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Avoiding Malpractice: A Case Analysis
A Twist on the Consequences
of Not Following Payer Rules
Carolyn Buppert, NP, JD
I
am apprehensive when I hear about nurse practitioners who practice in organi-
zations that have not dotted every "i" and crossed every "t" to conform to the
letter of the law when it comes to rules about provider supervision, board cer-
tifications, and Medicare and Medicaid payer rules. Everyone may be blissfully ig-
norant—until something goes wrong. Here is a case that justifies paying attention
to all these legal details.
CASE
A teenager was having behavior problems in school and the school referred her to a
mental health clinic for counseling. Medicaid covered the girl's healthcare. The school
notified the parents that the girl would not be allowed to take classes unless she saw
a psychiatrist.
At the clinic, the patient was referred to a cli-
nician, "Dr. O," who is a nurse practitioner.
The NP diagnosed bipolar disorder and
prescribed oxcarbazepine, an anticon-
vulsant. The girl had an adverse reac-
tion to the medication. Her parents
tried to call the NP twice, but phone
calls were not returned. The parents
decided to stop the girl's medication,
and she had a seizure, which required
hospitalization. After speaking with the
NP, the girl resumed the medication. Five
months later the girl had another seizure and died.
The parents filed complaints with various state agen-
cies, and, in doing so, learned that the NP was not a psychiatrist. State regulations re-
quire that a psychiatric NP be supervised by a board-certified psychiatrist and that
Inside
Avoiding Malpractice ...... 1
Diagnostic Challenge........ 5
Review Courses ................ 8
Certification Q& A ............. 9
Update: STD Treatment
Guidelines.........................15
News Briefs ..................... 19
2015 Live Courses
Pharmacology Update
(2-day course)
The Art of Wound Repair
(1-day course)
NP Essentials
(4-day course)
NP Certification
Exam Review
Course Tracks
Family, Adult-Gerontology,
and Adult Primary Care
Adult-Gerontology
Acute Care
Pediatric Primary Care
Psychiatric-Mental
Health
Women's Health
Fitzgerald Health Education Associates, Inc.
fhea.com Committed
to the success of nurse practitioners
1
Fitzgerald Health Education Associates, Inc. 978 •794 •8366 Volume 15, Issue 6, June 2015