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re: SB 435 would allow advanced practice nurses to not work under a physician
Posted on 4/5/18 at 11:21 am to Scooby
Posted on 4/5/18 at 11:21 am to Scooby
quote:
The last few med review panels I've been on, the MDs quickly clear the supervising physician of any wrong-doing and go directly at the NP, as it should be. However, they go a little unreasonably hard at the NP.
If you don't mind me asking, were they cases of bad luck (a bad outcome or an unusual case that could not have been picked up based on the visits at hand by a better history, physical, or experience) or cases where the NP should have known to ask for help but didn't?
Posted on 4/5/18 at 1:15 pm to Hopeful Doc
quote:
If you don't mind me asking, were they cases of bad luck
First was a compartment syndrome. Went to the ER after waking up with ankle pain. NP did uric acid and Xray, charted a good exam, and DX the guy with gout (middle aged black guy). Told to F/U with PCP in 2 days. Guy follows up, PCP (MD) doesn't do much, puts guy on different NSAID. 1 week later guy comes back with foot drop. PCP does US that shows popliteal abscess. Transferred to Ortho for emergent surgery due to compartment syndrome. Review panel clears ED Doc (as they should, MD just signed pain need Rx) and F/U doc. Says although this was a unique presentation, NP should have picked up on it. Put was symptomatic for 3 hours before seeing NP. Attorney says CBC was standard of care, and would have pointed to abscess.
Second was a guy that presented with chest pain and productive cough to a UC. NP Rx'd levaquin for bronchitis (which I would not have done, but the guy smoked and had and of recurrent bronchitis). 3 days later presents with STEMI due to dissection. Attorney says it's from Levaquin which had a black box warning for bronchitis (which was released after the incident happened). We found in favor of the NP, but admitted it wasn't a great idea to jump to a quinolone at first. They guy had a history of non-compliance and had a recent negative cardiac workup.
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