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GREENSBORO — No criminal charges can be filed in the case of three women hospitalized with kidney failure after receiving cosmetic injections at a Greensboro clinic unless more information is found, investigators and prosecutors said Wednesday.

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"We left it with the county health people and the county attorney's office that we'd be more than happy to come back in if they turned up any additional evidence that any criminal activity had taken place or was taking place," said Capt. Jonathan Jacobs of the Guilford County Sheriff's Office.

County health officials have said that women from Illinois, Maryland and Washington received cosmetic injections in late December at Altmed of the Triad in Greensboro.

They said the injections should have been given by or under the direction of a physician, but were not. They also said the material injected had not been approved by the U.S. Food and Drug Administration for cosmetic purposes.

At least one of the women will require a kidney transplant, said the county's public-health director, Merle Green.

Assistant District Attorney Howard Neumann said prosecutors will need more information before they can determine whether criminal charges are warranted.

"I don't know if anyone has a sample of what was injected into these ladies," Neumann said.

"I don't know whether anyone has followed up to possibly exclude other causes (of their illnesses), if they were having some other medical difficulties. A lot of other things would have to be followed up on before we could make any decision as to whether it was a prosecutable situation."

Green did not respond Wednesday to a message left seeking a response to Neumann's comment.

The county health department first ordered the clinic to stop administering Silskin injections, then ordered it to stop administering any injections at all.

Green previously said the county sought samples of the substance used in the injections, but clinic operator Laura Cheek had none left.

Because the injections were not given by or under the direction of a physician, Green said, they amounted to practicing medicine without a license, a criminal misdemeanor in North Carolina.

Green said her department has asked county attorney Sharron Kurtz to talk with Guilford District Attorney Doug Henderson about possible criminal charges.

Green said earlier this week that she still would like the sheriff's office or district attorney's office to obtain a search warrant for the clinic.

Green said the case underscores the danger involved when cosmetic injections are not overseen by a physician.

She said her department has heard from other patients who were reporting minor side effects. Those patients were being referred to their primary-care physicians.

The N.C. Medical Board, which regulates the practice of medicine in the state, has no real jurisdiction in the case, said Dena Konkel, the board's assistant director of public affairs.

"When it comes to practicing medicine without a license, outside of reporting them to the district attorney's office there's not a lot we can do," Konkel said.

The status of the clinic with respect to the N.C. State Board of Cosmetic Art Examiners could not be ascertained Wednesday. A message left for an enforcement officer was not immediately returned. A message left for Cheek at the clinic also was not returned.

Contact Lex Alexander at 373-7088 or lex.alexander@news-record.com