Friend of YouTube sensation Stevie Ryan speaks out about her care by psych NP

In December, Patients at Risk aired two podcasts in which we discussed the case of Gerald “Jay” Baltz, a psychiatric nurse practitioner who was under investigation by the California board of nursing for engaging in an inappropriate sexual relationship and providing questionable treatment to a patient who subsequently took her own life. 

While we did not provide any identifying details at that time other than what was included in public documents, since the time of that recording, friends and family members have come forward to identify the patient as Stevie Ryan, a Hollywood comedienne and YouTube sensation who seemed to be on the verge of stardom when her life came to a tragic end at the age of just 33 years old.

We are joined today by Yuni Kim, Stevie Ryan’s close friend and confidant, to discuss mental health issues and care provided by different types of mental health clinicians.  Yuni previously shared this information with the LA Times as discussed in this article: https://www.latimes.com/business/story/2021-04-01/stevie-ryan-death-nurse-practitioner

If you are having concerns about mental health, help is available.  Please call the suicide prevention lifeline at 800-273-8255.

Links to previous discussions of this case:
https://podcasts.apple.com/us/podcast/psych-np-patient-affair-ends-tragically-case-jay-baltz/id1539719940?i=1000503087095

https://podcasts.apple.com/us/podcast/differences-between-psychiatrists-psych-nps-case-jay/id1539719940?i=1000503719243

Get the book!  https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/

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Transcript

Rebekah Bernard MD: 0:07

Welcome to patients at risk a discussion of the dangers that patients face when physicians are replaced with non physician practitioners. I'm your host, Dr. Rebekah Bernard, and I'm joined by my co host and the co author of our book patients at risk, the rise of the nurse practitioner and physician assistant in healthcare. Dr. Niran Al-Agba. Before we start, I want to let our listeners know that during this episode, we will be discussing topics that some may find disturbing, including suicide. If you are having any mental health concerns or thoughts of self harm help is available, please contact the Suicide Prevention Lifeline for assistance. In December patients at risk aired two podcasts in which we discussed the case of Gerald J. Baltz, a psychiatric nurse practitioner who was under investigation by the California Board of Nursing for engaging in an inappropriate sexual relationship and providing questionable treatment to a patient who subsequently took her own life. While we did not provide any identifying details at that time, other than what was included in public documents. Since the time of that recording, friends and family members have come forward to identify the patient as Stevie Ryan, a Hollywood comedienne, and YouTube sensation who seemed to be on the verge of stardom when her life came to a tragic end, at the age of just 33 years old. We are joined today by unique Kim Stevie Ryan's close friend and confidant unique thank you so much for joining us to talk about this tragedy. And I'm so sorry for your loss.

Yuni Kim: 1:41

Thank you. I still miss her and think about her every day and oh, my god, she like her mom loved her so much and her family like it's it's a tragedy because she was so generous of heart, you know, absolutely taken advantage of I feel.

Rebekah Bernard MD: 1:57

what was it that made you want to come forward to talk about the story?

Yuni Kim: 2:01

Stevie was one of the first people I knew who talked about mental health openly. And I don't mean like she in detail, like as she was happening. If she was like, feeling depressed and crying, she would, she would show everybody and livestream and honestly, like I remember back then thinking like, like, I would never cry publicly just because that's how I was raised. You know, we're all raised like that. But it's in retrospect, I see how courageous that was to share. Like, obviously, we all have moments like that, where we cry, why can't we share those moments and just feel more human? I wanted to talk to you guys, because I know, I feel that Stevie would want me to talk to you guys. And I do feel like since she was such a pioneer in talking about mental health and what pills she was on or not on, like, she would want me to continue her mission and like help other vulnerable people. And I feel like especially with the pandemic, it's just really easy to exploit people in like the mental health industry.

Rebekah Bernard MD: 3:04

You're so right. And I saw that, you know, shortly before we lost her, she actually did a show where she talked about mental health. And I'm sure that was really inspirational to so many people that are struggling with mental health issues.

Yuni Kim: 3:19

I think it is I think even just to talk about it makes it on normalizes it, right? I want to talk about it sometimes on my social media, but most of the time I just, you know, delete, because I get embarrassed. And so I just really respect how open she was. That's really fearless to share that.

Niran Al-Agba MD: 3:38

You know, what I was so struck by is, obviously the LA Times pieces come out. And I commend you. And Stevie Ryan's parents, especially for having the same courage, I think you all displayed a ton of courage coming out and really sharing her story, because I know that wasn't easy. And so number one, I want to thank you but something that I kind of got the feeling from your quotes, as well as actually from her father, who said, I don't want him to continue doing this to other people. And I live in Washington State. And I think so much about the fact that he has a license to practice unrestricted in Washington State. And so ever since we talked about the story, we learned about Gerald Baltz, and the fact that he's licensed here. I think there's got to be something that we can do to carry it forward. So he doesn't hurt other people. I think number one, thanks for your courage. Number two, I agree. I think she would have Stevie would have wanted you and her parents to come out and talk about this. And so I guess what do you want out of coming forward and talking about it?

Yuni Kim: 4:36

I want people to know that sometimes they might not be talking to a psychiatrist. You got to make sure what are their qualifications, you know, um, I know that means dv 100% thought it was a doctor. I never knew what this different world of, you know, a different world of like nurse practitioners was, um, I'm really sad that I only found out all this stuff. until after her death. I, I think if people are at least know, to ask or just even research on their own, what their doctor's qualifications are like, are they really a doctor? That could? That's a really good first step.

Rebekah Bernard MD: 5:14

Yeah, you're so right. And just to recap, for people that don't know a lot about this story, Jay bolts had been a nurse for about six years when he met Stevie. He had a bachelor's degree in writing. And then he got his degrees in nursing, and ended up getting his master's degree to become a nurse practitioner. And he was supposed to be practicing under supervision with a physician, but it didn't seem like he ever really was getting that supervision. And when the Board of Nursing investigated him, they had a lot of concerns about the way he was practicing. His documentation was not good. He had prescribed all sorts of medications to her without really justifying why. And it really seemed like he was trying to get her to do this Transcranial Magnetic treatment, which we investigated that a little bit, and it's very expensive. And new. When did you first learn about his involvement with Stevie? I know, she talked to you through texts about him? What did you know,

Yuni Kim: 6:13

she didn't start really talking about him until April of 2017. And that's when they started dating. She was like, I think my, my doctor was hot. She sent me all these texts, we talked every day. And so like, did I know that it was wrong for a doctor to date? His patient? Yes. CV was really depressed. And we said, as a friend, I just just wanted to be happy. You hope for the best. Like you don't think the absolute worst might happen?

Rebekah Bernard MD: 6:42

I mean, of course, yeah, that makes perfect sense. I mean, you're her friend, it's not like you're gonna give her a lecture about it. You're just there to be supportive. You don't know. And you assume that he will, you know, do the ethical thing and be professional. But from the reporting that the Board of Nursing did, it certainly did not look like he was being very professional about it at all.

Niran Al-Agba MD: 7:03

Yeah, I wanted to ask kind of along the same lines, I think all friends will support their friend who has a crush on their doctor, you don't expect and actually, it's not really a doctor, it's a nurse practitioner. But again, the you don't expect the doctor or the nurse practitioner or whoever else in care to then reciprocate, right, it's our job, not to reciprocate and develop a relationship. So I guess, in all fairness,

Rebekah Bernard MD: 7:26

Because we're supposed to know better than the patients and are also very vulnerable. You're talking to somebody about the most intimate parts of your life. And it's, it's actually very well known in medicine in psychiatry, this idea of transference where you start to develop some feelings, because somebody is listening to you, they're paying attention to you. And in the medical profession, we're trained, and especially psychiatrist, that we do not act on that because a person is not genuine their feelings necessarily, it's coming out of a place of vulnerability. So that's why it's such a responsibility for a medical professional not to let that type of activity ever start, you're gonna acknowledge it, he didn't, he jumped on that, from what it looked like really quickly, and entered real quick into a relationship with her that definitely did not seem very go.

Yuni Kim: 8:13

I do know that. So they dated in April. And then ended April, beginning of May I forget, they broke, she broke it off with him. And she didn't want to date him anymore. The problem is, even though he said that he would refer to her to another doctor, she had to run into balls every time she went in for TMS. And so she I remember, she was telling me it's so awkward to run into someone you've broken up with. And he was still involved in her treatment, like trying to be involved. And even when he had referred her to someone else while he was eating, or he was still involved in her treatment. And I just thought she wanted to check yourself into the hospital. And he said, Don't go and I remember thinking at the time, okay, like she must not be that bad, right. And then I what I remember is after reading some complaint and seeing all the medications she was on, and I think back of the timeline, there was a time where she suddenly got so skinny and crying all the time and shaking. And I think it was the ADHD medication because well, she told him, I mean, there was a lot of weird, questionable stuff

Niran Al-Agba MD: 9:22

did she ever talk to you before about having ADHD, you know, part of the records show that he didn't really do a proper diagnosis. I mean, I'm a pediatrician. And, you know, we're trained, we have a number of questionnaires and a number of workups. In that process that we go through. You don't just throw medicines at someone. But I guess my question is, did she talk to you about those diagnoses as your as a friend or, gosh, I'm not sure about this guy, or did she ever express reservations about what what he was doing for treatment? Never. Do you think that's because she thought he was a doctor?

Yuni Kim: 9:53

Yes. 100%. Like, why are they allowed to be called doctors?

Niran Al-Agba MD: 9:58

They say physicians don't own the term doc. Doctor, that's the answer to your question. I mean, when we've asked it as well, the president of the American Academy of Nurse Practitioners says, quote, physicians do not own the term doctor, there's doctors of nursing practice. There's now a doctor of medical science, which is what a PA can call themselves as a doctor, and you'll see it all over social media. There's a ton of tick tock videos of this doctor of dermatology, they'll call themselves a doctor of nursing dermatology. So I I'm not sure why they're actually allowed. That's the answer they would give you. I think it's misleading. I don't I don't know how you feel as a as a patient or consumer.

Yuni Kim: 10:35

I feel like it's fraud. Honestly, I do. Like if would I want to go to an NP for my psychiatry? No, no.

Rebekah Bernard MD: 10:44

Yeah. I mean, that's one of the things that Niran and I talk a lot about, we agree with you, 100%. That is why we are getting the word out to other doctors, because a lot of doctors don't know about this, but mostly to patients. Because how would you know, and you have a lot of nurse practitioners saying we're just as good as doctors, we can do the same thing. They advertise to patients. And so here we are saying, well, maybe they can do some things, but they do not have the same amount of training. A psychiatrist does five years of training after medical school. I mean, that is a lot. A psychiatric nurse practitioner does 500 hours of training, there's no way that they can necessarily give the same care.

Niran Al-Agba MD: 11:25

So why do you think he didn't want her to go to the hospital? Do you have any thoughts about that?

Yuni Kim: 11:30

I mean, first is one he didn't want her to check in because he wanted to continue sleeping with her or two. He didn't want to get in trouble. Yeah, that's I think that's why right, he didn't want to get in trouble. He knew it was unethical. There's like, I have screenshots of their text and other friends screenshots of their text, know where he says, this is unethical for me, not for you. But for me, and I could lose my license and everything. He seemed to care more about himself, though, honestly, than her well being.

Rebekah Bernard MD: 11:59

It's pretty clear from the text messages, because he was telling her specifically, he's writing all sorts of things to her, and then saying, delete this, delete this. tell anybody. He was definitely looking out for his own best interest. It's clear. And I think that's what I get so upset about the fact that he did all of this. And he's been investigated. First of all, the person that reported him to the Board of Nursing seems to be Stevie's ex boyfriend. According to the reports, he found all these pill bottles, and he was like, What in the heck is all this about? And so he made a report to the board of nursing in 2018. Now, it took them two years to investigate till 2020. And here we are nine months after the Board of Nursing did their investigation and no action has been taken. He is still taking care of patients in California and in Washington State and nobody knows any any better.

Yuni Kim: 12:55

No, they don't. What scares me is on Instagram, during the pandemic, there were so many ads for mental health targeting young people that was for really cheap counseling, which, you know, I'm for I'm for, you know, counseling people can afford. But it just just made me sad to know how many people might be just they don't know what they're getting into with. If that's really a doctor. What makes me upset is what if she had at least continued her TMS therapy? I do know that after she stopped going to TMS because she just didn't want to run into him any more - that was like on May 28, or on May 22. And then, I mean, she died her on July, July one. And so for a month, she wasn't on any medication, nothing, because she had just like decided not to go anymore, because she didn't want to see Baltz. And so yeah, I mean,

Niran Al-Agba MD: 13:44

what was she like, during that month? Do I'm sure you spent time with her?

Yuni Kim: 13:48

Yeah, I did a lot. Um, before she died, she still went to jury duty. You know, I thought that was really cool. She still did that. She was really depressed. I mean, really, really, like I would call her and sometimes she would be crying. But she was still trying to pull through and be like, I'm really sorry, let me call you back. That's what I say the most angry is that she was trying? What do you do when someone's actually trying to get better?

Rebekah Bernard MD: 14:14

Right, I really I want to tell you something. You were a great friend, you did everything that you could to help and support your friend. And unfortunately, sometimes people do take their own lives. And I'm only telling you this because this wasn't your fault. You know, we had a psychiatrist on this podcast who lost a very dear friend to suicide. She's a psychiatrist. And she blames herself. Because she says I didn't see it. I didn't know the truth is, a lot of times when people are really ready to act on that. They don't tell people they don't let them know. And there wasn't necessarily anything you could have done when she made that decision. Now maybe if she had gotten the right treatment and had the right support and things like that, but this is not your fault. And I just think it's really important that you know that and that you don't hold on to any types of feelings of negativity. As far as your role in this, please know that.

Yuni Kim: 15:09

I mean, I appreciate that. I think. I do think, though, that anyone that loves Stevie, and there's so many of us, I'm sure we all feel that we could have done more. Like, if we had just known certain things before, you know, that's, there's that and

Niran Al-Agba MD: 15:24

like, what thing do you wish you knew before?

Yuni Kim: 15:28

I wish I knew, you can never assume someone's not going to be suicidal, just because they have dogs or cats. Like that's just not enough. I really thought that would hold her down. But it didn't. I just wish I talked to her more about her mental health. Like I thought it was like a privacy thing. So I didn't want to like pry and I knew she was uncertain medications, but not more. The one thing I will say is you shouldn't as a friend, like, don't just text someone like, Hey, do you need me just show up. Um, and I think that's really where that's what I wish I could have done is just shown up and not just text,

Rebekah Bernard MD: 16:03

one of the things you need that I've learned from talking to psychiatrist and psychologist is that when someone does get into that really, really dark state of mind where they really are thinking about hurting themselves, a lot of times, they kind of lose touch with reality, in a way. And at that point, you're right, it's really hard to get through to them. So I think it is a good idea to go there to be with them to be supportive. But a lot of times once a person is in that far along, and they're they're abnormal thought processes, it's really hard. So I think the key is really catching people early on. And of course, we know that she also had the loss of her grandfather, and that was really hard on her. And it may have just been the final straw. And she just wasn't in a good state of mind.

Yuni Kim: 16:49

That probably was the final straw, I think, but

Rebekah Bernard MD: 16:52

But of course, this You did everything that you could as a friend, but really, it was the role of the mental health system to help her and she was going for help. And it I think that is the biggest tragedy is that maybe if she had possibly been admitted for hospitalization, or of course been on the proper medications, gotten the right treatment not have been made vulnerable by what she went through with that sexual relationship, which is never appropriate, then, you know, maybe that things could have been different. And I think that's the hardest thing and then seeing just the disregard of the Board of Nursing for actually keeping him from doing that. Or even just letting patients know that this guy has a black mark on his record, we don't even have anything like that. And it's been several years,

Yuni Kim: 17:36

I just don't understand how he still is practicing with a license. In this field, you know, where he gets the prey on, most vulnerable?

Niran Al-Agba MD: 17:46

Well, it's hard just to let you know, when we do have bad practitioners, and that's across the board, it's really hard to get them removed without the public's help without people standing up and saying, Hey, this is a problem and putting pressure on the Board of Nursing. The Board of Medicine, I would say in most states is pretty quick. You know, anytime I that I've known of a physician sleeping with a patient, they've lost their license in the state of Washington. So what's fascinating to me is the Board of Nursing doesn't seem to be as upset about sex with patients

Yuni Kim: 18:14

that the Board of Medicine doesn't get involved because if NP psychiatrist MPs can prescribe medication, shouldn't that board get into it? also going above and also shouldn't the physician that was supposed to oversee a doctor both get in trouble too?

Niran Al-Agba MD: 18:28

he should and so to answer your first question, the Board of Medicine oversees only actual physicians, physician doctors, which is now becoming something we have to clarify with people. And it's the Board of Nursing that oversees the nursing practice doctors that are nurse practitioners and not necessarily doctor in the term that we use. That's the first thing and yes, the physician that was overseeing Gerald bolts should have been disciplined or should have been evaluated. But uh, but I don't see an open case or investigation. But you're right, that's who should be overseeing this. And I can tell you in Washington State. Now see, he's independent, he doesn't need a physician to supervise him. So again, any mistakes or any lives he harms end up only being looked at by the Board of Nursing when they get around to it.

Yuni Kim: 19:13

When they get around to it. I have to go testify in October. And so I'll do that. Yeah, October seems so far off. I just feel like this takes so long. I remember getting the call from the Board of Nursing and even then I was like, nursing like, okay, like maybe there. Maybe they take care of other things, too. I mean, I didn't know. I really didn't know until he listened to your podcast to be quite honest. Like what, what this whole world was and it opened me up to like more of like, the like how Stevie, the context of what Stevie went through before she died.

Rebekah Bernard MD: 19:49

Yeah, and that's really all that we're trying to do here is just let patients know that in some cases, nurses and nurse practitioners can definitely have a role. But if you're Having a really serious problem if you're not getting better than I would highly recommend to anyone that's listening to seek out a psychiatrist. And that's a medical doctor that went to medical school and did a residency and did a lot of training to be able to help patients with mental health problems. And there is help available. And maybe in some cases, a nurse practitioner can do a certain amount of work. But if you're not doing better, if you're doing worse, if you're having really dark thoughts, then seek care with a psychiatrist. And that is different from a nurse practitioner, psychiatric nurse practitioner,

Niran Al-Agba MD: 20:35

uni, what would you like to see out of this entire thing? So I mean, I know and I thank you for your courage testifying in October, because I know that's going to be hard. But what would you like to see be the outcome of the investigation in California?

Yuni Kim: 20:48

First, I would like him to lose his license. If he had one chance, and he blew it. I would also like him to not practice in Washington and Colorado. Why should you get to practice in other states. And so I just talked to more people spread the word on different kinds of mental health. And what you need to take care of, like, what you need to be careful of sad thing is like, can you really trust who you're talking to terms of like your doctor, if he is one or she is one? So that's what I want people to know, I guess, you got to do your own research.

Rebekah Bernard MD: 21:27

Well, you're so right. And it does make people lose faith in the health care system. And I think that's one of the biggest tragedies of this whole thing, maybe somebody out there won't get help now, because they're afraid or because they've had a negative experience. So our I think our message is not to give up. If you're going through mental health struggles, there is help available and maybe if you find someone you're seeing them, and they are unethical, they're trying to initiate any relationship that doesn't feel comfortable or right, or you're just not getting better with your treatment, then it's perfectly fine to say, you know, this isn't working out and get a second opinion and find a different clinician, preferably, I would say, a psychiatrist to talk to you. And you know, I always tell people, sometimes my patients I write recommend them to a psychologist, and they'll say, Well, I just had a bad experience. And I'll say, Well, you know, sometimes you get your hair cut, and you get a really bad haircut. Does that mean that you never get your hair cut? Again? No, you just don't go back to that same hairstylist, you said this was not good. So but you don't just say, Well, I'm done. You know, there are people who are better, and then others, different skill levels. And of course, sometimes you just have a better rapport with one doctor than another. So just because you're seeing somebody if it's not going well, and you're not feeling like you're getting the right care, it's great. And it's perfectly acceptable in any reasonable clinician, whether it's a doctor or nurse practitioner, they will never get upset at a patient for saying, you know, I'm not sure I think I want to just Can I get a second opinion? Can I get a referral to somebody else? If they say no, or they give you a hard time, that's a red flag. And that means that there's a problem. And I'm telling you, you can ask around, you can ask me if my patient says, Well, I'm not sure I think I'd like to get a second opinion. We'll say, Great. Please do and let me know. And we welcome that

Yuni Kim: 23:15

known. Yeah, I wish I wish we had gotten that second opinion.

Niran Al-Agba MD: 23:19

Well, and it sounds like you would have gotten it from the same clinic. That's the only part that's frustrating to me is I don't even think I realized that she stopped the therapy, because she was it was so awkward seeing bolts at the same clinic. And there's just every time I learned more about this case, I just feel like ethics were nowhere to be found in the entire area. Oh,

Yuni Kim: 23:40

when she was getting TMS therapy. on her Instagram page, she posted the guy giving her therapy, TMS is flirting with her to I mean, this whole place is just like, inappropriate. It just,

Rebekah Bernard MD: 23:51

you need to think some of it's like Hollywood, because you know, Niran, and I don't live in that world. So I mean, do you think that's a part of this? Is there some kind of something about the fact that she was sort of a celebrity? And do you think that played in

Yuni Kim: 24:05

that he wanted to date her? Well, maybe or just I'm not sure, honestly, I do think Yeah. tracted to her, but I mean, who wants it? She has a gorgeous and magnetic. But I'm not a psychiatrist who took an oath.

Niran Al-Agba MD: 24:19

Well, neither was he. I guess that's right. Neither was Gerald Baltz he was not a psychiatrist. He did not take take an oath. He took an online course. I mean, that's really what we're talking about. He got an online degree. He really just kind of wasn't any of those things that you would normally seek out when someone's suicidal and I will tell you this, I mean, I know the patients who flirt with me are like under 10. When they tell me they want to marry me, so it's a little bit different. But I still tell them they can't marry me and that they'll find someone their own age someday, even though they're darling little children. So again, it's our job, not to set inappropriate boundaries. And I will tell you during this pandemic, I hug children I say goodbye. I tell them they, they need to go forth and conquer on whatever their dreams are, but I don't flirt or get sexual with patients. And I know Dr. Barnard doesn't either, because we did take an oath. And we did go to school, and we gave up a lot of our 20s to try to help save lives.

Rebekah Bernard MD: 25:14

And especially if it's a vulnerable, my goodness, that just the idea that somebody is really hurting, and you know that they're going through all of this, and then to still put your own needs and desires ahead of that patient's interests, that it's just really egregious. And it's so sad. And I feel so badly that this happened to Stevie. And I'm glad that she had a good friend like you to talk to. And I'm really proud of you for speaking out so that other people can learn from this tragedy that maybe someone else can be saved, and and get better care and be okay,

Yuni Kim: 25:45

I just want to say that I'm I feel like I'm the lucky one that got to be friends with Stevie. That's how I feel about that.

Niran Al-Agba MD: 25:53

She sounds like an amazing human being. And I'm, I'm really glad you guys are speaking out on her behalf. I feel like that is what she probably would have wanted you to do, carrying on her message that she was already trying to put forth into the world.

Rebekah Bernard MD: 26:08

Absolutely. uni I want to thank you so much for joining us. And you know, if you ever want to come and talk with us ever again, please let us know. And we're here to help and support you in any way possible. And you're really a brave and wonderful friend. And just thank you for who you are.

Yuni Kim: 26:24

Thank you guys so much

Niran Al-Agba MD: 26:26

for thanks for all your work. And if you ever want to check in with us, even if it's after October, we're here and we'd love to chat with you again. Good luck.

Yuni Kim: 26:34

Thank you so much doctors.

Rebekah Bernard MD: 26:36

Thank you so much to Yuni Kim for joining us to discuss this situation and for her bravery and speaking out. If you'd like to learn more about the importance of physician led care, we encourage you to get our book. It's called patients at risk, the rise of the nurse practitioner and physician assistant in healthcare. It's available@amazon.com and at Barnes and noble.com. We encourage you to subscribe to our podcast into our YouTube channel. And if you're a physician and you'd like to help us work on this important issue, we encourage you to join us at physicians for patient protection. Our website is physicians for patient protection.org Thanks so much and we'll see you on the next podcast.