1 XAVIER BECERRA Attorney General of California 2 KENT D. HARRIS 3 LESLIE A. BURGERMYER Supervising Deputy Attorney General 4 5 6 7 Deputy Attorney General State Bar No. 117576 1300 I Street, Suite 125 P.O. Box 944255 Sacramento, CA 94244-2550 Telephone: (916) 324-5337 Facsimile: (916) 327-8643 Attorneys for Complainant BEFORETHE BOARD OF REGISTERED NURSING DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA 8 9 10 d-Oitt 11 In the Matter of the Accusation Against: CaseNo. 12 REBEKAH DEMOSS, aka REBEKAH SUZANNE DEMOSS 688 W. Lake Street Kingsburg, CA 93631 FIRST AMENDED 13 14 _,q(p3 ACCUSATION Registered Nurse License No. 515165 15 Respondent. 16 17 Complainant alleges: 18 PARTIES 19 1. Joseph L. Morris, PhD, MSN, RN ("Complainant") brings this First Amended 20 Accusation solely in his official capacity as the Executive Officer of the Board of Registered 21 Nursing ("Board"), Department of Consumer Affairs. 22 2. On or about August 29, 1995, the Board issued Registered Nurse License Number 23 515165 to Rebekah Demoss, also known as Rebekah Suzanne Demoss ("Respondent"). The 24 registered nurse license was in full force and effect at all times relevant to the charges brought 25 herein and will expire on January 31, 2019, unless renewed. 26 Ill 27 Ill 28 Ill 1 FIRST AMENDED ACCUSATION JURISDICTION 1 2 3. This First Amended Accusation is brought before the Board under the authority of the 3 following laws. All section references are to the Business and Professions Code ("Code") unless 4 otherwise indicated. 5 4. Code section 2750 provides, in pertinent part, that the Board may discipline any 6 licensee, including a licensee holding a temporary or an inactive license, for any reason provided 7 in Article 3 (commencing with section 2750) of the Nursing Practice Act. 8 9 10 5. Code section 2764 provides, in pertinent part, that the expiration of a license shall not deprive the Board ofjurisdiction to proceed with a disciplinary proceeding against the licensee or to render a decision imposing discipline on the license. STATUTORY PROVISIONS 11 Code section 2761 states, in pertinent part: 12 6. 13 The board may take disciplinary action against a certified or licensed nurse or deny an application for a certificate or license for any of the following: 14 (a) Unprofessional conduct, which includes, but is not limited to, the following: 15 16 17 18 19 20 21 22 (1) Incompetence, or gross negligence in carrying out usual certified or licensed nursing functions. (d) Violating or attempting to violate, directly or indirectly, or assisting in or abetting the violating of, or conspiring to violate any provision or term of this chapter or regulations adopted pursuant to it. (f) Conviction of a felony or of any offense substantially related to the qualifications, functions, and duties of a registered nurse, in which event the record of the conviction shall be conclusive evidence thereof. (i) Aiding or assisting, or agreeing to aid or assist any person or persons, whether a licensed physician or not, in the performance of, or arranging for, a violation of any of the provisions of Article 12 (commencing with Section 2220) of Chapter 5. 23 25 (k) Except for good cause, the knowing failure to protect patients by failing to follow infection control guidelines of the board, thereby risking transmission of blood-borne infectious diseases from licensed or certified nurse to patient, from patient to patient, and from patient to licensed or certified nurse .... 26 7. 27 In addition to other acts constituting unprofessional conduct within the meaning of this chapter [the Nursing Practice Act], it is unprofessional conduct for a person licensed under this chapter to do any of the following: 24 28 Code section 2762 states, in pertinent part: 2 FIRST AMENDED ACCUSATION 1 3 (a) Obtain or possess in violation of law, or prescribe, or except as directed by a licensed physician and surgeon, dentist, or podiatrist administer to himself or herself, or furnish or administer to another, any controlled substance as defined in Division 10 (commencing with Section 11 000) of the Health and Safety Code or any dangerous drug or dangerous device as defined in Section 4022 .... 4 8. 5 (a) [I]t is the intent ofthe Legislature in amending this section at the 1973-74 session to provide clear legal authority for functions and procedures that have common acceptance and usage. It is the legislative intent also to recognize the existence of overlapping functions between physicians and registered nurses and to permit additional sharing of functions within organized health care systems that provide for collaboration between physicians and registered nurses. These organized health care systems include, but are not limited to, health facilities licensed pursuant to Chapter 2 (commencing with Section 1250) of Division 2 ofthe Health and Safety Code, clinics, home health agencies, physicians' offices, and public or community health services. 2 6 7 8 9 Code section 2725 states, in pertinent part: 10 11 12 13 (c) "Standardized procedures," as used in this section, means either of the following: (1) Policies and protocols developed by a health facility licensed pursuant to Chapter 2 (commencing with Section 1250) of Division 2 of the Health and Safety Code through collaboration among administrators and health professionals including physicians and nurses. 14 15 16 (2) Policies and protocols developed through collaboration among administrators and health professionals, including physicians and nurses, by an organized health care system which is not a health facility licensed pursuant to Chapter 2 (commencing with Section 1250) of Division 2 of the Health and Safety Code .... 17 18 9. 19 21 Notwithstanding any other provision of law, a registered nurse may dispense drugs or devices upon an order by a licensed physician and surgeon if the nurse is functioning within a licensed clinic as defined in paragraphs (1) and (2) of subdivision (a) of Section 1204 of, or within a clinic as defined in subdivision (b) or (c) of Section 1206, of the Health and Safety Code ... 22 10. 20 23 Code section 2725.1 states, in pertinent part: Code section 2726 states that "[e]xcept as otherwise provided herein, this chapter confers no authority to practice medicine or surgery" .. 24 11. 25 (a) Notwithstanding Section 146, any person who practices or attempts to practice, or who advertises or holds himself or herself out as practicing, any system or mode of treating the sick or afflicted in this state, or who diagnoses, treats, operates for, or prescribes for any ailment, blemish, deformity, disease, disfigurement, disorder, injury, or other physical or mental condition of any person, without having at the time of so doing a valid, unrevoked, or unsuspended certificate as provided in this chapter or without being authorized to perform the act pursuant to a certificate 26 27 28 Code section 2052 states, in pertinent part: 3 FIRST AMENDED ACCUSATION 1 2 obtained in accordance with some other provision of law is guilty of a public offense, punishable by a fine not exceeding ten thousand dollars ($10,000), by imprisonment in the state prison, by imprisonment in a county jail not exceeding one year, or by both the fine and either imprisonment. 3 4 5 (b) Any person who conspires with or aids or abets another to commit any act described in subdivision (a) is guilty of a public offense, subject to the punishment described in that subdivision ... 6 12. Code section 2242, subdivision (a), states that "[P]rescribing, dispensing, or 7 furnishing dangerous drugs as defined in Section 4022 without an appropriate prior examination 8 and a medical indication, constitutes unprofessional conduct." 9 10 13. Code section 4022 states: "Dangerous drug" or "dangerous device" means any drug or device unsafe for self-use in humans or animals, and includes the following: 11 12 13 14 (a) Any drug that bears the legend: "Caution: federal law prohibits dispensing without prescription," "Rx only," or words of similar import. (b) Any device that bears the statement: "Caution: federal law restricts this device to sale by or on the order of a--------," "Rx only," or words of similar import, the blank to be filled in with the designation of the practitioner licensed to use or order use of the device. 15 16 (c) Any other drug or device that by federal or state law can be lawfully dispensed only on prescription or furnished pursuant to Section 4006. 17 14. 18 (a) The Legislature hereby declares that the dispensing and fmnishing of prescription drugs, controlled substances, and dangerous drugs or dangerous devices without a license poses a significant threat to the health, safety, and welfare of all persons residing in the state. It is the intent of the Legislature in enacting this provision to enhance the penalties attached to this illicit and dangerous conduct. 19 20 Health and Safety Code section 11352.1 states: 21 22 23 24 25 26 27 28 (b) Notwithstanding Section 4321 of the Business and Professions Code, and in addition to any other penalties provided by law, any person who knowingly and unlawfully dispenses or furnishes a dangerous drug or dangerous device, or any material represented as, or presented in lieu of, any dangerous drug or dangerous device, as defined in Section 4022 of the Business and Professions Code, or who knowingly owns, manages, or operates a business that dispenses or furnishes a dangerous drug or dangerous device or any material represented as, or presented as, or in lieu of, any dangerous drug or dangerous device, as defined in Section 4022 of the Business and Professions Code without a license to dispense or furnish these products, shall be guilty of a misdemeanor. Upon the first conviction, each violation shall be punishable by imprisonment in a county jail not to exceed one year, or by a fine not to exceed five thousand dollars ($5,000), or by both that fine and 4 FIRST AMENDED ACCUSATION 1 imprisonment. Upon a second or subsequent conviction, each violation shall be punishable by imprisonment in a county jail not to exceed one year, or by a fine not to exceed ten thousand dollars ($1 0,000), or by both that fine and imprisonment. 2 3 REGULATORY PROVISIONS 4 5 15. 6 As used in Section 2761 ofthe code, 'gross negligence' includes an extreme departure from the standard of care which, under similar circumstances, would have ordinarily been exercised by a competent registered nurse. Such an extreme departure means the repeated failure to provide nursing care as required or failure to provide care or to exercise ordinary precaution in a single situation which the nurse knew, or should have known, could have jeopardized the client's health or life. 7 8 Title 16, California Code of Regulations ("CCR"), section 1442 states: 9 10 16. 11 As used in Section 2761 of the code, "incompetence" means the lack of possession of or the failure to exercise that degree of learning, skill, care and experience ordinarily possessed and exercised by a competent registered nurse as described in Section 1443.5. 12 Title 16, CCR, section 1443 states: 13 14 17. 15 A registered nurse shall be considered to be competent when he/she consistently demonstrates the ability to transfer scientific knowledge from social, biological and physical sciences in applying the nursing process, as follows: 16 Title 16, CCR, section 1443.5 states: (1) Formulates a nursing diagnosis through observation of the client's physical condition and behavior, and through interpretation ofinforn1ation obtained from the client and others, including the health team. 17 18 (2) Formulates a care plan, in collaboration with the client, which ensures that direct and indirect nursing care services provide for the client's safety, comfort, hygiene, and protection, and for disease prevention and restorative measures. 19 20 21 (3) Performs skills essential to the kind of nursing action to be taken, explains the health treatment to the client and family and teaches the client and family how to care for the client's health needs. 22 23 (4) Delegates tasks to subordinates based on the legal scopes of practice of the subordinates and on the preparation and capability needed in the tasks to be delegated, and effectively supervises nursing care being given by subordinates. 24 25 (5) Evaluates the effectiveness of the care plan through observation of the client's physical condition and behavior, signs and symptoms of illness, and reactions to treatment and through communication with the client and health team members, and modifies the plan as needed. 26 27 Ill 28 Ill 5· FIRST AMENDED ACCUSATION 1 2 (6) Acts as the client's advocate, as circumstances require, by initiating action to improve health care or to change decisions or activities which are against the interests or wishes of the client, and by giving the client the opporttmity to make informed decisions about health care before it is provided. 3 4 18. 5 "Organized health care system" means a health facility which is not licensed pursuant to Chapter 2 (commencing with Section 1250), Division 2 of the Health and Safety Code and includes, but is not limited to, clinics, home health agencies, physicians' offices and public or community health services. 6 Title 16, CCR, section 1471, subdivision (b), states: 7 8 19. 9 An organized health care system must develop standardized procedures before permitting registered nurses to perform standardized procedure functions. A registered nurse may perform standardized procedure functions only under the conditions specified in a health care system's standardized procedures; and must provide the system with satisfactory evidence that the nurse meets its experience, training, and/or education requirements to perform such functions. 10 11 Title 16, CCR, section 1472 states: 12 13 20. Title 16, CCR, section 1474 states: 14 Following are the standardized procedure guidelines jointly promulgated by the Medical Board of California and by the Board of Registered Nursing: 15 16 17 18 (a) Standardized procedures shall include a written description of the method used in developing and approving them and any revision thereof. (b) Each standardized procedure shall: (1) Be in writing, dated and signed by the organized health care system personnel authorized to approve it. 19 20 21 (2) Specify which standardized procedure functions registered nurses may perform and under what circumstances. (3) State any specific requirements which are to be followed by registered nurses in performing particular standardized procedure functions. 22 23 24 25 26 (4) Specify any experience, training, and/or education requirements for performance of standardized procedure functions. (5) Establish a method for initial and continuing evaluation of the competence of those registered nurses authorized to perform standardized procedure functions. (6) Provide for a method of maintaining a written record of those persons authorized to perform standardized procedure functions. 27 28 (7) Specify the scope of supervision required for performance of standardized procedure functions, for example, immediate supervision by a physician. 6 FIRST AMENDED ACCUSATION 1 2 3 (8) Set forth any specialized circumstances under which the registered nurse is to immediately communicate with a patient's physician concerning the patient's condition. (9) State the limitations on settings, if any, in which standardized procedure functions may be performed. 4 (1 0) Specify patient record keeping requirements. 5 6 (11) Provide for a method of periodic review of the standardized procedures. 7 8 9 COST RECOVERY 21. Code section 125.3 provides, in pertinent part, that the Board may request the administrative law judge to direct a licentiate found to have committed a violation or violations of 10 the licensing act to pay a sum not to exceed the reasonable costs of the investigation and 11 enforcement of the case, with failure of the licentiate to comply subjecting the license to not being 12 renewed or reinstated. If a case settles, recovery of investigation and enforcement costs may be 13 included in a stipulated settlement. 14 15 DRUGS 22. Botox® is a trade name for onabotulinumtoxinA. It is a purified protein produced by 16 the clostridium botulinum bacterium, and is injected into muscles and used to improve the look of 17 moderate to severe frown lines between the eyebrows (glabellar lines). It can also be injected into 18 the area around the side of the eyes to improve the look of moderate to severe crow' s feet. 19 Botox® is a dangerous drug within the meaning of Code section 4022. 20 23. Juvederm® injectable gel is a sterile, biodegradable, non-pyrogenic, viscoelastic, 21 clear, homogenized gel implant used for volumizing and correcting facial folds and wrinkles. 22 Juvederm® is a dangerous drug within the meaning of Code section 4022. 23 24. Latisse® is the trade name for bimatoprost ophthalmic solution 0.03%. It is a 24 synthetic prostaglandin analog used in the treatment of hypotrichosis (inadequate or not enough 25 lashes). Latisse® is a dangerous drug within the meaning of Code section 4022. 26 27 25. Lidocaine hydrochloride is used as a local anesthetic. It is a dangerous drug within the meaning of Code section 4022. 28 7 FIRST AMENDED ACCUSATION 1 26. Radiesse is the trade name for calcium hydroxylapatite. It is used as an injectable 2 implant, and is indicated for sub dermal implantation for the correction of moderate to severe 3 facial wrinkles and folds. It is also intended for restoration and/or correction of the signs of facial 4 fat loss (lipoatrophy) in people with human immunodeficiency virus. Radiesse is a dangerous 5 drug within the meaning of Code section 4022. FACTUAL ALLEGATIONS 6 7 27. On or about October 7, 2014, the Board received information indicating that 8 Respondent may be engaged in the unauthorized practice of medicine by performing Botox® and 9 derma filler injections on consumers at parties without a prior good faith examination by a 10 licensed physician or physician supervision. 11 28. On or about October 7, 2014, Department of Consumer Affairs 1 Investigators L. C. 12 and R. H., acting in an undercover capacity, went toP. M.'s residence located in Clovis, 13 California, for P.M.'s Botox® and derma filler party. Upon arrival, P.M. asked the investigators 14 if they wanted body wraps, injections, fillers, or Botox®. As the investigators went into the 15 residence, they observed S. Z. sitting on a treatment table. A female subject wearing latex gloves, 16 later identified as Respondent, was observed injecting syringes into S. Z. 's facial area. Investiga­ 17 torR. H. heard S. Z. (while being injected by Respondent) ask "So this is Juvederm?"and 18 Respondent confirmed that it was. 19 29. On or about November 3, 2014, Investigator P. S-B. conducted an undercover 20 operation at Canter Fleurette A Beauty Affair Day Spa ("Canter") located in Clovis, California. 21 When P. S-B. arrived at Canter, she observed two women in the lobby area, one ofwhom was 22 later identified as consumerS. S-E. The investigator and S. S-E. conversed about Botox®. S. S­ 23 E. agreed that the investigator could watch S. S-E. receive her injections. Later, Respondent 24 arrived in the lobby and escorted the investigator and S. S-E. to a back room. The investigator 25 observed a massage table to the right, various bags at the end of the table, and a clear plastic 26 1 27 28 The investigators mentioned herein were employed by the California Department of Consumer Affairs in either the Health Quality Investigations Unit ("HQIU") or Division of Investigation Unit ("DOl"). 8 FIRST AMENDED ACCUSATION 1 container with syringes. S. S-E. sat on the table and discussed with Respondent the sites that 2 were to be injected with Botox®. The investigator observed Respondent prepare the injections (4 3 or 5 syringes) and place them on the table. Respondent wiped S. S-E.'s face with gauze and 4 injected her forehead at multiple sites using one syringe. Respondent used a different syringe to 5 inject the left eye lid area at multiple sites and then the right eye lid area. Respondent also 6 injected both outer corners of S. S-E.'s lip area. The investigator did not see a physician in 7 Conter; no physician conducted a physical examination on S. S-E. at any time. Later, DOI 8 investigators entered the establishment and announced their presence. 9 30. On or about November 3, 2014, Investigator M.P. interviewed M. F., the owner of 10 Conter. M. F. stated that she met Respondent about one and a half years earlier at a "girls party" 11 in Clovis. M. F. received Botox® injections from Respondent at that time. Respondent came to a 12 spa night event at Conter in June 2014 to provide Botox® and filler injections to consumer 13 attendees. M. F. received Botox® from Respondent on at least six occasions, including just prior 14 to the DOl's arrival on November 3, 2014. M. F. paid Respondent for the first Botox® injection 15 but all subsequent Botox® injections toM. F. were at no cost for hosting the spa night events. M. 16 F. never saw a physician prior to receiving Botox® injections from Respondent. 17 31. On or about November 3, 2014, Investigator M. T. interviewed Respondent. Respon­ 18 dent admitted that she provided Botox® treatments to consumers. Respondent told the investi­ 19 gator that she also provides Juvederm, sells Latisse products, and has a shop in Kingsburg called 20 ZLB Rejuvenation ("ZLB"). Respondent stated that R. G.; M.D. is the owner and Medical 21 Director for ZLB, and that he is aware that she goes to parties to provide Botox® and fillers to 22 patients. Respondent called Dr. G on her cell phone, and he agreed to come to Conter. Respon­ 23 dent stated that the prescription medications were ordered under Dr. G's license. She admitted 24 that there were no standardized procedures in place between her and Dr. G. 25 32. On or about November 3, 2014, Dr. G arrived at Conter and met with Investigator M. 26 T. Dr. G stated that he was the Medical Director for Respondent, that Respondent manages the 27 business, and that he helps her with any questions she may have. Dr. G admitted that he had 28 never been to ZLB and did not have any standardized procedures in place regarding physician 9 FIRST AMENDED ACCUSATION 1 supervision of Respondent. Dr. G also admitted that he had not conducted any good faith 2 examinations for ZLB or reviewed patient/consumer records for the business. He also admitted 3 that he had not conducted any good faith examinations of patients/consumers or reviewed their 4 records prior to Respondent's administration of cosmetic injections on patients/consumers on 5 November 3, 2014. Dr. G stated that Respondent uses his name and license information to order 6 prescription medication and does all of the ordering. Further, Dr. G has not reviewed any of 7 Respondent's training in the use ofBotox®. 8 33. On or about November 3 and 4, 2014, DOl investigators served Respondent with a 9 search warrant, and obtained a number of items and property from her person, vehicle, residence, 10 and place of business, ZLB, including, but not limited to, a blank prescription form belonging to 11 Dr. G, syringes, vials and/or boxes containing Botox®, Juvederm®, lidocaine, Radiesse, and 12 Latisse®, and medical records of various patients, including Conter owner M. F. and consumers 13 R. S., S. S-E., C. H., M. E., and S. H. The seized records were sealed and a return to the search 14 warrant was filed. 15 16 34. On or about December 16, 2014, Fresno County Superior Court issued an order releasing records seized and sealed by the investigators on November 3, 2014. 35. 17 On or about November 17, 2015, Investigator M. T. interviewed S. Z., who was 18 observed receiving Botox® injections on October 7, 2014. S. Z. stated that she did not see a 19 physician prior to being administered the Botox® injections by Respondent. 20 36. On and between November 17, 2015 and November 20, 2015, Investigator M. T. 21 interviewed patients/consumers S. S-E., C. H., and M. E. The patients/consumers admitted that 22 they had received Botox® and/or filler injections from Respondent at various locations including 23 Botox® parties at Conter, Respondent's place of business in Kingsburg (ZLB), and/or their 24 private residences. Those patients/consumers disclosed that they had not been examined by a 25 physician prior to receiving the injections by Respondent. 26 Ill 27 Ill 28 /// 10 FIRST AMENDED ACCUSATION 1 FIRST CAUSE FOR DISCIPLINE 2 (Criminal Conviction) 3 37. Respondent is subject to disciplinary action pursuant to Code section 2761, 4 subdivision (f), in that on or about January 23, 2017, in the case titled People v. Rebekah Suzanne 5 Demoss, Fresno County Superior Court Case No. F16905392, Respondent was convicted on her 6 plea of nolo contendere to violating Health and Safety Code section 11352.1 [dispensing or 7 furnishing narcotics], a misdemeanor. Said crime is substantially related to the qualifications, 8 functions, and duties of a registered nurse. Respondent's sentence included, but was not limited 9 to, two years probation and incarceration in Fresno County Jail for 180 days (176 days 10 suspended). The underlying circumstances of the crime are set forth in paragraphs 27 through 36, 11 above, incorporated by reference herein. 12 SECOND CAUSE FOR DISCIPLINE 13 (Gross Negligence) 14 15 16 38. Complainant incorporates by reference as though fully set forth herein the allegations contained in paragraphs 27 through 36 above. 39. Respondent is subject to disciplinary action pursuant to Code section 2761, 17 subdivision (a)(1), on the grounds ofunprofessional conduct, in that Respondent committed acts 18 constituting gross negligence within the meaning of Title 16, CCR, section 1442, as follows: 19 a. Respondent performed medical procedures on patients/consumers, the 20 administration of cosmetic injections using Botox®, Juvederm® and other derma fillers, without 21 any oversight or supervision by a physician. 22 b. Respondent performed medical procedures on patients/consumers, the 23 administration of cosmetic injections using Botox®, Juvederm® and other derma fillers, without 24 a prior good faith examination by a physician or mid-level physician extender; i.e., nurse 25 practitioner, physician assistant, etc. 26 c. Respondent performed medical procedures on patients/consumers, the 27 administration of cosmetic injections using Botox®, Juve"derm® and other derma fillers, without 28 any standardized procedures in place. 11 FIRST AMENDED ACCUSATION d. 1 Respondent performed medical procedures on patients/consumers, the 2 administration of cosmetic injections using Botox®, Juvederm® and other derma fillers, outside 3 of an approved health care system or organization, including Conter Fleurette A Beauty Affair 4 Day Spa, private residences, and her home residence. e. 5 .6 Respondent transported the dangerous drugs Botox®, Juvederm®, lidocaine, Radiesse, and/or Latisse® without any secured storage . f. 7 Respondent administered or furnished the dangerous drugs Botox®, 8 Juvederm®, Radiesse, and/or other derma fillers to patients/consumers without an order or 9 supervision by a licensed physician and surgeon. g. 10 Respondent failed to follow infection control guidelines to avoid risking the 11 transmission of blood-borne pathogens by injecting patients with Botox®, Juvederm® and other 12 derma fillers outside of an approved health care system or organization, including private 13 residences and her home residence. h. 14 Respondent failed to include in the patients' /consumers' medical records 15 consent forms for the medical procedures; i.e., administration of cosmetic injections using 16 Botox®, Juvederm® and other derma fillers, patient personal information and medical histories, 17 records or documentation pertaining to the medications/products used, and/or the lot numbers and 18 expiration dates of each vial of medication/product used. 19 1. Respondent engaged other persons, including; but not limited to, M. F., the 20 owner of Conter Fleurette A Beauty Affair Day Spa, to solicit patients/consumers for medical 21 procedures that Respondent was not legally authorized to perform or were outside her scope of 22 practice as a registered nurse, including the administration of cosmetic injections using Botox®, 23 Juvederm® and other derma fillers. 24 j. Respondent engaged in the illegal practice of medicine, as set forth in subparts 25 "a" through "d", above, incorporated herein by reference. 26 Ill 27 Ill 28 /// 12 FIRST AMENDED ACCUSATION 1 THIRD CAUSE FOR DISCIPLINE 2 (Incompetence) 3 4 40. Complainant incorporates by reference as though fully set forth herein the allegations contained in paragraphs 27 through 36 above. 41. 5 Respondent is subject to disciplinary action pursuant to Code section 2761, 6 subdivision (a)(l), on the grounds of unprofessional conduct, in that Respondent committed acts 7 constituting incompetence within the meaning of Title 16, CCR, section 1443, as set forth in 8 paragraph 39, subparts "a" through "j", above, incorporated herein by reference. 9 FOURTH CAUSE FOR DISCIPLINE 10 (Unlawfully Furnishing or Administering Dangerous Drugs) 11 12 42. Complainant incorporates by reference as though fully set forth herein the allegations contained in paragraphs 27 through 36, above. 13 43. Respondent is subject to disciplinary action pursuant to Code section 2761, 14 subdivision (a), on the grounds of unprofessional conduct, as defined by section 2762, 15 subdivision (a), in that Respondent furnished or administered Botox®, Juvederm®, and other 16 derma fillers to patients/consumers without an order or prescription from a licensed physician and 17 surgeon, dentist, or podiatrist, as set forth in paragraph 39, subpart "f', above, incorporated herein 18 by reference. 19 FIFTH CAUSE FOR DISCIPLINE 20 (Unauthorized Practice of Medicine) 21 22 44. Complainant incorporates by reference as though fully set forth herein the allegations contained in paragraphs 27 through 36 above. 23 45. Respondent is subject to disciplinary action pursuant to Code section 2761, 24 subdivision (d), in that Respondent violated or attempted to violate, directly or indirectly, or 25 assisted in or abetted the violation of, or conspired to violate, Code section 2726 of the Nursing 26 Practice Act by committing acts constituting the unauthorized practice of medicine, as set forth in 27 paragraph 39, subparts "a" through "d", above, incorporated herein by reference. 28 /// 13 FIRST AMENDED ACCUSATION 1 SIXTH CAUSE FOR DISCIPLINE 2 (Aiding or Assisting, or Agreeing to Aid Violation of 3 4 46. Complainant incorporates by reference as though fully set forth herein the allegations contained in paragraphs 27 through 36 above. 5 47. Respondent is subject to discipline under Code section 2761, subdivision (i), in that 6 Respondent committed acts constituting aiding or assigning, or agreeing to aid or assist any 7 person or persons, whether a licensed physician or not, in the performance of, or arranging for, 8 violations of the Medical Practice Act as set forth in paragraph 39, subparts "a" through "d", "f', 9 "h", and "i", above, incorporated herein by reference. 10 SEVENTH CAUSE FOR DISCIPLINE 11 (Failure to Follow Infection Control Guidelines) 12 13 48. Complainant incorporates by reference as though fully set forth herein the allegations contained in paragraphs 27 through 36, above. 14 49. Respondent is subject to disciplinary action pursuant to Code section 2761, 15 subdivision (k), in that Respondent knowingly failed to protect patients/consumers by failing to 16 follow infection control guidelines, as set forth in paragraph 39, subpart "g", above, incorporated 17 herein by reference, thereby risking transmission of blood-borne infectious diseases from licensed 18 nurse to patient/consumer, from patient/consumer to patient/consumer, and from 19 patient/consumer to licensed nurse. 20 PRAYER 21 22 WHEREFORE, Complainant requests that a hearing be held on the matters herein alleged, and that following the hearing, the Board of Registered Nursing issue a decision: 23 24 1. Revoking or suspending Registered Nurse License Number 515165, issued to Rebekah Demoss, also known as Rebekah Suzanne Demoss; 25 2. Ordering Rebekah Demoss, also known as Rebekah Suzanne Demoss, to pay the 26 Board of Registered Nursing the reasonable costs of the investigation and enforcement of this 27 case, pursuant to Business and Professions Code section 125.3; and 28 /// 14 FIRST AMENDED ACCUSATION ·----------~~---··-··- ~---~-----~-~-----~-- 1 I 1 3. Taking such other and further action as deemed necessary and proper. 2 3 CMOSEPH . MORRIS, PhD, MSN, RN ~' ' Executive Officer Board of Registered Nursing Department of Consumer Affairs State of California Complainant 4 5 6 7 SA2016102300 I 12598970.doc 8 9 10 11 12 13 14 15 \ 16 17 18 19 20 21 22 23 24 25 26 27 28 15 FIRST AMENDED ACCUSATION