Ms E is a nurse practitioner practicing in California. She started her career as a registered nurse in Kentucky before receiving her Doctor of Nursing Practice (DNP) in 2014. In 2020, she completed a PhD in Mind-Body Medicine and Integrative Mental Health through a California university. Ms E’s clinical focus is women’s health, functional medicine, and autoimmune and chronic diseases.
Prior to 2018, Ms E worked for a practice with a supervising physician. When Ms E received her DNP, the physician told her that she needed to “own” her degree, and had his staff refer to her as “Dr Sarah” (her first name) in the office with patients. The name stuck and patients began referring to Ms E as Dr Sarah.
In 2018, Ms E opened a women’s health clinic and launched a website and online digital presence. Ms E’s supervising and collaborating physician was Dr M, an obstetrician-gynecologist. Dr M was located out of state and would travel every 2 or 3 months to review Ms E’s patient files and prescriptions.
In 2022, an investigator from California’s Department of Consumer Affairs (DCA) visited Ms E’s office. The DCA is the governing agency over many professional groups in California, including medical and nursing boards. The investigator told Ms E that the agency had received a phone call from someone reporting that she had been presenting herself as a physician by using the term “Dr Sarah.” According to the California Medical Association, only medical doctors can use the title Doctor. Ms E told the investigator that she had always referred to herself as a nurse practitioner and never claimed to be a medical doctor.
After several months of investigating, the case was referred to the District Attorney in the county who charged Ms E with fraud.
Charges Against the DNP
Ms E was charged with violating California’s Business & Professions Code because of unfair business practices and false advertising. The complaint alleged that she described herself as Dr Sarah with third-party digital health care platforms such as Healthgrades and Sharecare. By referring to herself as Dr Sarah on these sites, the complaint charged that she “unfairly elevated her position among other registered nurse practitioners within these digital platforms who had correctly identified themselves as NPs.” The complaint also noted that search engines like Google can populate search results to capture her title as Dr Sarah, which may mislead the public into believing that Ms E is a physician.
“Defendant, as a nursing medical professional with a doctorate [in nursing practice], owes a duty to accurately promote her credentials while performing and advertising her professional medical services to the public,” read the complaint. “Both the Medical Board of California and the Registered Nursing Board’s paramount priority is to protect the public. Elevating her doctorate by encouraging patients to call her Dr Sarah improperly shifts the burden of understanding the scope of services a registered nurse can perform. Even more so with the statement, ‘I’m Doctor Sarah, a nurse practitioner,’ when California law prescribes who is permitted to say ‘I’m a doctor’ to a patient or the public.”
Ms E retained an attorney and continued to maintain that she had only ever called herself a nurse practitioner and had never held herself out to be a physician, regardless of the Dr Sarah moniker. When the District Attorney sent a settlement letter advising Ms E to pay an almost $20,000 fine to settle the fraud case, her attorney advised her that fighting the case would cost $50,000 and she should consider settling.
Ms E started a GoFundMe page to raise money for the settlement fee and her attorney fees. In November 2022, she settled the case. In addition to the fine, the settlement included being permanently enjoined from referring to herself as a doctor or using the prefix Dr or any other term implying she is a physician in the context of advertising or providing medical treatment to the public. For the first year, she will be required to search online each month to see if anyone is listing her as doctor and have these references removed. For the next 4 years, she will have to perform these searches twice a year. Ms E is also required to promptly correct any patient, staff, or physician who refers to her as doctor in any medical setting.
The Fallout Continues
Ms E gave an update on her GoFundMe page. She reported that she had received a citation from the California Medical Board demanding that she pay a separate fine for using the title doctor. In addition, the Board of Nursing has filed a complaint, which Ms E will have to fight or else give up her license in California.
“There are literally hundreds of people in our county who use the term Doctor who are not physicians. They hold a doctoral degree….” wrote Ms E on her GoFundMe page. She is not wrong. Many people who have a doctorate refer to themselves as “doctor,” including our current First Lady. But perhaps the difference is that they don’t do it in a medical setting.
This case has caused a great deal of consternation among NPs (and probably other nonphysician medical professionals). The District Attorney in the case faulted Ms E for failing to “advise the public that she was not a medical doctor” and failing to “identify her supervising physician,” which is not normally required without a reason. According to Ms E, a legal nonprofit has reached out with the desire to assist her, so it is likely that we have not seen the end of this case.
If you are a nurse practitioner in California, be very aware of how you advertise and market yourself and your services. Make sure that it is completely clear what your degree is and what is the scope of your practice. Do not use the term doctor with regard to yourself in the context of your medical practice. Be extremely careful about using the term doctor with regard to yourself in any written or online materials. To play it safe in California, stick to the permitted titles – certified nurse practitioner or advanced practice registered nurse.
Ann W. Latner, JD, a former criminal defense attorney, is a freelance medical writer in Port Washington, New York.