THE CHICKENS ARE COMING HOME TO ROOST Y’ALL….
There’s something to be said about common sense. Unfortunately, it is severely lacking in the scope creep movement. I have stated, ad nauseum, that when ANYONE, who has minimal to no education and training in the art and practice of medicine is allowed to practice it unsupervised and unimpeded, how the f**k can anyone be astounded when s**t happens? That is, when medical errors, malpractice and/or negligence occur? It is completely predictable and should be expected. I wrote on this exact topic a little over a year ago (https://authenticmedicine.com/2022/08/wtf-did-we-think-would-happen/) and quoted this paraphrased statement:
“Folks, when we invite people who have no business in our House, who then empower unqualified others to practice medicine by legislation and not education, we cannot then feign surprise at the resultant consequences of those actions. They are foreseeable.” –N. Newman, MD
In August 2020, I was a speaker on a webinar (Full Physicians for Patient Protection Video Press Conference – August 2020) sponsored by Physicians for Patient Protection(PPP), a patient advocacy group that supports and promotes physician-led, as well as truth and transparency in medicine. In that webinar, I shared nurse practitioner malpractice data from the Nurse Practitioner Claim Report, 4th edition. This report was a collaboration between the Institute of Safe Medication Practice(ISMP), the Nurses Service Organization(NSO) and the California Nurses Association(CNA). In that document, adverse incidents and claims regarding NP practice were compared between two datasets: 2012(1/1/2007-12/31/2011) and 2017 (1/1/2012-12/31/2016). The comparison revealed that there were increased adverse actions and payouts from the first dataset to the second. Diagnosis, medication and treatment/care management allegations accounted for 84.5 percent of all the closed claims in the dataset.
The 5th edition(2022 dataset) has now been published and to absolutely no one’s surprise, the news is worse.
Allow me to put this in context. The American Association of Nurse Practitioners(AANP) and its state chapters are seeking, and obtaining, legal approval from dimwitted, slovenly, mentally castrated, blockhead legislators to practice medicine without a medical license or oversight (aka Full Practice Authority) by the only individuals in the universe educated, trained and licensed to practice it. PHYSICIANS. Despite the fact that their formerly structured nursing education has dropped into the gutter and permits anyone with a pulse and a checkbook to become a nurse practitioner. Online. Poorly educated nurse practitioners, who have no ability to practice as registered nurses, are now “advanced” registered nurse practitioners(APRNs) given the authority to practice medicine, unsupervised, in 27 states across the country. Only in corporatized America does crazy s**t like this happen. And to add to that madness, not one legislative, nursing or governmental body has followed up in any of the FPA states to evaluate the practice and/or outcomes of care being provided by these inept charlatans. That’s right folks. NOT ONE. Nope. These imposters keep using “studies” of supervised NPs from some 20-plus years ago to promote the lie that they can practice medicine independently and as well as physicians. Those imbeciles in the legislature just take their word for it. Because nurses never lie. AANPs former president, Sophia Thomas, stated this on the AANP website:
Yeah, well, NP malpractice data proves otherwise. And how the f**k would Ms. Thomas know if the states that have FPA are among the healthiest in the nation when no one, including the AANP, have performed any studies or provided any evidence that that is the case? Because, bulls**t grows on trees in the world of scope creep. Bulls**t is a litmus test that requires no proof or evidence. Bulls**t walks, talks and has good game. And damn, are the AANP masters at that game.
Lest some virtue signalers attempt to divert the conversation and insist that NPs are “filling the physician gap”, as if that is a positive development, let me assure you–it isn’t. Here’s why. Per the AANP:
In other words, 70,000 NPs entered the workforce within a 3-year period. No other healthcare profession has expanded so rapidly. What is the likelihood that the majority of those 70,000 NP candidates attended competitive, brick-and-mortar, full-time programs? I’ll answer that for you. IT AIN’T LIKELY. Such excessive numbers are indicative of accelerated programs of low quality. This includes programs that have 100% acceptance rates. If a school has a 100% acceptance rate, is that not confirmation that no standards exist? It also explains why so many supposedly “highly qualified” NPs post in social media asking fundamental questions, the answers of which they should be learning or have learned in school….
…or they apply for jobs for which they are not equipped…
The absurdity of the NP who just completed an “educational” program is expecting “teaching/mentoring” on the job. It begs the question, for what exactly was she paying when she attended NP school if not teaching and mentoring? Certainly not an actual education, that is painfully apparent. The fact that she has no RN experience is a dead giveaway that she attended a degree mill. This is why I refuse to refer to any NP as “advanced”, unless I know exactly where they attended school and whether they have years of registered nursing experience..or not. This is also where I take issue with the AANP. Their unethical promotion that all NPs are competent to practice, even if they aren’t. Their refusal to acknowledge that degree mills do not provide a legitimate education and that “graduates” from those programs should not be rewarded when they have nowhere near the same achievements as the NPs who pursued their goals virtuously. It is an insult to the genuine accomplishments of those who did it right. I suspect the AANP will never take a firm stance on this matter because it would then be evident that the thousands of degree mill graduates to date have no business practicing…at all. The FPA movement would then be derailed and well, they simply cannot have that. So they ignore and deflect because independent practice for nurse practitioners is tantamount to any public safety issue.
With safety not being of the utmost importance, NPs, particularly FNPs, are becoming very comfortable with arbitrarily expanding their scope of practice. Illegally. Liposuction is the new thing. Doesn’t matter to them that performing surgery violates their state Nursing Act. When the cat’s away, the mice will play. And these rats are having a field day. So when the patient becomes septic because of piss-poor performance “standards”, they can just be sent to the ED for a real physician to manage the complications that these unqualified thespians cannot.
**It is important to mention that the FNPs in the Midlevel.WTF’s article were reported to the Indiana Attorney General. Both NPs were charged with being a “clear and immediate danger” to the public and had their licenses suspended for up to 90 days. One of the individuals has since left the practice. The owner remains; however, she is no longer performing liposuction. The “supervising” physician(a pathologist) who was not supervising and had not seen either NP in years was ordered to retire by his state medical board.
Secil Schodroski, the FNP in the first two videos, has recently been reported to the Missouri Attorney General’s office.**
I am truly baffled as to why legislators, physicians and others who support this nonsense do not review the national statistics on nurse practitioner malpractice data when it is public information. Again, there have been two other claims reports before the most recent, one in 2012 and another in 2017. Some important highlights from the most recent 2022 Claims Report:
Bottom line: The numbers are worse, not better. Moreover, the 2022 Claims Report includes information on NP-owned practices.
The above information represents patient outcomes. It’s troubling that for NP-owned practices, claims for death as an “injury” are TWICE that for the overall dataset. It’s there in black and white by the NPs very own malpractice insurance company. This data only represents the NPs who possess NSO malpractice insurance. What is the data for the NPs who are uninsured or have used another insurance company? Yeah, think about that. In my opinion, this is why no nursing body or establishment will do an updated thorough study on performance, costs, and healthcare outcomes of NPs in unsupervised states. Because the results would be appalling. I strongly believe that if any legislative or governmental body actually cared enough to perform such a study, they would find exactly what the Hattiesburg Study (https://authenticmedicine.com/2022/04/the-hattiesburg-study-an-unsurprising-surprise/) did, on a massive scale. The pressure would then be on representatives entrusted with the public’s welfare, to explain why they didn’t procure the NP malpractice data BEFORE they passed laws sanctioning unsupervised practice. Ultimately, the numbers in the report depict patients who have been harmed in some way, form or fashion.
To be fair, physicians are prone to the same errors in diagnosis. Per this quote from an AAFP article(https://www.aafp.org/news/health-of-the-public/20190716diagnosisstudy.html?fbclid=IwAR0xE9X0jDBHBkYhrkJpXuGmqix1rxgOr8tu0tsyqOhrAnneEzarOacLWiQ) based on a study (https://www.degruyter.com/document/doi/10.1515/dx-2019-0019/html) published in July 2019 in the journal, “Diagnosis”. The quote: “Slightly more than one out of three cases of medical malpractice that result in death or permanent disability can be linked to inaccurate or delayed diagnosis.” Here’s the distinction. Physicians are held to a medical standard, as we should be. It’s why we pay such high premiums for malpractice insurance. Expertise carries with it a very heavy responsibility that physicians accepted when we chose to enter this profession. We also pay a heavy price when those expectations are not met. The irony is that non-physician practitioners(NPPs), who are empowered by legislators to practice medicine without a medical license, are not held to this incredibly high standard. Thus when their actions result in medical errors, their accountability is minimized while the nearest presumed “supervising” or “collaborating” physician is more eagerly sought out by attorneys to answer for the NPPs blunders. I have yet to witness one NPP demand a physician be dropped from a case of theirs in which the physician has no culpability. The NPP will happily throw the doc under the bus if it lessens their liability. In that scenario, they are suddenly not so independent.
I’ve often said, you can’t fake it until you make it in medicine. Because the damage is visibly manifested in patients, the incompetence is exposed. This leads to a legal conundrum and subsequently, a reckoning. Someone’s got to pay. Welp, if their claims report is anything to go by…the chickens are coming home to roost y’all.
Sins, like chickens, come home to roost.–Charles W. Chesnutt
(A link to the aforementioned 2022 Claims Report, 5th Edition is below. Just download the pdf link in the article. Scroll to the bottom and view the link to the Claims Report, 4th Edition. Compare results then draw your own conclusions.
https://www.nso.com/Learning/Artifacts/Claim-Reports/Nurse-Practitioner-Claim-Report-5th-Edition)
In your area, do Nurse Practitioners have to practice to a MEDICAL standard of care, or a NURSING standard of care?
Just trying to get a feel for the on-the-ground reality out there.
In all states and territories NPs are held to a nursing standard while still being permitted to practice medicine w/o a medical license or training by legislators. Hence, patients have less recourse. NPs are overseen by nursing boards, not medical boards.
I watched a legislative session of the North Carolina joint committee on Health care in april 2022. They were talking about a subject that I have deep knowledge of – which is to say, I know when they are lying. I was appalled at the large portions of BS that were served to the legislators. I have made two youtube videos taking them down point by point.
https://youtu.be/xK2In5XwszM
https://youtu.be/lapxiOXMsXs
Hahaha! Phil, you hit the nail on the head. The AANP is in the habit of stating unproven “facts”. Fabrications and lies has never stopped them.
Regarding the claim that Unsupervised practice of Medicine laws (UPM) (what AANP euphemistically calls “FPA”) produce healthier populations, I believe their data are from some federal agency that graded states. But this is not the important point.
Here is the important point: Did you know that the increase in the number of NPs in the US is linearly related to the increase in opioid deaths in the US. And the correlation is extremely high. r = 0.982. There. I have PROVEN that the proliferation of NPs in the US has caused the increase in opioid deaths. At least by the AANP’s (faulty) reasoning. Parenthetically, there is a very high correlation of numbers of NPs with death by bedsheet strangulation, as well (r=0.952). I guess we know what to say about that!.
Of course this is the very common, and very elementary error of confusing correlation with causation. (Chapter 8 in the classic book “How to Lie with Statistics”)
In this case, they use one variable – presence or absence of UPM, and find a correlation with another variable that purportedly describes the general health of millions of people. Now, do we think there might be more than one variable, one other than FPA, that might have some relationship to a populations general health. Like, say economic status. Like Obesity. Like Hypertension. Like Smoking. Like…………..
But ,no, the AANP seizes on this one variable – UPM – and cites it as THE reason health is better.
I will give them some credit, and say that within their organization, there are probably multiple people who understand basic statistics well enough to know they should not use this argument. So, we throw out the stupidity explanation for using this, we are left with dishonesty. That is the cause of this bogus argument – pure dishonesty.
I would recommend that whenever you encounter this argument, do point out the 1:1 correlation of numbers of NPs with opioid deaths, and let the person try to explain that. (incidentally, there is also a correlation with sea level rise. If you want to get into the game, just pick anything that is increasing, as NPs are, and you will get a nice correlation. Say, numbers of tik tok videos. Just anything.)
Dr. Newman’s report is just another reason to practice and support DPC; in DPC the patient doesn’t have to wade through the first-line encounter with the NP in order to get to see the M.D.
The most important principle in effective propaganda is to cause the majority to doubt their own God-given reason & common sense, and surrender to the authority of the BRAND. We await an election next year where so many Americans romance THE BRAND that they can’t tell shit from Shinola. Being brainswept into obedience is not the way to having a free society. When the individual ability to assess QUALITY has been so scorned as to incapacitate people from thinking critically, the trucks roll in, and the Crapification Industry booms. This is the great peril of our times.