How far is too far in the MD-NP turf war?
I'm flairing this other rather than RANT, because I think it's something that we need to discuss. And yes, this is Lindsay Clancy-related.
Being vulnerable posting this at all. I’m not posting to the larger psychiatry sub because I feel like at least here, our mods will hold the line with brigading, and this is going to ruffle some feathers.
So after watching the Day 10 and 11 testimony (Jennfer Tufts’ cross-examination; direct testimony and cross-examination of PMHNPs Julie Paul and Rebecca Jolletta), I am left with this question: did the turf war between MDs and NPs kill 3 children?
While the clowns over on Noctor are gleefully saying things to the effect of doesn’t it make them happy that the PMHNPs involved with Lindsay Clancy’s case are being referred to as “Nurse,” I think a lot of us are missing something big.
It’s not that Rebecca Jolletta was the only clinician to suggest that bipolar disorder was the correct diagnosis; it’s that it got dismissed out of hand by pretty much everyone.
Look, it’s pretty clear that Lindsay Clancy was rejecting much of the help that she was offered. Rebecca Jolletta offered us a glimpse of that with her statement that when she suggested bipolar as a diagnosis to the Clancys, and Patrick said “My wife is not bipolar,” while Lindsay sat there silent. Lindsay was offered therapeutic doses of Seroquel, she had side effects. Problem is, most of the antipsychotic mood stabilizers have sedation as a major side effect in the first few weeks. She was offered olanzapine, rejected that too. I know lamotrigine eventually came into play (and correct me if I’m wrong, but I believe it was Jennifer Tufts who offered that), but too little, too late. It takes too long to safely titrate. I wish lithium had been offered by someone, but here we are.
Here’s the thing.
Dr. Jennifer Tufts was fresh out of residency. That is *not* a criticism. She had four years of practice under her belt, and she had experience as a resident managing postpartum disorders. However, all of us in the sub know how toxic the NP hate is in the residency sub, not to mention Noctor. I’ve seen that happens in real life as well, even among residents who don’t frequent Reddit, so I can only assume that the party line of “NPs have less training than PetSmart groomers,” is alive and well in real life.
Is it possible that Dr. Tufts, Dr. Goodman, and whoever was at Women and Infants (they’re not being sued, I presume due to jurisdictional reasons, since it would have to be a separate case brought in RI) dismissed the possibility of bioplar disorder because it was diagnosed by a PMHNP?
I think we have to consider that possibility.
Rebecca Jolletta had the benefit of hindsight with what had already happened with meds prescribed by Dr. Tufts, and it's a lot easier to spot once you have a pattern (Zoloft, Prozac).
But then LC went back to Dr. Tufts. We should always consider when a patient switches providers, did the provider actually do something wrong, or was the provider telling the patient something that they didn't want to hear?
From her testimony, Dr. Tufts said "well, it *might* be bipolar disorder" to the Clancys, when discussing the medication trials at South Shore Perinatal Behavioral Health (Paul and Jolletta's practice). She also then proceeded to vehemently deny that bipolar disorder was a possibility when on the stand. I know she's got a malpractice trial coming (as does Rebecca Jolletta), so her whole defense is that she didn't miss bipolar, but come on. Maybe the outcome might have been a little different if she hadn't gone on to dismiss that possibility.
I don't think in this case we'll ever truly know, and this is not a diatribe on the Clancys. They will have to live with what happened for the rest of their lives.
The NPs involved:
Julie Paul Credentials: BSN in 1992, worked as an L&D nurse, CNM in 2006; added PMHNP in 2018.
Rebecca Jolletta: MA in Counseling Psychology in 2013; MSN Through MHG Institute for Health Professions in 2019 (RN in 2017). MGH is a direct-entry program.
Yes, both have done the PSI Perinatal Mental Health training and are PMH-C credentialed.
My little cousin was a groomer at PetSmart for like a decade, I promise you she did not have more training than either of these women.
If someone has a better timeline, it wasn't as if I was taking notes during the trial. Obviously, we'll learn more someday when those malpractice suits are either settled or go to trial, and we'll hear from the forensic experts later in the trial.