Thanks for your comments. They're very enlightening.

So your thesis is that people should see real doctors for anything that might be serious. Fair enough. But some serious things present as possibly non-serious things that a clinic NP should handle with outpatient treatment, right? Including a case like this that might be easily treatable diabetes symptoms, or might be a serious infection that will kill the patient in 24 hrs? For clarity, this was not just an unusual lab value or two; the appeals court decision says the patient's initial symptoms were abdominal pain and fever [1].

Here's the point, I think: The NP, with her limited medical training, wasn't sure which side of the line this fell on. Two doctors told the NP that they thought the patient's symptoms were caused by diabetes, and by not taking action or encouraging her to send the patient to the ER, both doctors implied that it should be handled outpatient, and not involve a real doctor.

From the decision:

> Simon says that Dinter told her that Warren did not need to be admitted to the hospital. Dinter disagrees, saying that he responded “to what end[?]” to a question as to whether Warren should be admitted.

As you point out, nurses and NPs do not have a doctor's training. Suppose you were a GP or hospitalist and had a patient call you directly for some reason and you listened long enough to hear they had abdominal pain and fever and (modestly) elevated WBC. Would you tell them it's probably caused by diabetes, even if that's what you think? I doubt it. You wouldn't admit them yourself even if you could, right? But you'd tell them if they felt it was serious to get the hell to an ER and let them evaluate it, right? Given your view on lack of training of NPs, why treat them any differently than patients?

It's beside the point that the NP probably should have ignored the hospitalist's attempt at gaslighting ("to what end?") and sent the patient to the ER anyway. If doctors agree that NPs are not competent to be diagnosing as they currently do, then why discuss a patient's diagnosis (for the purposes of admission) with them as if they're a doctor and can competently make their own judgments? Remember this is all in the stage where the patient doesn't really have a doctor yet.

On reflection, I guess it's possible this is a case where competent doctors would genuinely think, because of details beyond what's reported, that it was diabetes... until it was too late. Maybe any other nurse would have thought so too, and not pursued trying to get the patient admitted at all. Maybe this was a statistically unlikely "lucky" (in the sense of being correct, in hindsight) gut feeling this NP had, which led to disagreement and opened the door for a juicy settlement? And perhaps this is all pointless, holding doctors and medical networks, as well as the nurse herself, responsible for a nurse's lucky guess that wasn't followed through on?

To hopefully quell some of your fears about the state of practicing medicine now in MN, let me quote:

> Our decision today should not be misinterpreted as being about informal advice
from one medical professional to another. This case is about a formal medical decision—
whether a patient would have access to hospital care—made by a hospital employee
pursuant to hospital protocol. We decide only that hospitalists, when they make such
hospital admission decisions, have a duty to abide by the applicable standard of care.

[1] for reference, appeals court decision: https://mn.gov/law-library-stat/archive/ctapun/2018/OPa17055...