The exploitation of consumers for both under-regulated and altogether unregulated medical and pseudo-medical procedures has taken centre stage in the media in recent years both in Canada and internationally. With practitioners who have unsatisfactory training advertising irreversible cosmetic procedures to unsuspecting consumers, there is significant cause for concern pertaining to ensuring that consumers are accessing properly licensed, insured and regulated providers. There are two seriously prevalent issues that currently persist relating to this topic. First, there is the problem that some health-related providers are not governed by a denoted administrative body. To illustrate these concerns, this article will use the case study of aestheticians who are not currently regulated despite providing personal services which, while seemingly harmless, have no regulatory oversight to ensure safety and diligence. The second widespread issue is that fraudulent and untrained “providers” are marketing their services in regulated industries as if they have the relevant qualifications. To illustrate this secondary issue, this article will discuss the current widespread influx of self-proclaimed “veneer technicians” who are offering veneer installation despite having no formal training or appropriate licensure to do so. In summary, this article will endeavour to convey that these two gaps are ultimately resulting in significant issues for consumers who, unbeknownst to them, may be engaging with irreparable procedures with providers who are not competent to be administering those services.
Regulation as it stands
The Health Professions Act (Alberta) (HPA) regulates a wide variety of health professionals and service providers in the province of Alberta.[1] The HPA governs the administration of 28 regulatory colleges with approximately 100,000 licensed professionals falling under its remit.[2] For instance, dentists in Alberta are overseen by the College of Dental Surgeons of Alberta, which is a regulated governance body under the HPA.[3] Furthermore, there are supplementary regulations which serve to both complement and enhance the HPA’s remit. Using the same example, there is the Dentists Profession Regulation,[4] which pertains specifically to the practice of dentistry and is extremely granular in terms of expectations for the profession. The HPA is complemented by the Public Health Act (Alberta) (PHA) which works concurrently with the HPA to protect the general public and establish management principles for public health risks.[5] Similar to the HPA, the PHA has numerous supplementary guidelines that provide standardized practice procedures. As an example, take the Personal Services Regulation; this regulation establishes industry requirements for personal service providers like aestheticians, tattoo artists or electrolysis providers to name a few.[6] It is important, however, to note that professionals who fall under the remit of the PHA and not the HPA are not licensed in the same way as professionals who fall under the HPA and therefore, are not regulated by a governing college.
Taken together in context, there are two key issues that persist surrounding this regulatory regime. First, there is an issue of under-regulation under the HPA. Contrary to popular belief, not all personal service providers are regulated or licensed. While the HPA is comprehensive for licensed or trained professionals who can be supervised by their respective colleges, non-licensed individuals fall outside of the scope of the law and supplementary regulations and therefore, cannot be subjected to any formal punitive action. While these providers may have some obligations under the PHA, they are not held to any harmonized standard that protects consumers from potentially risky or negligent procedures. The secondary issue is that even with a comprehensive legislative system in place, individuals who are altogether unqualified to offer HPA-governed practices cannot be reprimanded or penalized for providing fraudulent services, because the relevant Colleges have no remit over those providers. This leaves consumers exposed and often without sufficient recourse in the eventuality that an improperly trained individual provides a service incorrectly.
Under-regulation case study: Aestheticians
Aestheticians are known for offering innovative methods to improve one’s skin, body and overall health through both invasive and non-invasive procedures. Functioning as pseudo-health professionals, aestheticians are commonly found operating out of spas, standalone clinics and salons. Notably, this segment of professionals falls under the PHA’s Personal Services Regulation.[7] While aestheticians do not have the same requirements for practice that an enumerated group under the HPA might have, there are still baseline standards under the PHA that must be adhered to such as facility, and hygiene and compliance requirements.[8] In lieu of a more comprehensive regulatory and licensure system for aestheticians, there have been recent trends and issues relating to this segment of pseudo-health service providers.
In Alberta, there has been an industry-led call for enhanced oversight for aesthetic practitioners,[9] following the arrest of an individual posing as a fraudulent aesthetics doctor in September 2022.[10] More recently in August 2024, Health Canada issued a Public Advisory sanctioning an Alberta-based laser clinic for administering invasive techniques that they are unauthorized to provide.[11] In response to the sanctions, the provider publicly stated that they were under the impression that they were adequately trained to offer the procedures in question.[12] While this individual has now suspended their unauthorized procedures from their practice, they have stressed the need for a regulator who can step in and offer a harmonized licensing regime.[13] Problematically, even with Health Canada’s public reprimand, the PHA technically does not have the authority to prevent this practitioner or any other for that matter, from continuing to offer these services. The result of not having a harmonized set of standards for aestheticians in the same way that a doctor, optician or chiropractor has under the HPA is that there is not much bark to the bite of these such reprimands. The reality is that a statement from Public Health Canada, while compelling, does not actually solve the issue of under-regulation. To this point, even where punitive measures such as arrest are taken, there are unlicensed providers who still continue to provide their illicit services.[14]
Under-regulation at its core impacts consumers the most. Without a comprehensive legislative system for personal service providers in place, improperly trained professionals will continue to offer services that could potentially leave lasting impacts on consumers. Moreover, individuals who have taken formal training to provide these services and obtained qualifications may have credentials that actually do not allow them to provide the services that they think they are allowed to provide, as was seen in the above-mentioned laser clinic example.[15] To remediate this issue of under-regulation, the most pragmatic response would be to create a governing college and bring it under the remit of the HPA. In practicality however, this would be easier said than done. Creating a harmonized administration for a profession takes time, costs a significant amount and does not even ensure that individuals will stop engaging with illicit conduct, as will be seen in the next case study.
Unregulated case study: Veneer technicians
It is undisputed that invasive medical treatments such as veneer installation requires a trained and reputable professional to perform the procedure to ensure safety of the patient, quality of the service and longevity of the product. However, recently, there have been significant red flags relating to this topic.
There is currently an ongoing legal action in Ontario between a licensed dentist under the Royal College of Dental Surgeons of Ontario (RCDSO) and a class of former patients.[16] The suit is alleging that the dentist committed malpractice and directly profited from installing “unlicensed devices without patient knowledge” or consent.[17] Due to the poor quality of these unlicensed devices, which are namely veneers, patients have endured “pain and suffering, damaged teeth, bite misalignment and tooth discolouration.”[18] Fortunately for the consumers who are impacted by this alleged malpractice, as the dentist was most likely insured, the RCDSO has the jurisdiction to punish the practitioner and there is the opportunity to engage in the judicial process. This case study illustrates that even when regulated, engaging with permanent aesthetic procedures can pose significant risks to consumers if practitioners do not offer diligent and qualified services. On the other hand, what happens to consumers when there is no regulatory oversight over a “practitioner” due to that individual being unlicensed and therefore, unregulated?
There has been a recent trend where self-proclaimed “veneer technicians” offer irreversible services to consumers without any proper training or qualification. Marketing themselves through social media, veneer technicians offer low-cost alternatives when compared to licensed dentists and some even offer training classes for how to become a technician.[19] A statement released by the American Dental Association (ADA) stresses concerns around the risks associated with unlicensed and untrained professionals.[20] Highlighting the fact that untrained individuals could cause infections, issues relating to veneers being installed on damaged teeth and the potentiality for nerve injury (among other risks),[21] the ADA has stressed a need for diligence when picking a service provider. Alarmingly, many veneer technicians are operating in broad daylight and offering their illegal services in seemingly inconspicuous clinics.[22] As the sophistication for these unregulated and uninsured technicians continues to develop, it becomes harder and harder for consumers to differentiate between a qualified professional and a bogus fraudster.
Part of the problem that persists with these veneer technicians is that there is no regulatory regime to administer their practice because their practice is illegal in nature. With no regulation, there is no way that a college or professional body can oversee the administration of the practice. Moreover, reports indicate that some veneer technicians may be unaware altogether that what they are doing is illegal, having been brought into the practice on the false precept that they can be trained to offer these services in as short as two days.[23] To reconcile these issues, there is no clear action that stands out as one which will solve this problem, making consumer diligence more important than ever when it comes to selecting a provider for a treatment.
Who bears the risk?
One key thing that both under-regulated and unregulated fields have in common is that the consumers bear one hundred percent of the risks associated with sub-par treatments. On one hand, under-regulated industries perpetuate the fallacy that anyone can provide a service to a consumer. Moreover, training courses which are not adequately accredited create misconceptions that providers have taken proper steps to provide treatments. This creates confusion for consumers who may be unaware that a certificate on the wall of a practitioner might not actually give them the skills needed to provide a service. Without a clear regulatory framework that dictates a specific set of standards for these industries, medical-adjacent procedures are occurring without any oversight. On the other hand, unregulated industries, which essentially operate as scams, lure unsuspecting consumers in and often create irreparable issues. Again, providers may hold the genuine belief that they have the necessary qualifications to offer a service, being fed the misconception that they have been adequately trained to do so. These scam procedures are not only negligent but are also criminal in nature, raising the need for a unified and strong response from law enforcement to ensure the safety of consumers.
Problematically, there is not extensive case law to determine what sort of ramifications these unlicensed professionals will encounter. Moreover, no punitive damages have the potential to fix the injuries that have already occurred to unsuspecting consumers. At the core, consumers must remain diligent and ensure that they are properly vetting their medical and pseudo-medical service providers.
For more information about this topic or any questions related to the legal implication of this topic on your business, please contact the authors Michael Beard. Thank you to our articling student Jake Katz for his significant contribution to this blog.
[1] Heath Professions Act, RSA 2000, c H-7.
[2] Government of Alberta, “Health Professions Act Handbook” (November 2019) at 1, online (pdf): <https://open.alberta.ca/publications/9781460145791>.
[3] Ibid at Schedule 7: Profession of Dentists.
[4] Alta Reg 254/2001.
[5] Public Heath Act, RSA 2000, c P-37.
[6] Alta Reg 1/2020.
[7] Ibid.
[8] Ibid.
[9] Sarah Chew, “Estheticians calling for improved licensing requirements in Alberta” (27 October 2022), online: <https://edmonton.citynews.ca/2022/10/27/estheticians-calling-for-improved-licensing-requirements-in-alberta/>.
[10] Karen Bartko, “Woman posing as aesthetics doctor charged with fraud: Edmonton police” (4 October 2022), online: <https://globalnews.ca/news/9176334/edmonton-fraud-aesthetics-rossemarie-castro-rosales-doctor-marie-milne/>.
[11] Government of Canada, “Unauthorized treatments provided by individual posing as a practitioner at MedSkin Laser Center in Sherwood Park, Alberta, may pose health risks” (2 August 2024), online: <https://recalls-rappels.canada.ca/en/alert-recall/unauthorized-treatments-provided-individual-posing-practitioner-medskin-laser-center>.
[12] Karen Bartko, “Alberta aesthetics clinic calls for regulatory body after reprimand by Health Canada” (8 August 2024), online: <https://globalnews.ca/news/10689259/sherwood-park-aesthetics-clinic-unauthorized-treatments/>.
[13] Ibid.
[14] Nadia Stewart, “Illegal ‘Botox parties’ revealed in B.C. sting investigation of unlicensed practitioner” (4 March 2020), online: <https://globalnews.ca/news/6633298/illegal-botox-parties-revealed-in-b-c-sting-investigation-of-unlicensed-practitioner/>.
[15] Supra note 12.
[16] Matthew Hanick, “Ontario dentist allegedly used unlicensed veneers in patients’ mouths and pocketed the profit” (25 June 2024), online: <https://nationalpost.com/news/toronto/ontario-dentist-allegedly-used-unlicensed-veneers-in-patients-mouths-and-pocketed-the-profit>.
[17] Ibid.
[18] Ibid.
[19] Matthew Perrone, “Don’t fall for fake dentists offering veneers and other dental work on social media” (5 October 2024), online: <https://apnews.com/article/veneers-dentist-teeth-whitening-scam-unlicensed-d0d9d57613a10f18bc9735dc5eca4b41>.
[20] ADA Media Relations, “Statement on Recent Reports of “Veneer Technicians”” (14 May 2024), online: <https://www.ada.org/about/press-releases/statement-on-recent-reports-of-veneer-technicians>.
[21] Ibid.
[22] Justin Gray, “Investigators raid office of ‘Atlanta’s top veneer specialist,’ accused of being fake dentist” (3 October 2024), online: <https://www.wsbtv.com/news/local/atlanta/investigators-raid-office-atlantas-top-veneer-specialist-accused-being-fake-dentist/AB7CETGLXZAJLNS5BZIGJ43IMA/?utm_source=st.%20albert%20gazette&utm_campaign=st.%20albert%20gazette%3A%20outbound&utm_medium=referral>; and Lauren Victory, “Unlicensed dentist charged after leaving Chicago area patients with fake braces” (26 April 2024), online: <https://www.cbsnews.com/chicago/news/fake-dentist-scam-folo/>.
[23] Ibid.
