Betty Guerra won't be in court today.
And it's possible the medical assistant won't even be mentioned this morning when District Judge Kathleen Delaney holds a hearing on a temporary restraining order on emergency rules for medical assistants.
"I'm glad I don't have to be there," said Guerra, weeping Friday evening as she sat in her town home.
Yet Louis Ling, executive director of the Nevada State Board of Medical Examiners, admits that it was Guerra's July arrest on 10 felony counts on allegations of "unlawful practice of medicine" that served as a catalyst for today's court hearing.
"It would be fair to say that everything has stemmed from that," he said.
What medical assistants can and cannot do might be clarified in District Court today as Delaney reviews the process that led to the medical board's emergency decision to allow assistants to give flu shots.
The decision was blocked with a court order that the medical board seeks to have lifted.
But the outcome of today's hearing will do little to alleviate the woes now faced by Guerra, which include criminal prosecution and possible deportation. She is accused of administering cosmetic injections, an act commonly performed by medical assistants throughout Nevada, including those who work for at least one state medical board member.
Current Nevada law prohibits medical assistants from giving shots, but the restriction has largely gone unenforced.
"Her arrest kind of forced an issue," Ling said. "So many medical personnel were calling the governor and the medical boards about what they (medical assistants) could do. There was a lot of confusion, and we wanted to clear it up."
Guerra, a physician in her native country of Peru, said she never felt confused over the rules until she was arrested.
"I wasn't doing anything different than other medical assistants," Guerra, 45, said in halting English. "I always asked the doctor if it was OK, and he said, 'Yes.' Then I got arrested for doing what everyone else was doing."
By mid-September, Ling let the public know about the 30-year-old law authorities had used to arrest Guerra. The news roused the entire medical community. The law not only barred medical assistants from giving the kind of Botox or cosmetic injections for wrinkles that Guerra was accused of, it prohibited assistants from giving flu shots and other vaccinations.
Ling thought an emergency board meeting -- where new rules would permit medical assistants to give flu shots while prohibiting cosmetic injections -- would ensure that medical assistants could give vaccinations during the flu season, which is expected to be harsh.
The new rules were blocked after attorney Jacob Hafter -- who represents medical spa owners who want medical assistants to be permitted to inject Botox -- argued recently that the board violated the state's open meeting law by cutting off public comment at the meeting.
Delaney ruled that the regulations could not go into effect immediately and ordered today's hearing on the temporary restraining order.
Guerra, the mother of three children, seems stunned that so much has happened.
"I can't sleep at night," said Guerra, who is just a couple of college courses shy of becoming a registered nurse. "I may go to the prison, and now the immigration authorities are suddenly denying my request for legal residency."
It is fair to say, said Sandra Bledsoe, who runs the Focus Medical Weight Loss & Spa where Guerra once worked, that the Peruvian immigrant is not a typical medical assistant.
"How many medical assistants do you know who graduated from medical school and can speak four languages?" Bledsoe said. "But she never held herself out as a doctor. Dr. Robert Feingold supervised her and signed off on all her work."
Peruvian authorities said Monday that Guerra had a physician's license.
Feingold told the Review-Journal recently that he allowed Guerra and other medical assistants to give injections under his license. He was at the spa about four hours a day to supervise their work.
As she sat in her living room, Guerra told of how she left her native Peru in 1983 after she won a scholarship to a Russian medical school. She learned Russian, she said, and spent seven years in a university there. She showed a diploma from the school that she used to get her medical license in the Palestinian territories. She said she had to learn English there to get her medical license.
"I met my husband, an Arab who was studying to be a dentist, in Russia," Guerra said. "I stayed (in the Palestinian territories) for 12 years, but it got so dangerous. I was always afraid that my children might get shot. You know the Arabs and the Israelis are not friends."
Her husband did not want to leave, so Guerra divorced him and returned to Peru. But the pay was so low that she followed the advice of a cousin living in Las Vegas and came to Nevada in 2003.
"At first, I thought I would become a doctor or nurse here," she said. "But it cost $10,000 just to take the tests for a doctor's license, and I also needed to study. But I needed to support my children, so I became a medical assistant."
She worked at clinics in the Hispanic community, taking blood pressures, temperatures and weights. She then got a better job working as an assistant for Dr. Stephen Seldon in 2005. There, for the first time, she was taught by Seldon to give cosmetic injections, what she thought was Botox.
One day, she said, the office manager said Seldon was out sick. But Guerra found out he had been arrested, accused of giving illegal Botox.
"I quit right away," she said. "I did not want to get in trouble."
It wasn't long, she said, before she was visited by Todd Grosz, an investigator with the state attorney general.
"He got mad at me because I couldn't tell him a lot of bad things about Dr. Seldon," she said. "But I really didn't know anything."
Guerra said Grosz got even angrier at their second meeting.
"I think that's why he ended up charging me, in retaliation, but I didn't know what Dr. Seldon was doing," she said.
Edie Cartwright, a spokeswoman for the attorney general, said Grosz acted on a complaint from the medical board.
Earlier this year, Seldon was sentenced to 46 months in prison for a fake Botox scheme.
Four of the 10 counts against Guerra took place while she was employed by Seldon. Two involved injecting Botox, two involved suturing.
"I did simple sutures with the doctor right there, just as he told me," she said. "I never said I was a doctor, but Dr. Seldon would brag to the patients that I was a doctor in Peru."
The six other counts took place at Focus.
"I never had one complaint against Betty," Bledsoe said. "Todd Grosz subpoenaed records from my spa and started calling people and telling them that Betty wasn't supposed to be doing Botox. That's how he got complaints."
Cartwright said the attorney general's office doesn't generate complaints.
Guerra's arrest outraged medical spa personnel, including Bledsoe and Tracy Hurst. They called government authorities and pointed out that plastic surgeon Dr. Benjamin Rodriguez, vice president of the medical board, let his medical assistant, Monica de la Cruz, do the same thing.
Rodriguez's spokeswoman and daughter, Noelle Rodriguez, admits de la Cruz had long done injections of Botox on patients and suturing.
In an e-mail to the Review-Journal, she said de la Cruz was trained as a surgical technician and worked under the direct supervision of Dr. Rodriguez.
"I can only pray justice is done," Guerra said.
Contact reporter Paul Harasim atpharasim@reviewjournal.com or 702-387-2908.
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