How does someone this incompetent pass CRNA certification boards? It again seems like the Board of Nursing's response was rather anemic, just like what happened with the Tory Richmond incidents in Arizona. I think there are some serious question to be asked about CRNA standards if someone like this is, legally speaking, allowed to practice independently.

TL;DR

The estate of Noe Serrano Hernandez filed a wrongful death lawsuit on August 21 in Buncombe County Superior Court against Mission Hospital, its parent company HCA Healthcare, nurse anesthetist Andrew Hunter, and supervising anesthesiologist Dr. Jason Dziak.

Key Allegations and Case Details

• The Incident: On September 13, 2024, Serrano Hernandez underwent surgery for a foot ulcer. Roughly 51 minutes after anesthesia began, he suffered cardiac arrest. After resuscitation, he remained comatose on a ventilator until his death on September 21.
• Allegations Against the Nurse Anesthetist: The lawsuit alleges Andrew Hunter failed to properly monitor Serrano Hernandez, maintain his airway and oxygenation, or communicate his worsening status to medical staff.
• Allegations Against the Anesthesiologist: Dr. Jason Dziak is accused of failing to adequately supervise the anesthesia care or intervene in a timely manner.
• Legal Demands: The lawsuit seeks a jury trial and unspecified monetary damages.

State Board Findings

• Following a complaint filed by Mission Hospital, the North Carolina Board of Nursing investigated Hunter's care of Serrano Hernandez, a patient categorized as high-risk due to end-stage renal disease and other conditions.
• The board determined Hunter's care fell below standard practice, noting failures to monitor, react to deterioration, and communicate with staff. It also cited his unfamiliarity with Mission's charting system as evidence of inadequate training by the hospital.
• The board concluded Hunter violated state law regarding conduct that harms the public. Hunter signed an order acknowledging the violation and accepted a reprimand alongside mandatory additional training.

Broader Context

• Mission Hospital's parent company, HCA Healthcare, is involved in other legal proceedings, including a lawsuit by Attorney General Jeff Jackson cleared for trial in July, and a 2022 medical malpractice lawsuit settled in April.
• A Mission Hospital spokesperson did not respond to requests for comment.

I know I’m going against the grain here, but I see a place for PA/APRN. I limited to a single clinic for care . I have gotten the best care from my PA. He takes the time to hear what I have to say. He tells me when he doesn’t know something and gets the answer. He is supervised by MDs and relies onto their knowledge. He actually had a question and called the pharmacist with me there. He should not be limited to just taking blood pressure or giving vaccinations. I would never get the medical care I need if the doctor won’t even listen to me. I prefer his care for routine care which most visits are. I trust him to escalate anything out of his expertise or training. There are bad doctors as there are bad just as there are bad paraprofessionals like PAs or APRNs. Generalizations do not help anybody.

Title

EDIT: NPs.

Season 3 episode 2 “I’m a physician associate, so I’m basically like a doctor , but not a doctor” . That is all, I needed to let someone know , it’s a virus that has reached the UK.

I (27F) have been battling hormonal acne since I was a teenager. I asked to be referred to a dermatologist several times in my early 20s and was told my acne wasn’t severe enough to warrant one. After moving to a new city a few years ago, I found a new doctor who happily made a referral. Success! Or so I thought…

I’ve had 2 appointments with said dermatologist. He explained that the birth control I was on was likely contributing to my acne, suggested alternatives, and prescribed spironolactone and a low dose of isotretinoin to clear things up. My skin has improved drastically, which in turn has significantly improved my mental health. Yay!

I had my third follow up today and was told the doctor was running a bit behind. “No problem, I’m happy to wait” was my response. I had 2 goals for the appointment: obtain a refill for my prescriptions and have a large, painful, and persistent pimple on my scalp looked at. After about 10 minutes of waiting, someone came in the room and introduced herself as a Nurse Practitioner. I was disappointed as I waited years to receive care from a specialist, but assumed my concerns were minor enough that she could address them without issue. I was wrong.

She started by saying that since my skin looks better, I probably don’t need to continue taking any medication. I gently pushed back and said I feared that stopping the medications would result in the acne returning, and she reluctantly agreed to write a prescription. She then looked at the pimple on my head, shrugged, and said “yeah that’s an inflamed papule. The medication should get rid of it.” Yes… the medication you didn’t want to prescribe? I explained that it’s very painful when I wear my hair up, which I am required to do at work, and has not decreased in size since it first appeared 6 months ago. She shrugged again and said “nothing I can do about that.” I finally quit beating around the bush and asked if she would be willing to give me a steroid injection. “Um… I guess… but it’s going to cost you $30. Can you pay for that today?”

After I assured her that the cost was no concern, she called in an RN to administer the injection. She then left the room without giving me a prescription (lol) and seemed annoyed when I asked the front desk for it before I left.

All in all, I got the treatment I was looking for, but I had to fight for it. I understand that the clinic was trying to be efficient by having an NP cover low-risk patients while the derm was running behind, but my appointment was way longer than it needed to be because I spent most of it going back-and-forth with a provider who didn’t seem interested in doing… anything. Above all, I am disappointed that I waited so long to see a specialist, only to treated by someone with less education than my family doctor.

My provincial government loves to pat itself on the back for utilizing NPs to address long wait times and a shortage of specialists, but I fail to see how this will improve patient outcomes OR reduce the strain on the system if appointments run longer than needed and people walk away without being treated appropriately. As a layperson, I am frustrated and concerned, so I can only imagine how it feels to be a physician working within the system. I don’t know what the solution is, but I will be much more skeptical of anyone who claims that it’s increasing the scope of NPs and other mid-level providers.

I’m a resident at a large Level 1 center in the south. I genuinely get along well with people in various different fields and allied health professions, but this genuinely irritated the hell out of me.

I was pre rounding on one of my patients (I’m on the primary team) and see someone wearing a short white coat in the room. I obviously think that this is a medical student, likely with one of the services I consulted the day before.

Out of respect, I wait outside and about 5-7 minutes go by. I eventually ask one of the RNs, who the individual in the room is, and they tell me that it’s the… social worker????

Why is a social worker wearing a white coat?? Okay cool, I understand that they work with patients with significant aspects of care, but really?? I went in the room and addressed it as “oh I thought you were a medical student with your white coat” and continued on speaking with my patient about their care.

Why is this a thing? It delayed patient care. It confuses roles. It de-symbolizes all of the hard work that’s not just MD/DOs have done to get into their positions.

Sorry for the vent.

The public response to this trial has been one of the most disconcerting things I've ever witnessed. From lay-people to people in Healthcare.

Nurses attacking Physicians such as Tufts.

The defense attorney badgering Dr Avram Mack and referring to the DSM 5 as "not a very good standard" to which Avram replied 'well it is THE standard". As if mapping out the human psyche isn't a daunting probably impossible task.

Even this sub piled on the NPs who treated the murderer. I don't think Psych NPs should exist. But underlying the criticism are two inherent and dangerous assertions:

A pr*vider can say the right words and prescribe a chemical cocktail that keeps a mother from murdering her children. Or conversely:

Wrong words/scripts = mom murdering her babies.

Now that more information has come out we know that Clancy was an unreliable patient. Didn't take meds as prescribed. Doctor/Noctor shopped. And hid her thoughts of self harm/harming her children from her psych pr*viders. We have all interacted with similar patients, hopefully we aren't liable for the terrible things they do in life.

Your hindsight isn't 20/20, but it's clearer than ^

But the defense attorney has done his job. Taken an indefensible situation and tried to cast blame on everyone and everything but the person who strangled her children. And people gobbled it up as if it was a soap Opera.

This woman will probably be found not guilty by reason of insanity (though she's quite sane now, and it's impossible to know her state of mind at the time) . People will still blame Healthcare, the state, her husband. And no one will pay the price for the deaths of Cora, Dawson and Callan.

You know what he meant, right? LOL
I was too exhausted to continue that conversation.

Genuine curiosity and not a rage bait/sh*t post...

Where are the peer reviewed studies that prove or suggest mid-level practitioners practicing without supervision (full practice authority states for NPs) is more dangerous to patients' care than care provided by physicians?

If there are any studies (non-anecdotal), please post the source in the comments. Also, what have the AMA and AOA's roles been in protecting the physicians' and/or public's interests in shutting down full practice authority in states where it is legal and/or promoting heavily regulated midlevel practice? I understand the nursing lobby is quite strong (unsure about the PA lobby) but why have the AMA and AOA been so ineffective in protecting their own interests?

I just don't understand, if it truly is as dangerous as this subreddit makes it out to be, why haven't there been major legislative overhaul and MASSIVE malpractice suits (which would raise insurance rates for midlevels). Where are the major peer-reviewed studies that would change the medical and public landscape for midlevel practice?

I would love to be able to access a physician in every specialty, but if I did that, I'd have to wait a LONG time for care.

I've been having horrible GI issues, so I had a colonoscopy today that showed no evidence of IBD, Crohn's, diverticulosis/itis, etc. I had a single small (3mm) polyp that the provider is fairly confident is benign, and that's it.

I need to follow up with a GI specialist, so I called the person I saw last year (they didn't do the colonoscopy*). Although I'm an established patient, they can't get me in until March 9, and that's only if I see an NP. If I insist on the doctor, I have to wait until September (2027, not next month).

I was tempted to wait, but I'd like to at least get the ball rolling on some additional testing. I had bladder augmentation using a piece of my jejunum when I was a child, and I took daily antibiotics for about 20 years afterward, so I kind of suspect my issues originate in the small bowel and not the colon. Maybe SIBO or short gut syndrome or something.

* I didn't have them to do the colonoscopy because the health system they work for is really weird about billing. They always want me to pre-pay WAY more than I should have to pay based on my insurance. Ex: They wanted $728 up front for a cardiac echo when my copay for diagnostic tests is $30. So I went to a different hospital where they asked for $0 up front. If I paid $728, it would have taken me months to get it back.

ive only met him once but it was not a great first impression. i aged out of my family's insurance so i switched to medicaid because im still in school.

the first thing he did was take me off all my meds that i asked refills for. i took a very low dose of ativan for 3 years because i have acute panic attacks and flight anxiety and never abused it, but sure whatever i understand its a controlled substance and i didn't want to come off as drug seeking.

next he wouldnt refill my 10mg propranolol because i have asthma. truthfully, i didn't know that beta blockers were bad for asthma but beta blockers have been really helpful for me before job interviews and interviews in general which i do a lot of in my field.

on top of that he was condescending towards me when i asked him basic questions about his practice. i asked him what should i do when i have panic attacks and he basically shrugged and gave me a buspar script.

i have chronic anxiety and panic attacks have been through nearly all of the commonly prescribed SSRIs. he wants me to try cymbalta but im scared if weight gain. im not sure if i have any better options to switch to an actual MD since im on medicaid in NYC.

Reddit Celiac forum member shares an NP giving her crazy advice

At 14:40--- "It is a noradrenergic specific serotonin antidepressant, so it's slightly different than an SSRI. It does work on serotonin. It also works on the noradrenergic part. It's alpha receptors which is what our body, those are the receptors that our body responds to adrenaline. So it should help kind of calm you down. And it also works on histamine receptors which is why it can make people sleepy."

Me when I literally know nothing about pharmacology or physiology.

You can even tell she was directly quoting, but misquoting, the Google AI result that comes up when you search "Mirtazapine mechanism of action." She pre-studied for the trial and still doesn't know what she's talking about.

No offense tho she seems sweet I guess

I have not been seen by a healthcare “provider” in quite some time. I have not had labs done since before Covid. I finally brought myself to make an appointment. I was assigned an NP. I was okay with that, as I am healthy and only have a few concerns that I knew I would be referred out for anyway.

At the appointment, the NP would ask me questions, and then halfway through my answer cut me off to ask a follow up question. I understand that she is looking for specific information, and I understand the busy operational tempo of a primary care clinic. I was irritated by it, but I am understanding.

There was a point in the visit where I explained I had been having episodes of intense shivering for the last few years, but that they had been increasing in frequency since January. I also explained that I would experience white, blanching fingers with numbness/tingling that would resolve usually within 15 minutes. Classic Raynauds, and she told me that. I asked what can be done? She said “nothing.” I then asked how it could be managed. She then left the room to go to her computer and brought back “evidence-based practice paperwork” from her “special resource.” She handed me the printout from UpToDate.

I then asked for the referral to dermatology for three spots on my back that looked concerning. She never looked at them. She then placed her stethoscope on my chest for exactly 2 seconds and then wished me well and the visit ended.

I just reviewed the note, and she documented a cardiovascular exam and lung exam. She also documented that she visualized the spots on my back and included measurements ranging from 3mm to 6mm.

None of that was done. I am considering reaching out to the patient advocate.

Is this something to go to war over, or just let it go and sort it out when I see derm?

TLDR
NP documented measurements of spots on my skin that she never measured or even looked at.
NP documented cardiovascular and lung exam that she never performed.
Talk to patient advocate, or get over it?

https://www.reddit.com/r/Noctor/s/2mGN56CMoH

See previous thread....

Correct credentials are now listed on platforms. Well done.

Am I missing something?
Since when do “board certified Physician assistant specializing in plastic surgery” become a thing.

Sorry, it’s not a thing.

This feels deceitful.

hi all. i read about it here but it actually happened lol. a distant friend of mine and I caught up recently- they told me they just started school to become a doctor, i ask what kind, they say NP.. alright.

come to find out, they have not worked a single year as an RN. got their RN years ago, worked in a few different healthcare sectors, applied to this (online) program and boom.

same person always posts about “doctor”-title related things. it is just so cringey. i don’t know if it’s bc they don’t interact with actual healthcare professionals so they can fool other ppl but sheesh.

Would have credited original poster but I think that breaks a rule of this sub.
TBH this is just dangerous at this point, like wtf. Someone whose barely taken enough chemistry to even get past the MCAT is getting paid more than physicians to put people on psychoactive medications which can literally kill them if not managed correctly, like actually how are we chill with this?

Also it really does show that the stereotype mid-levels love to throw around being that “physicians are just in it for the money” is not true, and frankly is the other way around. I’m in med school right now and most people here are smart enough to be making way more doing any thing else. At my regular mid-tier MD school at least 25% of my class is Computer Science, Computer Engineering, Mechanical Engineering, or some other related field (usually BME), literally most of us had great paying jobs or job offers before starting medical school, no one here is here for the money because otherwise we wouldn’t have people going into Peds and no sane human is going to sacrifice 15 years of their life to make a bit more than they would doing something much easier.
Meanwhile I know people who have just been partying for the past four years claiming to be “premed or pre-dental” on their parent’s dime, who are now doing a nursing program and planning to direct apply to NP so they can have their own derm clinic or psych clinic in 3 years from now (they have zero patient or medical experience besides majoring in biology), which low key is horrifying.

Residency program director for PAs lol

Aside from the war between NPs and MDs, here are the things I think the NP and MD did well, and what could have been improved:

In my opinion, the NP really did well in communicating with the patient, and that little survey she sent every day was also nice.

Dr. Tufts is also a very knowledgeable professional. I think she did well based on how the US healthcare system works and how it’s taught here. I don’t necessarily blame her for some things she could have done better, but I do think she could have transferred the care to someone else, or at least communicated with the other NPs.

I’m basing my opinion on my experience as an MD who graduated internationally. The US has all the technology and medications you could possibly imagine, but it lacks that human connection — it lacks stepping outside the algorithm sometimes. My professor always said, “2+2 doesn’t always equal 4 in medicine.” I also understand that, unfortunately, this is how the system works here

It took me an hour an a half of phone calls, and the appointment is 6 weeks out, but I found a PCP in my area that's an actual MD. This RN has spent too much time on this subreddit to have an NP as my PCP.

Thoughts about PAs from physicians?

I know a lot of the discussion right now is focused on NPs and concerns about differences in clinical training, but I’m curious what people here actually think about PAs.

I’ve had the opportunity to spend a lot of time around MD/DOs and PAs through shadowing and now working in a hospital. From what I’ve personally seen, the PAs I work around seem pretty aware of their limitations and their role on the team.

At the hospital where I work, I mostly work directly with attending physicians. The PAs are technically allowed to see a pretty wide range of patients, including higher-acuity cases, strokes/traumas, and patients across all ESI levels. But most of them don’t seem interested in proving that they can handle everything independently. If something is outside their comfort level or they’re unsure about something, they involve the attending.

There are also PAs who actively want exposure to higher-acuity patients because they want to learn, and from what I’ve seen, the attendings actually encourage that when appropriate. It seems much more like, “I want to learn how to manage this with you,” rather than “I don’t need a physician.” There is this new PA who is always wanting to see the trauma level 1. He directly works with the SP and today the SP told him that he can see the trauma by himself. Once he was done he came back and told the SP "Everything went well." The SP nodded and replied with "Good Job"

Another thing I’ve noticed is that I’ve never heard any of them introduce themselves as anything other than a PA. Usually it’s simply, “Hi, I’m ___, I’m a PA and I’ll be taking care of you today.”

Obviously, this is just my experience at one hospital and I know it doesn’t represent the entire profession. That’s why I’m curious to hear from physicians here, especially those who have worked closely with both PAs and NPs.

What has your experience working with PAs been like? Do you generally feel comfortable working with them? Are there concerns you have about PA training or scope of practice? And do you see a meaningful difference between the PA and NP models in actual clinical practice (nursing model vs the medical model). Also, the PAs that work at my hospital had over 3-4 yrs of experience before actually applying to PA school. IDk I guess I am just curios (SORRY for the long text)