A groundbreaking civil case brought by the District Attorney of the County of San Luis Obispo, California has been making the online rounds recently. Nurse practitioner Sarah Erny, who has a "Doctorate" of Nursing Practice (DNP) from Vanderbilt University, is charged with promoting herself as “Doctor Sarah Erny” and failing to advise the public that she was not a medical doctor, which is a protected title in California per the state's Business & Professions Code, § 2054.
The formal complaint and final judgment from the DA's office can be found below.
Additionally, the California Board of Registered Nursing's formal accusation dated August 25, 2022 can be found below.
The DA's complaint reveals some very juicy tidbits, which we'll briefly summarize:
- Apparently, Ms. Erny tried to defend herself by claiming that shortly after getting her DNP, her patients “were so proud of her they started calling [her] ‘Dr. Sarah’.” It's also claimed that her supervising physician told Ms. Erny to “own her degree” and had his staff call her “Dr. Sarah” in the office and with patients.
- Ms. Erny operated a business providing medical services and products to patients called "Holistic Women's Healing", with both a physical office presence in Arroyo Grande, CA and online at www.holisticwomenshealing.com (now defunct). However, she failed to obtain and file a proper business certificate.
- Beginning in October 2018, Ms. Erny's collaborative/supervising physician was OB/GYN Dr. Anika Moore. The collaborative/supervisory relationship was terminated on March 7, 2022. During the approximate three years of supervision by Dr. Moore, Dr. Moore’s OBGYN medical practice was located outside San Luis Obispo County, primarily in Santa Maria, California, and outside the State of California.
- Ms. Erny claims that Dr. Moore would travel from out of state every two to three months for a weekend to review approximately 20% of her patient files.
- Per California's Controlled Substance Utilization Review and Evaluation System (CURES), Ms. Erny wrote more than 1,600 prescriptions for Schedule 2-4 drugs, with a majority being schedule 3 drugs for over 250 patients.
With regard to Ms. Erny's prescribing habits, the aforementioned accusation from the California Board of Registered Nursing provides some rather sordid details:
The investigation revealed that for the period from late 2018 through the first half of 2020, Respondent would see approximately 24-30 patient per week, with approximately 70% of her patients receiving prescriptions for controlled substances. During this time, Respondent wrote more than 1,600 prescriptions for Schedule II controlled substances, the majority of which were for testosterone (an anabolic steroid), for approximately 277 patients, including male patients being treated for hypogonadism or profound testosterone deficiency, as well as female patients being treated for peri- and post-menopausal issues. The majority of these prescriptions were for micronized testosterone powder, which would require compounding and assay for appropriate usage and dosage, while the others were for testosterone oil, which would need to be administered via injection.
A review of Respondent's controlled substance prescribing patterns revealed that Respondent was writing an excessive amount of testosterone, which was consistent with overprescribing.
Patients receiving prescriptions for testosterone are generally being treated for complex medical issues that require careful laboratory monitoring and repeat physical examinations for proper diagnosis and treatment, and are usually seen under the purview of physicians specializing in endocrinology or urology.
Respondent's facility consisted of an office environment without proper medical equipment, which would make physical examinations, assessments and treatment of patients difficult.
The investigation also determined that, during this time period, no physician was present at the facility. Dr. Anika Moore's supervision of Respondent only consisted of a weekend visit from out-of-state every 2-3 months to review approximately 20% of Respondent's charts. There was no contemporaneous sharing of medical records, and little to no oversight or monitoring of Respondent's prescribing of controlled substances to patients.
On a side note, what level of safe, medically appropriate supervision/collaboration can an out-of-state OB/GYN provide to a midlevel who hands out testosterone to male patients like candy, believes in "herbal wisdom" and "plant energy", and calls herself a "green witch"?
Ms. Erny continues to maintain her social media presence on Facebook, where she has a page with over 13,000 followers.
From the marketing and prose, it's evident that she holds herself out to be some sort of far-out, alternative medicine/spiritual healer lady with posts about essential oils and full moon rituals. Is this the kind of non-evidence-based crap they teach in DNP school these days? Crazy.
As of 11/24/2022, "Dr. Sarah" continues to host a massive amount of rather, uh, incriminating posts on her Facebook page, in direct violation of the injunction against her:
Disgustingly, Ms. Erny has started a GoFundMe with the goal of covering her legal fees, which as of 11/24/2022, has
persuaded tricked 236 chumps into donating throwing their money away to the tune of $21,611. On it, she writes:
I have Never I presented myself as a physician. Everything that was public stated that I was a nurse practitioner... my website, my business cards, everything. I am proud of being a nurse practitioner and have never presented myself as a physician... ever.
Um, excuse me? Maybe the abundance of screenshots above that clearly state "Dr. Sarah" with not a single fucking mention of "nurse practitioner" will jog your memory, Ms. Erny? If not, hopefully it will jog the memory of the District Attorney of San Luis Obispo County!
There are literally hundreds of people in our county who use the term Doctor who are not physicians. They hold a doctoral degree.... Chiropractors, optometrists, naturopathic doctors, acupuncturists, physical therapist, psychologists, all have their titles on their websites and yet when we presented this to the Medical Association and the District Attorney we were told that they would go after those people as well but I have to address this for myself. I feel I’m being singled out and do not understand this.
Ah yes, the good old whataboutism. We've seen better attempts at counterargument in high school-level debate tournaments. And being "singled out"? Someone has to be the first criminal punished, right? Hopefully, this case will set a precedent nationwide for legislators and law enforcement to pursue, prosecute, and punish nurse practitioners and other midlevel providers who attempt to fraudulently represent themselves as doctors/physicians.
They are asking me to not use my title of doctor on anything. I can put my title DNP after my name, but can't use Dr. Sarah. Not just in healthcare, they have told me I have to take it off my blogs, any writing I do and anything else. I don't have to state how much this tears me up inside. I worked very hard for this degree while I was working at CHC seeing 25 patients a day. I am very proud of my accomplishments with my degree and to be told I cannot use the title or I endanger my license here is very demoralizing.
Oh, boo hoo. You know who else worked very hard for their degree? The thousands and thousands of allopathic and osteopathic medical students who have not only worked extremely hard to get into medical school, but committed to the grueling educational and training pathway of residency, fellowship, and beyond. Meanwhile, for-profit NP and DNP diploma mills are gladly accepting any nurse with a thready pulse and an open wallet. And is seeing 25 patients a day supposed to be impressive or something? In any case, no one told Ms. Erny that she cannot use her title; she is more than welcome to call herself what she is, a DNP.
Ending on a legal note, we're somewhat disappointed to see that this matter has essentially concluded as a civil judgment/settlement and a slap on the wrist. According to the California Business & Professions Code § 2054, Ms. Erny's conduct rises to the level of a misdemeanor, which, in California, can be punished by up to a year's sentence in county jail. As pretending to be a doctor/physician is arguably a pretty serious crime with the potential for serious patient harm, we would have certainly liked to see Ms. Erny spend some time behind bars.
Refreshingly however, the California Board of Registered Nursing is moving to revoke Ms. Erny's RN and NP licenses pending a hearing. In a legal landscape where most state nursing boards seem to turn a blind eye to nurse practitioner malpractice and misconduct, it's great to see that the California board is actually attempting to do something. We wish the board the best of luck in their endeavor to permanently expel Ms. Erny from the nursing field. Hopefully, this groundbreaking case and the actions of the San Luis Obispo County District Attorney and the California Board of Registered Nursing will set a precedent nationwide for legislators and law enforcement to pursue, prosecute, and punish nurse practitioners and other midlevel providers who attempt to fraudulently represent themselves as medical doctors/physicians.