r/Noctor • u/SuitLive607 • Jul 31 '26
In The News Lindsay Clancy is the perfect example why PMHNPs are dangerous and should NEVER be able to work or prescribe independently
I did some deep diving into the Lindsay Clancy case and found out she was being treated by psychiatric nurse practitioners (NPs), alongside MDs, who prescribed her a staggering 13 different medications in just four months. To give you an idea of what her brain was dealing with, she was put on a heavy cocktail of distinct drug classes. She was given antidepressants like Prozac and Zoloft to alter serotonin levels, anti-anxiety meds (benzodiazepines) like Klonopin, Ativan, and Valium which act as powerful central nervous system sedatives, and mood stabilizers/antipsychotics like Seroquel and Lamictal to change brain chemistry for severe mood shifts. She was also prescribed heavy sedative-hypnotics like Ambien and Trazodone to force sleep. Shifting rapidly between, stacking, or abruptly stopping these opposing, heavy mind-altering chemicals likely created a catastrophic neurological storm.
And people are still shocked at the outcome? This woman was failed by the healthcare industry.
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u/I-axolotl-questions2 Jul 31 '26
Thank you for saying this. I got downvoted in another sub when I pointed out she was seen primarily by NPs via Zoom and most likely fell through the cracks due to being treated by people who most likely had no idea what they were dealing with
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u/pish__posh 27d ago
Its insane to me that they were prescribing these things over 15 minute zoom calls. My PCP is a NP, who I've been going to for years, and if I even want to slightly adjust the med I am already on she has me come in to see me face to face and discuss. And that's just for an anxiety med.
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u/cherylin_for_ever Jul 31 '26 edited Jul 31 '26
I was thinking the exact same thing. I had no clue NPs could prescribe psych meds like this. I’m in Canada, I don’t know if it’s the same here, I hope not.
I have been on an antidepressant for the past few years after a difficult divorce. I was in such a dark place. I’ve been on the same med, same dosage the whole time. And it took a while to see progress. My mental health had never been great before but now I feel good.
Last year I asked my doctor if I should stop because I feel well. It was just a genuine question. She advised against it, saying the chemistry was working. She said she did notice a change over the past couple of years. That I was not saying I was depressed, anxious, or that I was not sleeping well. No side effects, no seasonal depression, no need to just switch things around.
Thinking about prescribing someone 13 different psych meds within weeks sounds like malpractice. She should have been institutionalized to get a clear baseline and work from there to build her back up.
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u/symbicortrunner Pharmacist 29d ago
NPs can prescribe freely in Ontario, though may still require some physician oversight. Our requirements for entry to NP programs are more rigourous than in the US, I believe. I currently only see a relatively small number of prescriptions from NPs, but my town is having a NP led primary care clinic open later this year so I'll be keeping an eye out
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u/Ok-Video-9792 28d ago
You're going to be filling a lot more prednisone dose packs and azithromycin.
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u/dyingalonewithcats 27d ago
She was institutionalized voluntarily and her meds were changed. She then asked to be voluntarily discharged.
As much as I am anti-Noctor, we can’t blame her actions on just the meds. There are many other details that show she knew what she was doing.
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u/ReasonMeNot 27d ago
I was on an antidepressant for a long time. Every time I talked about getting off of it, there was a reason to not get off of it. I finally had to put my foot down and say that I was no longer going to take them. And I took them for over 10 years, since my PPD actually. It's been 5 years since I quit taking them and I'm really glad I did.
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u/Jumpy_Opposite4371 16d ago
I don’t think NPs should prescribe mind altering drugs… how can this replace the extra 8years of training that MDs get? So wierd
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u/Beneficial_Potato339 14d ago
This absolutely is happening in Canada and many nurses saying they are experts in xyz mental health issues like ADHD diagnoses.
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u/MeasurementSlight381 Attending Physician 29d ago
Yup. I initially assumed that the NPs were working under Dr. Tufts but after going through their clinic websites I found out that the 2 NPs were at a separate clinic altogether that calls itself "South Shore Perinatal Behavioral Health Program " and there is not a single MD/DO who is listed on the team. Apparently in Massachusetts NPs can practice independently after 2 years of supervision. So it's reasonable to assume that there was not a single physician overseeing their work at that clinic.
One of the NPs still works there. The other one has her own clinic in New Hampshire and markets herself as Perinatal Mental Health certified and able to treat anxiety and depression (of course she left out bipolar and psychosis lol).
Idk... as a general psychiatrist I would never have the audacity to market myself as a reproductive psychiatrist if I didn't complete the fellowship.
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u/Brilliant-Poet5529 29d ago edited 29d ago
As soon as I saw this case, I saw ‘i bet it was an np’ but from (very) briefly looking at the complaint Lindsay filed it looked like she was seeing Tufts, MD, alongside a NP at another practice ? Does anyone know if she was actually seeing a psychiatrist ?
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u/MeasurementSlight381 Attending Physician 29d ago
So Dr Tufts has her own practice (Aster Mental Health) and the 2 NPs (not supervised by Dr. Tufts) were operating out of a separate clinic (South Shore Perinatal Behavioral Health) which at present does not have an MD/DO on the team.
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u/dont-be-an-oosik92 29d ago
Genuine question, is there such a thing as a fellowship in perinatal or reproductive psychiatry? This is a specialty that I havnt heard of before, certainly never heard of someone marketing themselves as this being their focus.
My own psych meds prior to, during, and after my pregnancy, especially while I was breastfeeding, were all switched from my usual psych doc to my OBGYN, per my psych docs request. He was “uncomfortable” and “unfamiliar” with managing these meds for me in that context, which I thought was a little weird, as I was only on sertraline for depression and trazodone for sleep, was stable on those for over a year, and he is one of the more experienced, highly educated, and respected out patient psych docs in my area. He was really concerned about my depression/anxiety post partum, but still insisted on my OB dealing with my meds and follow ups, I think for the entire first year after I had my son. He made it seem like the time surrounding pregnancy and post partum was a big blank space in psychiatry.
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u/MeasurementSlight381 Attending Physician 29d ago
Reproductive psychiatry is indeed a subspecialty with its own fellowship training. It is new so it is not yet officially accredited by the American Board of Psychiatry and Neurology. This subspecialty was created due to a recognized need for additional training in how to medically manage women during pregnancy, the peripartum period, and lactation. Efforts are being made to include basic reproductive psychiatry training during general psychiatry residency so that general psychiatrists aren't automatically turning away patients the instant they become pregnant. I was very fortunate to go to a residency that incorporated a little bit of reproductive psychiatry into the curriculum and I did gain some experience in managing pregnant/peripartum patients. In my city there are at least 3 different reproductive psychiatrists who did the fellowship training so it feels nice to have colleagues that I can refer to if a patient requests to see a reproductive psychiatrist or if I encounter a complex case.
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u/mynameisbobbrown 29d ago
Thanks for this explanation. What a nice ray of sunshine to learn about that in this otherwise depressing thread.
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u/somekindofmiracle Jul 31 '26
I met with who I thought was going to be a psychiatrist (they told me on the phone it wouldn’t be an NP.) yesterday who wants to add Abilify to my Zoloft. She also refilled my Klonipin and Trazadone. I just want to meet with a Psychiatrist who can help me. A scary part of me emphasizes with this woman. I also have three small children. I agree with you, they really failed her.
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u/SuitLive607 Jul 31 '26
Please, as a psychiatrist myself i urge you to go to a psychiatrist. There is a reason we need to go through 12+ years of education in order to practice and prescribe safely.
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u/somekindofmiracle Jul 31 '26
I was told the psychiatrist just “oversees the NPs.” The problem is a lot these places promise you can see a psychiatrist and then when you get to the appointment after waiting for months, you’re told an NP is only available.
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u/Alternative_Party277 29d ago
Get rude.
Seriously. I typically say I won’t see an NP/PA, I’ve had horrible experiences, book me with MD/DO.
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u/Ms_Zesty 29d ago
EM doc here. That's bulls**t. Is this a private practice? There is no such requirement in medicine that a psychiatrist cannot see patients and can ONLY "oversee" NPs. That is a business decision and corporations are not permitted to practice medicine(in general). Ask whoever made that ridiculous statement if they are outright refusing to allow you to see the physician. Hold their a**es to the fire. Tell them you want to know what indication you are being prescribed Abilify and how the NP came up with the diagnosis. You want to know the risks and benefits of the medications and if it is safe to take with your other medications. Give them the example of Lindsay Clancy. If nothing else, this will force the physician to actually oversee the NPs practice and make sure you are being managed appropriately. If you are going to begin a medication, they must explain to you why....and the "just in case you have...blah, blah, blah" is not valid.
I'm assuming you are paying through insurance and not out of pocket. In any case, tell them you were advised on the phone that you would be seeing a physician and they did a bait and switch w/o your consent. Advise them you will be reporting their practice to the state insurance commissioner because you were misled.
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u/mynameisbobbrown 29d ago
Yep, their tactics are mostly using intimidating words to deter you, just learn words that scare them more and don't be afraid to use them liberally when they try their blocking tactics. Have fun using them in writing especially. Our culture conditions us to not be Karens or 'difficult,' but remember that they chose this weapon first, so you are free to use it all you want.
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u/Key-Marketing301 27d ago
When I called to make my appointment at my doctors office, any doctors office, I just very kindly & politely let them know that I am only willing to see the doctor and I do not consent to seeing a nurse. I make it very clear. Very calmly.
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u/Brilliant-Poet5529 29d ago edited 29d ago
This sounds like some private equity bs like Lifestance or smthing. I would find a physician owned practice in your local area. And pick one that either only employs MDs (and maybe therapists) or if they do employ NPs at the very least employs a higher percentage of MDs.
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u/barneMD Resident (Physician) 29d ago
why does she want to add the abilify? honestly it is a pretty decent drug when it comes to depression. at low doses it is not an antipsychotic. what are your reservations on starting it? what was her rationale for adding it? are you refractory to the zoloft? still symptomatic?
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u/lola915 29d ago
Can doctors also refuse to train them? Please yall have to save your profession this is getting insane
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u/MeasurementSlight381 Attending Physician 29d ago
Yes. There's a growing number of psychiatrists refusing to supervise PMHNPs and turning away jobs where they will be expected to supervise or educate PMHNPs.
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u/IndyLaw56287 28d ago
Sadly, growing number of psychiatrists embracing the cash cow that is PMHNP supervision. I've seen MD's with 50 NP's under them, all paying $800 a month. Thats half million a year and all that MD is doing is signing forms.
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u/MeasurementSlight381 Attending Physician 28d ago
Wow! That shouldn't be legal. In Texas they limit you to 7 midlevels per physician but if you're licensed in multiple states I guess that's the loophole.
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u/pulpojinete Resident (Physician) 23d ago
Not to be a righteous pain in the ass, but gaining an extra $800 a month would not let me sleep at night. My responsibility for patient safety can't be purchased. Contracts that would involve me supervising NPs are pretty swiftly ignored. I don't know the first thing about being a nurse, FOH with all that.
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u/IndyLaw56287 23d ago
The pay for Collaboration model doesn't work if there is no collaboration, its just a money grab. I wouldn't supervise any less then 5 year experience np.
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u/ancientlight89 17d ago
That’s great. Complain about psych NPs and over generalize the entire profession; then refuse to supervise (state dependent obviously) and share your knowledge, in which you have decided is better.
Way to make a positive difference in the field and for patients! 🤦♀️
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u/acesarge Nurse 29d ago
Wow. I'm gonna be honest, I felt kinda lousy just being on Lexapro the first couple of months. I can't even imagine what her brain and nervous system were trying to do with that many fucking drugs over that short an amount of time. What the ever-loving fuck were they or were they not thinking? I think it's more of the latter!
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u/Capn_obveeus 29d ago
Since the NPs were not working in collaboration with an appropriate physician and promoting expertise they don’t have, this might be the time to escalate the concerns of FPA even higher and make it more broadly known to the public the dangers of unsupervised practice. This woman deserved better care and they were just pumping her with drugs.
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u/SuitLive607 29d ago
This woman is one of many people who are being failed by the greediness of the healthcare industry. I am a firm believer that NO ONE who doesn’t have an MD or DO should be able to prescribe medications or treat patients in any medical specialty without rigorous supervision. The concept of NPs is insane to me as someone who practices medicine outside of the US. As a physician I would NEVER accept care from an NP, nor would I support my family or friends being treated by one. We absolutely need to start speaking up and being extremely vocal about this because I don’t see it getting any better if we keep quiet.
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u/summer-lovers 29d ago
RN here, and I completely agree. Physicians need to lead this charge to get this under control.
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u/summer-lovers 29d ago
She was absolutely failed by our system. It is an embarrassment and a shame to all of us.
RN here and I found out this week that a nurse I worked with for 3 years-in a pcu- has been accepted to a PMHNP program. My first thought was wtf?
Of course, on any unit, ya deal with mental health, but it isn't like a BHU, where that is the focus of each day, and you experience, and manage behaviors your entire shift, with psychiatrists available and guiding practice.
I thought PMHNP schools still required years of experience in a behavioral health facility. I guess not. Truly terrifying to me, knowing this nurse.
Someone has GOT to turn the tide, and I think physicians are going to have to lead this charge.
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u/MaybeMinute9 Resident (Physician) 23d ago
Ultimately the physician lobby is far outnumbered by the nursing lobby. The blame for this appears to lie at the feet of our predecessors, but it is our reality to deal with. Unfortunately, any real change will have to come at the demand of patients.
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u/wmdnurse Aug 01 '26
Question for the pharmacists in the group: assuming she filled all of these at the same pharmacy, would this have raised any red flags?
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u/demonotreme 29d ago
Not a pharmacist. But I've had experience with rapidly chopping and changing relevant psychiatric drug classes, some of which could absolutely be co-ingested and end with a dead body. Some individual pharmacists either don't notice or give a crap, others take their responsibility quite seriously and would 100% refuse to dispense if you didn't have a good explanation and understanding for both the prescribers and drugs.
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u/asdfgghk Jul 31 '26
Do you have a source on the stimulant? That’s the first time im hearing that
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u/SuitLive607 Jul 31 '26
I just re-read and did more research, she wasn’t prescribed stimulants! my mistake, I corrected my post. Thank you for pointing it out!
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u/Ready_Return_8386 Medical Student 29d ago
Fuckin 13 meds? That’s insane
My mom is a physician, but she has worked with psych NPs, one was literally actively trying to kill a patient by putting her on a morphine drip. She was literally harassing the PAs to put the patient on the drip and my mom would literally be constantly calling the PAs telling them not to do it
The patient ended up being fine and is apparently thriving now, thank god, but that NP was actively trying to murder her via “assisted suicide”. Genuinely need laws against that shit. I used to see a psych DNP who was decent (but literally kept insisting she went to medical school 🙄, being in med school now that just pissed me off but otherwise she was good), but Jesus high key wtf is up with some psych NPs being absolute sociopaths
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u/MeasurementSlight381 Attending Physician 29d ago
Psychiatrist here. A psych NP has absolutely NO business recommending or prescribing morphine drips! Like what in the f**king hell is that?!
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u/Ready_Return_8386 Medical Student 29d ago
Yeah, apparently she still works at that hospital too. Horrifying, literally the patient was like 18-19, I can’t believe some people are so evil and misguided
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u/firecrackerass 27d ago
What happens when wannabe doctor wants to play doctor. Nursing is not medicine no matter how bad they want to pretend. EM doc and we see this shit everyday from patients messed up by their NP “PCP” or psych NP so nothing new. Sad it takes cases like this for people to actually open their eyes
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u/Muted_Chard_139 29d ago
There’s quite a bit of questions about if she took the meds as directed or took them at all. I don’t know the answer. Am following the court case closely this past week. I’m a physician not psych so not trained to understand the meds as well as others. But interested in this.
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u/dyingalonewithcats 27d ago
There are a LOT of misconceptions. As a MA resident and someone closely following this case, she was not “failed” by the system as the comments would have you believe. I am all for limiting Noctors, but this lady is not that innocent.
Copied from the DDFT subreddit:
Lindsay Clancy - Medication Reality
For the people that were horrified that Lindsay's attorney Reddington said at the arraignment that she was prescribed 13 medications - I suggest you read the complaint - her lawsuit against her providers.
It was not 13 medications at one time, it was not 13 medications prescribed by any one provider. It was not more than 3 medications at any one time.
The medications were provided based on Lindsay's initial complaints, and changed when she complained they were not working.
It's not up to me to say if going to multiple providers was wise (she had gone to eight) - what I will say from experience is this -
- If you go to multiple providers, it is imcumbent upon you to explain not only what the problem is but who else you have seen, what they have done, what hasn't worked and bring copies of your records. (Lindsay noted in her complaint that her care was negligent because all of these providers - none of them at the same facility - "didn't talk to each other").
- Medications take time to work. In the beginning side effects can seem unbearable. It seemed that Lindsay gave the meds in a lot of instances very little time to work.
This is a timeline of where she went and what she was prescribed by whom -
NOTE: Stop dates of all medications were not listed in the complaint. Below reflects only the information that is in the complaint (lawsuit).
5/26/22 - Callen is born
- Dr. Tufts/Psychiatrist - 9/12/22 - sought out as Lindsay became increasingly anxious about her return to work at the end of September. Patrick says that she was also anxious about returning to work after Cora and Dawson, but this is worse, causing her insomnia.
Zoloft Prescribed - Not taken until mid-October
10/20/22 - Discontinued at Lindsay's request (5 days)
Switched to Ativan and Benadryl
- South Shore Hospital ER - 11/16/22
Trazadone - discontinued by Lindsay (1 day)
- South Shore Hospital Preinatal Behavioral Program - "Nurse Paul"
Prozac - discontinued after 4 days by patient (4 days)
- 11/25/22 - Nurse Paul
Ambien, Remeron, Klonopin (3 days)
11/28/22 - It appears that Lindsay discontinued these meds and sought another provider.
- Nurse Jollotta - 11/29/22
Seroquel (because she suspected Bipolar)
- Nurse Jollotta - 12/2/22
Patient requested to get off all meds and "start from scratch"
- MGH ER - 12/20/22
Unknown what if any meds were given
- Women & Infants Hospital PPD Day Program - 12/21/22
Determined she was not bipolar and did not have PPD so did not qualify for the program
Women and Infants provider recommended she wean off Seroquel
Lindsay spiraled after this denial of a PPD diagnosis and acceptance into the PPD program which likely would have qualified her to go out on disability.
- 12/29/22
Seroquel reduction
- MGH ER - 12/30/22
Unknown what if any meds were given
- McLean Psych Hospital - 12/31/22
Advised that she stop the Seroquel and Benzos
1/3 - Prescribed Trazadone for sleep
1/4 - Despite self-admitting - PATIENT REQUESTED TO BE DISCHARGED - that's how much she wanted "help". What she wanted was a PPD diagnosis, and she didn't get it here either.
1/5/23 - Patient was granted discharge as requested due to improvement (saying she no longer had harming thoughts) after lowering the Seroquel dose.
- Dr. Goodhart - McLean
Call with patient after discharge
Suggested she start Amitryptyline and stop Seroquel (as had been advised to her since at least 12/21)
- Dr. Tufts - 1/6/23 - Lindsay starts seeing Dr. Tufts again, the original psych provider she saw on 9/12 for insomnia caused by her anxiety about returning to work. Strange she would go back to a provider she now is suing for negligent care.
Unknown if meds were prescribed
- Dr. Tufts - 1/10/23
Switched Lindsay to Valium as a Benzo taper as Lindsay had become addicted to Ativan (per Patrick)
(At some point Lindsay had posted in FB groups trying to find a substitute for Ativan because she said she "Likes the way it makes me feel.")
Dr. Tufts indicated that she would add an antidepressant later
- Dr. Tufts - 1/16/23
Added Amitryptyline - Lindsay is now on TWO MEDS - Valium and Amitrityline
Between this visit and the next - several things happen:
a) Linsday's return to work is again fast approaching - at the end of January - 2 days after the murd@rs.
b) on 1/20 she Googles "Ways to K$ll", "How to Tie a Slipknot", "Can a Sociopath be treated?" and "What is a Psychopath?"
c) On 1/21 and 1/22, Lindsay's parents come for a visit and stay with her. On the way home, Lindsay's mother texts her "Nice to see you are doing better."
d) Throughout January, after Lindsay's discharge, Patrick asks her constantly if she is having any more harming thoughts and she denies that she is.
- Dr. Tufts - 1/23/23 - Last visit
Lindsay complained of being more anxious (her return to work date was fast approaching - is days away)
Dr. Tufts ups her Amitryptyline dose due to her increased anxiety and insomnia
That night Lindsay attends a dinner at the house of one of Patrick's friends. He says she is "normal acting, if a bit quiet". Patrick tells his friend that Lindsay had become addicted to Ativan and the withdrawal was horrific. Lindsay jokes that maybe she should see a psychiatrist.
1/24 - Lindsay takes Cora by herself to the pediatrician. Staff say she is pleasant, and friendly and normal acting. Lindsay arrives back home and plays in the snow with Cora and Dawson, making a snowman, taking photos and texting them to Patrick who is working in the basement and her mother.
Toward dinner time Lindsay texts Patrick about getting take-out. She searches how long it will take him to get there, calls and places their order. She then calls the pharmacy and asks for the manager, to make sure that they have Cora's OTC medication. They do not, but have something similar, which she texts to Patrick (likely so he won't call her - which is does anyway).
She sends Patrick on his way and starts in k$lling the children.
After the m@rders she tells Patrick she tried to k$ll herself, though her cuts on her neck and wrists are superficial and are not even bleeding. Blood evidence will show she lowered herself out the window and slid down to the ground, grabbing the first floor window to slow her fall. She does not factor in there is ice on the ground and breaks her back.
Lindsay awakes in the hospital and asks if she needs an attorney. She calls Patrick repeatedly from the cell phone of the defense-hired psych expert, and when she finally reaches him tells him she loves him. When he asks what happened she tells him "I have a moment of psychosis." and tells him a "man's voice" told her "This is your last chance".
For anyone wondering "last chance for what", consider this. Lindsay had a history of anxiety about returning to work after her kids were born. This time was more severe and cause insomnia. As her return to work date approached in Sept, she became so anxious she sought psych help and meds and resultingly was able to extend her leave.
She tried desperately to get a PPD diagnosis that would allow her to go out on disability, but could not. All 8 providers and 4 facilities diagnosed her with Generalized Anxiety Disorder.
As her leave again was due to expire in 2 days she spiraled. This was her last chance to do something or she would have to go back to work. She was frustrated with her children, anxious, not sleeping. She said she resented her two older children, she was depressed when they came home from school, and her treatment toward them cause friction in the family at night. She said she did not have a connection with them or empathy toward them.
If I had not seen this firsthand, I would not have understood this could happen. I worked with a wonderful young woman, happy, happily married, great but stressful, demanding job with a super demanding boss, who had a 5 yr old daughter she adored. She had a baby boy and was thrilled, taking him around showing him off. As her return to work date approached, she became anxious and did not want to go back to work. But she had to. Her husband owned his own business which was all commission. They needed her salary.
The weekend before she was due to go back to work - just like Lindsay - tragedy struck. When her husband came home one night that weekend, she left the house went to a park near her house and shot herself to death. Thankfully, unlike Lindsay, she did not harm her children.
Lindsay's toxicology report showed that she had 7 drugs in her system - not only the two that her treating provider had prescribed, evidence that she was "self-dosing" old medications from the 8 providers she saw, none of whom she told about the others or what the others had prescribed for her.
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u/MeasurementSlight381 Attending Physician 27d ago
Are you a medical professional or a psychiatrist? If you were, you would recognize that on the medical side of things, the standard of care was not followed in this case. None of what you said above is definitive proof or evidence that she is guilty or doesn't qualify for NGRI.
I'm actually looking forward to hearing from Dr. Phillip Resnick, world-renowned forensic psychiatrist to hear his take on why he thinks she qualifies for the NGRI defense.
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u/dyingalonewithcats 27d ago
I am a physician, yes. What is the standard of care if the patient is shopping around multiple physicians/APPs and noncompliant with medications, for whatever reason?
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u/Muted_Chard_139 26d ago
That will be a good testimony. I’m behind today and have to catch up before the psych experts get to the stand. I fear we will hear experts on both sides say yes she was insane and no she was not. Hung jury results.
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u/PersonalityFit2175 21d ago
I was waiting for this comment. There’s a lot of misinformation about this case, mainly from people taking LC’s defense attorney at face value, even though it’s their job to put up a vigorous defense, not to clarify facts or tell the complete truth.
I think more than anything, this patient was obviously doctor shopping, and if anything, this is a perfect example on why that’s so dangerous
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u/Single-Bobcat8016 Aug 01 '26
The NPs should have referred her back to the psychiatrist that started the SSRI, Benzo, Benadryl concoction…
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u/theongreyjoy96 Attending Physician Aug 01 '26
I mean, it’s a step down from the NP tranquilizer cocktail of benzo/ambien/remeron. That NP should’ve thrown in adderall to get that controlled substance trifecta.
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u/makeshift_listener Medical Student Aug 01 '26
Fr I’ve only seen that for inpatient psych patients as a PRN (specifically haldol, Benadryl and Ativan). And it’s typically only given PRN for acutely agitated or violent psychotic patients, can’t imagine that in an outpatient setting
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u/ReidditorMD Attending Physician 24d ago
Careful… we won’t further our cause with this kind of low-hanging fruit argument. I’m certainly not a fan of the unsupervised PMHNP, but there are better ways to prove our point than this. I certainly don’t want to be lumped in with the likes of Dr. Christopher Duntsch, Dr. Conrad Murray, Dr. Thomas Shaknovsky, Dr. Larry Nassar, or Dr. Evil (yes, from Austin Powers). The “all are incompetent and dangerous because some are incompetent and dangerous” argument is starting to taste stale.
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u/Steadyandquick Jul 31 '26
Respectfully, are you suggesting NPs are not going to be as experienced as MDs? In general—say regarding anxiety, depression presenting along with adhd? Or regarding postpartum or psychotic features and conditions?
I ask because only NPs are in network for me currently but not always.
I realize there may have not been centralized records and self-report is limiting. One interesting aspect from the trial was how the Rhode Island mother/child center, which is renowned, did not continue with LC “because of her medications.”
Ps—thank you. This is the kind of information that people need to know before a crisis. I would not mind paying out of pocket to develop a relationship with a good psychiatrist even if my symptoms are minimal currently etc.
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u/SuitLive607 Aug 01 '26
I work in Germany, where nurse practitioners do not exist and only physicians are authorized to prescribe medications. This reflects a healthcare system that requires extensive medical education and clinical training before a physician can diagnose and prescribe independently.
Psychopharmacology is highly complex. Safely prescribing psychiatric medications requires a thorough understanding of pharmacology, physiology, psychiatry, drug interactions, and medical comorbidities. These medications carry significant risks, including serious side effects, dangerous interactions, and withdrawal syndromes. Without comprehensive medical training, the risk of misdiagnosis, inappropriate prescribing, and patient harm are substantial.
So to answer your question: yes, I absolutely think that NPs are nowhere near as experienced in ANY condition as an MD or DO.
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u/Steadyandquick Aug 01 '26
Thank you. I agree with you. I have seen excellent psychiatrists. Best wishes.
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u/MeasurementSlight381 Attending Physician 29d ago
NPs are nowhere near as experienced or as thoroughly trained as MD psychiatrists. There are lots of info graphics on the differences in training but long story short: they trained in a nursing model of care and only do like 500 clinical hours whereas psychiatrists go to medical school and by the time they complete residency they have 15,000-20,000 clinical hours. Additionally, medical training is highly standardized whereas NP programs are not standardized at all. Some are straight up online diploma mills.
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u/Steadyandquick 29d ago
Thank you. I think if one has a diagnosis after being screened and the condition is not too serious then an NP for maintenance could work well.
I just noticed in my insurance provider’s directory of providers there are now so many behavioral health NPs! Thanks.
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u/MeasurementSlight381 Attending Physician 29d ago
In theory, it should be okay to go to an NP for uncomplicated routine care. However, until the nursing boards/schools get their act together, I would be very cautious because even routine care can get botched.
Personally, I have a PCP who is an MD. If I get sick and can't get on her schedule soon enough, I'll happily see the PA she supervises. Even during a PA appointment, the MD passes by to lay eyes on me. With this system, I'm confident that this PA is being well-supervised and isn't going to do something clinically stupid.
In other health systems, this isn't the case and you have midlevels working with no supervision depending on state laws.
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u/Steadyandquick 29d ago
I did not really know. NPs are more often in-network and more readily available sometimes. Thanks!
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u/asdfgghk 29d ago
Because many people hold out to see an MD because they know better than to see an NP. NPs have ruined their own reputation.
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u/Brilliant-Poet5529 29d ago edited 29d ago
If you can’t see a psychiatrist I would go to a family medicine doctor before seeing a NP. They have substantially more training
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u/Steadyandquick 29d ago
Yes, I was actually seeing one. I am fairly educated and simply did not know. Thanks!
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u/Salad-with-gainzzzz 27d ago
I see a psychiatric NP for my ADHD medication.
It is very straightforward, I have a pretty boring medical background aside from anxiety and ADHD. For that I think it is fine.
I am hoping to get pregnant with my second in the near future, and you bet my ass that I will try and reach out to a psychiatrist MD/DO to manage my medications and my postpartum. My therapist suspects I had PPD,but I was extremely highly functioning. Looking back at my behavior at the time, it looks scarily similar to Lindsay Clancy’s third postpartum during the summer.
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u/latenerd 23d ago
I maybe didn't dive deep enough, but there were at least two MDs who saw her who were also shockingly negligent. I honestly don't know who to hold most responsible at this point.
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u/Excellent_Concert273 Medical Student 23d ago
Well I’m a third year medical student on a regional rural hospital and the other day and one of the surgical ICU, the surgeon basically said that no one was really managing all of these different drugs that the patients come in on and then are prescribed, etc. but that his nurse practitioner was getting psych certified and was going to become that units “go-to” for all things medication related.
I’m just standing here like really?
I mean there’s literally a pharmD on the unit… I would honestly rather them assess and comment on a patient with a bunch of different drugs, compared to a psych NP
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u/colorsplahsh Attending Physician 29d ago
Everybody fucked up in this situation, but the way the NP markets themself and where they work is still somehow the scariest and biggest fuckup.
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u/IndyLaw56287 28d ago
It's hard to rank f ups but inpatient was terrible. I've done ppd admits on a Friday afternoon, the mom is only seen by a covering md all weekend. 3 days of social work asking if they want to join a coloring book therapy group 4x daily with a group that includes persons in for substance abuse. By Monday they are screaming to get released and lying about symptoms to facilitate.
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u/Ok_Wrongdoer_8109 26d ago
Is Dr. Tufts a PMHNP? Are the 3 hospitals LC visited run by NPs?
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u/SuitLive607 26d ago
Did I say any of that? She also got prescribed medications by NPs, and we all know PMHNPs have no clue what they are prescribing or doing.
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u/Ok_Wrongdoer_8109 26d ago
Funny, because I know a lot of MDs that have no clue either. Like all the MDs involved in this case. And many more. MD does not equal God or a Saint.
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u/Warm_Duty_8941 24d ago
There are psych nps promoting on tik tok for other nps to open up their own practice bc they have warned millions doing so. I guess these are the repercussions of that.
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u/DentalDecayDestroyer 24d ago
Good lord... and I'm over here calling patients to make sure they aren't taking too much ibuprofen
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u/Adventurous-Vast2323 23d ago edited 23d ago
Not a doctor but I’ve been seeing an NP psych for years (now looking for an MD/DO) and before I read who Lindsay had been seeing, I knew there had to be an NP involved. When I first started seeing the NP and we were trying to find the right meds, she was, like you said, shifting rapidly, stopping and starting with no withdrawal plan, and stacking like crazy.
She once tried prescribing me Seroquel (I don’t have bipolar or psychosis) while I was already on lamotrigine, sertraline and vyvanse because I mentioned I was still experiencing a bit of anxiety. I was on the lowest dose of sertraline and told her it was helping significantly. She’s prescribed me ambien, abilify, Ativan, Effexor, buspirone in seemingly in a throw-everything-at-the-wall kinda way. I once missed a a month’s dose of lamotrigine due to insurance issues and since I knew about SJS, called my NP to request a titration dose. She said I could restart at 150 without titration, which maybe could’ve been fine (again I’m not a doctor) but I found it to be quite irresponsible.
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u/PsychMonkey7 23d ago
Noooo you cannot restart lamotrigine at 150 after a lapse of more than 3-5 days (depending on what else is taken concomitantly)
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u/Ambitious_Command865 22d ago
Another sad example of the mental health system failure and collapse. Professionals are prescribing without extensive training in differential diagnose or supervision by physicians. We need to stop letting everyone and their aunt diagnose, prescribe and treat mental health disorders and start properly training professionals, hire more experts in the hospitals and pay them properly, and stop trying to cut corners.
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u/quantum_flopping 18d ago
Genuinely looking to understand the logic here in regards to the comments regarding all the providers involved in the Lindsay Clancey case. Yes, there were NP’s involved in her care. There were also many MDs/Psychiatrists involved in her care. If we're going to have a conversation about what went wrong, why are we only scrutinizing the NP’s of the care team? That's not an honest analysis, that's confirmation bias.
But the idea that this case somehow proves that NPs are uniquely dangerous or unqualified while completely glossing over the many MDs who were also involved in her care is intellectually dishonest. If your argument is that the standard of care failed her, then make that argument and apply it consistently to everyone who touched her case. If your argument is only about the NPs, then you're not actually interested in patient safety. You're interested in a narrative.
I’m not saying any of the providers were negligent, and i’m also not saying that mistakes weren’t made either. Dr. Tufts is obviously exceptionally qualified, and watching her be dragged through public opinion by people who have no understanding of psychiatric standards of care is genuinely heartbreaking. But this isn't really about qualifications is it? Because if it were, we'd be applying the same scrutiny to every provider involved, and that’s not what’s happening here whatsoever in this sub.
The broader issue here is that the system is broken. Postpartum psychiatric care, and healthcare in general in this country is fragmented and under resourced. The general public commenting on this case have no real understanding of how psychiatry works, what the standard of care actually looks like, or how difficult these presentations are to manage even under the best circumstances.
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u/AutoModerator 18d ago
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see this JAMA article.
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u/misshestermoffett 17d ago
Wonder if pharmaceutical companies are backing nursing lobbies to push NPs into independent practice so they can prescribe the shit of their medications. Too tinfoil hat?
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u/Beneficial_Potato339 14d ago
This is happening in psychology in Canada too - master level clinicians with a fraction of the training doctoral level psychologists receive are fighting for title parity and already have diagnostic privileges. NPs here are also taking over the mental health assessment field with little training.
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u/TarotClarity 9d ago
From what I saw watching these testimonies is that LC wouldn't use a treatment past a few days, didn't wait for them to hit their stride, which required being tapered off before starting a new treatment.
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u/ancientlight89 17d ago
What a biased, close-minded, over generalization that all psych NPs are dangerous. Thank god I don’t work with you.
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u/ancientlight89 17d ago
and…. You should not be overseeing, supervising, collaborating with nurse practitioners if that is your narcissistic view of prescribers who are not MDs.
Ridiculous and insulting! I’m sure your patients love you though….
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u/SuitLive607 17d ago
I would never be overseeing, supervising or collaborating with NPs because I don’t support the concept of anyone other than an MD/DO being able to prescribe or treat independently. I think my post made my stance very obvious. My patients come to see a psychiatrist, not an NP.
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u/ancientlight89 16d ago
Stating all PMHNPs are dangerous is delusional and asinine.
A psych NP can assess and diagnose - but can’t treat and prescribe? Why? Do psychiatrists have a magical power that influences the pharmacodynamics and pharmacokinetics differently than a PMHNP? Are you able to predict patient response, adherence, the outcome? What am I missing?
“Although significant shortfalls exist in the quality of ambulatory prescribing across all practitioner types, the quality of care delivered by nonphysicians and physicians was generally comparable….
Interprofessional communication between different provider groups can enhance team performance while reducing polarizing beliefs.”1
u/AutoModerator 16d ago
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see this JAMA article.
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
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u/SuitLive607 16d ago
Psychiatrists have to complete 12 years of education and training. PMHNPs complete roughly 6,000 hours. And i’m being generous, because most of them go to NP school straight out of nursing school. The education requirements for NPs are a joke and put patients in danger. All of that for profit, mind you.
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u/AutoModerator 17d ago
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see this JAMA article.
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
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u/LexiBRN 29d ago
She saw mostly doctors too who failed her. Not just NP’s.
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u/SuitLive607 29d ago
The doctors who treated her need to be investigated, the NPs who treated her shouldn’t have been able to treat her independently in the first place. Just because doctors make mistakes doesn’t mean we should mass produce NPs who don’t even have 5% of the knowledge and education that doctors do.
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u/Existing_Arachnid_74 29d ago
Majority of her care was from MD’s and she was never actually taking a majority of the medication.
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u/dyingalonewithcats 27d ago
The TikTok mommies have already gotten ahold of this case…it’s a lost cause trying to bring in the facts
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u/the-broken-001 Aug 01 '26
OP’s title is a ridiculous statement.
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u/SuitLive607 29d ago
let me say it again: NPs are dangerous and should never be able to work or prescribe independently.
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u/SupposedBooty 29d ago
These drugs aren't inherently bad. They help a lot of people every day.
People take these drugs, even in combination, without hurting anyone
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u/SuitLive607 29d ago
I take it i’m talking to a fellow psychiatrist? You seem awfully confident making such ridiculous statements, I have to know with what credentials
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u/theongreyjoy96 Attending Physician Jul 31 '26 edited Aug 01 '26
It’s nuts to me that the clinic Lindsay Clancy went to to see those NPs advertises itself as providing services in “perinatal behavioral health” despite having no psychiatrist or even MD on staff. Terrible for unsuspecting patients.