Six-month jail sentence for Botox practitioner who continued to practice without license too harsh

The Court of Appeal of British Columbia, in a November 12 decision, reduced the contempt sentence of a woman who had continued to provide Botox injections despite not having a license and being under an injunction prohibiting her from the practice. The court held that a six-month sentence was too harsh a punishment.

In 2018, a provincial district court sentenced Maria Ezzati to six months in jail after it found her in contempt of court for repeatedly engaging in the unlicensed practice of medicine while under an injunction not to do so.

Ezzati was giving Botox shots and dermal filler to patients without a license, including at parties in 2019 and 2020 where she injected dozens of people with Botox while hiding her unlicensed status from those patients and failing to collect any prior medical histories. Additionally, in at least one instance, a patient was forced to seek help from a legitimate medical provider for complications related to the shot.

The unlicensed practitioner served only 29 days before being released on bail, but appealed her contempt conviction nevertheless. She argued, among other things, that a six-month sentence for her actions was unreasonable.

Ezzati made two notable arguments on appeal. First, she charged that the judge hearing her case had improperly used affidavit evidence from an expert witness who had opined that Ezzati was engaging in behavior that could risk her patients’ lives through potential complications from the injections, an assertion repeated by the judge.

She also argued that the witness had not established any qualifications to provide an opinion on that point, and so any reliance on his opinion in issuing her contempt sanction was impermissible.

The court agreed with Ezzati that the expert’s opinion should not have been used to determine her sanction, but also held that the mistake had no effect. The expert had stated that use of drugs by a non-licensee may expose patients to risk of harm or death but had not made a specific statement about the injections performed by Ezzati.

The judge had erroneously relied on that evidence, wrote Justice Gregory Fitch. But, because another expert witness had testified to the specific risks associated with cosmetic injections—testimony that the judge could have legitimately relied on—the material effect of the judge’s error was not sufficient to have an impact on Ezzati’s contempt sentence.

Ezzati’s challenge to the length of her imprisonment met with more success. Although Justice Fitch noted that Ezzati’s “conduct in choosing to disobey the injunction on a second occasion—and to engage in conduct more serious than that which underlies the first contempt finding—was very serious” the court nevertheless held that a six-month sentence was excessive.

Several factors led to that decision. Acknowledging “that conduct of the sort engaged in by [Ezzati] is relatively rare” and “more difficult to identify an established sentencing range in cases of this kind,” the justice nevertheless held that the sentence was unreasonable.

First, Justice Fitch explained, a six-month contempt sentence for Ezzati’s second instance of contempt was an unreasonable escalation of the $5,000 fine she faced for the first breach. Additionally, the sentence varied too widely from previous cases involving unlicensed medical practice. And, he explained, the sentence failed to show the restraint required in cases of sentences for civil contempt.

On that basis, the court reduced Ezzati’s sentence from six to three months.