day of the procedure.
"Appointments were to be made for follow-up patients only, and not any new patients."
He said when the employee, who was engaged in the clinic as a health care assistant/administration support officer, realised that the woman was a new patient, she telephoned him and asked what she should do.
"I then made an error of judgement and informed her, given the circumstances, to do an initial assessment as I would normally do and if there are no contraindications, to proceed with treatment," the doctor told HDC.
The woman was injected with a total of 30 units of Botox.
In the report, she told the HDC she was not made aware of the risks and side effects prior to treatment, and she was not provided with any written information about it.
The doctor said the fault came from the pressure of having the patient's friends in the room, who came along for the procedure.
"Overwhelmed by an extended audience to witness her actions and their enthusiastic encouragement to go ahead, [the employee] made an error of judgement to forego most of the steps for an initial assessment and proceed with the treatment for [the patient].
"She checked the medical questionnaire for any contraindications and explained the most common side-effects."
The report said the patient signed a consent form, but it was the unqualified employee who signed as the 'doctor'.
"There was no discussion prior to the treatment of the contents of the consent form, nor any discussion on possible risks, side effects, or post treatment protocols," the woman told HDC.
"I was not told how many units I was getting, the only question asked was 'what was I hoping for' (in regard to my wrinkles) and I explained I'd rather have less the first time to see whether I liked it. Then the Botox was injected."
The woman told the commissioner that a couple of days after the procedure, she started experiencing several symptoms.
"Racing heart rate, feeling of dread, shaking, sweating, inability to fall asleep (I was awake the entire night), body felt like it was on fire and I had electrical surges through my arms and legs, heavy legs, feeling [off-balance]."
Deputy Health and Disability Commissioner Deborah James said the doctor breached the code for directing the unqualified employee to administer the woman's Botox injections.
"As the registered health practitioner, the doctor was responsible for ensuring he delegated his clinical work to appropriately qualified and trained staff.
"I am concerned that the doctor also asked the employee to assist with Botox treatments for other consumers, when she was not qualified to do so."
James said the woman was not provided with adequate information, and there was not a proper discussion about the risks and side effects.
"Ultimate responsibility to ensure that the risks were discussed, and that appropriate informed consent was obtained, rested with the doctor as the medical professional who remained responsible for the treatment."
The HDC report showed since the complaint was laid by the patient, the medical centre has reviewed and updated its consent form and its policy and procedure on Botox.
It said the doctor was no longer practising, and his practising certificate expired in 2020.
"The employee told HDC she now works in a job 'which does not include any type of clinical activities or cosmetic treatments'," the report said.
In a list of recommendations, the Commissioner suggested the doctor undertake a competence review, with the assistance of the Medical Council of New Zealand, if he decided to return to medical practice.
She also recommended that if the medical centre reviews and updates its policy to ensure that only a doctor or registered nurse can provide Botox treatment, and not a 'physician assistant'.
"I recommend that [the employee] familiarise herself with the requirements to practise as a registered nurse in New Zealand.
"I also recommend that [the employee] ensure that she does not sign any documentation or consent forms as a 'doctor' in future," James said.
