NP pill mill

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Yet another pill mill I saw recently on Facebook. They are marketing very effectively. Lots and lots of pill mills popping up lately, esp. with telepsych.

Name - Hello Ahead

Yes, search for it... "links provide credibility", says the moderator

 

[calvnandhobbs68]

IDK if pill mills will ever go away though. There’s always gonna be people who figure out they can make a quick buck by using their ability to prescribe controlled substances. It used to be clustered in certain states with lax enforcement. Now with telepsych/telemedicine it’ll be a bit less clustered but it’s the same old stuff we saw before.

Don’t forget that it was mostly licensed physicians who ran these pill mills before. Can’t say doctors are soo much better in this regard although I will say that it opens up the prescribing pool to a degree that we probably have a lot more bad actors to worry about.

Edit: and check it out, they have 3 “physician advisors”. Don’t worry there’s always gonna be plenty of docs willing to sell their access to controlled substances.

 

[finalpsychyear]

Seeing this nonsense I just shake my head and thank god I won't have to keep seeing what we have created for all that much longer. Are NPs allowed to prescribe in canada or australia I wonder? If not, I am heading there in 10 years probably around the time they start doing surgical procedures in the good ole USA.

People on this forum do realize that the Amazon's and Walmarts and every XYZ pharmacy out there is drooling at the bit to get in on healthcare visits and procedures.

Dont' be suprised if their lobbying efforts (pouring money into certain political candidates) essentially allows 100% autonomy for anything a MD including surgical fields can do. In fact, the fact that it has already gotten to this degree this quickly it is very likely to happen now and has everything with lobbying money going into the right pockets.

 

[TexasPhysician]

If not, I am heading there in 10 years probably around the time they start doing surgical procedures in the good ole USA.

I read about an interventional cardiology NP recently.......

 

[finalpsychyear]

I read about an interventional cardiology NP recently.......

I know of some doing endoscopy and colonoscopy... the end will come like a thief in the night.

 

[reca]

I know of some doing endoscopy and colonoscopy... the end will come like a thief in the night.

Yeah, Hopkins has a "GI Fellowship" for NP's. This sentence in particular stands out:

"The Practitioner Fellowship Program is integrated with the Division's Gastroenterology & Hepatology Fellowship Program for physicians, so that first-year fellows in both programs receive comparable training experiences."

 

[finalpsychyear]

Yeah, Hopkins has a "GI Fellowship" for NP's. This sentence in particular stands out:

"The Practitioner Fellowship Program is integrated with the Division's Gastroenterology & Hepatology Fellowship Program for physicians, so that first-year fellows in both programs receive comparable training experiences."

10 years ago no one would believe that they would gain scope of practice to do this and now look. Im just glad i take nothing for granted and work fairly hard. I do worry about the upcoming gen of docs who are med students and starting residents. Those at the end of residency are also in the clear imo.

 

[splik]

10 years ago no one would believe that they would gain scope of practice to do this and now look. Im just glad i take nothing for granted and work fairly hard. I do worry about the upcoming gen of docs who are med students and starting residents. Those at the end of residency are also in the clear imo.

scope of practice for GI sounds like a bad pun!

 

[Liquid8]

Seeing this nonsense I just shake my head and thank god I won't have to keep seeing what we have created for all that much longer. Are NPs allowed to prescribe in canada or australia I wonder? If not, I am heading there in 10 years probably around the time they start doing surgical procedures in the good ole USA.

Psych NPs aren’t really a thing in Australia.

NP training here is a relatively recent thing, and quite demanding - to the point that it’s not often financially viable for a nurse to obtain the extra qualifications needed. They need to have worked at basically the top of their speciality field for a number of years (for psych this means senior roles like inpatient unit manager, community team leader or independent CL nurse) before being eligible for the NP Masters. These senior nursing roles are salaried and at the upper end of nurse earnings, so any decision to return to part time study is already a pay cut.

But say they do get through, and decide to specialise in psychiatry (my gut feeling is that the features that make psychiatry and mental health unpopular as a career for doctors also apply to potential NP). They would then be competing directly with private psychiatrists as we don’t have salaried outpatient setups here. The private setting is fee-for-service role, with a portion of this going towards practice running costs, rent and other perks like sick/annual leave/superannuation that would otherwise be included in a salaried position.

There are two factors that make it difficult for NPs to compete against psychiatrists. The first is the medicare rebate. For an initial psychiatrist appointment it is over $200, so for example if a patient is charged $300 for the appointment they are rebated $200 by the government and are $100 out of pocket. The equivalent long NP consultation has a rebate of about $60, so a patient would be out of pocket by $240 at the same $300 charge. The NP can’t compete on price, as the psychiatrist could ultimately “bulk bill”, or choose to accept the $200 medicare rebate leaving the patient without any out of pocket expense. An NP could do similar, but would likely struggle to meet the costs of running a practice.

The other factor is the referral system. To see a specialist, patients must first be referred by their GP. While referral pathways to specialists are long established and even newly minted specialists can have difficulties early on as referral practices are also well engrained. I don’t think seeing an NP actually requires a referral, but I think this is actually a disadvantage. There are strict rules on advertising medical services (basically you can’t), and as most patients have a family GP who they trust, it’s also likely they won’t be aware of NP services or wouldn’t use them due to being more comfortable with existing referral procedures.

Outside of psychiatry I can't say I've heard much about NPs in Australia. There was a primary care NP clinic some years ago that folded due to lack of demand. There has been some more recent chatter about a Gastroenterologist training up NPs to do scopes, which has drawn the ire of GPs who have essentially said they'd boycott (i.e. stop referring to) these specialists as they think their patients actually deserve to see a medical specialist not an NP.

 

[Jules A]

Neurosurgery NPs.
Did I count 32 on Stanford's website? Decent niche if they are acting in the role of a first assist but I'd suspect it will expand. Also noted it doesn't look like many of them could possibly have had years of RN experience to bridge the education gap.

Neurosurgery Advanced Practice Providers

med.stanford.edu

 

[Jules A]

Seeing this nonsense I just shake my head and thank god I won't have to keep seeing what we have created for all that much longer.

I'm 10 years to tapping out and thankful for this on a daily basis. The supply and demand issue regardless of who is working will surely lead to reduced quality and wages. The thing is the young-ins will figure it out. Every generation thinks the next one is going to hell in a handbasket but humans are fairly hardy, sort of like cockroaches.

 

[splik]

Neurosurgery NPs.
Did I count 32 on Stanford's website? Decent niche if they are acting in the role of a first assist but I'd suspect it will expand. Also noted it doesn't look like many of them could possibly have had years of RN experience to bridge the education gap.

Neurosurgery Advanced Practice Providers

med.stanford.edu

but they don't actually do any surgery or step foot in the OR. They provide care for patients on the wards and post-op in clinic.

 

[Extralong]

I have encountered plenty of NPs that are proud of their online education through a quick track from RN to NP.

 

[Jules A]

but they don't actually do any surgery or step foot in the OR. They provide care for patients on the wards and post-op in clinic.

There are two at my hospital and they are in the OR with the neurosurgeon. Not sure what if anything they do but they absolutely are in the OR.

 

[reca]

Honestly, surgical NP's are the least of our problems. They actually do tend to function as physician extenders and not pseudo-replacements. Mostly basic care on wards and post-op, close up patients after the surgery is done (honestly, a med student could do this at the end of a surgical rotation), etc. They increase the productivity of the surgeon without replacing them for patient care. This is the reason why surgeons tend to have the least antagonistic relationships with midlevels.

 

[calvnandhobbs68]

Honestly, surgical NP's are the least of our problems. They actually do tend to function as physician extenders and not pseudo-replacements. Mostly basic care on wards and post-op, close up patients after the surgery is done (honestly, a med student could do this at the end of a surgical rotation), etc. They increase the productivity of the surgeon without replacing them for patient care.

Yeah the role of post-op inpatient followup and clinic followup in surgical specialities are probably the best example of NPs/PAs as they were originally intended. Very algorithmic but had previously required residents/attendings to do this and easy to access the actual doctor if something is over their heads who knows the patient fairly well in these cases. ICU/CICU/PICU/NICU NPs tend to function okay in this role as well (although I've seen some ICU NPs I'd never want taking care of my family...), since they typically work with attending supervision who at least has a birds eye view of all the patients in the unit and can respond almost immediately to any problems.

Outpatient/ED/urgent care is honestly where they're the most dangerous. Basically can have a fresh BSN-NP grad who has barely seen patients outside of his/her nursing rotations (so can have less actual clinical contact than a 4th year med student) jump into basically independent practice from day one with maybe some bogus "collaboration" agreement with a doc that reviews 10% of their charts every month. I don't think some of these things are out of the capability of most NPs with a few years of training (you definitely don't need a physician for most urgent care/fast track problems) but it's the total lack of real medical decision making experience that's the killer.

 

[finalpsychyear]

I'm 10 years to tapping out and thankful for this on a daily basis. The supply and demand issue regardless of who is working will surely lead to reduced quality and wages. The thing is the young-ins will figure it out. Every generation thinks the next one is going to hell in a handbasket but humans are fairly hardy, sort of like cockroaches.

Hi. Congrats for being that close to the promise land. I hear what your saying but what has occurred is similar to when insurance took over the patient-dr relationship and dictated care based on their algorithms, PA requirements etc.

In fact, this may be even worse as docs themselves created a new massive influx of competition who are all going to get fully autonomous very soon enough.

The simple model of supply and demand which has been medicine's greatest attribute is now fully threatened by mid levels. That is massively different to any other issues ever created. Of course this will take time so current crop who are practicing are safe but this is one topic i am seriously fearful for what is to come more so than any medicare for all situation.

 

[PikminOC]

Yet another pill mill I saw recently on Facebook. They are marketing very effectively. Lots and lots of pill mills popping up lately, esp. with telepsych.

Name - Hello Ahead

Yes, search for it... "links provide credibility", says the moderator

I have seen telepsych places also do drug tests at every appt so they can bill for that too

 

[PikminOC]

I have encountered plenty of NPs that are proud of their online education through a quick track from RN to NP.

Dnp online too!

 

[PikminOC]

Hi. Congrats for being that close to the promise land. I hear what your saying but what has occurred is similar to when insurance took over the patient-dr relationship and dictated care based on their algorithms, PA requirements etc.

In fact, this may be even worse as docs themselves created a new massive influx of competition who are all going to get fully autonomous very soon enough.

The simple model of supply and demand which has been medicine's greatest attribute is now fully threatened by mid levels. That is massively different to any other issues ever created. Of course this will take time so current crop who are practicing are safe but this is one topic i am seriously fearful for what is to come more so than any medicare for all situation.

As you can see from OP posted, they are here now and competing now.
It's not just the future. They are here now

 

[PikminOC]

Honestly, surgical NP's are the least of our problems. They actually do tend to function as physician extenders and not pseudo-replacements. Mostly basic care on wards and post-op, close up patients after the surgery is done (honestly, a med student could do this at the end of a surgical rotation), etc. They increase the productivity of the surgeon without replacing them for patient care. This is the reason why surgeons tend to have the least antagonistic relationships with midlevels.

Not out here in private practice land. They have their own practices and are seeing everyone with a collaborative physician 90 miles away

 

[Sushirolls]

I'm perturbed by the ARNP issue, but I also know my skills, my experience, my training are superior.
If market forces change drastically I have no problem stepping up to the competition plate and swinging for left field, knocking a sixer, or sinking a half court jump shot.

I'm open to the competition, and honestly already am where I'm located. Its probably 60-70% ARNP in my little area. I get enough patients disappointed by ARNP care it's its own referral source.

 

[Ironspy]

I'm perturbed by the ARNP issue, but I also know my skills, my experience, my training are superior.
If market forces change drastically I have no problem stepping up to the competition plate and swinging for left field, knocking a sixer, or sinking a half court jump shot.

I'm open to the competition, and honestly already am where I'm located. Its probably 60-70% ARNP in my little area. I get enough patients disappointed by ARNP care it's its own referral source.

I agree. I don’t take insurance and most patients who pay cash want to see a psychiatrist.

It is bad for patients for the reasons described and poor care results in more poor outcomes &downstream costs

 

[FlowRate]

I've mentioned it before, but there's a private practice in the area with "ADHD" in its name. $400 initial visit, $200 30-minute follow-up, and $X000 psychological testing for every new patient. I think that being a patient of their clinic is diagnostic, but not for ADHD.

But it's run by a psychiatrist and psychologists. Pill mills aren't just NP's.

but they don't actually do any surgery or step foot in the OR. They provide care for patients on the wards and post-op in clinic.

That's what most of our surgical NP's and PA's do, as well. A couple of PA's in interventional rads place ports, though.

 

[reca]

Not out here in private practice land. They have their own practices and are seeing everyone with a collaborative physician 90 miles away

They're independently performing surgeries on patients in surgical centers that they own? What field of surgery is that?

 

[Jules A]

In fact, this may be even worse as docs themselves created a new massive influx of competition who are all going to get fully autonomous very soon enough.

Physicians ignored the elephant in the room and didn't address the As Seen on TV NP programs and the lack of any experience or admission requirements. Now the cow is out of the barn. Do you think if medical schools followed along and increased the numbers of physicians the need for mid levels would level off?

 

[Sushirolls]

Physicians ignored the elephant in the room and didn't address the As Seen on TV NP programs and the lack of any experience or admission requirements. Now the cow is out of the barn. Do you think if medical schools followed along and increased the numbers of physicians the need for mid levels would level off?

No, because we are still attached to the Governmental ... well, we are still attached to the government handout of CMS funded residencies. This needs to end, no more CMS contributions to GME, AND a transition to universal independent license at Medical School graduation, or worse after PGY-I year can lead to recognition as a GP. Residencies and our default model of requiring them are the limiting factors to physicians in the US, not the capacity of the MD/DO production line. By decoupling residencies from government funding, a new growth model will emerge no longer constrained by such 'golden handcuffs.'

Flood the market with MD/DO/MBBS/MBCh grads who are independently licensed as GP and then there will be no need for ARNP/PA. Why hire the inferior trained product when you can have a real physician? Residencies for better or worse will be reserved for more competitive physicians. This is the only solution to get back to a physician only healthcare model.

 

[erg923]

I've mentioned it before, but there's a private practice in the area with "ADHD" in its name. $400 initial visit, $200 30-minute follow-up, and $X000 psychological testing for every new patient. I think that being a patient of their clinic is diagnostic, but not for ADHD.

But it's run by a psychiatrist and psychologists. Pill mills aren't just NP's.


That's what most of our surgical NP's and PA's do, as well. A couple of PA's in interventional rads place ports, though.

I am just gonna copy and paste at this point:

"There are good reasons to assess cognitive abilities for treatment planning... but a potential ADHD diagnosis is not one of them on the average. It is true that people with ADHD are a bit more likely to have certain cognitive profiles than are people without ADHD. For example, people with ADHD, on average, tend to score slightly lower on tests of working memory, processing speed, and verbal fluency than on tests of visual–spatial reasoning, fluid reasoning, and crystallized intelligence (Schwean & Saklofske, 2005). However, most people with ADHD do not have this particular profile and most people with this profile do not have ADHD. In the end, a diagnosis of ADHD cannot be ruled in by any particular cognitive profile, nor can any particular cognitive profile rule it out. If you are already confident (in either direction) about whether ADHD is the correct diagnosis, there are no cognitive test results in the world that should undermine your confidence."

I would loooove to tell patients that getting alot of psychological testing and rating scales and/or cognitive testing significantly changes their kids treatment of potential ADHD, anxiety, depression, behavior problems, and/or insert garden variety psych problem here. But I happen to have a very large N data base that says...it does not.

Can it? Yes. If you have someone really accentuate the nuances. However, most psychologists actually suck at this and most of the other beneficial and nuanced aspects of psychological testing assessments. And this is coming from a trained clinical psychologist.

 

[FlowRate]

I am just gonna copy and paste at this point:

"There are good reasons to assess cognitive abilities for treatment planning... but a potential ADHD diagnosis is not one of them on the average. It is true that people with ADHD are a bit more likely to have certain cognitive profiles than are people without ADHD. For example, people with ADHD, on average, tend to score slightly lower on tests of working memory, processing speed, and verbal fluency than on tests of visual–spatial reasoning, fluid reasoning, and crystallized intelligence (Schwean & Saklofske, 2005). However, most people with ADHD do not have this particular profile and most people with this profile do not have ADHD. In the end, a diagnosis of ADHD cannot be ruled in by any particular cognitive profile, nor can any particular cognitive profile rule it out. If you are already confident (in either direction) about whether ADHD is the correct diagnosis, there are no cognitive test results in the world that should undermine your confidence."

I would loooove to tell patients that getting alot of psychological testing and rating scales and/or cognitive testing significantly changes their kids treatment of potential ADHD, anxiety, depression, behavior problems, and/or insert garden variety psych problem here. But I happen to have a very large N data base that says...it does not.

Can it? Yes. If you have someone really accentuate the nuances. However, most psychologists actually suck at this and most of the other beneficial and nuanced aspects of psychological testing assessments. And this is coming from a trained clinical psychologist.

I'm assuming that you're either posting this to agree with me about how ridiculous their practice is or otherwise misread my post.

 

[PikminOC]

They're independently performing surgeries on patients in surgical centers that they own? What field of surgery is that?

Im talking about psychiatry.

 

[PikminOC]

I'm perturbed by the ARNP issue, but I also know my skills, my experience, my training are superior.
If market forces change drastically I have no problem stepping up to the competition plate and swinging for left field, knocking a sixer, or sinking a half court jump shot.

I'm open to the competition, and honestly already am where I'm located. Its probably 60-70% ARNP in my little area. I get enough patients disappointed by ARNP care it's its own referral source.

Patients want their feel good drugs. When I say no, they go to the np who ignored red flags and says yes

 

[keifernny2]

Patients want their feel good drugs. When I say no, they go to the np who ignored red flags and says yes

The liability system in a free market should weed out people that practice like this, by having bad outcomes lead to lawsuits and putting “the fear” into people practicing beneath standard of care. For some reason,it doesn’t. Either there aren’t enough patients being harmed, or patients who are being harmed are not motivated to sue for some reason.


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[calvnandhobbs68]

The liability system in a free market should weed out people that practice like this, by having bad outcomes lead to lawsuits and putting “the fear” into people practicing beneath standard of care. For some reason,it doesn’t. Either there aren’t enough patients being harmed, or patients who are being harmed are not motivated to sue for some reason.


Sent from my iPad using Tapatalk

meh not really. To be caught as a bad actor you have to be a REALLY bad actor. Like people dying because they mixed the oxy, xanax and ambien you prescribed then had a few drinks that night. Or prescribing more opioids than there are people in the entire city you practice in (which actually happened in a few of the known pill mill areas). There are very few doctors/NPs being named in these opioid lawsuits and the ones that are were so blatantly overprescribing that you can’t really argue against their prescription patterns.

There’s a difference between bad care and malpractice level care. Diagnosing ADHD in every adult that comes in your office, says they have attention problems and score high on an ASRS self screener then giving them all stimulants isnt likely to come back to bite you in the ass as malpractice. Even in surgery which is a much higher immediate risk field, all the scrub nurses know who the crappy surgeon is. Does that mean the crappy surgeon is ever really going to be recognized as crappy? Probably not because the patients typically don’t know the difference and unless you kill or seriously injure multiple people, you’re unlikely to face any professional consequences (Ex. the neurosurgeon that actually killed/paralyzed multiple people before he was finally caught up with).

 

[tr]

The liability system in a free market should weed out people that practice like this, by having bad outcomes lead to lawsuits and putting “the fear” into people practicing beneath standard of care. For some reason,it doesn’t. Either there aren’t enough patients being harmed, or patients who are being harmed are not motivated to sue for some reason.


Sent from my iPad using Tapatalk

Free market correction only works under specified conditions. One of those is free flow of information, i.e., the quality of the outcome must be clear to the consumer. This is true for consumer goods like shoes, where anyone can tell if their shoes are keeping their feet dry effectively or not. It is most certainly *not* true for medical care, which is a complex service in which it is often extremely difficult to discern on an individual basis whether a given bad or good outcome is related to a particular action taken by a care provider.

For example, the free dispensation of antibiotics for nonbacterial illnesses has broad harms in that it disseminates resistant bacteria to the community. Now if an individual dies of a pan-resistant infection, how are they going to go out there and sue every provider that hands out Z-packs for rhinovirus?

Within psychiatry, suppose an individual with BPD is being inappropriately treated with a major mood stabilizer. How is that individual supposed to discern that they should really be getting DBT instead? And suppose they eventually do figure it out, are they going to go back and sue the person who treated them with the mood stabilizer? That's not realistic. Lawsuits are a huge financial, cognitive, and emotional drain and people do not undertake them without very strong motivation and expectation of a payout.

 

[Jules A]

Patients want their feel good drugs. When I say no, they go to the np who ignored red flags and says yes

Fine with me and rather than argue ad nauseam I have no problem telling a patient they can definitely find someone willing to prescribe whatever they want with little or no regard for indication or safety. There are times when it is best to agree to disagree and I'm ok with that.

 

[Jules A]

The liability system in a free market should weed out people that practice like this, by having bad outcomes lead to lawsuits and putting “the fear” into people practicing beneath standard of care. For some reason,it doesn’t. Either there aren’t enough patients being harmed, or patients who are being harmed are not motivated to sue for some reason.

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Ahhh in a perfect world. I'd add often the people who are harmed or killed particularly with those SUD have burned bridges with their families and no one is left to advocate on their behalf.

 

[PikminOC]

The cases I have seen where there are problems with prescribing, the nursing board does nothing, the medical board disciplines the "collaborating" doc, and the malpractice lawyers go after the physicians.

 

[Jules A]

The cases I have seen where there are problems with prescribing, the nursing board does nothing, the medical board disciplines the "collaborating" doc, and the malpractice lawyers go after the physicians.

I've actually seen the what I feel are minimal consequences for both professions despite egregious polypharm. As for board vs. board consider the ability for a psychiatrist to diddle a patient and continue practicing, has happened in my area. Picture the panel faces on a nursing board with type of complaint.

 

[TexasPhysician]

I've actually seen the what I feel are minimal consequences for both professions despite egregious polypharm. As for board vs. board consider the ability for a psychiatrist to diddle a patient and continue practicing, has happened in my area. Picture the panel faces on a nursing board with type of complaint.

If we punish every physician, NP, PA, counselor, etc for every alleged complaint by a psych patient, there would be none left. Your situation may have proof - I have no idea how serious to take it. I have no doubt that some are real victims. The counseling board gets these complaints more frequently. I’ve had a complaint against me for assault. Further research revealed that I prescribed a medication that was the color red. The devil hid in the red pill and caused stomach pain. The stomach pain was a result of my prescribing, hence I assaulted his abdominal area.

We can debate alleged complaints all day, but prescribing history and notes don’t lie.

 

[PikminOC]

I read the disciplinary action. There are nurses with felonies practicing

 

[PikminOC]

Yet another pill mill I saw recently on Facebook. They are marketing very effectively. Lots and lots of pill mills popping up lately, esp. with telepsych.

Name - Hello Ahead

Yes, search for it... "links provide credibility", says the moderator

This place doesn't take insurance, has physician advisors listed, and delivers the meds to your door.

 

[psychapp121]

If we punish every physician, NP, PA, counselor, etc for every alleged complaint by a psych patient, there would be none left. Your situation may have proof - I have no idea how serious to take it. I have no doubt that some are real victims. The counseling board gets these complaints more frequently. I’ve had a complaint against me for assault. Further research revealed that I prescribed a medication that was the color red. The devil hid in the red pill and caused stomach pain. The stomach pain was a result of my prescribing, hence I assaulted his abdominal area.

We can debate alleged complaints all day, but prescribing history and notes don’t lie.

LOL

 

[Jules A]

We can debate alleged complaints all day, but prescribing history and notes don’t lie.

He admitted it and yeah prescribing history was terrible also.

 

[PikminOC]

He admitted it and yeah prescribing history was terrible also.

Then he may be connected or have an excellent lawyer.
Were you are at the hearing that you know exactly what was said?

 

[Jules A]

Then he may be connected or have an excellent lawyer.
Were you are at the hearing that you know exactly what was said?

So either I'm lying for no particular gain or perhaps the board of physicians sanctions are in fact public record.

 

[PikminOC]

So either I'm lying for no particular gain or perhaps the board of physicians sanctions are in fact public record.

Was he sanctioned? My state only shows the sanctions. No other specifics like how they pled etc. And how do you know another board would have sanctioned the provider even more? Physicians are held to the highest standards.

 

[WisNeuro]

Was he sanctioned? My state only shows the sanctions. No other specifics like how they pled etc. And how do you know another board would have sanctioned the provider even more? Physicians are held to the highest standards.

Much like every professional board, I'd imagine this varies pretty wildly from state to state. Heck, took Duntsch several years to finally get his license revoked, and that took persistence from former colleagues to get it done.

 

[PikminOC]

Wasn't he running from state which was making it more difficult to nail him down

Much like every professional board, I'd imagine this varies pretty wildly from state to state. Heck, took Duntsch several years to finally get his license revoked, and that took persistence from former colleagues to get it done.
[/QUOTE

 

[WisNeuro]

Wasn't he running from state which was making it more difficult to nail him down

I believe he got a job in the same city after he was reported to the board. Pretty sure it all took place in Dallas before he moved out of state. And even then, the only way to keep him from getting another license was to bring criminal charges against him. All of this occurred after the fact that he was using cocaine while operating on residency. If these are the highest standards, I'd hate to see what the low standards are.

 

[PikminOC]

I believe he got a job in the same city after he was reported to the board. Pretty sure it all took place in Dallas before he moved out of state. And even then, the only way to keep him from getting another license was to bring criminal charges against him. All of this occurred after the fact that he was using cocaine while operating on residency. If these are the highest standards, I'd hate to see what the low standards are.

Like I said, theres a nurse with a felony. Thats a pretty low bar. The licenses from state to state are not connected for any professions. Sometimes people sneak until they get caught. The bar for criminal prosecution is high so it takes time to get the proof together.