The ‘Dr. Sarah’ Case: A Wake-Up Call for Physicians and Practitioners
Collaboration between physicians and advanced practice providers is not just about financial arrangements or contractual agreements; it's about fostering a mutually beneficial relationship built on effective communication, commitment, proper oversight, and compliance.
A recent settlement in a suit brought forth by the District Attorney of San Luis Obispo County highlights the potential risks when these crucial elements are neglected.
Dr. Anika Moore was recently fined $25,000 for failing to properly supervise a California nurse practitioner, Sarah Erny, who was identifying herself as “Dr. Sarah” to her patients. Erny, in turn, faced a nearly $20,000 fine for misrepresenting herself as a licensed doctor.
Details of the ‘Dr. Sarah’ Case
Sarah Erny earned her doctorate in nursing practice from Vanderbilt University. Soon after, while practicing in Arroyo Grande, CA, she began promoting herself as “Dr. Sarah Erny.” According to court documents, Erny was operating an independent medical office under Dr. Moore's supervision in 2018, unbeknownst to Moore.
According to the SLO County news release, Dr. Moore, practicing in Massachusetts at the time, claimed she was misled into believing that Erny was working in a clinical setting with other physicians. This lack of awareness allowed Erny to operate independently, allegedly seeing 8 to 10 patients a day and issuing hundreds of prescriptions, including scheduled substances, without clear communication to patients regarding her status as a nurse practitioner.
California law mandates a written collaboration agreement between collaborating physicians and nurse practitioners, outlining roles, duties, and specifics regarding prescription medications. California Business and Professions Code Section 2054 also states that it is against the law for any healthcare professional other than a licensed physician or surgeon to call themselves “doctor.”
According to court documents, Dr. Moore admitted to only "skimming the contents" of the collaboration agreement and did not spend much time evaluating the circumstances under which Erny would provide medical services. In addition, Dr. Moore allegedly didn’t review any physical medical records during her supervision of Erny. The lawsuit states that Moore failed to identify the substances Erny could prescribe and didn’t develop protocols within the agreement.
These oversights, combined with the failure to develop protocols, potentially violated state laws and compromised patient safety.
The Risks of Poor Collaboration and the Importance of Compliance
The “Dr. Sarah” case can teach us an important lesson about collaborative healthcare and compliance. Healthcare collaborations are more than formal agreements; they require a commitment to transparency, communication, and proper oversight.
While collaboration can certainly be a positive financial opportunity for a physician, it is primarily a shared responsibility to maintain the highest standards of patient care and compliance with regulations.
Despite differing opinions on the validity of the case, the heart of the matter lies in the breakdown of communication and lack of safeguards within Moore and Erny’s collaboration.
Both doctors and advanced practice providers benefit from having provisions in place to make sure their collaborations are compliant. Ongoing evaluations, regular chart reviews, and transparent communication are all important components of the collaborative model and promote a spirit of continuous improvement and high-quality care.
Compliant Collaboration Is a Shared Responsibility
The compliance landscape is complex and continually changing, and navigating regulations can be difficult for both physicians and practitioners. Not to mention, regulations vary widely between states. What could be seen as a harmless miscommunication can result in major consequences.
This case highlights the risks that physicians take when they passively enter into collaboration agreements, perhaps solely for financial compensation, without a genuine commitment to fostering a robust collaborative relationship.
When this commitment is lacking, all parties involved – the supervising doctor, the nurse practitioner, and patients – may experience career and life-changing consequences.
Healthcare collaboration compliance involves proactive due diligence and relationship building from both sides. Supervising physicians must take great care in routinely evaluating the terms of a collaboration agreement and the performance of the nurse practitioner, while practitioners must commit to clear communication and upholding the high standards of their profession.
Collaboration agreements are not a formality – they are a legal framework for a team-based approach to medical practice.
Don’t Navigate Compliance Alone
Clinical collaborations are regulated by complex rules that vary based on state and clinical specialty. Zivian Health was created to handle all the challenges of creating strong and compliant collaborations so that physicians and practitioners can remain focused on their core competence – patient care.
Our priority is maintaining the compliance of all of our collaborators. Even more, Zivian aims to make clinical collaborations more productive via a convenient and secure platform, regulatory expertise, and an empowering clinical community.
Whether you are an advanced practice provider, physician, or healthcare enterprise, Zivian was created for you. Contact us today to learn more.
Sources for Reference
“SLO County nurse called herself ‘Dr. Sarah.’ Now her supervising physician has been fined.” Yahoo News. February 1, 2024.
County of San Luis Obispo District Attorney News Release. January 31, 2024.
