Malpractice Costs Will Soar if NPs are Deemed On Par With Physicians

Dear Administrator Verma,

Deeming non-physicians to be essentially equal in training and experience to physicians amounts to a dangerous experiment on American patients. It is improper and unethical for the federal government to be making such decisions regarding the scope of practice of medical professionals.

I have spent over 40 years as a complex litigation specialist. Handling over 35,000 malpractice claims. It seems the law of unintended consequences is at play. Currently the “Captain of the Ship” doctrine limits liability to allied health personnel. It also limits professional and legal liability costs. Placing nurse practitioners and Physician assistants on par will indeed lead to greater claim frequency and increased legal costs. Rates for all providers will increase. In fact underwriters will increase offices with PA’s and NP’s. We could see malpractice costs for internal medicine practices rise from $1-3,000 to $9-12,000 per allied health professional .

We saw the law of unintended consequences occur with EHR and once down that “rabbit hole” there is no return. There is both a patient and physician expense that has not been calculated.

Likewise it is irrational and counterproductive to pay a minimally trained person the same as a highly trained, experienced person. If the reimbursement is the same for poor quality as for good quality, but the poor quality costs less to provide, the entities that degrade quality have a competitive economic advantage. Medicare’s existing price controls are already impeding patient access to high quality care and should not be exacerbated by additional flawed policies that further disregard important differences between practitioners. 

The bottom line is that patients’ lives are at risk. The federal government should follow a policy of “first do no harm.” It violates this principle to impose top-down edicts declaring that non-physicians are qualified to practice medicine. I urge the federal government to reject such policies.

Peter Leone

President, Edge Professional Liability Services

Time to Educate the Public on the Difference Between Physician Extenders and Physicians

NJ Physicians Mark Nemiroff, MD, George Petruncio, MD and IP4PI’s Craig M Wax, DO say the difference matters and believe it is time that the public knows the risks of having non-doctors imply that they have the same qualifications as physicians.

They have introduced Resolution 6-2019 at the Medical Society of New Jersey House of Delegates:

Title: Investigation of the autonomous practice of physician extenders in New Jersey and education of the public regarding the differences between physician extenders and physicians.

Sponsored by: Camden County Medical Society

Whereas, physician assistants (PAs) and nurse practitioners (NPs) in the State of New Jersey must have supervising physicians; and

Whereas, there appear to be PAs and NPs practicing semi-autonomously or autonomously in New Jersey with practice names implying they are “Certified Physicians,” and

Where as, physician extender and mid-level practitioner advertisements appear to fraudulently indicate medical licensure, putting public health at risk, and therefore be it

Resolved, the Medical Society of New Jersey call on the New Jersey licensure and regulatory agencies to investigate the legitimacy, guidelines and regulations pertaining to physician extender advertisements and autonomous practice, and be it further

Resolved, the Medical Society of New Jersey educate the public on the difference in education, ability and licensure requirements of physician extenders versus physicians.

Submitted by:

Dr. Mark Nemiroff, President Camden County Medical Society

Dr. George Petruncio

Dr. Craig M. Wax

NPs Running the ER: What Could Go Wrong? A Lot.

Guest post from Patrick Horn, M.D.:

I made a post on Physicians for Patient Protection (PPP) earlier this week about my personal experience with an NP that was negligent and could’ve easily cost my life, but I typed up a statement for use formally and have sent it to a lot of groups. If you feel it might help you in the fight against NP independent practice feel free to use it. You have my permission to us my story, my name, whatever you need. And I’m happy to discuss my story with anyone.

My name is Patrick Horn from Edmond, Oklahoma, and I wanted to share my story regarding a poorly trained nurse practioner that could’ve cost my life. I came into the Mercy Hospital ER, Oklahoma City, on Wednesday, 2/27/2019, as a trauma case after a severe MVA at approx 8am where the vehicle rolled into a very deep ditch on its side at high speed after losing control on the ice at the bottom of a steep hill in a rural area.

My truck hit the deep ditch/ravine so hard that both front wheels cracked off, air bags deployed, the truck flipped on its side and wedged into the large ditch. After seeing my vehicle, everyone at the scene has said I’m lucky to be alive, much less that I crawled out of the vehicle under my own power.

At Mercy ER, I never saw a doctor. Just an NP, Dawn Womack, APRN.  I came in complaining of severe spinal back pain and abdominal pain. She ordered a thoracic x-ray only and a zofran for the abdominal pain, and almost sent me out the door with Naproxen after misreading the x-ray as normal.

I asked that an MD radiologist read it before I was released and learned that I had fractured thoracic vertebrae per radiologist reading and CT confirmation.

She never bothered to do more imaging, including none of my c-spine nor my lumbar spine nor my abdomen nor my head, nothing. Seems like she really didn’t want to do a thoracic CT but did so based on what the radiologist recommended and based on my pushing for help. She just tried to get me out the door as quickly as possible. I get that they were very busy that day due to all of the ice slips and falls, but given the potential severity of my trauma after a severe MVA that probably should’ve killed me, this management is inexcusable.

No abdominal CT for the abdominal pain after the MVA, no complete spinal CT, no imaging of the cervical or lumbar spine, no head imaging, nothing. I could’ve been bleeding in my abdomen from a ruptured aorta, lacerated spleen or kidney, and she never would’ve never known.

I fractured my spine and she sends me out with a script for the weakest pain medication available simply because she’s an NP and refuses to ask her supervising MD to write for something stronger. I’m still in pain and suffering.

I’m a physician and I went through a trauma rotation at OU as a student, at our level 1 trauma center at OU Medical Center, and I know how it should be done. I’ve talked to other ER docs and all said that my c-spine should’ve been cleared, I should’ve gotten a complete spinal CT, an abdominal CT given the abdominal pain s/p MVA, and maybe even a head CT given the force of the accident. She never even did a physical exam except for pointing to my back and asking where it hurt. I don’t even remember seeing a stethoscope. She completely missed my injured shin where I fell trying to crawl out of the vehicle onto the icy ditch. I also had to wait for hours (in pain in the waiting room) before even being taken back to a room, and then was taken to a makeshift room, never hooked to a monitor, not given an IV, etc. No labs were ever done. I was not given pain medication until a long time later, and then it was PO since they never started an IV.

And then the nurse announced an NP was coming in and would be running my case. Oh brother. I was in so much pain and shock I didn’t even think to ask for an MD, and had I done so, that probably would’ve delayed my treatment more.

This NP was grossly inept and her treatment of a complex trauma case was negligent. Mercy shouldn’t be having NPs run trauma cases in their ER. If this ever happens again I will not be going back to Mercy if I can keep from it (sometimes in traumas we have no choice where we go) because I easily could’ve become paralyzed or even worse died.

I asked for as much as I could given that I’m a doc and know some things, and pressed for the CT, but given that I was in so much pain, it was tough, and by the end of it, I was tired of fighting the negligent care and just wanted to go home.

What’s scary is that I’m a physician and knew some of what to ask for…what does the general public do who doesn’t know any better? Suffer as a result of the negligence until something catastrophic happens?  Even at that, I’m a psychiatrist, so trauma/surgery isn’t my specialty, and I really didn’t know fully how negligent the care was until I got home and talked to a few ER physician colleagues of mine.

I had an idea though that I wasn’t getting the best of care, but it’s been awhile since I did trauma/surgery in med school…still even I could tell that so much was being missed.

Simply put, NPs shouldn’t be managing such complex cases, especially without adequate supervision. The fact that I never even saw a physician is scary, given the severity of my case. It’s as if she blew it off and didn’t realize how serious it was. I really don’t think she intentionally tried to do me bad (she seemed nice), but she was just incompetent and way in over her head with my case. NPs are not physicians and don’t have the training to be in that role. God forbid we allow them to practice independently. My story is a great example of what will happen if we do that.

Patrick Horn, M.D.
Medical Director, Psychiatrist
Oklahoma City, OK 73139

I should not be mandated to PAY-to-Practice this great noble profession of Osteopathy.

IP4PI supporter Gina Reghetti, D.O. shares correspondence regarding continued attacks on the osteopathic profession.

Just a note to let you know that I received a letter today from the AOA, dated 1-9-2017 and signed by Jeffrey L. Weaver, O.D., yes, OD, not DO, an Optometrist who is the Vice President, Certifying Board Services, and from Eunice Lee, Associate Vice President, Client and Member Services, informing me that I have until February 1, 2017 to renew membership to keep my AOA board certification active. My board certification is wrongfully time-dated to expire in December 31st, 2022.

My scanner isn’t connecting to my PC wifi so I am unable to email the letter to you currently.

I called Jeffrey L. Weaver, O.D., this morning to confirm that he is not a DO, and I had a conversation with him for more than an hour regarding my views and concerns of the wrong agendas that the AOA has enforced on their doctors, such as re-certifications, and OCCs and membership dues connected to certifications. Continue reading

OMT – Is there an app for that?

I had a student who wanted to create an app for PAs and NPs with counterstrain positioning, codes, and paymehts electronic records and insurance coding send all rolled into one so non-DOs can use and code for OMT(osteopathic manual treatment).

As his teacher, I was more than a little disappointed. This ‘all you gotta do’ attitude and get rich quick off creating an osteopathic app was shallow and disrespectful of Osteopathic practices and I refused to participate. As a D.O., our students get 1000 extra hours of osteopathic principles, practices and treatment experience than our other physician colleagues.  We are in a period where this type activity will increase and trivialize the value of OMT if THIS is what it comes to mean. By sheer volume this over simplified version of OMT could become what they think it IS. This is dangerous and we should issue policy and position statements carefully as a profession.

I knew this type activity was in the works, so I am not surprised, but I am a little dismayed that THIS is what has come to Osteopathy.

Carlisle Holland, D.O.
Holonomic Institute
Sebastopol, California 95472
Holonomics are the Principles of Integrative Medicine