One of the differences between physicians and nurse practitioners is that physicians are regulated by a state Board of Medicine, while in most states, nurse practitioners are regulated by a state Board of Nursing. This distinction is important, because while nurse practitioners are functioning in the same capacity as physicians—ordering and interpreting tests, making medical diagnoses, and writing prescriptions for medications—they are overseen by a regulatory body that includes nurses without experience in this type of practice, which can result in a lack of appropriate action when a nurse practitioner is practicing improperly.
Today we are going to discuss the case of nurse practitioner Jeffrey Young, the so-called, “Rock Doc,” who was indicted in 2019 for prescribing controlled substances to his patients “to obtain money, notoriety, and sexual favors.” Despite multiple reports to the Tennessee board of nursing, outside agencies took five years and action before Young finally lost his prescribing privileges. Emergency medicine physician Dr. Teresa Camp-Rogers joins us to discuss the details of this case.
Atlantic article: https://www.theatlantic.com/health/archive/2021/01/rock-doc-opioids/617405/
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
PhysiciansForPatientProtection.org
One of the differences between physicians and nurse practitioners is that physicians are regulated by a state Board of Medicine, while in most states, nurse practitioners are regulated by a state Board of Nursing. This distinction is important, because while nurse practitioners are functioning in the same capacity as physicians—ordering and interpreting tests, making medical diagnoses, and writing prescriptions for medications—they are overseen by a regulatory body that includes nurses without experience in this type of practice, which can result in a lack of appropriate action when a nurse practitioner is practicing improperly.
Today we are going to discuss the case of nurse practitioner Jeffrey Young, the so-called, “Rock Doc,” who was indicted in 2019 for prescribing controlled substances to his patients “to obtain money, notoriety, and sexual favors.” Despite multiple reports to the Tennessee board of nursing, outside agencies took five years and action before Young finally lost his prescribing privileges. Emergency medicine physician Dr. Teresa Camp-Rogers joins us to discuss the details of this case.
Atlantic article: https://www.theatlantic.com/health/archive/2021/01/rock-doc-opioids/617405/
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
PhysiciansForPatientProtection.org
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.
Niran Al-Agba MD:Good evening.
Rebekah Bernard MD:One of the differences between physicians and nurse practitioners is that physicians are regulated by a State Board of Medicine while in most states nurse practitioners are regulated by a State Board of Nursing. This distinction is important because while nurse practitioners are functioning in the same capacity as physicians ordering and interpreting tests, making medical diagnoses writing prescriptions for medications, they are being overseen by a regulatory body which includes nurses without experience in that kind of practice, which can result in a lack of appropriate action when a nurse practitioner is practicing improperly. Today we're going to discuss the case of Nurse Practitioner Jeffrey Young, the so called 'Rock doc' who was indicted in 2019 for prescribing controlled substances to his patients to obtain money, notoriety and sexual favors. Despite multiple reports to the Tennessee Board of Nursing. It took five years and action from an outside agency before Jung finally lost his prescribing privileges. Emergency Medicine physician Dr. Teresa camp Rogers joins us to discuss the details of this case. Dr. Camp Rogers, welcome to the show.
Teresa Camp-Rogers MD:Hi, thank you.
Rebekah Bernard MD:Teresa, can you start us out by telling us about why you got interested in this story,
Teresa Camp-Rogers MD:I became interested in his story specifically, because of my more recent experience as a Chief Quality Officer. If you look at processes of regulation, it's kind of gives you like an audit. We can use examples, cases like this can show us the processes in place, they can show us if the processes are robust enough to really hold people accountable when they need to be. And that's initially what drew me to the case.
Rebekah Bernard MD:So you read this article that was featured in The Atlantic magazine. Now this story of Jeffrey Young had been out for a while it had gotten the media across Tennessee and across the US. But what really caught your attention was this Atlantic piece that was an investigative journalism piece that really explored Jeffrey young and tell our audience a little bit about Jeffrey young and what you know about his story.
Teresa Camp-Rogers MD:What I know is basically from that article, what I learned from reading the Atlantic article was basically egregious disregard for ethics and standards. And it's just what you described earlier, it's he is from my understanding, a nurse practitioner in Tennessee that really thrived on the notoriety of popularity, and his apparent need for that made him abandon a lot of ethical principles from what I read was really challenging to see that the process that was in place, held him accountable. And that's what really struck me.
Niran Al-Agba MD:And I was just going to do a recap, and then kind of ask you why it's hard to hold them accountable. Because this is something that Dr. Bernard and I see all the time you know, it, it takes like five years, even after the death of someone to really get the nursing board to do something about it. And so just to recap, Jeff Young, as a nurse practitioner was in Jackson, Tennessee, patients would say they like that he made him feel comfortable. They felt like he took their pain seriously. And this is something we see with both doctors and nurses who treat pain. There's this kind of sometimes there's this relationship that develops where boundaries come down. I think that's probably the best way to put it. And most people liked his sort of plain spoken approach to medicine, which sometimes patients feel like smacks with elitism. And so he had this kind of down to earth, you know, he was tattooed, he was the 'rock doc,' which seems young and full of vitality. And what's fascinating is he was sleeping with patients. I mean, in a nutshell, if you're going to summarize what was going on, he was trading sex for drugs, essentially. And it's not even an unusual thing. I mean, I think we've already talked about other psychiatric nurse practitioners who were having sex with their patients that are still working, you know, this is a kind of recurrent theme. And so with that, what I want to ask is, what do you see as the problem with accountability, I'm sure doing some of the quality control, you're seeing maybe loopholes or things that make it challenging,
Teresa Camp-Rogers MD:right. When I have looked at disciplinary hearings, which are publicly available on nursing board and medical board websites, if you take time to read through those, you can very easily see a distinct difference in process and accountability. Things like this will unfortunately happen with physicians. I mean, that's the first thing to come to terms with when we as physicians see this happen with a nurse practitioner, we're not saying oh, this would never happen with us. We're saying if it happens to a physician, that when that physician comes to the medical board, the processes are robust, they are swift, and they are non negotiable. And you can see this you can you can literally go to the nursing Board of Medical Board websites, and you can read the disciplinary summaries of a physician and See it be carried out in a timely manner.
Rebekah Bernard MD:Yeah. And that was not the case here. And I actually, after you read this Atlantic piece, you actually wanted to write a response to them to point out these differences. And so we'll get into that in a minute. But I want to just kind of summarize the complaints that were made against Young and just really the inaction that occurred first of all, Young opened his own practice called preventagenix in 2015. But before he even opened his practice, in 2012, he was working for a different company, and he was accused of supplying testosterone without a clear medical reason to high schoolers who wanted to bulk up. So the history was that there was a young man that went to his house, paid cash, and knowing that no doctor would prescribe testosterone to a healthy young teenage boy. So the health department did receive a complaint about this. However, the complaint was never assigned to an investigator. So that was in 2012. Then starting in 2015, he accrued 13 complaints to the state health department accused of abusing his license. And finally, in 2013, he prescribed a cocktail of medications to a patient, hydrocodone, a benzodiazepine, and Adderall which is an add medication, but he failed to diagnose the patient's hypertension over prescribed to him, and then the patient died of a stroke. So that's in 2013. In 2014, he then sees patient who came in complaining of low back pain and numbness in the left arm, there was no physical exam, and yet he prescribed him Percocet and Valium, and hydrocodone. So what do you think when you hear Percocet, which is oxycodone, valium, and hydrocodone when you hear something like that?
Teresa Camp-Rogers MD:I think all of us kind of repel just initial just kind of gut reaction. And I think all of us would kind of have a very strong knowledge that that's inappropriate.
Rebekah Bernard MD:Yeah, I mean, you're not going to mix two different narcotic medications oxycodone, and hydrocodone. And there's always a warning on mixing benzodiazepines with opioids. And then also he threw in a muscle relaxant just you know, throw icing on the cake. And unfortunately, that patient died of an apparent drug overdose. And they found all sorts of pill bottles, some of which had been prescribed by young. So all of these were getting reported. And yet there was no action that was taken until the DEA got involved and until the Justice Department actually ran a sting operation. And it's interesting because neuron, remember, when we discussed the Kevin Morgan case in which he was prescribing testosterone, it was actually only through an outside agency, the DEA that he was stopped, the nursing board really did not actually take action.
Niran Al-Agba MD:What's really interesting to me is like Teresa was saying, in Washington state, there was this whole big, maybe about five, six years ago, there was a big thing where many physicians just had their licenses revoked, for prescribing testosterone unnecessarily, and then growth hormone for sort of those wellness and vitality kind of clinics. And so I really want to emphasize in this episode, in particular, as Teresa said, doctors do this, this isn't saying only nurse practitioners make these mistakes or cross these boundaries or sleep with patients. It definitely happens physicians, I mean, there may be more examples where physicians have done that. However, there are far more countless more examples where physicians are no longer practicing, they've lost their licenses. And the reaction is, as you said, swift. And so what I find interesting is sometimes and that seems like there's some problem, maybe with the Board of Nursing, the amount they have to cover, you know, I suspect they're overwhelmed, I really don't want to insult the board of nursing because I think up to the more recent years, they've done a great job of keeping nurses maybe that have addiction or other things like all healthcare providers have, you know, they do a good job of holding those people accountable. So to me, this feels like a big kind of glaring red flag that we need to talk about. And we need to do something about because unfortunately, like you're saying, when deaths occur, it ends up being like an outside Department of Justice, the DEA something that sparks it against the nurse practitioner, and I think that's waiting too long. I don't know, Teresa, if you've seen any of this or had Have you ever seen where the DEA is the first to go after a doctor versus like the State Medical Board?
Teresa Camp-Rogers MD:I haven't. My exposure to this is since this legislative season, but I've I kind of dove in headfirst, because it's it's the gap is there, the experience with regulatory compliance extends some time back. But once I got exposed to this legislative season, I've kind of really, really enjoyed finding the gaps. But I think you point that out exactly right. Like it's not a critique of the nursing board. This is what we do every year in a hospital. We look for these as opportunities for improvement. And those hospitals out there that do use DNV, as their regulatory as their accreditation agency know that it is an opportunity. You know, it's not a gotcha. This is not a gotcha. This is a opportunity to close a gap. And it comes down to for me I think about those patients that were referred to the board, and I think about a process Where the medical decision making could have been evaluated? Right? And that's what really that that's what to me stand out is like, what could work? How would we get this to work moving forward? What sort of legislative options or regulatory options are there to allow the nursing board to demonstrate collaboration at a system level? Right? We're asking for collaboration between the Board of Nursing and the Board of Medicine, just like we're asking for collaboration at an individual level, I think about those individual patients and what could have been done?
Rebekah Bernard MD:Well, you do think about that, because you think, you know, if somebody had taken some action, let's say back when he was prescribing testosterone inappropriately, or the first patient that got harmed, we wouldn't necessarily have had more patient deaths. And I think that is what the crux of this issue is about is that these regulatory bodies are in place to make sure that bad actors do not continue. And it doesn't seem as if that process is working effectively. But I want to talk about some of the other factors that allow this to continue. And the first thing I think we have to look at is the opioid manufacturers, I mean, neuron, what do you think about what we know about how they may have encouraged a little bit more prescribing, they seem to really target nurse practitioners?
Niran Al-Agba MD:Well, I think what the target to be honest with you is sort of what I would say our niche prescribers. So it's funny, it's actually not funny, but it's ironic to hear the two of you talk about like benzos and to narcotics. And sometimes I feel like you're speaking a completely different language, because when I one time prescribed a kid with a really bad neck crank, I wasn't flexor or backson. It's robots that I prescribed to prescribe, like half a 500 milligram and the kid was maybe 12, or 13. And really gave proper, you know, instructions. And the kid was just in a lot of pain and was actually miraculously better. The next day, I did one half a pill. So when you're talking about muscle relaxants, and then all these other things, I'm like, wow, I don't even have any concept of what I would do with narcotics, because I simply don't prescribe them. That's a great example. Because the pharmacy, the Purdue pharma, and the companies that make opioids, they aren't going to stop by my office, because I'm going to look at them with a blank stare. I think what they probably do, I don't know if we can prove it, but they look at what's being prescribed because I know drug reps can do that. And sometimes they used to ask me, like, why aren't you prescribing this inhaler? And I say, well, it's too expensive. I'm not going to do that to patients. And so you know, I just would refuse to do it. And so I think the same thing goes on. And when they see someone who's really going through a lot of prescriptions, and those patients are filling them, I suspect, they actually target those ones. And so they target high volume providers, generalist nurse practitioners, physician assistants, and those who really don't necessarily have extra training in pain. I know there was a doctor at me on Twitter this weekend. And he's someone who was investigated and arrested by the DEA. And it's really interesting to me that he prescribed like 3000, schedule to and then a bunch of schedule three and schedule for drugs. And I just think that that's going to flag the interest of the pharmaceutical companies
Rebekah Bernard MD:young actually prescribed a million opioids according to this article, and so what you're saying you said that there's not really it's hard to prove, but there was a lawsuit filed by the state of Tennessee in May of 2019, in which they said, quote, opioid manufacturers such as Endo, the maker of apana, and Purdue pharma, the maker of OxyContin targeted high volume providers, in particular generalist nurse practitioners and physician assistants. So there definitely was some of that. And then I think we also have to look at the patients to a certain extent, and part of it is that, you know, patients really trust their medical provider practitioner, and nurses in particular, actually one of the most trusted groups, but also when you read about young people love 10 patients felt listened to patients rallied to his to help him when he posted things on Facebook about how he was being persecuted.
Niran Al-Agba MD:I don't know what either of you think of this, I'd be interested my dad had this expression for many years, he would say patients will love you to death. And they'll hate you to that. And it wasn't saying that either. Or it's saying the ones who love you to death and like massively overly get involved, then they sort of can turn on you in a heartbeat. And I'm not insulting patients, I want to be clear, but I find there's a personality type that is risky. And I suspect a psychiatrist when they're doing therapy with patients that are hurting or have mental health issues. certain personalities have this tendency to kind of cross over and and so and I'm not blaming patients, I want to be clear, I'm just saying it's, it's on us as physicians to say no, that's not okay. Sometimes I'll have a warning bell like when they really love me, I'm like, Okay, I need to step back. I need to put a boundary here for their safety, and it's not their fault. It's it's really our fault if we're not in tune to it. So I do want to say with pain patients, I find a lot of physicians and nurse practitioners fall into this because there's this kind of enmeshment that occurs and I just think it's really important we maintain the ability to treat patients properly, but not from a distance like I just but something that makes us remember we're the doctor and there trusting us. So we really need to be careful. And I don't know if you see that Teresa in the work you're doing.
Rebekah Bernard MD:Yeah, I was gonna ask you, Teresa about that specifically, you know, you're an ER doctor. And so people do come in and pain and crisis all the time. And they talked about how young was, quote, people pleaser. And so maybe some of this started altruistically, maybe that he will just wanted to help people. How do you feel about that, and when you are dealing with these patients, do you have any special techniques that you would share with other doctors?
Teresa Camp-Rogers MD:Oh, I don't know, if I have, I don't know, if I have any special techniques, I think it's that balance of establishing a connection and a genuine belief in what they're experiencing. And then it's very interesting, because like, you have to couple that connection, that rapport and genuine belief in them with a very strict boundary of it might not be true, because that happens, but then to work them up completely. And then if you find a cause for them, then you treat it and you make it very objective. And so you care for them as human being, and then you balance it with, well, let's be objective and very kind of sterile and boundaries. So it's a very technical decision, and that you don't make the decision making without any emotion. You're right.
Rebekah Bernard MD:That's how physicians are trained, we need to, of course, show empathy to our patients. But we have to be thinking about what the patients need, not necessarily what they want. But I don't know, of course, Young did certainly wasn't practicing that way. And I don't know if nurse practitioners are trained that way, rather, just giving people what they want, rather than what they actually need. And you know, we do know that they have higher patient satisfaction rates in some studies, and maybe that comes back to giving people what they want, but again, not necessarily what they need. And of course, as physicians, our mantra is supposed to be do no harm, as much as possible. So in this is a case of your you feel like you're doing the right thing, but you're actually harming the patient.
Teresa Camp-Rogers MD:Just as a quick little thing, I'm kind of a fan of audits, what may be interesting on that is to do a sort of educational audit to see if that's taught, right, because I know that our clinical experience, you could emergency medicine, they can be traced back to when we learned that. But that might be interesting to look at, educationally when that's taught to nurse practitioners.
Rebekah Bernard MD:Yeah. And also when you talk about audits, maybe auditing your own practice to see how many opioids you're getting out. So in the case of young, he was eventually seeing up to 50 to 85 patients a day, which is just nuts. I mean, a crazy busy day for me would be 30. In my previous practice. Now, I'm 20. And that's good. So 50 to 80 a day, and many of them were on opioids. In court, his attorney said it was only 25% of his patients. But the nursing board investigator said that it was the largest quantity of opioid prescription she had ever seen in a patient panel. So he was definitely prescribing. And, you know, that reminds me of when I was in one of my early practices, I had a partner, she was a family doctor, and she was such a kind person, she was such a trusting and believing person. And so if someone told her they had pain, she would prescribe and they would say no, no over the counters worked and, you know, kind of give her the story. And this was in the days in which we were taught that we should give everyone pain medicines, opioids specifically and that we had to use a pain scale, and that not treating pain could get us into trouble. And so she liked me. And you know, we were all trained that way. But she really went down that road because she was such a kind hearted person. So what happened was, it was a small community, and probably similar to Jackson, Mississippi, the word got out that she was a liberal prescriber. And next thing you knew, she was saying, I don't understand why do I have all these patients that that, you know, she didn't get it? Because she didn't, you know, it didn't even occur to her that patients would do that or take advantage of her. It took her a really long time. And it was a chart audit, that she realized, like, whoa, I'm way out of step with my prescribing compared to other doctors what's going on, and then kind of figured out that that was the problem.
Niran Al-Agba MD:I will tell you this, we've talked about this education piece before. And I happen to work with a pediatric nurse practitioner. And what's fascinating is she got no training on immunizations. And I mean, zero, like somebody else will handle that as sort of what she said her schooling taught her. And here we are pediatrics, like just doing pediatrics. Can you imagine? Like not under not not being taught anything about all of them? You know, and I mean, I draw my own. And it just I found it fascinating because I looked at at one point, I was like, you have to know this stuff like like full stop. This takes time. And it's going to take hours and you need to make sure you are the experts in the room on this. And so your pointer he said is a really interesting one. Like I actually think as we're coming across different experts in different people that are non physicians in certain specialties. It would be really interesting to go back and figure out how much training did they actually have in this particular area. And I think that's a piece of standardization that's going to end up being really important. I mean, I can't imagine doing a primary care nurse practitioner pediatric schooling a doctorate level, no less, not getting any training on immunizations.
Teresa Camp-Rogers MD:Well and then that ties it back to To the Jeffrey young case is that Hippocratic Oath isn't in there. I guess we all can guarantee it. We know it's not. And there's a there's a litany of things that aren't, do they have to be? I don't know, that's the marketplace of ideas to decide. But I think that we all have to understand we and the hospitals where they work, right need to know the physicians that are hiring them need to know what was in it, what was in the education and what wasn't. And what are the consequences of that?
Rebekah Bernard MD:You know, that's an interesting point, because Jeffrey Young was being theoretically supervised by two physicians. And they actually were actually they were busted in this big sting operation along with a whole bunch of other clinicians, pharmacists, doctors and nurse practitioners really, really horrible situation. And so there was a complicity there. So what ended up happening in this case is that another agency besides the nursing board began to investigate that was the Tennessee Bureau of Investigation, then there was more people getting concerned one of the supervising physicians reviewed charts and realize that things were not good with Drew from his supervising arrangement, pharmacists began to refuse to fill prescriptions. So there was all sorts of red flags. The health department threatened to file charges against him and suggest that he surrender his license, but he did not do that. And the investigation continued for two more years until the DEA finally got involved. They went in raided the clinic, they took 10,000 individual doses of hydrocodone. So it sounds like he had a dispensing license. On top of that he had hydrocodone I guess, unless he was traffic. I don't know exactly
Niran Al-Agba MD:how my guess is patients brought them back into him. I mean, again, I'm interpreting but when patients don't know how to get rid of things, they'll say like, oh, I don't want to have these at home. What do I do? I bet he was getting them back. And I will tell you that we don't have a way to dispense IV meds and I have people bringing in meds to me all the time. And what I do is I dump them in the Biohazard. I open the bottle, dump them in the Biohazard. And that's actually witnessed. It's not even I do, too. Yeah, I just like I have my one of my colleagues or my medical assistant, literally, I write down I count, put him in the Biohazard. And you can't get your hand in the Biohazard, which I'm really pleased about. So kids can't or rescue it, or whatever. Plus, it went into a whole bunch of ways. Yeah,
Rebekah Bernard MD:there's all sorts of needles and blood. Yeah, that's not something you'd want to stick your hand in at all. But
Niran Al-Agba MD:it prevents, I would say, any employees or any staff or any patients from harming themselves while keeping it out of the water. And so I do that, but I but I handle the document and count and then it's double signed by someone and I'm the only one like I, me and another person, I never let like two staff members do it just for just again for process and accountability and all of those things. And so I suspect he was pocketing those. That's anyway what I could be.
Rebekah Bernard MD:But you know, what's interesting is he got raided by the DEA, and he still didn't get shut down. He closed that particular clinic, he opened a new clinic called GeneXus health. And he offered mostly cosmetic treatments at this point. So he's doing Botox and fillers which I can't imagine that that's in his scope as a family nurse practitioner than he would see sometimes over 50 people per day, he was billing insurance. And they said it was a problem in the article because he wouldn't do any documentation. So they would try to submit the bill and the insurance company wouldn't pay. And then he continued his antics, again, trying to trade sex for drugs, drugs for sex. So this went on until 2019, came before the Board of Nursing, and he had his license put on probation. But what's interesting is he could no longer prescribe schedule two or three controlled substances, which are opioids or and Adderall, but he was still allowed to prescribe testosterone cough syrup with codeine, and I think benzodiazepines as well. So And had he not had the next thing happened to him, he would have been allowed to get his privileges reinstated in 2020. And it was only the only thing that actually brought him down was the sting operation that happened in late in 2019, in which official swept through the area charging 53 different medical professionals with trafficking drugs,
Niran Al-Agba MD:don't forget to mention that he actually solicited I think it was an undercover officer for sex, essentially, and sex for drugs. And so let's be really clear that he definitely did that and got caught.
Rebekah Bernard MD:And then he got released. This is I mean, this is crazy to me. He got released on bond and then continue to prescribe Xanax and Valium. There was an article about it. And so it was so bad that the nursing board did nothing about it that the court actually the Department of Justice trial attorney prosecuting him came before the judge and said to the judge, that the court should do what the nursing board did not stop Young from further harming the community by prescribing dangerous substances and exploiting his patients. And the only way to ensure this is to detain him in other words, put him in jail and not let him out on bond. And the judge revoked his bail because partly because what he heard and partly because of some of the Facebook posts that Jung had made which they said how out showed a propensity for violence. So a lot of really just unbelievable. The story is unbelievable to me, because I can't imagine I've never heard of a story this egregious happening to a physician. I mean, there may be some, but I think it would have been stopped way before this.
Niran Al-Agba MD:And it is worth mentioning, you know, this was a kind of a close knit town. He had a number of police officers who who are his patients as well. And so I think what was going on is he sort of it's almost like a mob boss. I don't exactly know how that works. But it's kind of how I imagined it from the movies. There was some I think that there was some intimidation against one of the nursing board investigators at one point, if I go back, let me say that
Rebekah Bernard MD:she said that people would call her house and hang up. And one time she saw like a shadowy figure running through her yard, and she felt threatened and intimidated. And yeah, all sorts of things like that. I mean, like you said, really shady and scary stuff. Yeah,
Niran Al-Agba MD:I just think there was a lot of shady Enos in this story, which was a real credit to the reporter who did the investigative piece. But again, it's like he had his hand in enough cookie jars. I think that's part of the reason it went on for so long. And I think it's such a critical point that the Board of Medicine would have stepped in and done something. I mean, certainly the moment there's even a crime committed, the Board of Medicine puts the license on hold. So at least here in Washington, you know, they're very quick to do this. And I think that's fine. I just I don't see the same kind of response from the Board of Nursing, which is a shame.
Rebekah Bernard MD:So Teresa, after you read this article, then you just you found that they really left out that piece that comparison to physicians, right?
Teresa Camp-Rogers MD:Yes, absolutely. They left that out, because I think
Rebekah Bernard MD:this could have happened with a physician, but that physician would have been investigated by the Board of Medicine and the physician would have been held to medical standards.
Teresa Camp-Rogers MD:Yeah. And you can see that you can see where when a physician, you can go find this go whatever state you're in, go to the Board of Medicine, website, whatever state you're in, and literally peruse in all of our free time look through the disciplinary summaries. They are amazing. And I'm I mean, I'm biased, obviously. But the reason they're they're great is because they are so detailed. And so patient centered. When there's a medical physiology question when there is an active medical diagnosis, that same question, the board takes their time and goes line by line, sometimes even minute by minute, what medication did they receive at what time and was this appropriate, and conclusions are made about medical acts of diagnosis by a board of people who are trained in those medical X, the reason I use medical X for diagnosis is because that's what nurse practitioners are doing, despite the fact that they're nurses. And despite the fact that they're regulated by the nursing board, they are doing these medical acts of diagnosis. And I would encourage you to go to the Board of Nursing and see if that ever happens. You can kind of judge it by the type of consequences, like the disciplinary actions. And you can see where for the medical, they'll have remediation courses, or they have classes where they can send doctors to make sure that they're, you know, still good at practicing medicine. And I just don't see the same thing when I compare the two.
Niran Al-Agba MD:And it's also really important point to make it clear in most of these states, the Board of Nursing holds a nurse to what's called the minimum acceptable standard. So again, that's a really important point that if they miss a vital sign, or if they miss something that we would consider significant, they often say well, but nobody died as a result of that Miss vital sign. And so it's really this kind of minimal standard. And I would say we don't do that with the Board of Medicine. What I
Rebekah Bernard MD:think is interesting is that patients have no idea about this, we interviewed unique Kim, the friend of Stevie Ryan, who passed away after she was improperly treated by a nurse practitioner. And she said she stopped us and she said, Wait a minute, what do you mean Board of Nursing? And what do you mean, he's not a doctor. And so I mean, basically, patients don't think the average patient really understands the difference. They just trust that the person they're going to in a white coat is going to take good care of them and has the best training and that if they're not a good doctor or nurse practitioner, that someone will stop them. And unfortunately, that is not the case, at least what we're seeing in these cases, it's taking years for any action to be taken. So this is really important for patients to know about. And I think that Teresa, I think your letter that I don't think they published it, but I wish that they would have just to point out to readers that as egregious as these acts were and and hopefully we won't see physicians doing it, if a physician was doing it, there's a lot more standardization and quicker action to get that stopped. And if nurse practitioners are practicing independently, then perhaps they should be regulated by an agency that's more aggressive, like the Board of Medicine. Absolutely. Thank you so much, Dr. Teresa camp Rogers for joining us. If you'd like to learn more about this topic, 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 at Barnes and Noble and@amazon.com We would love for you to subscribe to our podcast and our YouTube channel. It's called patients at risk. And if you're a physician please join us at physicians for patient protection.org to help fight for physician led care. Thanks so much and we'll see you on the next podcast.