NP doing pain procedures

[nvrsumr]

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So I had an MA come interview for a job today. She said the NP at her previous practice was doing facet and epidural injections in the above chiro clinic. Note on the first page it mentions the NP and internist have training in procedures.

What is the best way to have this practice investigated? Supposedly the procedures are done by the NP under the supervision of the internist.

 

[nvrsumr]

Update- I was informed by the "state medical board" to report the issue to the nursing board and they will determine if outside of the scope of practice of a NP.....

I filed a complaint with the nursing board.

 

[geauxg8rs]

within 10 minutes of your complaint the nursing board will now deem this practice a "nursing center of excellence". they will likely put your complaint in their circular suggestion box.
This is the problem where NPs are regulated by nursing boards and when they start practicing medicine the nursing boards dont do anything. the medical board is powerless.

 

[Ducttape]

ive heard procedures being done by CRNAs as being part of their scope of practice...

then again, she may only be doing joint injections/trigger point injections, which may well be under the scope of a nurse practitioner in her state.


what concerned me as much... they are apparently a spine center, but they are really first and foremost a chiropractic center.

maybe its just me, but im a little concerned when their intake form asks about previous med management, specifically: hydrocodone, fentora, dilaudid, magnacet, oxycodone, darvocet, methadone, fentanyl, morphine, opana, oxycontin... then Cymbalta, Lyrica, skelaxin, flexeril, soma.

No NSAIDs, no TCA, no gabapentin, (no topiramate, depakote or trileptal either, for a pain clinic)...

 

[DrAwsome]

within 10 minutes of your complaint the nursing board will now deem this practice a "nursing center of excellence". they will likely put your complaint in their circular suggestion box.
This is the problem where NPs are regulated by nursing boards and when they start practicing medicine the nursing boards dont do anything. the medical board is powerless.

Why the heck are we so powerless? When did we become so powerless? After all we are an essential part of the healthcare system are we not>

 

[facets]

Nurses define the practice of nursing which includes everything including cardiac bypass, just ask them, 3/4 of our training is not neccessary. They are so much better, cheaper, smarter, just ask them

 

[geauxg8rs]

We are told that nurses will fill in the gaps in rural areas.
The poor underserved souls wandering through the wilderness who have to travel many days by foot to the big city to see the doctor.

This "spine" center is in the rural area of Denver. Hardly the underserved area that needs Noctors.

 

[Aether2000]

I think medicine needs its own "Star Chamber"

 

[nvrsumr]

I am pretty fired up about this. The center is in a suburb of denver and there are probably 7 fellowship trained pain docs within 10 miles....

I am wondering if I should file a complaint with the medical board about the internist "supervising" this NP?

 

[DrAwsome]

I am pretty fired up about this. The center is in a suburb of denver and there are probably 7 fellowship trained pain docs within 10 miles....

I am wondering if I should file a complaint with the medical board about the internist "supervising" this NP?

Yes, you should. If nurses are going to be doing doctor type procedures, then they need to go to medical school and become doctors. If internists are doing anesthesia procedures, they should definitely be investigated. Greed is killing our profession!

 

[PinchandBurn]

I am pretty fired up about this. The center is in a suburb of denver and there are probably 7 fellowship trained pain docs within 10 miles....

I am wondering if I should file a complaint with the medical board about the internist "supervising" this NP?

Nvrsumr-

You trained at a great place. So you have credibility.

Here's what I woudl do in your situation. Call up all 7 of the pain docs in that region. Then really collectively file these complaints to both boards. This is really a scam.

Additionally dont stop there. Find out if she has priveleges at a hospital. if she does then that's a pretty easy fix to block them at the hospital level (tlk to the chief of anesthsia, who is typically over giving priveleges).

Dude, then I would do other htings that require a little cash. Like making PCPs , surgeons aware of this nonsense. Also, put up fliers/posters in the area, asking questions like, "is you pain doc fellowship trained? is he/she eve a doctor. who do you want placing needles next to your spine and doing injections that COULD paralyze you'.

I think we really need to roll out more vivid signs like this, thats when the public will actually take notice.

Whatever you do, do it NOW, before the roots grow. I would recommend getting those 7 others together and even contacting Manchikanti about this [email protected]

 

[Ducttape]

i would first find out what procedures they are doing, as i mentioned previously. there is noone who is pain certified at that clinic. if they are truly doing "pain procedures" above and beyond tpi's, then they should be reported.

and one other place that it might be beneficial is to report them to cms, if they are billing insurance for procedures they are not certified to do.

 

[PinchandBurn]

i would first find out what procedures they are doing, as i mentioned previously. there is noone who is pain certified at that clinic. if they are truly doing "pain procedures" above and beyond tpi's, then they should be reported.

and one other place that it might be beneficial is to report them to cms, if they are billing insurance for procedures they are not certified to do.

find out if they have fluro?

I betcha anythng those quacks are doing 'si joint injections'. If they are and they dont have fluro, it's fraud!

Finally, I would also threaten the one MD in that 'group'. She'll I'm sure be more responsive if you warn her that she will be reported ot the MD board. She will then stop 'overseeing' the NP.

 

[Jcm800]

As soon as there is a complication, the NP and Chiro will point their fingers at the "supervising" MD, they didn't "know any better"

 

[jettavr6]

find out if they have fluro?

I betcha anythng those quacks are doing 'si joint injections'. If they are and they dont have fluro, it's fraud!

Finally, I would also threaten the one MD in that 'group'. She'll I'm sure be more responsive if you warn her that she will be reported ot the MD board. She will then stop 'overseeing' the NP.

The NP is leaning on the fluoro machine in her picture on the website

 

[joshmir]

This goes on in Arizona as well in the phoenix area; I have seen the charts

 

[DOctorJay]

Looks like on August 16, 2009 CRNAs were teaching cadaver courses on vertebroplasty and neuromodulation...

http://www.painmd.com/attachments/326_conference-brochure-FINAL.pdf

 

[PinchandBurn]

Looks like on August 16, 2009 CRNAs were teaching cadaver courses on vertebroplasty and neuromodulation...

http://www.painmd.com/attachments/326_conference-brochure-FINAL.pdf

wow these MDs/DOs associated with this are teh biggest sell outs of the profession. They should really be banished from our Interventional Pain Mgt PHYSICIAN societies. These guys are the ones that opened the flood gates.

 

[DOctorJay]

One of these guys lists himself on his website as an ASIPP member. Email to Lax?

 

[PinchandBurn]

One of these guys lists himself on his website as an ASIPP member. Email to Lax?

definitely

 

[DrAwsome]

Nvrsumr-

You trained at a great place. So you have credibility.

Here's what I woudl do in your situation. Call up all 7 of the pain docs in that region. Then really collectively file these complaints to both boards. This is really a scam.

Additionally dont stop there. Find out if she has priveleges at a hospital. if she does then that's a pretty easy fix to block them at the hospital level (tlk to the chief of anesthsia, who is typically over giving priveleges).

Dude, then I would do other htings that require a little cash. Like making PCPs , surgeons aware of this nonsense. Also, put up fliers/posters in the area, asking questions like, "is you pain doc fellowship trained? is he/she eve a doctor. who do you want placing needles next to your spine and doing injections that COULD paralyze you'.

I think we really need to roll out more vivid signs like this, thats when the public will actually take notice.

Whatever you do, do it NOW, before the roots grow. I would recommend getting those 7 others together and even contacting Manchikanti about this [email protected][/QUOTE

Agreed! definitely put pressure and start emailing. And like another poster said, reaching out to the MD and telling her she's going to be reported will likely get more reception than anything else. And by reception I mean action.

 

[Ducttape]

the funny thing...

booking a room at the "Hampton Inn" for this pain course.

compare that to the typical hotels one books for for a "real" conference.

 

[nvrsumr]

Update

Had a new patient who had cervical facet injections by this nurse.

No follow up from the nursing board.

No response to my email to Lax.

No interest by my local colleagues to get involved.

 

[DOctorJay]

One of these guys lists himself on his website as an ASIPP member. Email to Lax?

Done. Awaiting response.

 

[sjohnson321]

just out of curiosity any updates?

 

[emd123]

Update

Had a new patient who had cervical facet injections by this nurse.

No follow up from the nursing board.

No response to my email to Lax.

No interest by my local colleagues to get involved.

Just curious, did they use fluoro or was it some blind sham injection?

 

[clubdeac]

What about the state medical board? How can u suggest to cms to do an audit?

 

[nvrsumr]

Update:

I got a response last week from my state medical society and their attorney is reviewing. The same day I received a leter from the state nursing board stating they are reviewing and it may take several months for a resolution.

 

[foxtrot]

Anything yet from ASIPP? It is funny, because I got an email today asking to notify them of advanced practitioner nurses doing pain management and any poor outcomes. Keep us updated because with the new CMS language, CRNA's are going to be allowed to do interventional pain management. So glad I spent that extra year of traning learning how to drive a needle, place SCS, place and fill intrathecal pumps, and position the fluoro machine, when I could have taken a weekend course. WTF is going on in medicine.

 

[PinchandBurn]

Anything yet from ASIPP? It is funny, because I got an email today asking to notify them of advanced practitioner nurses doing pain management and any poor outcomes. Keep us updated because with the new CMS language, CRNA's are going to be allowed to do interventional pain management. So glad I spent that extra year of traning learning how to drive a needle, place SCS, place and fill intrathecal pumps, and position the fluoro machine, when I could have taken a weekend course. WTF is going on in medicine.

i agree it's ridiculous!

whoever on here that had seen notes from a Xray tech doing an epidural or whatever while the radiologist was 'observing' should send that in to ASIPP.

THat's also nonsense.

 

[facets]

Yeah that was me. I had records documenting several TFI s by an XRay tech under CT and dutifully sent copies to the Arizona Medical Board in December or November, ASIPP, ASA, AZ ASA, ISIS, so far the response is -nothing. Nobody appears to be able to intervene and I got another patient who had a TFI from the same tech in June so apparently he is still doing this with no consequences. The entire medical establishment is sitting around with their &icks in their hands while the techs run wild.

 

[painstop]

So did the new CMS resolution come out already?

 

[PMR 4 MSK]

Yeah that was me. I had records documenting several TFI s by an XRay tech under CT and dutifully sent copies to the Arizona Medical Board in December or November, ASIPP, ASA, AZ ASA, ISIS, so far the response is -nothing. Nobody appears to be able to intervene and I got another patient who had a TFI from the same tech in June so apparently he is still doing this with no consequences. The entire medical establishment is sitting around with their &icks in their hands while the techs run wild.

Medical boards are only interested in making it look like they are corralling wild docs, not midlevels. If a doc gets a comlpaint, many boards go after them with a vengence. But since many state boards don't oversee midlevels, they don't care, "not my jurisdiction."

 

[jsaul]

Medical boards are only interested in making it look like they are corralling wild docs, not midlevels. If a doc gets a comlpaint, many boards go after them with a vengence. But since many state boards don't oversee midlevels, they don't care, "not my jurisdiction."

this is exactly right all the while they charge docs high fees to maintain licenses in their respective states so that the board adminstration officials get paid a nice heft salary