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Betty's Story Part 2: A father's plea for NP accountability after the death of his daughter

Seven-year-old Betty died just 15 hours after she was evaluated by a pediatric nurse practitioner in a pediatric urgent care without any physician on-site. Betty's father, Jeremy Wattenbarger discusses the efforts he has made to seek accountability and ensure that other children receive physician-led care.


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'Betty's Law' pushes for transparency among healthcare practitioners

COMPLETE TRANSCRIPT


Rebekah Bernard MD:0:06

Welcome to 'Patients at Risk,' a discussion of the dangers that patients face when physicians are replaced with nonphysician practitioners. I'm your host and the co-author of the book 'patients at risk the rise of the nurse practitioner and physician assistant in healthcare,' Dr. Rebekah Bernard, and I'm so pleased to be joined by a special guest co-host sitting in for Dr. Niran Al-Agba. This is Dr. Amy Townsend. She is a fellow board member with me, of physicians for patient protection. Amy, thanks for joining us.


Amy Townsend MD:1:33

Thank you so much for having me. It's a pleasure to be here with you guys.

Rebekah Bernard MD:1:36

Thank you. We're back for a second discussion with Jeremy Wattenbarger. He is the father of seven-year-old Betty Wattenbarger, who unfortunately lost her life from pneumonia and sepsis, just 15 hours after she was evaluated in urgent care by a pediatric nurse practitioner who failed to properly diagnose her. And now Jeremy is fighting to make sure that other children and other patients know what kind of care they're getting, and that they are kept safe. Jeremy, thanks for joining us again.


When we left off, in part one, we kind of recapped the story of what happened and some of the challenges that Jeremy has faced in trying to get justice for Betty. But really more than that, trying to protect other children to make sure that patients have access to physician-led care. And we talked about how it was very challenging. It took multiple efforts for you to report this to the Board of Nursing. Finally, it required your state senator's involvement to get them to even investigate. And ultimately their only criticism of the nurse practitioner was just that she failed to completely document vital signs. And that's because those are the only things that they can really oversee, which are nursing tasks. But as Amy pointed out, this nurse practitioner was not practicing nursing. She was practicing medicine. She was evaluating a child. She told her parents she'll be okay. Just take her home, give her some Motrin. And of course, we know that Betty passed away just some hours later.



Photo of Betty during urgent care evaluation

So Jeremy, tell us after you kind of reached the limit to what the Board of Nursing was willing to do to help, what was the next step that you took?


Jeremy Wattenbarger:3:20

Well, in parallel with the nursing board investigations, I was also opening the complaints against the supervising doctor, Dr. Michael Cowan, all of those were deny, deny, deny, and eventually, the general counsel told me 'Do not file another complaint, they will not receive it or accept it' because they got so tired of me pestering them over and over, you know, because they there are multiple infractions that Dr. Cowan was responsible for, they're not willing to hold him responsible for anything. And in that case, that's when I brought up the position about the proxy and asked about the proxy if that was the direction they wanted to go. And they said yes, that's what we believe happened. And that's he was doing the right thing. So now they're having to investigate the proxy because they have no choice now because they accepted Michael Cowen's proxy as being true.


Rebekah Bernard MD:4:06

So basically, just to recap, the nurse practitioner was in Texas, they're required to be supervised by a physician, the nurse practitioner was technically supervised by a physician who was on vacation, I would guess, or doing something in Cambodia, and had therefore designated the supervising status to a different physician who actually may not have even been licensed to practice medicine. So what you're saying is that the Board of medicine or whoever is not taking any action against the doctor who was in Cambodia, because technically he had passed the buck to someone else. Does that - is that right?


Jeremy Wattenbarger:4:40

That's correct. That's correct. Yeah. They said that since he had done that, you know, he was doing the right thing. He was never called by the NP, and he wasn't in the room. So he owes no responsibility. And he was doing the right thing is what they say.


Rebekah Bernard MD:4:52

And of course, now he's the part-owner with the nurse practitioner. It's so interesting. You told us in the last segment that the nurse practitioner is actually At the time was or she has been the majority co-owner of the pediatric urgent care?


Jeremy Wattenbarger:5:06

Yes, that's correct. She took up the majority ownership of that clinic in the summer of 2019. After Betty's death.

Rebekah Bernard MD:5:13

Amy, do you hear of other cases in which nurse practitioners or PAs owning urgent cares or medical clinics?

Amy Townsend MD:5:19

In the state of Texas, nurse practitioners can own their own clinics. And as we talked about in the last segment, there is truly a conflict of interest there in the fact that the nurse practitioner who owns the clinic is essentially employing the physician.

Yet the physician is supposed to be overseeing the quality of the work of the nurse practitioner, that's actually giving them a paycheck. But that is completely legal in the state of Texas. There are some restrictions on physician assistants, and that they are not allowed to be majority owners in medical practices. However, there are ways that they have managed to find loopholes in some of those laws to create the structures that there are some physician assistants as well that primarily are owners of different clinics

Rebekah Bernard MD:6:05

It just blows my mind to think that you could have a nurse practitioner or physician assistant owning a clinic, hiring someone to supervise them, then not giving proper care to a patient having a patient pass away, and then not be held accountable in any way for their care. You open - you hang a shingle, you say 'I'm an urgent care.' Urgent Care means you're just as close to almost an emergency room, you are technically taking care of the sickest people and you're supposed to be ready to care for them. And yet, clearly, this is false advertising because you're not getting the kind of care that you would expect to get it. Do you agree with that, Jeremy?


Jeremy Wattenbarger:6:41

Yeah, I do. Also, just to add to that, too, is that the supervising physician, the state of Texas is chapter 157, that covers the supervisory, and there is one segment within the law itself, which says that the physician is responsible for all medical acts that he delegated, he or she delegated, the medical board tends to look away from that and looks at the other part of it, and says, 'Oh, well, you know, he wasn't in the room, he didn't get a call.' So there's some conflict there also.

Amy Townsend MD:7:12

Yeah, the law actually says that they are responsible a physician is responsible for ensuring that whatever act they are delegating, that the nonphysician is properly trained to do that act. So as long as they have some type of documentation, saying they in good conscience have determined that the nurse practitioner is able to do that task, then they are no longer responsible for the actual task after that.


Rebekah Bernard MD:7:40

And I guess technically that documentation would have been the policies and procedures of the urgent care, which Jeremy has pointed out were improperly followed because the policy said that if vital signs were unstable, they should be rechecked before a child or person is discharged. And I think Jeremy said that was disregarded. There were three different policies that were disregarded.

Jeremy Wattenbarger:8:03

Yeah, there were two policies that were disregarded. The vital sign policy, though, is disregarded at least three different violations on that policy. The physician also Dr. Michael Cowan, states that she did not have any variance to those policies. So she was supposed to follow those policies. And the nurse practitioner, as many people would do is they review those policies every year. So there was absolutely no reason why she does not know her policies.


Rebekah Bernard MD:8:25

Wow. I mean, clearly, she just used her own independent medical judgment to say that Betty was fine. But that's there's a reason why we have those policies and procedures. And there's a reason why nurse practitioners are supposed to follow protocols and things like that. So clearly that was violated. So, Jeremy, you've been working really hard to make sure that this doesn't happen again. You tried many routes. And then now most recently, you're really working now with the medical examiner's office because you're trying to get some changes made to the way Betty's death has been named as a natural death. Can you tell us about that?


Jeremy Wattenbarger:9:01

I followed up with the medical examiner and that it's under review right now that it's something that - it's a request I put in but and I can't go into a lot of details right now about it. But there is a Special Victims Unit in the city of Denton that has now been engaged and they have collected all the materials that I have. And they've started their process now of looking at everything because, at some point, you no longer can say well, she just made a mistake and she misdiagnosed. You have to look at it from the other perspective.


Number one, you have an urgent care, which is not a licensed medical facility. So this would fall under the same kind of guidelines that a corporation or a company would fall under because it's not a medical facility. And if there are clear guidelines and policies that outline patient safety or to protect, you know, a customer or anyone else that comes into their business, and the customer becomes injured or ends up dying, it becomes a criminal matter at that point because now you're no longer talking about oh, I made a mistake and it wasn't intentional. She knew the policies. She knew the policies were there in place for patient safety. She violated the policies knowing that those policies were in place for patient safety and a patient died. So at that point, you have what looks you know at minimum criminal negligence or more so that's got to be looked at in that process with the medical examiner you know, that's going to be handled by the police department now that's they're talking with the medical examiner about that piece. And that's kind of out of my hands at this point.


They're working that that avenue because this is got to the point where it's no longer simply she misdiagnosed Betty, you know, she was negligent in Betty's death because she clearly knew what she was supposed to do. And she had knowledge of what was supposed to happen on that site. She didn't do it. And then to make matters worse, within 20 minutes of receiving the medical examiner's request, Betty's medical rampart records were then tampered with and altered multiple times over the course of the next 12 past three years. He sees almost every month they go in and do views and edits and modifies and changes on the records.


Rebekah Bernard MD:10:54

Yeah, that's a really big no-no, I mean, right, Amy? I mean, this is the medicolegal 101 never change or alter or tamper with the medical record. It just doesn't look good. It's not right. I mean, Amy, when you say that's kind of like a mandatory thing for physicians for any healthcare practitioner?

Amy Townsend MD:11:12

Yeah, absolutely. You never go back and change the record, particularly not once there's documentation that a complaint or something like that some

Rebekah Bernard MD:11:20

Of the things that were some of the logs that were modified, just changing some of the information, changing the actual code of the billing code to make it seem as if a more in-depth examination and assessment was done, which actually, you've noted that may be triggering an insurance audit as well.


Jeremy Wattenbarger:11:40

It's already a Blue Cross Blue Shield is already assigned an insurance fraud investigator to that because they're concerned because the change came after the death. And after they received the medical examiner's request for records. That change occurred the day after my daughter died and is made by the doctor. And so if he was not supervising, and he was not there, why is he making the change? And how does he know?


Rebekah Bernard MD:12:02

For any of our listeners out there, if you're a physician, a medical student, resident, never change medical records, you can write an addendum, you can, of course, consult your malpractice carrier, I mean, unfortunately, bad outcomes and tragedies do happen. And the most important thing, if you're involved in something like this is you need to figure out what went wrong, how you can learn from it, take accountability, and don't try to hide things because you never get away with it, it just doesn't look good. And so that's my advice to everyone out there.

Jeremy Wattenbarger:12:32

And one thing a lot of doctors don't realize either, and I come from a digital forensics background. So I did some research on this also, was that just the simple act of viewing the record in some EHR systems can actually modify the time and date stamp. And so you see, a lot of times doctors after a patient has died will go back in, and they'll start doing views on the record over and over. That's not what you want to be doing. Because it looks like you're trying to find a way out of you know, whatever just happened.

Rebekah Bernard MD:12:58

You know, it's interesting, because I have had bad outcomes, unfortunately, I think we all have. And the first thing that I always want to do is to say like 'Did I miss something? Was there something I could have done differently?' So I've always like had that compulsion to go in and just review and look and not to change things, but just to, you know, beat yourself up about it and say, What could you know, was there a sign? Could I have done something differently, but to your point, you've got to be really careful even about just like going back and reviewing everything because it can look bad. So you're working on those issues. And then the other thing that you've been working on, which I'm just so amazed is on a legislative basis, and can you tell us about Betty's law and how that came about?

Jeremy Wattenbarger:13:41

Betty's Law, it didn't even make it to the floor for a public hearing. It was squashed by the legislators pretty quickly because there is clearly an agenda to have unsupervised APNs. And they felt that at some way that might intrude upon, which which it didn't.

But they felt that way. And that was simply just a first step in some accountability that, you know, there had to be a name badge and had to be some type of identification and have credentials. And that's I think that was the real sticking point was that they had to have the credentials. Because a lot of people don't want the credentials on the badge because they want to call themselves provider which or a consumer or patient or anyone else. And they come in they say, provider. Well, what's your qualifications is the next question. So if they have to call themselves a provider and then put their qualifications, then they have to identify themselves as a nurse and not a provider. So they didn't like that. I think that was one of the big sticking points from what I understood.


Rep. Jared Patterson sponsored 'Betty's Law'

Amy Townsend MD:14:34

Jeremy did fabulous footwork on this, you know, in getting in contact in particular with His representative Jared Patterson and he was actually able to put me in contact with some of Mr. Patterson's staff. And so I've talked, I talked to them multiple times. And we originally were trying to model that piece of legislation after legislation that was recently passed in New Jersey. The legislation passed in New Jersey was very thorough in that. Not only did require that you clearly state credentials. But they also require that in any clinic that there was not a physician on-site that there had to be some type of notification to patients publicly as well as identifying the actual supervising physician for any nonphysician on site. So it was very thorough and is a great piece of legislation.


Unfortunately, when we talk to Jared Patterson's office, I think he's a relatively new representative, the chair of the committee, or this type of legislation was Stephanie Klick who has been trying to push independent practice for nurse practitioners for years now. And so I think that he was somewhat shy about pushing the extent of the New Jersey law in Betty's law, but it was definitely something that could have been, you know, a step forward in transparency, to make sure that patients would at least be able to identify what exactly is the training of the person that you're actually seeing, you know, there are those requirements already in a lot of hospital facilities. But as Jeremy has already mentioned, previously, urgent cares are not held to the same standards as hospitals. And so when you're talking about, you know, a private clinic or an urgent care, they don't have the same requirements for those badge identifications. And so it would have been great to kind of close that loop. And to make sure that that credentials could be easily identified in an outpatient setting.


Law advocating for transparency allegedly blocked by Rep Klick

Rebekah Bernard MD:16:24

Because Jeremy, you said that not only did the nurse practitioner not introduce herself as a nurse practitioner, but she wasn't wearing any kind of identification badge, and there would have been no way for you to actually know that.

Jeremy Wattenbarger:16:36

Yeah, there there was nobody wearing any identification badges and that, that I understand that the nursing board does have regulations against that. And I filed that complaint, the nursing board said 'prove it.' Well, I don't have a picture from that day. I'm sorry, I don't have a picture of her not wearing her name badge. And so you constantly run into this, this back and forth with the nursing board, you file a complaint? And then the nurses? Well, no, I did. And then you have to say, well, No, she didn't. And they never believe the person on the other end, they always leave the nurse at that point. And that's kind of where you get stuck at.

Amy Townsend MD:17:07

While we're talking about legislation. One of the other things I would really love to cover or Jeremy to talk about is in this year in the Texas legislative session, we had a bill that there were some folks that were very aggressive at trying to pass independent practice for nurse practitioners in Texas, it was House Bill 2029, that was written and sponsored by Stephanie Klick, who was you know, chair of the House committee that actually was going to hear this bill. And we had, of course, a lot of people from a physician standpoint that showed up to give testimony, but Jeremy showed up in you know, he took the time to show up and give the testimony about Betty. And I can't tell you how impactful his testimony was. It was absolutely amazing. His discussion and his points, you know, as he talked to legislators, and I don't know, Jeremy, have you ever, you know, testified in front in front of legislators before because you look like a pro?

VIEW Jeremy Wattenbarger's testimony: scroll to 5 hours 5 minutes

Jeremy Wattenbarger:18:06

No, I've never testified in front of legislators before. That's something I go around doing. But when it's necessary, I do I have a public speaking background myself, I was a I was in radio for several years. So I have a public speaking background. And I also am an evangelist and preach in churches. So it's quite a bit different than standing in front of a group of legislators, but they all put their pants on the same way we do. So at the end of the day, they work for me, and they need to be accountable to me. And I think sometimes they're forgetting that piece of it, the legislators are there forgetting the piece that they work for the people and the people don't work for them. And we've seen that with Stephanie Klick the comments made at the beginning of the hearing regarding opposition and people or opposition to her that talk about things like what happened with Betty those type of statements. There's no place for that in a public forum, especially coming out of the legislator's mouth and then subsequently, or her supporters also making the same type of statements that has no place. I mean, that's, that's uncalled for.


Rep. Stephanie Klick, a trained nurse, advocates for independent NP practice

Amy Townsend MD:19:06

And then you know, anyone who's listening to this podcast, who is not involved in medicine, or you know, not a physician, or you know, not even in charge of a big healthcare system, every day people can have an impact on legislation that has passed. And so I can't stress how important it is for people to show up. And you know, as I said, you did an amazing job. And I think everybody was just in all for you to get up there and tell a story that I know was difficult for you to tell, but it had a tremendous impact on everyone there.


Rebekah Bernard MD:19:40

It almost felt like Jeremy's testimony just derailed the whole momentum that they had o getting independent practice because it almost seemed like there was just silence after that because what you said was so impactful. And we know that legislators really when they hear from their constituents and they hear stories about what What ha happened, they really, that really opens their eyes, that' really important to them. And some people that were there told me that you could have heard pin drop after you were done and that they almost felt bad for the people that went after you. It was like somebody from the AARP, because and basically, nobody was listening anymore After you made that impassioned speech, it was just clear that this was not the right direction to go. So like you said, Amy, a person's experience and going and testifying can completely change what's going to happen with a bill even if it seemed to be making really strong progress, which I think that one did seem to be, you know, one of the things speaking of full practice authority independent practice, and there was a news article about Betty's law. And they talked to the CEO of the Texas Nurse Association, Cindy Zolnierek. And what she said they said: What do you think about this Betty's law? Do you think that nurse practitioners need to identify themselves and that sort of thing, and she said quote, 'any patient loss is a tragedy. And while we do not know the details of this particular case, the evidence demonstrates that the care provided by advanced practice registered nurses is generally as safe or safer than physicians, you will find anecdotes of misdiagnosis with unfortunate outcomes for both APRNs and physicians. However, if you look at the statistics patients have no greater risk when treated by APRNs. Amy just before I get into my diatribe, tell me what you think when you hear that?


Statement from TNA CEO Cindy Zolnierek against 'Betty's Law'

Amy Townsend MD:21:37

Yeah, you know that that is a repetitive statement that we hear over and over from nursing leadership and APRN leadership. And it's almost like if they say it enough times, they think that it's going to make it a reality. And I know that you will probably talk about that.

There are no studies out there that actually looking at unsupervised practice medical practice by nurse practitioners. All the studies that they cite have been done under physician supervision.

And most of the time, they're looking very simple pre-diagnosed problems like high blood pressure, or diabetes and can we control those things. Those type of scenarios are much much different than trying to independently diagnose a random person that walks in of the street. And Betty is a great example of diagnosis in managing a diagnosis that has already been determined or completely differerent.


Rebekah Bernard MD:22:31

Yeah, you know exactly what you've said, there are absolutely no well-performed studies showing that unsupervised nurse practitioners or physician assistants can provide high quality, safe and effective care. They can provide safe and effective care when working very closely in physician-led teams, specifically with one on one on-site supervision. They can also perform well if they are following protocols very carefully that are created by physicians and they always have a physician to refer to every study done has always eliminated high-risk patients. Most of the time studies have eliminated children. Most of the time studies have eliminated anyone that has anything outside of the most basic health care conditions. So to make this argument that nurse practitioners can provide as good or better care than physicians, just across the board and unsupervised is completely a false statement. And like you said, Amy, it seems like they feel like if they just say it over and over again, that people will believe them.

We're here to tell you and Jeremy is here to tell you that we need more scientific evidence that nurse practitioner practice is safe before they're allowed to do it independently.

And in my opinion, nurse practitioners and PAs should always have very close physician supervision. To me, that means on-site supervision, or at least very close phone discussions are making sure that protocols are being followed as in this case, it was not your Jeremy, what do you think when you hear about this kind of laws, a statement that she made saying, you know, she's sorry for your loss, but you know, they're still just as good?


Jeremy Wattenbarger:24:08

I've reached out to some of the nursing groups here in the state of Texas and ask them to hold their own accountable and they won't do it. That's one thing I've talked to legislators about too, is metrics. And metrics are very important in any setting urgent cares, you know, are one area where you see a lot of APRNs, where are the metrics that show what they're saying is true.

Metrics are very important in any setting...urgent cares are one area where you see a lot of APRNs, and I've never seen metrics on anything. When I've asked what metrics over and over, nobody can show me metrics. So until you can show me numbers and metrics, I call BS.

Amy Townsend MD:24:37

The training is different, right? I mean, you know, there's a huge discrepancy in the amount of training both quantity and quality of the training that physicians receive versus nurse practitioners. So you know, the burden really is on them to give proof of the statements that they're making, and they just have not done it.



Difference in Training - Know your Practitioner

Rebekah Bernard MD:24:55

Especially as we see the increase of these diploma mills, these online schools I think this nurse practitioner that saw Betty had graduated in 2007. So she wasn't a brand new graduate. But you know, nowadays, we're seeing less and less well, high-quality training, we're seeing a lot more online training. So you're 100%, right, we need to see those metrics. I find it very interesting that while half of the states in the union allow the unsupervised practice, and have for some years, there is still no data being published showing outcomes. And there's been plenty of opportunities to do that, but it hasn't happened. And like you said, Jeremy, if then if the data isn't there, then you know, the onus is really on them to show that they can be safe and effective.


Amy Townsend MD:25:40

The one question that I have for Jeremy is now that I mean, you've been through this terrible experience, I mean, how do you now approach healthcare differently? I would definitely think that this would have an impact on the way that you kind of, you know, approach care for you and your family from this point forward.

Jeremy Wattenbarger:25:57

Yeah, I mean, we do we approach it a lot more in a cautious manner. You know, we asked a lot of questions. I didn't even know what a provider was until this all started. Now, whenever I walk into an urgent care and, or wherever I walk into, you know, they're, they're still urgent cares, we have Cook's urgent care, which is right down the street from us, but they also have an onsite physician inside that urgent care, too. And he's, he's there, and the dude is legit. I mean, he's, he was an army VA doctor. So I mean, he knows his stuff. And he was a primary care doctor. So we go to any place like that, that's who she sees my other daughter does the same thing with me, I don't, I won't see a mid-level at all, it has to be a doctor.


And sometimes that can be kind of cumbersome, especially in our area where we're at because doctors are being pushed out more and more. And we're seeing a higher level of Urgent Care types, scenarios, mid-levels everywhere, and no doctors to be found. And there was even a new practice that was opened up that's supposed to be doctor's primary practice, and you call it down there. And they said, 'Well, you can see the provider, and the doctor only comes in once a week.' Well, that's really not sufficient. So it is it does become very difficult. We live close to a few large cities, but you see him dotted all throughout the Texas landscape, the urgent cares have really cropped up everywhere. And they're almost to the point where it makes it very confusing for a patient, you have something that needs to be seen, but it's not quite what you think's an emergency, and you're not sure where to go, you end up walking into one of them. And then all of a sudden, you're saying, Well, hey, we got a provider. Well, most people, when they hear the word provider, they hear doctor, they're thinking it's a doctor, and it's really not. And you want to ruffle some feathers, the feathers simply say, well, you mean nerves, don't you? And or APN Yeah, that that really aggravates people, I've noticed that it really causes some people some angst, and I have no idea why. But oh, you are what you are.


Amy Townsend MD:27:59

One of the primary things that we want to convey to the public is that it is perfectly okay for you to ask about the training of the person that's going to provide your health care.

That is one of our most important messages is to have that transparency. And so we want to give patients kind of the tools to be able to do that so that you can advocate for yourself and advocate for your family.

Billboard It's OK to Ask

Rebekah Bernard MD:28:25

In our l st few minutes. Jeremy, do you h ve any other messages or anything else you want to say to our listeners today about what you've been through?

Jeremy Wattenbarger:28:34

Yeah, I mean, the something does happen, God forbid it does happen, then you have to be aggressive with these people, you have to go in and you have to take charge, you have to really push them. Otherwise, nothing will get done. They'll literally sit there and run the clock out on you. And say, 'Oh, well, it happens sometimes.' And that was the exact statement the doctor made during his testimony at the e d was, Oh, well, these things happen sometimes. No, No, they don't. They shouldn't happen sometimes. And I think that patients, especially in the state of Texas, need to really be aware of how our current state is. And I'm not talking about just the state itself. I know that the state of the actual laws and regulations that are here. They are not patient-friendly. I'll tell you that they are not patient-friendly. I've run into it over and over. We have medical liability caps, which are one thing that needs to be addressed. We've talked about it, it's okay that they're in place. However, the requirement to have an expert report before discovery is absolutely ridiculous. It was one of the things that held us up in collecting any type of evidence for almost a year you know what you can do to evidence and a y ar trying to collect no evidence for a year you can't do any discovery until the expert report is accepted by the actual judge itself.


Rebekah Bernard MD:29:48

And Jeremy did that expert report have to be from another nurse practitioner or was able to be a physician?

Jeremy Wattenbarger:29:54

it could be from a physician in this case it was from a physician and that's that had to be submitted before the case could even be brought forward to you to do discovery. That right there in itself is a travesty of justice. It's very important at the very beginning if something like this happens, a sentinel event a, you know, a never happened type event, you know, those types of things, you need to be collecting evidence immediately. And a lot of people in the state of Texas aren't aware of how bad the laws are, and how poorly they are written. And they continue to degrade. And at one point, there used to actually be onsite supervision here, there actually used to be on-site supervision, they pulled it away. And so you constantly see this, this erosion of patient safety and patient rights here in the state of Texas, and it needs to be addressed. I've addressed it with multiple representatives and senators, but nobody seems to really want to take charge and actually run with it.


And so I'm continuing to push and Representative Patton's office had a very good discussion about this, you know, I sent it over three things. One of them was the chapter 74 issue. The other one was that I believe that we need to have an ombudsman aside at some point for these nursing board and medical board investigations, who actually is having some oversight because I can't tell you who actually oversees those board investigations. And I've never been able to figure that out. They operate in a black hole that's completely anonymous to everybody. And most patients don't realize that when they file a complaint, that investigation can go several different ways. And a lot of them are not very good. They're not looked at they're not reviewed, and you have no oversight, and nobody's actually following up with you or giving you status. And Lord help you if you try to ask for the actual testimony itself. Because I went through that also with the nursing board asked me for the nurse's testimony that was initially given because she's given contradictory statements multiple times. And I was denied by the nursing board to have it they said you have to appeal to the AG, I appealed to the AG said, 'No, you can't have it based on occupational codes.' So who actually can see those documents? And that's what we ran into with the Tarrant County Medical Examiner is for the original set of records for Betty, they classified them as highly confidential and said that I did not have enough clearance to see those. And they had to be approved by the AG to be seen.


So these are the types of things we have going on in the state of Texas. And I don't think a lot of patients are aware of it. I think a lot of patients need to be aware of it. And I think they need to know that when you walk into an urgent care or any place for that matter. If you're being seen by an APN you might want to think about that twice again, because they're really not being held accountable. I mean, the medical board, maybe it might happen. But the nursing board, good luck. They cover rear ends like nobody's business down there. They hide. And I'm telling you, you have to literally get the general counsel on the phone to get anything done down there. They'll tell you to know, I know Amy ran through this too. We don't have the money to continue. We don't have enough bodies or people to be able to further this investigation. This is all we can do. No, I think I paid enough in tax dollars, you can do that. I think you can handle that.


Amy Townsend MD:32:55

Well, I'm absolutely amazed at what you have been able to accomplish. And I look forward to continuing to you know, work with you on legislation that hopefully we can move the ball forward in the next session. And we'll continue to push all we can do.

Rebekah Bernard MD:33:11

Yeah, and in the meantime, patients just needed like, like Amy was saying it's okay to ask. And one quote that I have from Jeremy here was that if they had known that the provider was a nurse practitioner and not a doctor, quote,' had we known she was an advanced practice nurse, w would have said, you know what, she probably doesn't have t e skills to see Betty based on the way she looked that day and we would have taken her to an emergency room.' So you do need to ask, and it's okay to see out physician-led care. There's nothing wrong with that. To learn more about this topic, w would encourage you to get the book patients at risk the rise of the nurse practitioner and physician assistant in healthcare.



It's available a Barnes and Noble and@amazon.com Please subscribe to our podcast and our YouTube channel. It's called patients at risk. If you're a physician, please join our group. It's called physicians for patient protection. Our website is physiciansforpatientprotection.org if you're patient listening and you want to tell your story or you have concerns, please reach out to us. We would love to talk with you and get your story out there. Thanks so much for listening and we'll see you on the next podcast.

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