The California Board of Medicine makes Accusations against physicians available to the public. Check Doctor License status here. The Medical Board's search system has been touted as one of the best in the country [Dahlberg, Sacramento Bee 7/12/10]. Patients seeking to learn more about their doctors/potential doctors can easily view discipline Accusations lodged against physicians, which can lead to a more informed decision.

However, medical professionals, healthcare practitioner advocacy groups and defense attorneys protest the disclosure of Accusations prior to any final action being taken against a physician. The exposure of Accusations, prior to any final action being taken, creates a situation where a doctor can be judged on the basis of unproven complaints or allegations.

The ultimate goal is to protect the public, and allow patients to access a practitioners' history, while simultaneously protecting physician privacy and due process rights under the law. The disclosure of unsubstantiated Accusations has the potential to mis-inform patients and ruin reputations of healthcare professionals, but also allows patients to make more informed decisions based on the nature of the allegations. It is a "Catch 22" for everyone involved, but the physicians bear the brunt of the detriment to their careers and profession if patients make judgements based on untruthful accusations.

Nurse Practitioners prime candidates for Primary Caregivers in the face of Dr. Shortages:

Nurse practitioners are going to play an integral role as primary caregivers, filling the void left by massive physician shortages throughout the United States. (Stuart, 4/28/10). The Association of Medical Colleges reports that the U.S. may be facing a 150,000 doctor shortage by 2025. (Chapman, 4/18/10 Chicago Tribune "Nursing our way out of a doctor shortage"). The American Medical Association estimates the doctor shortage to equal a deficit of 85,000 by the year 2020. Regardless, the data is evident that doctors are facing extraordinary understaffing difficulties at the same time they are facing astronomical increases in their patient loads.

28 States currently have introduced legislation designed to expand the role of advanced practice nurses to that of Primary Caregiver. ("Fewer doctors may lead to more patients seeing nurse practitioners") Several states already allow independent advanced nursing practice, and many other states are currently seeking to fill the void left by a lack of physicians. Oklahoma is currently seeking to expand nurse practitioners' roles (Coburn 4/21/10 "Officials look to PAs, nurse practitioners for aid in physician shortage"), as well as Oregon, Washington, California. (Johnson AP 4/14/10 "Shortage may mean a bigger role for nurse practitioners"), New York (Gordon 4/25/10 "Take advantage, New York, of our nurse practitioners)

Nurse practitioners, or "advanced practice nurses," are highly trained registered nurses who usually possess a masters degree or a doctorate in a specialized nursing discipline. Nurse practitioners have advanced education, experience and training in the diagnosis, treatment and management of common illnesses (Parker, ehow "Nurse Practitioners & Patient Education). The American Academy of Nurse Practitioners indicates that 95% of advanced practice nurses already prescribe medications, writing an estimated 19 prescriptions per day.  

Healthcare Reform impact on doctor shortages:

32 Million more Americans are anticipated to be included in the healthcare patient pool as a result of the recently passed healthcare reform legislation. (4/14/10 "Use nurse practitioners to reduce doctor shortage") This large number of additional patients will further exacerbate physician shortages across the country. Medicare typically reimburses nurse practitioners at a lower rate than doctors are reimbursed, which could end up saving millions of dollars at a time when our economy is in dire need of reducing government spending. Maryland columnist Jay Hancock explains that nurse practitioners should be allowed to practice completely independently from physician supervision, and that they are already allowed to practice independently in Washington, Oregon, Alaska, Washington D.C. (Hancock, The Baltimore Sun "Md. should make nurse practitioners independent").(Stuart, 4/28/10 "Nurse practitioners key to unlocking healthcare access").

Doctors are beginning to mount opposition to such measures arguing that allowing nurse practitioners to usurp physicians' roles will place patients at risk. Dr. Daniel Carey, President of the Medical Society of Virginia, has stated, "When you talk about increasing the scope of practice of nurse practitioners...we have problems with that. They are not acknowledging the significant difference in training." (Smith 4/26/10 "Health reform may expand non-physician roles") The American Medical Assoc. (AMA) President James Rohack has said, "increasing the responsibility of nurses is not the answer to the physician shortage." (Bagg, 4/19/10) "Doctors have shown up in white coats to testify against nurse practitioner bills. The AMA, which supported the national health care overhaul, says that a doctor should supervise an NP at all times and in all settings. Just because there is a doctor shortage, the AMA argues, is no reason to put nurses in charge and endanger patients." Associated Press; Maher 4/19/10 "Hey Nursie!" The Battle over Letting Nurse Practitioners Provide Primary Care"). One critic claims "doctors went to their medical schools for a reason, and allowing a nurse to take over their roles is a short-sighted way of solving these shortages." (Joyner, 4/18/10 "Let doctors, not nurses, doctor")

Nurse practitioners have accumulated their own support, and are beginning to form their own professional associations across the nation. (Gallaher, 4/22/10 "Whatcom County nurse practitioners form new professional association"). Univ. of Southern Indiana Professor Daniel Lucky describes the difference between Nurse Practitioners and Physicians as not being education or professional qualifications but instead it is their healthcare approach, "NP practice is based on the nursing model of care -- not the medical approach...Nursing teaches us that we should not reduce human beings to mere signs and symptoms, place a disease on someone, give them a pill and send them off. As nurses we are trained to look at the entire patient from a holistic perspective and then, actively partner with the patient and family to not only correct problems, but also enhance optimal health. Nursing care places the patient -- not the provider -- as the central focal point." (Beaulieu, 4/14/10 "Expanding roles of nurse practitioners stir controversy"). In fact, the Josiah Macy, Jr. Foundation recently released a report recommending immediate removal of legal and financial barriers preventing advanced practice nurses from providing primary care. (Glenn, 4/20/10 "Nurse practitioners new primary care providers?") Nurse practitioners assert that they are not trying to infringe on doctors' specialities, but are a critical resource in providing patient care in this time of dire need. (West, 4/27/10 "Not looking to replace doctors") In actuality, nurse practitioners do not commit malpractice as often as physicians or, at least, they are not sued as often -- only 1.4% of Nurse Practitioners are named as a primary defendant in medical malpractice lawsuits. (Stuart, 4/28/10 "Nurse practitioners key to unlocking health care access")

Conclusion -- Let the Nurses Doctor!

Murphy Jones LLP represent nurses in licensing, discipline and malpractice matters and are intimately familiar with the nursing profession, and have full confidence in nurses' abilities to render superb healthcare to patients.As healthcare attorneys, we support the expansion of nurse practitioners' primary care roles provided that they do not usurp the proper functions of physicians. Physicians are adept with dealing with advanced diseases and treatments for complex disorders; whereas advanced practice nurses are more than capable of diagnosing common diseases and disorders, and prescribing medications to treat patients. A 2000 study published by the Journal of the American Medical Association reported that patients of nurse practitioners recovered as well or better than patients under the supervision of a primary care physician. A main benefit of expanding nurse practitioners' roles is that they manage patients with current illnesses and simultaneously teach patients how to stay healthy. This is exactly the type of care America needs if we are going to improve the overall health of our citizens and simultaneously lower health care costs. Often times, patient satisfaction is higher among patients receiving care from an advanced practice nurse as opposed to a licensed physician. (British Medical Journal 4/6/10 "Systemic review of whether nurse practioners working in primary care can provide equivalent care to doctors") So with happier and healthier patient results coupled with reduced costs and government spending, allowing nurse practitioners to use their knowledge helping patients while reducing the doctor shortage voids is common sense and good business judgment. 

As the old adage says, "Doctors diagnose, Nurses HEAL!" So why not let nurse practitioners do both?!

View related videos:

• "Doctor of Nursing Degree Changes Healthcare"
• "The Congressional Report: Health Care and the Nursing Shortage"
• "Nurse Practitioners look for a bigger role in health care" Feb. 10, 2011

Aspiring nurses must complete fingerprinting with LiveScan, and the board must receive the results from the Dept. of Justice and the Federal Bureau of Investigation which can take 3 – 6 weeks. As of August 10, 2009, the Board is no longer issuing interim or temporary licenses prior to the completion of the fingerprinting process. This process can be lengthy and should be prepared in advanced to ensure timely licensing and/or certification. If you need help with the licensing process, contact our attorneys for a consultation.

http://www.rn.ca.gov/

National Nurses United will be comprised of the merging of the 3 existing unions: Cal. Nurses Assoc., Massachusetts Nurses Assoc. and United American Nurses. The 3 unions, already powerhouses among legislative organization for nursing professionals, plan to combine forces and unite under the new National Nurses United (NNU) title. Each member union will hold a national convention to ratify the merger, and the NNU will hold its founding convention in December 2009.

Modern Health Care

Texas nurse downloaded entire computer hard drive (over 3,000 pages of patient files) after being fired because she told supervisors she was going to file written report about patient care violations.  The Texas court of Appeals upheld her conduct under whistleblower laws, over objections based on medical confidentiality. Whistleblower laws not only permit but require nurses to report abuse, neglect and other illegal and wrongful acts.

Westlake Surgical vs. Turner, 2009 WL 2410276 (Tex. App., August 7, 2009).

Murphy Jones Law healthcare attorneys are interested in the development of Texas’ case-law relating to nurses’ duties to patients and their protection from liability for acts relating to protection of patient interests. Recently in Nevada nurses have continued to be disciplined for conduct similar to that in issue in the Westlake Surgical v. Turner. The judicial development may provide a basis for Nevada and California nurses, and other healthcare professionals, to protect their licenses in jeopardy of professional discipline for actions relating to “unauthorized removal of medical records.” We follow case law, and state legislation, closely to ensure efficient protection of our clients right to practice medicine.

http://twitter.com/NurseAttorneys

South Dakota class action similar to Las Vegas endoscopy clinic suit. http://bit.ly/xNbS8. The recent Las Vegas endoscopy clinic practice of re-using syringe vials which led to a Hepatitis outbreak among patients has a sister personal injury medical malpractice legal action stemming from similar practices in a South Dakota facility.

The recency of the lawsuits make for interesting ongoing comparisons in the cases’ developments.  The healthcare attorneys at Murphy Jones LLP will keep you informed as to the respective outcome in each matter, the similarities and differences in each states’ action, and the impact on local Nevada legislation and medical practices.

CMS reports that Scripps Memorial La Jolla and Scripps Mercy Hospital in San Diego, CA, boast the highest survival rates for pneumonia and heart failure patients. The data reflects info. gathered from patient discharges between July 2005 – June 2008.

ADVANCE article: http://nursing.advanceweb.com/Editorial/Content/Editorial.aspx?CC=203928

Full CMS Report: www.hospitalcompare.hhs.gov.

CMS published an announcement 7.20.09 describing regulatory changes that will impact standards for Medicare reimbursement starting 2010. The press release articulated the definition of “direct supervision” of an physician who is supervising nurse practitioners, clinical nurse specialists and/or certified nurse midwives as,”For services provided in the hospital, direct supervision means that the physician must be present in the hospital or on campus and immediately available to furnish assistance and direction throughout the performance of the procedure. For services furnished in an off-campus outpatient department, direct supervision means the physician must be present in the off-campus department and available to furnish assistance and direction throughout the performance of the procedure. In or out of the hospital, the physician need not be present in the room when the procedure is performed.” FEDERAL REGISTER July 20, 2009 Pgs. 35424 – 35425

Murphy Jones LLP healthcare attorneys stay informed of medical industry developments, such as this, which may affect a practitioner’s ability to successfully protect her license in disciplinary hearings before State Boards. Our administrative law practice incorporates information from all arena’s affecting the healthcare industry and our clients’ rights.

Teamsters have filed an additional charge of Unfair Labor Practices with the National Labor Relations Board for alleged retaliatory conduct against employee Dale Slover, RN. Nurse Slover testified in May 2009 against the hospital and has filed a subsequent quality review report. See: http://www.lasvegassun.com/news/2009/jul/04/teamsters-boulder-city-hospital-retaliated-/

Murphy Jones LLP has created a Twitter account generating tweets providing up to the minute news and developments relating to professional practice of medicine, the nursing profession, State Boards of Nursing, medical malpractice litigation impacting professionals’ rights and responsibilities, and other interesting legal developments in the healthcare industry. With our administrative law healthcare attorneys staying informed of trends, changes in the law and case precedent, we post information relevant to medical practitioners and the legal industry.

Visit us at http://twitter.com/NurseAttorneys , and start following today to keep informed about recent developments.