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Midlevel Malpractice with Attorney Robert Painter

In the book Patients at Risk, we outline the tragic case of Alexus Ochoa, a 19-year-old woman who died when a nurse practitioner failed to properly diagnose and treat the blood clot in her lungs. The only reason that the details of this case became public was because of a lawsuit filed by the patient’s family. Court records reveal not only a lack of appropriate medical care, but more importantly, the incredible efforts that Mercy Health Systems, a multi-billion-dollar corporation, routinely went through to hire and credential nurse practitioners to work in positions completely outside of their scope of practice, putting patients at risk to save money and increase profits.


Today we talk with attorney Robert Painter about the role of the legal system in holding bad actors like this accountable. Mr. Painter is a former hospital administrator who is now a medical malpractice and wrongful death lawyer at Painter Law Firm in Houston, Texas.


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TRANSCRIPT


Rebekah Bernard MD 00:07

Welcome to 'Patients at Risk,' a discussion of the dangers that patients face when physicians are replaced with non-physician practitioners. I'm your host, Dr. Rebekah Bernard, and I'm joined by my cohost and the coauthor of the book 'Patients at risk: The rise of the nurse practitioner and physician assistant in healthcare,' Dr. Niran Al-Agba.


Niran Al-Agba MD 00:24

Good evening.


Rebekah Bernard MD 00:25

In our book, we outline the tragic case of Alexis Ochoa, a 19-year-old woman who died when a nurse practitioner failed to properly diagnose and treat the blood clot in her lungs. The only reason the details of the case became public was because of a lawsuit filed by the patient's family court records revealed not only a lack of appropriate medical care, but more importantly, the incredible efforts that Mercy Health Systems, a multibillion-dollar corporation routinely went through to hire and credential nurse practitioners to work in positions completely outside of their scope of practice, putting patients at risk to save money and increase profits.




Today we're going to talk with attorney Robert Painter about the role of the legal system in holding bad actors like this accountable. Mr. Painter is a former hospital administrator, who is now a medical malpractice and wrongful death lawyer at Painter Law firm in Houston, Texas, Mr. Painter, welcome to the show.


Robert Painter 01:22

Hey, thanks. Great to be here.


Rebekah Bernard MD 01:24

Robert, I was reviewing your website. And you really seem to have a unique perspective on nurse practitioner malpractice, that not all plaintiffs’ attorneys, let alone patients really understand. Tell us how you got interested in nurse practitioner malpractice?


Robert Painter 01:39

Well, so I've seen that, you know, from the perspective of being a hospital administrator for a little while in the 90s and seeing the rise of what we call back then I guess it's not politically correct now, but mid-levels. And you see the rise of mid-levels, which, you know, from my perspective really came about because hospitals and bean counters wanted to increase profitability. And what we've seen then is these lobbying organizations really coming about trying to take the mid-level and just delete the mid and make it level with physicians who have the higher level of care.

The rise of mid-levels, from my perspective really came about because hospitals and bean counters wanted to increase profitability. And what we've seen is these lobbying organizations really coming about trying to take the mid-level and just delete the mid- and make it level with physicians who have the higher level of care.

So, what I started seeing, you know, really after going to law school, and then starting on the defense side, this defending hospitals and medical schools and providers, and then since '06 being on the plaintiff side, the patient side, is seeing the role of these mid-level providers, whether it's nurse practitioners or physician assistants, just really getting increasing roles and responsibility without that commensurate education. And there's so many cases where I've seen this, that I started really noticing this and wanted to get more up to speed to be able to prepare it, or to be able to prepare and represent my clients. In fact, just I have a couple examples of cases I'm working on right now one with a nurse practitioner, one with a physician assistant, many, many with CRNAs, that we could talk about, but you just start to see, once you're you are even tuned to this, you see the same issues over and over.

You just start to see, once you're you are even tuned to this, you see the same issues over and over.

Niran Al-Agba MD 03:10

What do you think if I mean, I guess after doing it on the plaintiff side, what do you think, are some of the answers? You know, part of the reason we wrote the book, and people are always surprised about this, especially physicians, is I always say, 'Look, I'm on the side of the patient. This book was written for patients, because I feel like it's my contribution to try to educate them.' So, I guess, from your perspective, cases you've done what is the answer? What can we do to help patients more?


Robert Painter 03:35

Well, you know, I think I appreciate the comment of saying you're on the side of the patients, because I really believe that- I mean, I've yet maybe there might be one person that I've encountered over, you know, 20 plus years in healthcare, and that was Dr. Death. Because I have been one of the cases against Dr. Duntsch in Dallas, you know, which was the subject of the Dr. Death series and all that. But anyway, you know, setting that one aside, pretty much everyone really everyone who goes into medicine, everyone who goes into any of these healthcare fields does so to help patients. And with what I've seen, you know, from my perspective, as is just there are more and more demands on physicians and healthcare providers. And sometimes the person who gets lost in the mix of the healthcare team is really the most important member, which is the patient.


You know, one of the things that I thought was really interesting about the intro of your book about the nurse practitioner is, you know what, without a lawsuit, the truth about this nurse practitioner, and that type of the facts surrounding that would be would be shielded. And in fact, that's exactly how you have for example, in the case of in Dallas with Dr. Duntsch, Dr. Death, that's how those cases came about. Because there are so many privileges with hospitals about how credentialing is done, how hiring and the peer review process and the hospital committee process is shielded from public view that really without litigation, and so and even then it's tough, you know, these facts don't come out. So even though I have I handle health liability claims for patients, I really view doctors, hospitals of those who have the best interest of patients in mind, it really is allies rather than adversaries philosophically.


Rebekah Bernard MD 05:31

You mentioned that you see some of the same things over and over again, can you talk about what some of those issues are?


Robert Painter 05:38

Well, in terms of nurse practitioners, and physician assistants, I'll throw out also

certified registered nurse anesthetist, which are also these advanced practice nurses, similar to nurse practitioners, is you see, really, in my view, these mid-level providers - I'll still refer to them as that - as having a shocking degree of autonomy without proper training.

Mid-level providers - I'll still refer to them as that - have a shocking degree of autonomy without proper training.

And you know, I was just looking at one today we're working on a case up in a Texas case. And we're looking into this situation where you have a nurse practitioner who makes an entry on a medical record as an intensivist. That's pretty interesting to me to say you have a nurse practitioner intensivist, as an intensivist by definition is a critical care specialist, who really as extensive training on treating the most acutely or chronically ill patients. And needless to say, in that case, the nurse practitioner intensivist blew it and saw a patient who was really, really acutely ill. And just within minutes of her evaluation of the patient in the emergency room, he had an arrest and was resuscitated but was left with a permanent brain injury. That situation you start looking into as you go over and over and over on it. But you start looking into the backgrounds of the training, what qualified this person to be an intensivist you know, the person who's seeing a really ill person so ill that emergency room physician is ordering in consultation with a with the ICU and ICU admission. What qualifies that nurse practitioner? Well, this one in particular had an online degree. So, you look at a for profit online degree. And you're looking at, you start digging into it and saying, 'Well, what exactly qualifies this person?' It's unclear that there was much of any clinical emphasis at all. And you see that over and over.

But you start looking into the backgrounds of the training, what qualified this person to be an intensivist you know, the person who's seeing a really ill person so ill that emergency room physician is ordering in consultation with a with the ICU and ICU admission. What qualifies that nurse practitioner? Well, this one in particular had an online degree. So, you look at a for profit online degree. And you're looking at, you start digging into it and saying, 'Well, what exactly qualifies this person?' It's unclear that there was much of any clinical emphasis at all. And you see that over and over.

There's another case that to go over to the physician assistant side of physician assistant who was tasked to see neurosurgery console so level one trauma center. So, you have a guy that is that hits a tree at 65 miles an hour, head and spine surgery is consulted. And a PA shows up I suppose to the PA and her level of supervision by the neurosurgery, rather the spine surgery service, was exclusively through text messaging. Would you want to have if it's you or your loved one in a hospital that has a loss of sensation and extremities, that slowly moving upward? They finally get a spine surgeon consult and you have a PA show up is texting the spine surgeon? No way. And we see that though, over and over and over again.


Niran Al-Agba MD 08:41

So I guess my question, you know, it's interesting, I just had to renew my hospital, I'm on staff with a number of hospitals to children's hospitals. And I got this funny email recently about well, you haven't admitted enough patients to our hospital. And so, because of that, you know, you can't have privileges. And of course, I called and explained that I would be calling a lawyer and I just wanted to find out why after 20 years, this is a kind of a new thing. And within a couple hours, you know, they called me back and said, 'oops, it was a big mistake.' You know, you're good. So, I guess the reason I'm bringing that up is they have all these kinds of funny, esoteric things they want to do to doctors, you know, gosh, I'm not admitting enough patients during COVID, which I okay. And so it's a question so my question is how does like I couldn't get neurosurgery privileges? Right? I couldn't get intensivist privileges and I'm not complaining about that. But my question is, how does the PA get intensivist privileges? How did they - How did they allow this or because I guess I don't even understand I how.


Robert Painter 09:41

I don't really have any clue. You know, from a again, from a background as a former hospital administrator. I don't know how we got to this place. Other than you know, you could look at it and analogize it to - there's a problem in medicine. When you have administrators who aren't physicians making calls on the way medicine is practiced just the same way when you have judges who aren't trained in medicine, science statistics, or anything, making these determinations on a lot of things, and we'll talk about that later.

There's a problem in medicine. When you have administrators who aren't physicians making calls on the way medicine is practiced just the same way when you have judges who aren't trained in medicine, science statistics, or anything, making these determinations on a lot of things.

But you know, I think what happens is this is it goes back to is you're saying, hey, the credentialing or re credentialing for physicians the process of how you can get permission to practice our hospital, they look at you not really, as independent physician with independent duties to the patient, but they look at you as a revenue center. If you aren't generating enough revenue, then what's the problem? You know, and and I think when you look at it really with the mid-levels, is mid-levels - which used to be called another term was physician extenders - is they were a way to basically allow physicians, in theory to be able to see a lot more patients. And I think what they're doing is, it's really hard to rationalize how this makes sense in terms of patient care, because in my view, the solution is you, you put more qualified physicians or the medical staff, and then you can use the mid-levels to, to handle things to assist under appropriate supervision. But what they've done is just in a way, they're looking at to the hospital, there's a lower overhead, a lower expense to have a nurse practitioner, physician assistant. And then if you have them having independent practice authority, they can order all the tests and all the Diagnostic Imaging, Lab work, and all the other things that end up making the hospital lot of money. And I think that's really the answer. It's a financial driven decision.

Mid-levels - which used to be called another term was physician extenders - is they were a way to basically allow physicians, in theory to be able to see a lot more patients. And I think what they're doing is, it's really hard to rationalize how this makes sense in terms of patient care, because in my view, the solution is you put more qualified physicians on the medical staff, and then you can use the mid-levels to handle things to assist under appropriate supervision. But what they've done is just in a way, they're looking at to the hospital, there's a lower overhead, a lower expense to have a nurse practitioner, physician assistant.

What I expect, as you know, it seems like they're these trends that happen in healthcare and, and they'll last 10 years, and then you figure out, it doesn't work, and then you go back to it. But the problem is in this one, it's to me an existential crisis, because it's demoralizing to physicians, I think you know, you don't have to go much farther than Med Twitter, just to see the type of therapeutic venting that goes on there of things that, you know, what are we doing here? You know, and I really feel bad about that.


Rebekah Bernard MD 12:22

You know, you mentioned lower overhead. And one of the elements of that is that nurse practitioners typically have much lower malpractice coverage, and their malpractice tends to be much less expensive. Do you find that it's more difficult to get your clients justice if they've been harmed by a mid-level practitioner because of those limitations?


Robert Painter 12:44

Well, so in general, what I can comment on that from a Texas perspective, because most of my cases are in Texas, and one of the things that I would even say, you know, without delving into that third rail of vaccines and COVID, but even the federal, the feds, the President Biden, and other policymakers at the national level would be well advised to remember that health law policy is really a state law consideration. It's not a federal thing. It's reserved to the States. Well, you know, in some ways, and in pandemics, it would be convenient to have a national policy, but you know, in general, you have 50 states with 50 different sets of laws. Like for example, in Texas, really the coverage of mid-levels is not really that different from physicians. So, part of that could be tort reform and part of it is really practice area dependent.


But one of the things that I think has been mucked up in some jurisdictions is what exactly is the responsibility of a mid-level provider when something goes wrong? Now typically what I've encountered, and I could give examples of many, many, many anesthesia cases, where you have physician anesthesiologists who have extensive anesthesia and critical care training, and then you have certified registered nurse anesthetists who are mid-level providers, who have a lot less training, usually when there's a case where there's an adverse outcome that we think is related to negligence, we'll name both the anesthesiologist and the CRNA. They're usually employed by the same practice group, and they usually have the same insurance. In most cases. Almost all the cases though, despite you read on Twitter, or LinkedIn about how brilliant and capable the CRNA is evaporates very quickly when you depose because then it's a matter of they're depending on the anesthesiologist, although occasionally you'll get some that that'll stick with it.

Almost all the cases though, despite you read on Twitter, or LinkedIn about how brilliant and capable the CRNA is evaporates very quickly when you depose because then it's a matter of they're depending on the anesthesiologist, although occasionally you'll get some that that'll stick with it.

But in terms of the coverage, I think there's something that you have to look at with nurse practitioners and CRNAs. People like that because they come from really a different is an odd because it's really an odd creation of law, where you have people who were really being allowed to practice medicine at some level, who have no medical training whatsoever. They come from a different and entirely different discipline, a nursing discipline. And I know you all know that very well. But a lot of people don't want to judge us, a lot of attorneys don't understand it. Under Texas law, for example, the Board of Nursing is very clear, and regulating nurse practitioners that there are some functions that nurse practitioners do that are nursing functions. There are some functions that are medical functions. And so, in the cases that I handle involving nurse practitioners, I'm very careful with the experts that we use to delineate which is which, because that's really an important distinction.


Niran Al-Agba MD 15:50

Well, and I'm glad you brought that up. Because I think, like you said, it's state dependent - Washington is a great example. You know, nurse practitioners are pretty much independently working, actually they are, they're fully independent. And so many people bring up to us this, this fact that when they are practicing nursing, so many of those practitioners are just simply practicing nursing versus the doctors are simply practicing medicine. And so there's this idea, and I know, we've listed a few of the cases, you know, I think it's Kaiser, and then there's the Lattimore versus Dickey case, those aren't in Washington, per se, but this idea that nurse practitioners, you know, you have to use an expert, that's a nurse practitioner to testify against standard of care for a nurse practitioner, and vice versa physician against a physician, and we're seeing some of these cases where that's not true.


Can you talk a little bit more about that just as a general rule, because people will first say you can't testify against a nurse practitioner, and I'm finding in some of the legal work, I'm doing that actually, there's a number of ways you can talk about it, because they're doing my job, for example, if you're serving as a pediatrician, you know that difference?


Robert Painter 16:51

Well, and it's a great point. So, my, the way - this is a typical lawyer answer, well, it really depends, right? So then where you look at it in whatever state you're dealing with, you know, for example, as an expert witness, the lawyer, the physician expert would need to look at what does the law say? So, what I would look at any time that I look at, you know, for example, just yesterday, or Friday, today, I was working on a case involving a nurse practitioner, that nurse practitioner who was an intensivist, and but was not really anyway, it's a whole different story. But I go back and look at it, I re review what does the nursing board say, in this? In this case, it's Texas. So, I look at what does it say. And then what you want to do is you look at what you need to do to qualify an expert to testify as to the standard of care, that's really the standard of care is set by the licensing agencies. So, for a nurse practitioner, it would be the in Texas, the Board of Nursing, for a physician assistant in Texas would be the medical board.


And you look at what it is now in Texas, we have kind of a bifurcated system, where you have to have Initial reports that kind of our threshold reports the define the standard of care, that determined that just gives fair notice the other side what's going on, and then satisfies the court that the claim has merit. Those are very regulated. Once you pass that hurdle you go in and you have your full case, some of the cases that use you sent over where those initial threshold reports. And one of the things is that you look again at the statute, each state regulates what's an expert in Texas, you look exactly at the statute, and what is the statute say?


So, our statute says, which is civil practice code section 74, in terms of looking at who qualifies as an expert sections for physicians and healthcare providers. So, it's interesting right there in my book, it's a no-no to call a physician, a health care provider, you aren't a provider, you're a physician. Okay? So, there's, that's a different thing. Right? Okay. There's a separate section for other people who are non-physicians, they're called providers, okay. So, you look at it and in our law to testify against a physician, you have to be a physician. Okay. It reminds me of the old Sesame Street things, the boxes, things that are different aren't the same, which one of these is different? Okay. So yes, the nurse practitioner, yes, the PA Yes, the CRNA. They can do some things, but you don't get to testify against a physician under Texas law period. Okay. Second thing, you don't get to testify as to causation. In other words, you can't say what error occurred and what caused harm, aren't allowed to do it. Okay. You go to the statute, though, about health care providers.


And it's kind of interesting, and there's actually one cases that you emailed about, or we discussed is the Simonson case. And there's a later case that's called San Jacinto Methodist Hospital versus Bennett. And it's a 2008 case out of Houston's 14th Court of Appeals. I love this case, because, you know, I use it a lot. And it's a case that explains why under the law, a properly written report from a physician can provide opinions as to the standard of care for a nurse practitioner, or a physician assistant. And again, it gets back to looking at exactly what the licensing authorities say, nurses, advanced practice nurses, they practice primarily nursing, not medicine.


Under Texas law, they're allowed to perform certain tasks that have to really be policed in written agreements of supervision from a physician. The same is true for physician assistants. And so you look at it and the question is, again, under Texas law that varies by state, the question is, under Texas law, when there's an opinion as to a health care provider, you could have that opinion on standard of care come from another health care provider, ie a non-physician, or you can have it from a physician who's familiar with the those same issues that are at play in the case. So like in this Methodist Santa Methodist versus bad case, what the court said is the expert report there, who was a physician internist. And what the Court of Appeal said, ‘well, of course, the internist physician's report comes flat out and says that he is responsible for in this case,’ it was a decubitus or pressure ulcer case, that of course, he understands what the standard of care is for a nurse practitioner, for a physician assistant to care for those. So, he has that expertise. And the court said, ‘of course,’ yeah, it flies. So absolutely, you can do it. But in each state, there's going to be there will be different authorities, and you have to start with it, and say, well, what is the licensing authority? Say, what are PAs, what a nurse practitioner is allowed to do? And then what is the definition of an expert. So, without those definitions, you can't really say.


Rebekah Bernard MD 22:28

Robert, have you represented anyone in a state where nurse practitioners have independent practice or full practice authority, I'm just wondering how that plays out as far as the medical legal issues and responsibilities?


Robert Painter 22:42

I cannot think I cannot think of a case now where there was a mid-level in a state, you know, outside of Texas, we've had a number of cases with hospitals, and you know, regular RNs, and physicians, but I can't think of that. Now. Again, though, what you look at it, though, in any state, what you want to have, is an attorney who's experienced in handling health litigation claims, which is very different, because the types of experts that you need will be different.


If I were looking, for example, in Washington state, which is one of those unfortunate places that have, you know, unlimited mid-level authority. So anyway, you have this as this growing trend, what I would look at it there is, you know, there has to be a definition, there's a licensing authority, that says what those mid-levels are allowed to do, again, as incredible as it is, to me, even in a state like Texas, which limits nurse practitioners, you have a nursing board, granting authority to a non-physician, someone with no medical training whatsoever, to practice medicine within a box. It really doesn't make any sense.

There's a licensing authority, that says what those mid-levels are allowed to do, again, as incredible as it is, to me, even in a state like Texas, which limits nurse practitioners, you have a nursing board, granting authority to a non-physician, someone with no medical training whatsoever, to practice medicine within a box. It really doesn't make any sense.

But you have to look at what that says under Washington law, we would look at those rules and regulations and see what's allowed. And then I still think that there would be an argument to be made that, you know, in terms of looking at what like, for example, this this pressure sore case, the type of argument that I use in appellate courts or in trial courts, really, that when invariably is there's a standard of care that substantially developed among different disciplines.


So that could be there are some areas that you think about it. For example, in using the COVID situation, you're going to have ER physicians, pulmonologists, critical care physicians, mid-levels, that in certain issues are going to follow the same standard of care, you're going to have more advanced people that have a higher level, but there's going to be that overlapping thing. So, in the expert, the experts I work with I encourage inclusion of language in the reports of things like this. Well, if they're giving an opinion, for example, on nurse practitioner, the standard of care on the specific issue in this case is substantially developed in the field of whatever my medical specialty is plus nurse practitioner or PA, training for this particular type. And, and that work. So, if I were to look at a case in Washington again, the way I would look at it is I would go straight to, if it's a nurse practitioner case, go to the Board of Nursing rules, you'll look at it. And that's how you have to thread that needle. But it's very, always a very careful thing.


Rebekah Bernard MD 25:38

You mentioned how basically, this is a license that's been granted to practice medicine to nurses, by legislators, and I've had physicians come up to me and say, why can't we just sue the legislators for allowing this to happen? Is that completely outlandish? Is there any kind of role for action like that?


Robert Painter 25:58

Well, it's not, it's probably not any more outlandish than letting nurse practitioners practice medicine. But it just really, though, it's not allowed, you know, the legislators have the legislative immunity. What is allowed is to replace those legislators with people that are more informed. Have you ever thought also about this contradiction or paradox in the arguments that a physician cannot testify as the standard of care of a nurse practitioner who is practicing about that, practicing to a degree medicine, and I'm allowed to do that, but a physician, who is really practicing medicine, is not allowed by law to testify as to my standard of care? I mean, it's an absurd proposition. And I think these really need to be challenged and pushed back.

Have you ever thought also about this contradiction or paradox in the arguments that a physician cannot testify as the standard of care of a nurse practitioner who is practicing to a degree medicine, and I'm allowed to do that, but a physician, who is really practicing medicine, is not allowed by law to testify as to my standard of care? I mean, it's an absurd proposition. And I think these really need to be challenged and pushed back.

And I'll tell you another thing, really, that I would encourage, in terms of physicians, is hopefully about the supervision you're given. You're giving, you know, because it's under these. Well, for example, in Texas, it would I'm not, I'm not trying to be completely anti midlevel, because they have a role with supervision. But if you look at the unfettered practice of medicine, by people who are not physicians, in a state like Texas, it could end tomorrow if all physicians just terminated the supervision agreements. So, you don't have to do that.

If you look at the unfettered practice of medicine, by people who are not physicians, in a state like Texas, it could end tomorrow if all physicians just terminated the supervision agreements.

Now, of course, then the mid-levels may go to legislation say well give us yeah, let's adopt

the Washington model. And I think I don't think politically that would fly in Texas. But these are some things that, you know, we didn't get in any of these jurisdictions, you didn't get there overnight. It was a gradual erosion.


Niran Al-Agba MD 27:43

And my question was going to sort of be about what do you say to people who probably have lumped you in with many of us that are told that we're anti middle level, or we're jealous, or I mean, you name it, you know, our egos are hurt, or they're, they're, I think the ANP said that our book, we were mad that we were losing money, I mean, they'll come up with anything, instead of patient safety, of course, which is our number one priority. So, you know, what do you say to those who just say, well, you're just the lawyer who hates nurse practitioners, then, and that's it, you must have doctors in your family, and you're against them losing their, their piece of the pie?


Robert Painter 28:17

Well, it's always funny, because every time I write an article, one that touches on a mid-level issue, I get hate mail, you know, from the nurse practitioners, or whoever's, actually, the CRNAs are the most vicious. And usually, my response is just to write another article about, you know, the topic and but I think that the solution to misinformation is more correct information. But as I you know, as always, when I engage whether which I really don't do that often, but what I would say is this, you can look at it is we look at cases of meeting me in my profession, I look at cases, our office looks at cases based on patient safety lapses. And sometimes those are physician cases. Sometimes they're mid-level, sometimes their hospital, what I would call system cases, and wherever the truth is, is where we go. And so, I don't have a practice that's limited to mid-levels.


I think that mid-level, what I guess the phrase that I like for the scope creep, and the scope of, you know, in my preference, I think the best model for patient safety is to have mid-levels as physician extenders to help on the lower acuity type things. But as scope creep happens, and you have more autonomy of people with less training, it's bad for patients and you're going to see it over and over and over. You're gonna see these bad outcomes and you know, so when I tell people when they you know what, usually what I'll get in the hate mail from after speaking or giving an article writing an article or something about it is, well, you must you have something against a mid-level.

I think the best model for patient safety is to have mid-levels as physician extenders to help on the lower acuity type things. But as scope creep happens, and you have more autonomy of people with less training, it's bad for patients and you're going to see it over and over and over. You're gonna see these bad outcomes.

So, what this looks at the sense that we file we sue, you know, a wide variety of cases of hospitals, physicians, whoever. It's not saying these are terrible people, but it's just, it's about patient safety. I think we will see in the next 10 years, a lot more suits against mid-levels, because you're going to see you see more and more autonomy. What I always challenge with mid-levels who come to me with because they typically have that is the say, you know, for example, the CRNAs, though I'll see this, well, we've done these studies, where CRNA care is actually not equal to but better than physician anesthesiology care. And so, we're really, who wrote the study? Well, lo and behold, it was a CRNA Association. Okay, let's get let's get real here, you know, and those type of situations are kind of amusing to me,


Rebekah Bernard MD 30:59

in our last few minutes, just wondering, what advice do you have for physicians to be able to work together with our attorney colleagues to help our patients get justice?


Robert Painter 31:08

Yeah, I think that, you know, one of the things that's important is to be informed about what's going on in your state legislatures. And, and speaking up about it, you know, physicians still have a lot of respect in state legislatures. And, you know, I'll say this as, as someone who comes from former healthcare background, working with a lot of physicians having a lot of doctor friends, doctors are notoriously ill informed about what's going on politically. And really, it's until it bites them. And so, you want to stay out ahead of it.

I'll say this as, as someone who comes from former healthcare background, working with a lot of physicians having a lot of doctor friends, doctors are notoriously ill informed about what's going on politically. And really, it's until it bites them. And so, you want to stay out ahead of it.

And I also encourage physicians to intern terms of patient safety. And I wrote about today about a case up at the University of Pittsburgh Medical Center, where there was a whistleblower who was a physician on the medical staff there who revealed some really alarming things that were going on and in patient surgery scheduling, and the US government ended up intervening in the lawsuit there and it's a very serious matter. So, what I would say is this, there are things that physicians have unique perspective to see if you see something that's against patient care, speak up. That's actually what like in the Doctor Death case, what led to that, getting to the medical board as a physician, in the operating room saw a surgeon he felt this guy's skills are so unskilled, he can't even be real. Well, maybe that's something that physicians rather than just ranting on Twitter, could speak up and do something about and the same goes true with physician assistant nurse practitioner supervision. When you see it, speak up, do something about it.


Rebekah Bernard MD 32:50

Thank you so much. I want to thank our guest Robert Painter - we will have the link to his law firm in the show notes. So, thank you so much for joining us. If you'd like to learn more about this issue, we encourage you to get our book. It's called patients at risk the rise of the nurse practitioner and physician assistant in healthcare. It's available at amazon.com and at Barnes and Noble, please subscribe to our YouTube channel and our podcast. It's called patients at risk. And if you're a physician, we'd love for you to join our group physicians for patient protection. Thanks so much. We'll see you on the next podcast.

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