DNP in California: A Lesson in Transparency

Introduction

Not playing by the rules can have serious consequences. At the end of 2022 in San Luis Obispo, California, a nurse practitioner, Sarah Erny, signed a settlement to pay almost $20,000 and was ordered to remove most mentions of herself on the Internet and remove her own website because she did not play by the rules. As I tell my son's baseball team or any of the coaching teams that I'm a part of, you must figure out how to play by the rules and then still win the game. Rules exist, and if we break those rules, even when what we do seems harmless or is not deliberately intended to harm anyone, we must be ready to pay the price. 

Two Little Letters

It all started when Sarah Erny, a nurse practitioner, became the subject of a civil complaint from the District Attorney's office in San Luis Obispo, California. Ultimately, the complaint was about referring to herself as “Doctor” (Dr.) Most cases like this are complicated, filled with laws and opinions, and this one is no different.

Sarah Erny practiced functional medicine as a nurse practitioner, and in 2018, or thereabouts, she earned her Doctorate of Nursing Practice from Vanderbilt University. Certainly, an achievement to celebrate and be proud of ~ no question about it! The problem developed after that. She started referring to herself as Dr. Sarah or Dr. Sarah Erny, both to her patients, on her website, and on all her social media posts. And that is just not allowed. 

There was a complaint, quickly followed by an investigation. What they found they didn’t like. She was indeed referring to herself as Dr. Sarah, Dr. Sarah Erny, or Dr. Erny without clarifying that she was a DNP and not a MD or DO. Ultimately, she was found to have violated four counts of the California Business and Professions Code. 

In my opinion, she got off with a light slap on the wrist, which again was the fine of almost $20,000. She also was enjoined, an injunction against her, from calling herself Dr. Sarah. In addition to that, she was asked to remove “Dr.” from her website, from all her social media, and then actually go and do Google searches, every once in a while, asking third party websites that list her as “Dr. Sarah” to remove her as a doctor.

At the end of the day, I don't even think her saga is over. She got off a little bit light because it is a criminal offense, and they only came after her for civil penalties, so far.

Transparency

There are many opinions all over the Internet from what you might think are reputable sources regarding Sarah Erny’s case. But this is a good reminder and rule, not only in California, but in any state. It's more about transparency. I tend to agree with the result of this case because misrepresenting yourself is misleading to the public. And in fact, the district attorneys complained in this case, even putting a footnote in, that a study from 2020 found that 40% of the population believes that the DNPs are medical doctors, and 19% of the population think that NPs are doctors as well. So, there's a lot of confusion out there, and ultimately in this instance, the DA's office sent a good warning shot to everybody else that says, “Hey, let's just be transparent about what we are and who we are.” Be proud of your accomplishments, for sure, and all the degrees and certifications you've earned, but don't confuse people into thinking that you're something that you're not. And that's kind of the crux of it. 

Public Misconception

Most reasonable people would think that anyone with “Dr.” by his or her name is a medical doctor and would offer medical services & treatments, and perhaps sell medical supplies, right? I had somebody come to me close to a year ago who was also a fellow DNP and asked me if she could use the word “doctor,” and I told her not to. In this context when you're giving medical services and medical treatments, it's just not appropriate. Many people have PhDs and can be appropriately called “Doctor,” such as an adjunct professor at a university. However, in the medical profession, you need to be very careful to not mislead the public. Not only can you mislead the public by falsely calling yourself “Doctor,” but also you can mislead them in other ways. For example, I’m certainly not going to call myself Dr. Scott and wear a white coat and stethoscope on my website, giving the impression I’m a medical doctor when I’m a lawyer. You need to state the discipline you received your PhD in. 

Nurse Practitioners

Nurse Practitioners are needed and are a necessary part of where medicine is going in the future. Sarah Erny’s case is about protecting patients and the general population. This case is not meant to take anything away from NPs who have earned their doctorate degree. Congratulations! Be proud of the training and experience you have. Represent yourself as a nurse practitioner. You can say that you even went and got additional training and got a Doctorate of Nursing Practice at a specific institution of higher learning. But do not call yourself “Doctor.” Clarity on this subject is needed to avoid misleading the public that can lead to criminal or civil action. Be clear. 

Conclusion

Sarah Erny’s case hinged on these things and her saga isn’t over. In November, she agreed to pay that settlement. Currently, based on information I have at this time in January 2023, the nursing board in California is attempting to take her license away. There's a hearing set for April on that issue. Not only is the nursing board pursuing further action, but it seems clear that the medical board is also going to take some sort of action.

The takeaways here are

• be transparent about who you are, what you are, and what your training is to your patients,
• be proud of it,
• and do what you're able to do to stay within the scope of your license and within your standard of care (there were no allegations of this in Sarah Erny’s case).

Ultimately, the best course, and to avoid trouble, is to be transparent. Use the term “Doctor” according to the laws in your state. 

If you have any questions about what to call yourself or how to represent yourself accurately, reach out to me at Functional Lawyer and schedule a consultation. 

Sources:

1. District Attorney Dan Dow Announces Settlement with Arroyo Grande Nurse for Unlawfully Advertising Herself as “Doctor” 

2. Legal Complaint

3. Legal Settlement Agreement