Can a nurse practicioner own and operate a ketamine infusion clinic?

March 15, 2023 4:07 PM

I went to a ketamine infusion clinic recently for depression, it was owned and operated by a nurse practitioner. There is no physician present, and no physician signing off on orders. The NP told me that in Ohio NPs can give ketamine without a doctor signing off. Is this true? Also, I had an awful experience and was treated negligently, is there a place I can report this NP to, like an NP governing body or something?
posted by maxexam to Law & Government (13 answers total)

Here is an overview of an NP’s scope of practice in Ohio, which seems to support what you were told: an NP in Ohio must practice in collaboration with a physician, but per the linked article on collaboration, the physician does not need to be physically present, just available for consultation. They can also independently prescribe medication. The full text of the scope of practice law is also available online here.

You can file a complaint with the Ohio Board of Nursing, who manages NP licensure in Ohio, here.
posted by MadamM at 4:17 PM on March 15, 2023 [4 favorites]

I just attended a training on topics about things like this today. Because ketamine is an approved FDA drug with legitimate uses without any real restriction on its use basically perscribers are allowed to perscribe off label if they feel it is clinically appropriate. If she's allowed to perscribe, then legally she's not doing anything wrong even though ethically she may be. I'm not super familiar with Ohoi's laws to give a definitive answer.

Reporting to the nursing board is something you should absolutely do. No one should be running a ketamine clinic without the support needed to run one and respond to patient needs.

I'm sorry about your experience.
posted by AlexiaSky at 4:33 PM on March 15, 2023 [1 favorite]

Hi, just confirming that here in Ohio, NPs can prescribe if they have a supervising physician of some sort. My psychiatrist is an NP. If you're comfortable doing so and in the Cleveland area, would you be comfortable memailing me the practice so I can avoid it?
posted by chesty_a_arthur at 5:20 PM on March 15, 2023 [2 favorites]

Response by poster: There is no supervision physician though. No supervising physician on-site. No supervising physician off-site. No physician involved whatsoever.
posted by maxexam at 5:43 PM on March 15, 2023 [1 favorite]

Supervision and collaboration are different. In supervision, nothing happens without the doctor’s sign-off. MadamM’s link links here to describe how collaboration is different. They set standards together, and the MD needs to be available for consultation, but does not need to sign off on anything. Did she specifically say she is not consulting with an MD at all, or is it simply that there’s no MD signature on any of the orders? The MD signature is not required, but being able to contact one if a problem arises is.
posted by brook horse at 6:02 PM on March 15, 2023 [1 favorite]

The people evaluating your complaint can be counted upon to be ardent advocates of expanded prescription and procedural privileges for RNPs and PAs from a prospective of care access or guild prosperity, or both. If you don't want your complaint to be dismissed out of hand, focus on what you didn't like about the care you received, not your unhappiness with the low/non-visibility of a physician in the care.
posted by MattD at 8:43 PM on March 15, 2023 [9 favorites]

Seconding "focus on what you suffered." Put it this way: if there had been a doctor on hand, and you'd been treated negligently, you'd still want to file a complaint, right? Negligence from a doctor is still negligence. Maybe you'd be complaining to a different professional board, but you'd still be complaining. So focus on that.
posted by nebulawindphone at 7:06 AM on March 16, 2023 [5 favorites]

Some states allow APRN level licenses to practice completely independently, without MD oversight; this varies by state.

I would highly recommend directing all of these questions to the licensing board in Ohio; ostensibly their entire job is public safety, and will be able to tell you if this person is violating any rules on the books. Complaints filed through boards are often 'closed' and not able to be reviewed by the public, and you may feel like this is kind of like yelling into a black box.
posted by furnace.heart at 7:55 AM on March 16, 2023 [1 favorite]

I’m biased because I am a psychiatrist (that is a physician who has specialized in psychiatry), jbut I would NEVER refer my patients to these clinics. They are the equivalent of pill mills, and I am still shocked the government is this lax on ketamine clinics (and so much else when it comes to healthcare). I wouldn’t even supervise one. I’m going to guess the NP has almost no psychiatric training or very limited. I’ve treated several patients who have gone through one of these very for-profit clinics and has had a terrible experience and worsening of their psychiatric illness. You can report to your state’s board of nursing, as nurse practioners are not under the medical board.

Also to a comment above, an NP cannot be a psychiatrist. They may be a psychiatric mental health nurse practitioner, but the education and training demands between a physician who specializes in psychiatry (a psychiatrist) and an NP are WORLDS apart.
posted by namemeansgazelle at 9:10 AM on March 16, 2023 [4 favorites]

my infusion clinician is a Nurse Anesthetist, fwiw.
posted by j_curiouser at 10:12 AM on March 16, 2023

I would NEVER refer my patients to these clinics. They are the equivalent of pill mills, and I am still shocked the government is this lax on ketamine clinics (and so much else when it comes to healthcare). I wouldn’t even supervise one. I’m going to guess the NP has almost no psychiatric training or very limited. I’ve treated several patients who have gone through one of these very for-profit clinics and has had a terrible experience and worsening of their psychiatric illness.

namemeansgazelle, I'm not trying to get off topic, but are you saying that you think that ketamine shouldn't be available as a treatment because it's ineffective or harmful, or that it should be administered in more heavily regulated and supervised medical settings, or something else? I'm asking both for my own curiosity, and because I think it might help OP sort out how to direct her complaints about her own treatment (should they be complaining to the NP licensing authority that the NP did a bad job, or trying to get more oversight passed so that ketamine clinics are better regulated, or advocating to ban the use of ketamine as a psychiatric treatment?) Thanks for lending your expertise!
posted by decathecting at 1:17 PM on March 16, 2023

Hi, decathecting:

Great questions, and apologies to derailing the thread at all. I do hope this will give OP further context.

I think ketamine therapy should absolutely be available and there is good data to support it for treatment-resistant depression and I've referred many people to reputable places. But clinics like this are very scary. Often there is no psychiatrist, meaning there is no specialist physician to work with people with treatment-resistant depression, which is VERY hard to treat and I'd argue one of the hardest diagnoses to manage in psychiatry. Some places are run by only NPs or maybe even anesthesiologists or emergency medicine doctors with NO psychiatrist on board--now this isn't because NPs or anesthesiologists or emergency medicine doctors suddenly care about treating some of the toughest psychiatric patients out there that will keep a psychiatrist up at night. It's because it's not regulated and $$$$. These clinics are major cash cows. Most of these places don't take insurance and people pay thousands of dollars for treatment (though ketamine is dirt cheap). I've had some patients start abusing their oral ketamine that was mailed to them after talking to a nurse practitioner online for 5 minutes. Often there is no appropriate follow-up. There is no ensuring pt also has other modalities on hand (ie, psychotherapy). Everything about the care at these clinics is second-rate, except for how much they charge.

So as a treatment: yes, it's a wonderful thing to have in our arsenal for treatment-resistant depression, a diagnosis that can feel so hopeless for so many. But "entrepreneurial" healthcare providers--both physicians and nurse practitioners--are taking HUGE advantage of this very vulnerable population that is hopeless after years of other treatments not working. NPs, anesthesiologists, emergency med doctors, whatever--none of them have enough experience in treatment-resistant depression to be running these clinics with no psychiatrist involved. (in fact, most of healthcare can't stand working with patients with psychiatric illness period.) It's a HUGE ethical breach. But again, it's America, so healthcare = $$$$.

I tend to refer my patients to the closest academic center in town, but I'm in a major metro area in a coastal city. I totally understand that's not available for everyone.
posted by namemeansgazelle at 1:49 PM on March 16, 2023 [4 favorites]

(namemeansgazelle - Yep, I realized that I call her that and she's a psych NP; her doctorate is in nursing practice.)
posted by chesty_a_arthur at 5:51 PM on March 16, 2023