This case involves a 28-year-old male patient who had been undergoing mental health treatment every 6 months for 6 years. During this timeframe, the patient was seen and solely treated by a nurse practitioner. The nurse practitioner saw the patient in sessions which lasted less than 10 minutes at a time. The nurse practitioner diagnosed the patient with bipolar disorder, along with a variety of other mental health disorders, and prescribed the patient Clonazepam, Escitalopram, Lamotrigine, and Trazodone. The nurse practitioner never consulted with physicians at the affiliated mental health center. The patient was eventually referred to another psychiatrist who informed him that he had been misdiagnosed with bipolar disorder and had been inappropriately prescribed medications during his treatment. An expert family medicine nurse practitioner with experience working in a mental health capacity was sought to opine on the standard of care.
Question(s) For Expert Witness
- 1. Do you routinely treat patients in a mental health setting, like the one described above?
- 2. How long have you been practicing in this capacity?
- 3. What is the duty of the nurse practitioner in this type of case?
Expert Witness Response E-053622
I am a board-certified family nurse practitioner, and I maintain a clinical practice. I have been practicing as a board certified family nurse practitioner in family practice and addictions medicine since 1999. I teach on the role of the NP in practice as well as the current clinical guidelines across the lifespan and diagnoses. I currently evaluate and treat patients with mental health diagnoses. As an assistant professor and core faculty member at a top tier, doctoral-level family nurse practitioner program, I have lectured across the lifespan, including mental health assessment, treatment, and follow-up in children and adults. I have published several peer-reviewed articles on vulnerable populations and presented at national conferences on mental health issues. The duty of the NP is to follow the practice guidelines for the patient’s associated symptoms according to the American Psychiatric Association. This includes using the recommended screening tools and appropriate diagnostic tests to formulate a valid diagnosis. Through the NP’s practice agreement, the collaborating physician should have been consulted if there were any questions about the definitive diagnosis or if the patient’s case became complicated.
Expert Witness Response E-063220
I have been a family nurse practitioner for 20 years and have practiced 2 days a week as an FNP in a rural clinic for the past 10 years. I am also board certified in psychiatric mental health (PMHNP). I have had a private psychiatric practice since 2009, and I work there once a week. I have treated patients with psychiatric diagnoses in primary care for 20 years, and I teach clinical specialty courses in adult health and psychiatry. I teach specific courses on mental health diagnosis and management to FNP and adult and gerontology NP students and lecture routinely on the management of psychiatric conditions to primary care nurse practitioners. Primary care NPs are generally not educated to diagnose and treat bipolar disorder. It is not a part of their board exam, nor is it expected of a new graduate or clinician. Since there is a recognized shortage of psychiatric specialists, many primary care providers have obtained further education on the diagnosis and treatment of bipolar disorder in the general population. There are clear diagnostic criteria for bipolar disorder with the recommended treatment and management guidelines. Anyone assigning that diagnosis would be expected to have conducted an appropriate clinical exam and history.