By Jennifer Henderson

A California nurse practitioner who implied that she was a medical doctor must refrain from doing so going forward and pay nearly $20,000 in civil penalties, according to a settlement announced by the District Attorney's office for San Luis Obispo county.

Specifically, Sarah Erny, RN, NP, is required to cease any claims of being a "doctor" in her role providing medical treatment to the public, and work to identify and make reasonable efforts to correct information on internet sites referring to her as "doctor" or "Dr.," court documents filed in the case showed. Erny must also pay $16,000 that will be placed in the Consumer Protection Trust Fund account for the District Attorney's office as well as $3,750 for investigative costs to the office.

In California, the state's Business and Professions Code prohibits all but a few healthcare professionals from calling themselves "doctor" or "physician," with the courts holding that limiting the use of titles is to protect the public, the District Attorney's office noted in its announcement of the settlement in Erny's case. When it comes to specially trained registered nurses, titles such as "certified nurse practitioner" and "advanced practice registered nurse," are permitted.

However, in the case of Erny, the nurse began promoting herself as "Doctor Sarah Erny" shortly after earning a doctorate degree in nursing practice, the District Attorney's office said. From October 2018 until March 2022, the nurse hosted a professional website and was active on various social media accounts where she identified herself as such.

Additionally, though Erny indicated that she was a nurse practitioner in most instances, she also failed to advise the public that she was not a medical doctor and did not identify her supervising physician, the District Attorney's office said. Online search results also listed "Dr. Sarah Erny," without mention of her being a nurse.

In a complaint filed against Erny last month, the District Attorney's office detailed how Erny contended that, after earning her doctorate degree in nursing practice, patients were so proud of her they started calling her "Dr. Sarah." Erny also contended that her supervising physician told her she needed to own her degree, even having other staff call her "Dr. Sarah," according to the complaint.

The complaint further stated that, in 2018, Erny opened a business called, "Holistic Women's Healing," through which she provided medical services and products to patients. Erny saw eight to 10 patients a day on Monday, Wednesday, and Friday at an office in Arroyo Grande, and most of her patients were allegedly unaware of the supervisory and collaborative arrangement she had with a physician, according to the complaint.

In addition to medical services and products, Erny prescribed medication to patients, the complaint stated. Entries in California's Controlled Substance Utilization Review and Evaluation System showed that she wrote more than 1,600 prescriptions for Schedule II to IV drugs, with a majority being Schedule III drugs for over 250 patients, according to the complaint.

In announcing the settlement, the District Attorney's office highlighted that national surveys indicate that the public is confused about who is and who is not a medical doctor.

"We want all health care professionals to clearly display their education and licensure so that patients know who is providing their care," Dan Dow, District Attorney for San Luis Obispo county, said in a statement. "All forms of professional medical services advertising, including websites and social media accounts, must be free of deceptive or misleading information and must clearly identify the professional license held by the advertiser. Providing patients upfront with the proper title of our healthcare professionals aids consumers in making a more informed decision about their healthcare."

Erny's lawyer Melanie Balestra, NP, said in an email that several other types of health professionals, including naturopaths, psychologists, physical therapists, acupuncutists, and optometrists also use the "Dr." prefix in front of their names, and "no one has gone after them."

"Why is Ms. Erny singled out?" she stated. "Is this discrimination against Nurse Practitioners?"

Balestra added that on her website, Erny "always explained she was a nurse practitioner. No evidence was ever presented where she stated or wrote she was a physician. There was no witness that stated Ms. Erny stated she was a physician. She held herself out as Dr. Sarah, the nurse practitioner, or Dr. Sarah Erny, DNP."