Ontario’s nursing regulator is moving to ban unsupervised esthetic injections by unlicensed staff, amid growing concerns about oversight of the med spa industry.
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regulator → move → industry
The move comes after the College of Nurses of Ontario (CNO) had released sweeping guidelines for nurses in esthetic services but drew criticism for failing to fully fill a regulatory gap: Without being on site, nurses can delegate the injecting of customers to unsupervised staffers who are not overseen by a college.
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who → come → college
The CNO is set to vote on the proposed change to its practice standards today, as the college continues to tighten its grip on esthetic services.
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college → set → services
Since January, an ongoing Star investigation has revealed details of four patients who were allegedly harmed after receiving esthetic treatments in GTA clinics.
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who → reveal → clinics
None of the delegating medical directors were on site at the time of the procedures.
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None → delegate → procedures
One of those patients died.
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One → die → patients
After an esthetician allegedly applied lidocaine cream — a prescription numbing drug — over the 38-year-old woman’s face and body in preparation for microneedling, the woman started seizing and vomiting, and was pronounced dead at a nearby hospital.
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woman → apply → hospital
A coroner later found she died of lidocaine toxicity.
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she → find → toxicity
The clinic’s medical director and delegating nurse, neither of whom were on site during the procedure, have denied they breached any duty of care.
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they → delegate → care
Loose policies have led to a flood of unsupervised medical procedures performed by unqualified
Under the CNO’s proposal, nurses must be on site when they delegate medical esthetic procedures such as Botox and filler injections, as well as microneedling, to a staffer who does not otherwise have authority to perform the treatments.
“It will very, very significantly improve the safety of the public,” nurse practitioner Negin Nikfar said.
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Nikfar → lead → public
Nikfar and other experts told the Star that the amendment is taking direct aim at a trend called “rent a licence,” where doctors and nurse practitioners have acted as delegating medical directors for multiple med spas, in some cases collecting thousands of dollars a month while having little to no involvement in the day-to-day operations.
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doctors → tell → operations
Experts have said the practice opened the floodgate for unsupervised medical procedures performed by unqualified people.
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practice → say → people
In March, the College of Physicians and Surgeons of Ontario (CPSO) began requiring doctors who delegate procedures to be physically on site to supervise treatment.
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who → begin → treatment
If the new rules are approved by the CNO council, nurse practitioners in esthetics will also be required to issue direct, client-specific orders instead of a general directive that applies to multiple patients.
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that → approve → patients
They would be required to complete a client assessment in person or virtually before giving the direct order.
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They → require → order
“I think it’s a great step forward,” said Dr. Ashwani Singh, an Alberta-based veteran in the esthetic medicine industry.
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Singh → think → industry
“It is going to return us to the roots of medicine, which was having you in front of your patient, examining your patient, having a conversation with your patient, getting a treatment protocol for that patient, and then treating that patient.”
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which → go → patient
Singh founded a forum of esthetics physicians from across the world advocating for stricter regulations around injectables.
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Singh → found → injectables
The CNO’s council agenda noted that the forum expressed its support for these proposals.
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forum → note → proposals
The proposed changes followed a public consultation, questions from media outlets, and a CNO analysis of recent professional conduct case files, according to the council agenda.
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changes → propose → agenda
Singh, who said the CNO has been “slow” to address these concerns because of pushback from the esthetic industry, expects the new rules, if passed, will limit customers’ exposure to botched procedures.
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rules → say → procedures
“There is a lot of money to be lost,” if the proposed rules are approved and enforced, he said, noting that the on-site requirements for delegating nurses could have a significant impact on the business interest of medical directors paid by multiple clinics.
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requirements → be → clinics
“At the end of the day it should only be one interest, the patient,” Singh said.
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Singh → say → day
The majority of nursing regulators in Canada have established guidelines for safe client care in esthetic practice.
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majority → establish → practice
The pushback from the industry
An online petition with more than 3,000 signatures has raised concerns about how the proposed requirement for a direct order for each patient would impact nursing autonomy and reduce access to regulated health care professionals, and wants the CNO to make regulations based on evidence.
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CNO → raise → evidence
“The concerns are legitimate,” said Nikfar, who is medical director of YMG Aesthetic Clinic and did not participate in the petition.
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who → say → petition
“It will create additional documentation, administrative work, and some existing business models will need to change.”
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models → create → documentation
She also called on the CNO for more clarity on how a nurse is expected to use a direct order for each patient to avoid what she worries will be “unnecessary documentations and unclear implementation.”
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she → call → patient
CNO spokesperson Elizabeth Almeida said that if a proper client-specific order is in place and the client’s condition and circumstances, as well as the treatment goals, remain unchanged, then a new assessment or order is not required for every visit.
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assessment → say → visit
Nikfar told the Star that though the proposed new rules have already prompted her to make a few adjustments at her clinic, she is very happy with the direction the CNO is taking to ensure patient safety.
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CNO → tell → safety
“Business efficiency is important,” she added.
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she → add → ?
“But it should not replace clinical accountability.”
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it → replace → accountability
The Aporia
