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Dear Dr. Vegas: Nevada NPs are still prescribing Schedule II substances, and you're not

Dr. Vegas cast photoOctober 29, 2004 -- Tonight's episode of CBS' "Dr. Vegas," Lance Gentile's "Limits," features nurse practitioner Alice Doherty. Unfortunately, the episode presents Doherty as merely a skilled assistant to the show's physician character Billy Grant, who must rescue her from a mistake brought on by her inability to handle her unrequited love for...physician Billy Grant.

In this episode, the show for perhaps the first time confirms onscreen what its publicity materials promised: that the Doherty character was a nurse practitioner (NP). We really weren't sure, because the depiction of Doherty we've seen in the first five episodes has been more or less the feisty version of the standard "ER" staff nurse--someone who will at times argue with physicians about care, but whose main job is to assist physicians (who receives virtually all credit or blame for patient outcomes), and of course, to serve as a convenient romantic interest for them. For Doherty, that has meant assisting Las Vegas casino physician Grant as he saves lives, and of course, falling in love with him, but seeing no patients on her own. In this episode, however, one of the other major characters, casino manager Tommy Canterna, explains to an old friend's ne'er-do-well son that Doherty's NP status means she gets to "play doctor." The expected innuendo follows. As in the past, and consistent with the "ER" model, Doherty has no real comeback.

But the episode's main subplot shows us what the show means by "playing doctor." Doherty is struggling to handle the fact that Grant, with whom she recently had a brief affair, does not love her as she loves him. So she gets drunk with the ne'er-do-well, then when he injures himself on the casino dance floor, brings him back to the casino clinic, where she forges Grant's signature on an OxyContin prescription--never suspecting that her date is stealing the prescription pad and will soon be getting Grant in a world of trouble with the police and licensing authorities, especially when a hotel guest OD's and almost dies. Of course, Doherty is aghast and wants to lawyer up, but Grant saves the day by telling the police that he authorized Doherty to write the prescription (apparently they did have some understanding about prescriptions). The show gives viewers the clear the impression that NP's like Doherty cannot prescribe narcotics like OxyContin. However--and we are sad to have to say this about a show so committed to health care accuracy--Nevada NP's are in fact authorized to administer, dispense and prescribe DEA Schedule II substances such as OxyContin.

Leaving that aside, this plotline operates as a takedown of NP autonomy, not that the show has really admitted they have much. It's true that anyone can fall in love, get drunk and make mistakes. But it's pretty hard to get around the vision of the irresponsible NP, that flighty female who can't handle her failed romance or her liquor, and needless to say can't be trusted with the awful power of the prescription pad. Of course, this damsel must be rescued by none other than the heroic physician whose liberty and license she has imperiled.

The episode does include one example of patient advocacy by Doherty. In another subplot, Grant and Doherty treat the alcoholic, out-of-control father of the show's "beautiful blackjack dealer" character, an angry man who has made a scene at the casino and who actually hits his daughter at the clinic. Grant is ready to treat his minor wounds and cut him loose, because he dislikes him. Doherty argues that Grant owes him more, a full court press for alcoholic rehabilitation, including detox, counseling and so on. She prevails, but the whole thing is phrased in terms of all the things that Grant should do for the patient, when in fact, a staff nurse could (and would) do virtually all of it--to say nothing of an NP with extensive prescription rights. In other words, Doherty acts as a patient advocate, but she has no autonomy and no significant responsibility; everything begins and ends with the physician. Grant does push her to persuade the patient to go through with this, which she does. But the implication is still that this is happening under his direction. And of course, it is the physician who supposedly stays with the patient 24/7 during the detox, a vision of the care of detoxing patients that is laughably inaccurate.

At the end of the episode, the Doherty character quits her job at the clinic, unable to work with Grant because she loves him so much, and it appears that she is now off the show as well. A few days after the episode aired, the show was put on hiatus, at least for November sweeps, and possibly for good. Is it a coincidence that as soon as the show jettisons its sole nurse character, which it has never respected anyway, it goes off the air? Yes.

See the "Dr. Vegas" website.


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