ER Patient Death Due To Incompetent NP

[MedicineZ0Z]

Case below that any 3rd year med student could manage independently and literally impossible to miss by anyone who has experience beyond MS3.

"Below is a case that happened in my state of Oklahoma that just settled where NP did not know how to manage at an ER, she was an FNP working in ER 2nd to her last shift as she had been terminated but they allowed her to work her 30 days. One of the defendants that was listed was the supervising physician. The 19 yo died, Jury awarded family $6 million. Textbook case of PE

This happened in my state of Oklahoma!!!! This makes me sad, terrified, angry for the patient and her family. This NP is now working in the ER in Iowa. No disciplinary action against this NP!

Guess who is listed as the defendant? The supervising physician!!

“On Thursday March 21, 2019, an Oklahoma County jury returned a verdict for $6,190,000 in favor of the family of 19-year-old Alexus Ochoa-Dockins and against Mercy Health and other defendants in a medical malpractice case arising from the 19-year old girl’s alleged wrongful death.

Alexus Ochoa-Dockins graduated from Del City High School in May of 2014. Alexus was a National Honor Student and outstanding basketball player

In September of 2015, Alexus had just begun her sophomore year at Redland College. After she and her boyfriend went home for the weekend to visit family, they returned to El Reno on Sunday, September 28, 2015.

After arriving back to the college dormitory, Alexus complained of chest pains and shortness of breath. Her boyfriend testified at trial that Alexus told him “I can’t breathe.” She then passed out. Her boyfriend called 9-1-1.

Melissa Belanger, the Mercy EMS paramedic who responded and who testified at trial, reported Alexus had fainted, had shortness of breath, chest pain, low oxygen saturation, fast heart rate and fast breathing when she transported her to Mercy Hospital El Reno. According to medical expert testimony at trial, these were all classic signs and symptoms of a pulmonary embolism, a blood clot blocking blood and oxygen to the lungs. Additionally, Alexus was on birth control which according to expert trial testimony is a known risk factor for developing a pulmonary embolism.

At trial, Ms. Belanger, the paramedic, testified she called Mercy Hospital El Reno enroute and told the nurse she was on her way with a 19-year-old female who she believed had a pulmonary embolism and would need a CT.

The only medical provider in the Mercy Hospital El Reno emergency room was Antoinette Thompson-Ducasse, a family nurse practitioner. A family nurse practitioner is an advanced practice registered nurse who receives special training, education and certification in an area of specialty. According to Family Nurse Practitioner Thompson’s testimony shown at trial, she had never taken any classes in her nurse practitioner school for acute care or emergency medicine. She was only a family nurse practitioner. However, 8 months earlier Mercy granted her privileges to provide care and treatment to acutely and critically ill patients in the ER at Mercy El Reno. In fact, according to trial testimony, she was often the only medical provider in the emergency room in El Reno.

Initially, Thompson ordered a CT scan of the chest along with a urine sample. While in the bathroom to give the urine sample, Alexus passed out again. When the urine sample came back it showed presumptive positive for meth. However, the test was negative for amphetamine, which was unusual. According to testimony, Thompson and others knew the test may be inaccurate. Alexus, her boyfriend and her mother told Thompson something had to be wrong with the test because she did not do drugs. She was an athlete. At trial the testimony showed that nurses at Mercy did not believe Alexus exhibited behavior consistent with someone taking meth. At the request of Alexus’s mom, Thompson obtained another urine sample, which came back nagative for meth. Despite the negative meth test, Thompson cancelled the chest CT that would have diagnosed the pulmonary embolism and diagnosed Alexus with meth use and admitted Alexus overnight. An autopsy report confirm that Alexus had not taken any drugs.

Evidence showed at 12:22 a.m. after Alexus had been in the hospital for 8 hours Thompson finally ordered a CT scan of the chest but only after consulting by phone with another medical provider. However, Thompson did not order the scan “stat” or urgent. As a result, the radiologist did not read and report the results back to Thompson until 2:30 a.m. the morning of September 28th. The CT chest showed blood clots or pulmonary emboli in both lungs. Alexus was finally transferred to OU Medical Center and arrived a little after 3:30 a.m. Alexus was at the point of death when she arrived at OU Medical Center. Doctors at OU Medical Center attempted to give her the clot-busting drug tPA. It was too late. Alexus died at 5:26 a.m.

Shockingly, evidence at trial showed Mercy had terminated Thompson on September 1st for quality/safety concerns-27 days before Alexus showed up at the Mercy El Reno ER. The termination was effective October 1 as the contract required 30 days notice. The evidence showed Mercy would be required to pay Thompson during the 30 days whether she worked or not. Mercy decided to allow her to work during this 30 days instead of having another provider work during this period. Thompson was working her next to the last shift when she saw Alexus.

According to testimony, Alexus received no treatment for her blood clots in her lungs during the 11 hours she was at Mercy Hospital El Reno.

According to Glendell Nix, the attorney who represented the family, “The evidence at trial showed Alexus had all the classic symptoms of a pulmonary embolism which could have been promptly diagnosed with a simple blood test and CT scan. The evidence at trial showed that had she been diagnosed and treated during the first eight hours she would have survived.”

At trial, the family presented evidence the family nurse practitioner was not properly trained, educated or credentialed to diagnose such life-threatening conditions as a pulmonary embolism even though Mercy put her in charge of the emergency room. As a result, Alexus did not receive appropriate blood thinners or any other treatment to dissolve the blood clot.

Nix said, “The family is hopeful that the lawsuit and verdict will lead to changes at Mercy to ensure there are appropriately qualified medical providers at all Oklahoma hospitals so this kind of tragedy does not happen to another family.”

https://www.oscn.net/dockets/GetCas...6rwgym1WoGeChmEn7MGgkiu4vKCR168QxP0bqXWYQRUmM

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[Tenk]

Sad. Welcome to “discount” medicine where the price you pay is in blood.

 

[Goro]

A clinician friend of mine posted some transcripts of the trial on FB. This just confirms my "good for shots and sniffles" belief.

 

[WedgeDawg]

Moving to TIH

 

[MedicineZ0Z]

Moving to TIH

Isn't this something you want getting maximum views? It's also very much (extremely) relevant to med students.

 

[MedicineZ0Z]

Sad. Welcome to “discount” medicine where the price you pay is in blood.

Physicians make errors too which is what the opposing side will argue I'm sure. But there's a HUGE difference in errors that are made due to be neglecting things or not doing your job right (which is almost all physician errors) versus complete incompetence for the job.

The dragged out thought process in this case make it incredibly obvious this person did not have any working knowledge to workup shortness of breath, a fundamental and critical chief complaint in emergency medicine. The sheer lack of knowledge is astounding, they didn't even bother to look anything up! BTW, no surprise at all after meeting midlevels urgent care settings who can't adequately interpret EKGs/imaging etc.

 

[ciestar]

Wow. I figured this was a PE from the start...
this stuff scares me

 

[southerndoc]

I'm not sure this patient would've survived had it been diagnosed earlier, but it definitely looks bad when you don't treat. Meth may give you tachycardia, tachypnea, chest pains, and shortness of breath, but it rarely causes hypoxemia. Unfortunately, we all miss stuff. I think hanging this NP out to dry just because she's an NP is naive for physicians to think this kind of gross negligence will never occur to them. As an expert witness, I can attest that it does and you'd be surprised how some of the best docs sometimes do things that are grossly negligent.

For the OP who was surprised that the supervising physician was named, keep this in mind when you are an attending. If you are supervising a PA or NP -- either directly or indirectly -- you are responsible for the patient's care. By supervising the APP, you are accepting responsibility that he/she is an extension of you, and any negligence (failure to act, failure to treat, or improper treatment) is your responsibility even if you never see the patient. If you aren't comfortable with this, then you shouldn't supervise APP's. The courts have been quite clear on this.

 

[Booze Aldrin]

I think hanging this NP out to dry just because she's an NP is naive for physicians to think this kind of gross negligence will never occur to them.

I don't really care whether it is naïve so much as I care whether it is effective in the war the midlevels have been waging on our profession. If asinine hokums like "brain of a doctor heart of a nurse" are fair game for the mids to use against us, it'd be completely stupid and self defeating for us to hold back on using incidents like this one to defend ourselves. This isn't a leisurely drunken debate whose main aim is to arrive at the objective truth for entertainment's sake, this is a real-world battle to preserve our livelihoods. Effectiveness (within legal limits) is all that matters and the only metric by which an argument should be judged is whether it contributes to winning or to losing.

The public already believes the mids are nicer and cheaper. The admins love them because they cost less and mindlessly follow protocols like good little corporate cogs. If we can't even make the claim that they are also less competent and liable to make deadly errors at a much greater rate than us and use anecdotes such as this story as evidence, then we might as well put away our stethoscopes and start applying for greeter jobs at wal mart. It would suck enough to lose after investing so many years and so much money into this profession, but to lose without even putting up a fight would be a thousand times worse.

 

[betamale]

I remember the recruiters for Mercy in Oklahoma telling me that they do not allow IM and FPs work in their ERs only ABEM/AOBEM docs but an NP or ER resident can work there by themselves.
Shame on the doctors really as they are the ones that wrote the bylaws and discriminate on their own colleagues. I heard that ER is shutting down several months ago for a multitude of reasons, not sure if it was or not

 

[MedicineZ0Z]

I'm not sure this patient would've survived had it been diagnosed earlier, but it definitely looks bad when you don't treat. Meth may give you tachycardia, tachypnea, chest pains, and shortness of breath, but it rarely causes hypoxemia. Unfortunately, we all miss stuff. I think hanging this NP out to dry just because she's an NP is naive for physicians to think this kind of gross negligence will never occur to them. As an expert witness, I can attest that it does and you'd be surprised how some of the best docs sometimes do things that are grossly negligent.

For the OP who was surprised that the supervising physician was named, keep this in mind when you are an attending. If you are supervising a PA or NP -- either directly or indirectly -- you are responsible for the patient's care. By supervising the APP, you are accepting responsibility that he/she is an extension of you, and any negligence (failure to act, failure to treat, or improper treatment) is your responsibility even if you never see the patient. If you aren't comfortable with this, then you shouldn't supervise APP's. The courts have been quite clear on this.

Yeah and how absurd is it that midlevels are not responsible for themselves?

You should name some examples, cause there's no way someone who did residency in north america or even went to school here would make an error of this magnitude. Or did you not read the full thing?

I remember the recruiters for Mercy in Oklahoma telling me that they do not allow IM and FPs work in their ERs only ABEM/AOBEM docs but an NP or ER resident can work there by themselves.
Shame on the doctors really as they are the ones that wrote the bylaws and discriminate on their own colleagues. I heard that ER is shutting down several months ago for a multitude of reasons, not sure if it was or not

To add insult to injury, this NP had 0 training or courses in anything related to EM. A PGY1 in non patient contact specialty would provide drastically better care than this.

 

[VA Hopeful Dr]

Yeah and how absurd is it that midlevels are not responsible for themselves?

You should name some examples, cause there's no way someone who did residency in north america or even went to school here would make an error of this magnitude. Or did you not read the full thing?

To add insult to injury, this NP had 0 training or courses in anything related to EM. A PGY1 in non patient contact specialty would provide drastically better care than this.

Same reason residents usually get dropped from lawsuits - the supervising attendings are better targets. If you don't want midlevel independence (and most of us don't), this is what's going to happen. Its why most doctors I know who do supervise midlevels won't supervise them if they aren't on site with them at all times.

My wife saw an almost identical case in residency. Both the ER and the admitting team missed a massive PE that presented just like this. Its actually quite common to miss those - why do you think everyone gets scanned for them with any symptom even approaching something that could be a PE?

I suspect he can't name names as you can't usually talk about lawsuits after the fact.

 

[MedicineZ0Z]

Same reason residents usually get dropped from lawsuits - the supervising attendings are better targets. If you don't want midlevel independence (and most of us don't), this is what's going to happen. Its why most doctors I know who do supervise midlevels won't supervise them if they aren't on site with them at all times.

My wife saw an almost identical case in residency. Both the ER and the admitting team missed a massive PE that presented just like this. Its actually quite common to miss those - why do you think everyone gets scanned for them with any symptom even approaching something that could be a PE?

I suspect he can't name names as you can't usually talk about lawsuits after the fact.

Cancelling a CT after it is ordered on an obvious PE?

 

[VA Hopeful Dr]

Cancelling a CT after it is ordered on an obvious PE?

Yep, changed to a RUQ US for cholecystitis

 

[Lexdiamondz]

Yeah and how absurd is it that midlevels are not responsible for themselves?

You should name some examples, cause there's no way someone who did residency in north america or even went to school here would make an error of this magnitude. Or did you not read the full thing?

To add insult to injury, this NP had 0 training or courses in anything related to EM. A PGY1 in non patient contact specialty would provide drastically better care than this.

Hindsight is 20-20 my friend. I certainly don't have so much hubris to say that I could never miss a PE - even though I went to a T-10 medical school and am in an relatively competitive and well-known ACGME accredited EM residency. Would I have scanned her sooner? maybe, maybe not. Having not been at the foot of the bed looking at the patient, I can't say that with any certainty whether or not the NP was way off base given what they were seeing in front of them.

As more and more of your training wheels come off, you'll come to see that relatively few things are "textbook" - especially in the ED where everyone is undifferentiated to varying degrees. Making absolute statements like "a PGY1 in a non-patient contact specialty blah blah blah" just reveal your own naïveté. Yes, this patient probably would have been better served by a BCEM doc than an NP. But whose to say the outcome would have been different? And whose to say that the text you're reading accurately depicts the clinical picture that the NP caring for this patient actually saw before them? None of us where there, none of us know what really happened, and an MS4 at the peak of the Dunning-Kruger curve is probably the last person to be casting stones.

 

[MedicineZ0Z]

Hindsight is 20-20 my friend. I certainly don't have so much hubris to say that I could never miss a PE - even though I went to a T-10 medical school and am in an relatively competitive and well-known ACGME accredited EM residency. Would I have scanned her sooner? maybe, maybe not. Having not been at the foot of the bed looking at the patient, I can't say that with any certainty whether or not the NP was way off base given what they were seeing in front of them.

As more and more of your training wheels come off, you'll come to see that relatively few things are "textbook" - especially in the ED where everyone is undifferentiated to varying degrees. Making absolute statements like "a PGY1 in a non-patient contact specialty blah blah blah" just reveal your own naïveté. Yes, this patient probably would have been better served by a BCEM doc than an NP. But whose to say the outcome would have been different? And whose to say that the text you're reading accurately depicts the clinical picture that the NP caring for this patient actually saw before them? None of us where there, none of us know what really happened, and an MS4 at the peak of the Dunning-Kruger curve is probably the last person to be casting stones.

Good ol defending med levels.

 

[Lexdiamondz]

Good ol defending med levels.

Dude you haven't even started your FM residency yet and your hateboner for midlevels is at pathological levels. Get laid, smoke weed and enjoy the rest of 4th year - your first trainwreck night float shift as an intern will slap you in the face soon enough.

 

[SLC]

I’m gonna side with the majority here; I can’t hate on this NP too much because the linked article was written after the fact and can’t possibly relay the thought process going through the NP’s head. It’s easy (and tempting) to play armchair quarterback once the perverbial excrement has hit the fan. Who knows what this NP saw in the heat of battle? Obviously she was wrong, and it sounds like she had no business being in the ED, but that’s partly on hospital admin and her supervising doc (notice who got sued BTW, it’s never the admin) so yeah it was a pretty bad miss, but I’ve seen board certified physicians miss some prett scary stuff too, and not that uncommonly.

When I was a resident I moonlighted in a specialty (gyn) hospital doing Medicine consults. I saw some seriously scary stuff going down there on a regular basis. I dx’d a case of nec fasc. one morning, in a diabetic patient with a presumed bartholin abscess. I was called to do a “pre-op clearance” so she could go to the OR for drainage. She’d been admitted 5-6 hours earlier and was sitting there with only an order for Septra DS. The Gyn resident team didn’t even seem to want my opinion on the case other than to run her through the Gupta algorithm.

But I could smell the necrosis from the moment I came into the room, so I suggested a CT scan. Voila, gas all through the perineum and up to the anterior abdomen and into the thighs and glut’s. She got transferred to the real hospital right quick. Attending on that case was a USPSTF doc, and a known and respected expert in his field.

Got called to “rule out MI” on a patient being discharged 3 days after a hysterectomy, I don’t recall why she was there that long in the first place; but the resident calls and says “my fellow wants you to rule out MI, she’s been complaining of left shoulder pain since post op...I think she has a torn rotator cuff but whatever...”

After a few minutes interviewing and examining the patient, it’s clear that she’s been having posterior shoulder pain, dark urine, and that her operation had gone quite long. She was a big lady, close to 180kg. A CK revealed that she had rhabdo causing her the pain; probably from subscapularis or other nearby muscle compression while flat on her back that long at around 400lbs.

Also caught PE’s that the ED didn’t even want to entertain the possibility of, more than a handful of times. Pregnant women clot, it’s like these OB’s forget that or something...

I could go on and on, but none of these consults came from Midlevels; all MD’s at a well regarded hospital with a well regarded residency program.

Make no mistake though, I don’t supervise midlevels as an attending, I refuse to as a rule. I’m not gonna get hung out to dry for someone else’s malpractice mistake. No amount of money is worth that IMO. And the money that’s usually offered to supervise midlevels is a slap in the face when the risk involved is considered.

 

[Little Green Mensch]

Very tempting to Monday-morning QB, since there seem to be a quite a few points at which the diagnosis of PE was missed. I do wonder what role the NP's unfamiliarity with the ED setting played.

The story strongly implies her supervising physician was not present that night, and while that might not have made a difference in the patient's care (due to anchoring bias), I don't think off-site "supervision" is reasonable in the ED. One also wonders whether the phone consultation was made with the attending, or with another doc.

In the therapy world, assistants don't evaluate patients or come up with treatment plans. Instead, they execute the treatment plan and assess whether the patient is making progress toward his goals. They'll talk to their supervising therapists if they think the plan needs to change, and their input is usually taken seriously, but they aren't ultimately responsible for that decision. Mid-levels in medicine should be treated similarly. They should not be evaluating undifferentiated patients, where the probability of a missed diagnosis is highest, without immediate and meaningful supervision. Similarly, for a consult, I'd want the assessment of the consultant who has trained for 6-8 years in his field, not some random mid-level who was hired last Thursday.

Oklahoma has independent practice for evaluation, but requires physicians to cosign prescriptions. In this case, the evaluation is where things went wrong - no treatment was given. That being the case, maybe the state should re-examine its laws.

Also, looks like it's time for this article (in the Journal for Nurse Practitioners) to be updated: https://www.npjournal.org/article/S1555-4155(09)00430-9/abstract

 

[762513]

Hindsight is 20-20 my friend. I certainly don't have so much hubris to say that I could never miss a PE - even though I went to a T-10 medical school and am in an relatively competitive and well-known ACGME accredited EM residency. Would I have scanned her sooner? maybe, maybe not. Having not been at the foot of the bed looking at the patient, I can't say that with any certainty whether or not the NP was way off base given what they were seeing in front of them.

As more and more of your training wheels come off, you'll come to see that relatively few things are "textbook" - especially in the ED where everyone is undifferentiated to varying degrees. Making absolute statements like "a PGY1 in a non-patient contact specialty blah blah blah" just reveal your own naïveté. Yes, this patient probably would have been better served by a BCEM doc than an NP. But whose to say the outcome would have been different? And whose to say that the text you're reading accurately depicts the clinical picture that the NP caring for this patient actually saw before them? None of us where there, none of us know what really happened, and an MS4 at the peak of the Dunning-Kruger curve is probably the last person to be casting stones.

Great post, thanks for adding perspective. I’ve seen crit care boarded MD’s miss PE’s too. It something that happens that shouldn’t. The OP will post anything he can find attacking midlevels. Hope he is able to work with people when he hits the wards. It might be a rough residency for him.

 

[deleted18755]

I'm a radiation oncologist who stumbled upon this thread...

Excuse my ignorance, but can somebody explain to me how exactly an MD can be "supervising" when the NP was in the ED alone?

Does that mean the MD is somewhere else in the hospital and can come down quickly or he is physically not even there? In these situations, does the NP have to present all cases to him over the phone within x minutes of when she sees the patient or just when she wants and/or isn't sure what to do? Does he have a choice or is he forced to be "supervising MD" in a "take it or leave it" situation for that particular job? If he has a choice, does he get to pick which NP's he supervises (those with whom he has worked extensively and therefore has some sense of clinical skills/experience or anybody . . . literally even an NP who was terminated but for some reason is still working?)

It seems like a whole lot of responsibility and liability without much benefit (does he get compensated somehow or is it just part of the job description and total compensation package?).

Thanks in advance for the responses. This seems insane to me both from the perspective of a physician/somebody who works in healthcare and an everybody person who could be a patient in a situation like this one day.

PS: I've worked with NP's and PA's who are exceptional and I'm not ashamed to admit that are probably even smarter than I am but I can't imagine being responsible for patients I've never seen or met who are evaluated and treated by an NP or PA I've never worked with!

 

[VA Hopeful Dr]

I'm a radiation oncologist who stumbled upon this thread...

Excuse my ignorance, but can somebody explain to me how exactly an MD can be "supervising" when the NP was in the ED alone?

Does that mean the MD is somewhere else in the hospital and can come down quickly or he is physically not even there? In these situations, does the NP have to present all cases to him over the phone within x minutes of when she sees the patient or just when she wants and/or isn't sure what to do? Does he have a choice or is he forced to be "supervising MD" in a "take it or leave it" situation for that particular job? If he has a choice, does he get to pick which NP's he supervises (those with whom he has worked extensively and therefore has some sense of clinical skills/experience or anybody . . . literally even an NP who was terminated but for some reason is still working?)

It seems like a whole lot of responsibility and liability without much benefit (does he get compensated somehow or is it just part of the job description and total compensation package?).

Thanks in advance for the responses. This seems insane to me both from the perspective of a physician/somebody who works in healthcare and an everybody person who could be a patient in a situation like this one day.

PS: I've worked with NP's and PA's who are exceptional and I'm not ashamed to admit that are probably even smarter than I am but I can't imagine being responsible for patients I've never seen or met who are evaluated and treated by an NP or PA I've never worked with!

So you can legally supervise a midlevel from a distance in most states. In mine you're only required to be within I think 45 miles. Supervise in the legal sense only means you're responsible for them and must be available if they need you. What that means is left vague.

 

[haujun]

meth user could still have PE. If you see hemorrhoid would you cancel colonoscopy for patient with GI bleed?

 

[southerndoc]

I think she canceled the CT thinking the patient was high on meth. It can explain tachycardia, tachypnea, and shortness of breath, but it doesn't explain the reported hypoxemia by EMS. Of course, that record may not have been available to her and the nurse may not have documented or relayed it. EMS run reports have been increasingly brought into litigation. It gets really bad when the ED doc didn't have access to the report (because it was later sent to the hospital). I reviewed a case 2 years ago where a patient was documented to have hit her head during a syncopal event. Patient didn't remember it. She was vomiting a lot in the ER and required multiple doses of Zofran and Reglan. Was discharged without a head CT. She denied headache or at least that's what was documented. She was found dead the following morning in her bed by her 6 year old child who "couldn't wake mummy." That was settled out of court for a large amount.

One case I reviewed involved a patient with a positive troponin (0.6) who was sent home prior to it resulting. She was an obese smoker with high cholesterol who had a non-diagnostic EKG for her chest pain, which the physician documented as "feels like a bulldozer sitting on my chest." The nurse told him what the troponin was. Instead of calling the patient back, he told her it was lab error and actually added an addendum in the chart. Patient was brought to same ER 8 hours later in cardiac arrest. Post showed 100% LAD occlusion.

Another patient with a saddle embolus diagnosed by CT never got any anticoagulants despite the board-certified ED physician documenting she had a saddle embolus. "Will defer to hospitalist for anticoagulant of choice."

Don't tell me that docs don't make grossly negligent decisions. Everyone has their "duh" moment. I'm not advocating for NP's and PA's to be staffing ER's without physician backup in the ER available at all times and also seeing the patients with the APP's.

 

[NicMouse64]

These two screenshots from the court documents though are what make this case such a big deal. The NP was deceptive on her level of training and the patients thought they were seeing a physician.

 

[southerndoc]

These two screenshots from the court documents though are what make this case such a big deal. The NP was deceptive on her level of training and the patients thought they were seeing a physician.

Definitely not acceptable.

 

[ryryguy]

I'm not sure this patient would've survived had it been diagnosed earlier, but it definitely looks bad when you don't treat. Meth may give you tachycardia, tachypnea, chest pains, and shortness of breath, but it rarely causes hypoxemia. Unfortunately, we all miss stuff. I think hanging this NP out to dry just because she's an NP is naive for physicians to think this kind of gross negligence will never occur to them. As an expert witness, I can attest that it does and you'd be surprised how some of the best docs sometimes do things that are grossly negligent.

For the OP who was surprised that the supervising physician was named, keep this in mind when you are an attending. If you are supervising a PA or NP -- either directly or indirectly -- you are responsible for the patient's care. By supervising the APP, you are accepting responsibility that he/she is an extension of you, and any negligence (failure to act, failure to treat, or improper treatment) is your responsibility even if you never see the patient. If you aren't comfortable with this, then you shouldn't supervise APP's. The courts have been quite clear on this.

As a physician I can assure you the odds were in her favor of survival.

 

[lemurcatta]

These two screenshots from the court documents though are what make this case such a big deal. The NP was deceptive on her level of training and the patients thought they were seeing a physician.

Not going to comment much on the substance here other than to point out these look like filings from the plaintiff, so you have to understand they are going to present the events in a way to paint the best possible story to get what they want (make the whole thing look like a cluster **** from the beginning).

I’m absolutely sure that anyone who has ever been through a lawsuit related to their practice knows this. I was once sued as a paramedic by an unlicensed and unisnsured driver of a car, with expired registration, who had ran a red light and hit the side and rear of my ambulance while a patient was aboard. The allegations she made in her filings were patently absurd. Apparently I hit her while driving recklessly with willful and wanton disregard for her health and safety as an innocent bystander, and tried to flee the scene afterwards...

 

[NicMouse64]

Not going to comment much on the substance here other than to point out these look like filings from the plaintiff, so you have to understand they are going to present the events in a way to paint the best possible story to get what they want (make the whole thing look like a cluster **** from the beginning).

I’m absolutely sure that anyone who has ever been through a lawsuit related to their practice knows this. I was once sued as a paramedic by an unlicensed and unisnsured driver of a car, with expired registration, who had ran a red light and hit the side and rear of my ambulance while a patient was aboard. The allegations she made in her filings were patently absurd. Apparently I hit her while driving recklessly with willful and wanton disregard for her health and safety as an innocent bystander, and tried to flee the scene afterwards...

There were no doctors in the ER. What is absurd about someone wanting to see a physician? What a terrible comparison. You story reaks of lies by the other party, the facts in this story are corroborated by multiple witnesses that show that the exhibits you see are actually correct. The cognitive dissonance is real, eh?