Hemoglobin of 5.2, no big deal

Anonymized physician submission. Lightly edited for clarity and grammar.

In today’s episode of “WTF, NP?” I give you the saga of a failure to act on a critical lab result. I was on call for my SMI (Serious Mental Illness) clinic about a month and a half ago, and got a call early in the morning from the lab. A patient with a hemoglobin of 5.2.  I drop a note in the chart, email her psych NP (who’d ordered the CBC), and say in both “ED, STAT. Please send out a case manager to her home to go get her (patient has no phone).” I call the other medical director of her clinic (I oversee two, he oversees the other two), he talks to her team as well, and relays the urgency of the situation. “Got it, will do.” Except...cut to six weeks later and now there are emails flying back and forth about this same patient. Turns out, the patient never made it to the ED way back in February. Instead, the NP decided to repeat the labs in March (yup), which were THE SAME, and then tried to turf the issue to the primary care NP, who was like “Absolutely not - patient needs a transfusion!” It was the FNP who alerted the CMO to the situation because she was concerned that the psych NP was not making substantial efforts to get the patient to the ED, instead asking the FNP if “optimizing her thyroid” would solve the issue and asking her to consider sending a referral to GI. When the psych NP was asked about the situation, she lied about it, stating that she had just happened to see the Hgb when she saw the patient as a walk-in and the patient had refused to go to the ED. I obviously called her out on this with everyone CC’ed, including her email confirming receipt of the information and a screenshot of my note in the chart. You don’t know how much I had to cool off before I screamed, “What fucking part of take the patient to the emergency room did you not understand?!”  If the patient had actually refused and I had been informed, I would have petitioned her to get her to the ED against her will, if need be. Thank all that is holy that this patient is still alive. We sent her to the ED that day.  And I had a calmer, but still frank, conversation with the NP about her (lack of) ability to recognize a critical medical situation. The NP did not respond to my email; her boss will address it with her in person when he returns from vacation this week. Unfortunately nothing will happen to this NP. The CMO even gave me the directive to not be “too harsh” with her because we are so short-staffed that we cannot afford to lose another “BHMP” (“Behavioral Health Medical Professional,” which is what they call all of us in [redacted]).