DENTON, Texas (NewsNation Now) — A special NewsNation investigation into health care in America will introduce you to two families sounding the alarm about the care their loved ones received, and what they feel is a lack of transparency.

Even before the story aired Thursday night on NewsNation, there was significant pressure directed at us by the AANP — The American Association of Nurse Practitioners — not to run the story, and alleging that our report unfairly maligns nurse practitioners in America.

That is not the case and certainly not our intention, and it’s one reason we interviewed the AANP in this story.

During this pandemic, nurse practitioners have proved to be absolutely critical to our country’s health and well-being, and are essential to our health care system. In fact, everyone featured in this story agrees about that.

The two families you’ll meet say this is about accountability and transparency. Both families filed medical malpractice lawsuits after losing their children. They both caution parents to be aware of who’s treating their child, raising awareness around the growing role of nurse practitioners and physician assistants.

THE WATTENBARGERS

7-year-old Betty was the light of the Wattenbarger family. Her autism, though, made it difficult to communicate, so last year, when she had a fever and wasn’t acting right, they called her pediatrician.

Betty’s mother, Stacy Wattenbarger, said the pediatrician’s office told them that they couldn’t see her daughter because they “don’t take Wednesday afternoon appointments.” They suggested pediatric urgent care, instead.

So Betty’s parents took her to the Pediatric Urgent Care of Denton, Texas.

Stacy said that the center told her that Betty was positive for a type of flu. She said they listened to Betty’s lungs but didn’t detect anything, so “they just sent us on our way basically.”

But by the next morning, Betty’s condition had taken a turn for the worse.

“She falls down in the shower and I thought, something is not quite right, but you know, she does have the flu because that’s what they told us,” Jeremy Wattenbarger said. “I said, well let’s make you really comfortable. I get her favorite pillows. I got her show going.”

Jeremy said he walked back several minutes later and Betty’s head is hanging off the pillow, with blood coming out of her mouth.

They rushed her to the nearest hospital emergency room. But she didn’t have a heartbeat, and the doctor couldn’t get her to breathe.

“And I remember hearing flatline and I knew at that moment, my daughter was dead and that she was gone,” Stacy Wattenbarger said.

Only after they received the autopsy did Betty’s parents begin to understand what had happened.

Jeremy Wattenbarger said they found out that Betty had sepsis and streptococcal pneumonia.

“And so what had happened is, the day before when she went into Denton Pediatric. And when she went in there, is that she was actually probably in the beginning stages of sepsis, or in the middle stages of sepsis shock,” he said. “She had severe pneumonia and had a third of a cup of fluid in her left lung on the start of pneumonia in her.”

Jeremy said Betty’s ailments should’ve been diagnosed at the urgent care center.

Stacy said that at the time, they didn’t have any doubts about the care Betty was receiving in Denton.

“I believed 100% that they were the experts,” she said. “They had the credentials, the experience. I believe that she was being seen by someone who had the knowledge to diagnose properly.”

Stacy said she believed Betty was being seen by a doctor, but she had actually been treated and diagnosed by a pediatric nurse practitioner.

Dr. Amy Townsend, a family practice doctor in Bridge City, Texas, had received Betty’s medical records. She is on the board of advocacy group Physicians for Patient Protection.

“Any physician who would’ve looked at that child would have been able to tell that child was critically ill and known that that child should have been sent to the ER and admitted to the hospital, particularly with the knowledge that her oxygen saturations were low,” Dr. Townsend said.

What was most striking to Dr. Townsend was Betty’s vital signs.

“When she initially arrived to the clinic, her heart rate was documented as being 170, which even for a child with a fever, that is very concerning,” she said.

Dr. Townsend added that, “Even an oxygen level in the low nineties for a child that age is something that should alarm any physician.”

In Texas, nurse practitioners can diagnose and treat patients, as well as prescribe medicine as long as they are under a doctor’s supervision. Under state law, the doctor is not required to be physically on-site.

“There needs to be a doctor, or someone, who is supervising on-site, who sees what’s going on, knows what’s going on,” Jeremy said.

The Wattenbargers have filed a medical malpractice lawsuit against Pediatric Urgent Care Denton and the caregivers involved, alleging misdiagnosis and gross negligence.

In their legal response, the defendants deny the allegations and say they provided “appropriate care” and that her death was caused by a “pre-existing health condition.”

THE DOCKINS

In the fall of 2015, Amy and Marlon Dockins’ daughter, Alexus, was a 19-year-old sophomore honor student and basketball player on the Redland College basketball team in El Reno, Oklahoma.

One day, she complained of chest pains and couldn’t breathe. Paramedics rushed her to the emergency room at Mercy El Reno Hospital, where they thought she was being treated by a doctor.

Amy Ochoa Dockins said the woman treating her daughter introduced herself as the attending physician, and told her that Alexus would be OK but that she needed to be kept there for observation.

Hours later, Alexus was clinging to life. She had been suffering a pulmonary embolism.

“I felt like I was dreaming,” Ochoa Dockins said. “Like, I just left my daughter. I couldn’t believe it.”

Alexus died hours later.

The family wasn’t only devastated by her loss, but also by what they uncovered later: that Alexus wasn’t treated by a physician, but rather by a family nurse practitioner.

“I was speechless. I was angry. It just wasn’t fair. It wasn’t fair,” Ochoa Dockins said.

The Dockins sued for medical malpractice and for “negligent credentialing” on the grounds that the family nurse practitioner should never have been allowed to treat acutely or critically ill patients. And they won.

“She died for the most senseless reason of all. In a nutshell: corporate greed,” said Dr. Niran Al-Agba, a pediatrician outside Seattle. “The corporation put a nurse practitioner in that ER that didn’t have the training to be in an ER alone, and over a 12-hour process, a beautiful, healthy 19-year-old girl with her entire life ahead of her lost her life.”

Al-Agba is the author of a new book, “Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare.” The book claims to expose a “vast conspiracy of political maneuvering and corporate greed that has led to the replacement of qualified medical professionals by lesser-trained practitioners.”

“Many of the states were asking for a lot of these non-physicians to be granted free practice authority or full practice authority, so that they’re practicing independently,” Dr. Al-Agba said. “And I think my concern and the concern of many others is that they may not have the full scope of training or the full 11 years of training that physicians received. And so when they’re doing the same job as physicians, the question is how can they provide the same care?”

SUPERVISION VS INDEPENDENCE

It’s an issue and heated debate playing out across America.

According to the American Association of Nurse Practitioners (AANP), 22 states now allow nurse practitioners to work with total independence from doctors in their own practice. That is, for example, operating an urgent care-type facility with no physician attached to it. Meanwhile, sixteen states allow independence with some restrictions, such as varying levels of supervision by physicians.

“I think medicine itself is changing,” said Sophia Thomas, president of the AANP. “There are a lot of health care providers that are able to co-mingle, and there’s a lot of overlap in health care. And all of us, with our collective skills, are able to blend together and really provide good health care for patients.”

When asked about whether the AANP supports full-practice authority for nurse practitioners, Thomas said it’s been “underscored by opinions and recommendations” from the Federal Trade Commission, the National Academy of Medicine and the National Governors Association.

“They all recommend nurse practitioners, who full practice authority, because they know and understand that NP practice and clinical outcomes are equal to our physician colleagues and NPs improve access to care,” she said.

But the American Medical Association disagrees.

They oppose nurse practitioners practicing without physician supervision. In their report “Physician-led Health Care Teams,” they wrote, “nurses are indispensable, but they cannot take the place of a fully trained physician.”

The data shows a clear trend. The number of advanced practice nursing jobs is expected to grow by 45% by 2029, according to the Bureau of Labor Statistics. It’s much faster than the average growth rate of 7% for doctors.

Today, there are over 400 nurse practitioner schools in the country, and many of them are online. Some boast 100% acceptance rates.

Columbus State University in Georgia, for instance, advertises that family nurse practitioner students can complete coursework “100% online” in “as little as 2 years.”

By comparison, there are only about 150 accredited medical schools in the U.S., and none of them are online.

Dr. Al-Agba said one of the key issues is the difference in clinical training hours required of physicians compared to nurse practitioners.

A physician will complete 6,000 hours in medical school, and 9,000-10,000 during residency. A nurse practitioner might only complete 500 to 1,500 clinical hours, with no residency required.

“What troubles me is that patients are, they don’t know what’s happening. They assume when someone says to you, ‘I’m Dr. Smith or Jones,’ that that’s a physician who’s been to at least 11 years of training, and that’s not true anymore,” said Dr. Al-Agba. “We have physician assistants who can obtain a doctor of medical science degree. They can walk into any room in America, that’s a clinic or a health care center, and introduce themselves as a doctor and the patient doesn’t know the difference.”

Sophia Thomas said “nurse practitioners need to graduate from an accredited program of nursing where there’s oversight, they’re expected to meet core competencies, and things like that.” She said AANP takes issue with programs that don’t meet these standards.

For Amy Ochoa Dockins, it’s a matter of transparency.

“I’m not against nurse practitioners in health care at all. This is not what this is about. I’m against people outside of their scope. If you don’t understand something, or if that’s not your practice area, don’t try to work it. You need experience,” she said.

The Wattenbargers said they continue to fight as the voice for Betty.

“It has destroyed our entire family. We’ll never be the same,” Stacy Wattenbarger said. “And we don’t want this happening to another family.”

The families NewsNation spoke with agree, that you should ask questions of whoever is providing you care, regardless of whether you visit an urgent care, or an emergency room.