Here's a tragic and fatal case of midlevel incompetence and malpractice from across the pond, in the United Kingdom. Like in the United States, nurse practitioners also exist in the UK, but their education and regulatory standards are much more variable compared to their counterparts in the US.
The patient in question, a 19-year old male student by the name of Toby Hudson, was suffering from a sore throat and related symptoms, and seems to have had difficulty getting an appointment be seen by his GP promptly due to phone issues. As such, much like one might do in the United States, he decided to go to a walk-in urgent care clinic, where he was seen by a nurse practitioner by the name of Briony Jefferis. It should have been clear from his vital signs that something could be seriously wrong: "'He had a normal temperature of 36.1 degrees, a heart rate of 102bpm and rated his pain at an eight out of ten." Nevertheless, he was "given pencillin" and sent home - a decision that, in my opinion, is a result of the hubris and overconfidence that seems universally endemic to the nurse practitioner profession. NP Briony is quoted as stating, "He did not show any signs of sepsis and his symptoms were consistent with those of tonsillitis...Neither myself nor the triage nurse were remotely worried." Not remotely worried, eh? Try reconciling that with the fact that the patient went into cardiac arrest en route to the hospital and later died.
Yet another case of gross misdiagnosis and mismanagement by a nurse practitioner, and a young life needlessly lost as a result. If this sounds familiar, it should. Remember the case of Betty Watternbarger, the seven-year old girl who was sent home by a nurse practitioner at a pediatric urgent care and later died of sepsis and streptococcal pneumonia? In an emergency department or urgent care setting, there should be absolutely no excuse to not consider sepsis on the differential whenever an infection is present. Simply based on his tachycardia and borderline low body temperature, along with the obvious source of infection (tonsillitis) he would've already ruled in for SIRS criteria and sepsis. It's absolutely unconscionable to think that this patient died at the hands of an incompetent midlevel when all the obvious signs of impending severe illness and decompensation were there. We can only hope that Toby's death will not be in vain.