Advanced Practice Providers and Liability Risk

Advanced Practice Providers and Liability Risk Posted By:
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It is a misconception that advanced practice providers (APPs) can't get sued because any errors are a physician's responsibility. PAs and NPs can and do make errors for which they and their supervising physicians are responsible. In the United States, patients sue for almost anything, and when there is a malpractice lawsuit filed, usually anyone and everyone who may have played a part in the patient's care is included.

However, numerous studies have continued to confirm that APPs are far less likely than physicians to be sued. When they are sued, the awards and settlements are much smaller than for cases involving physicians. Still, cases involving APPs are increasing along with the number of practitioners who are graduated into the profession annually.

The top five reasons for malpractice suits are typically:

1. Failure to diagnose/missed diagnosis of a patient's medical condition, resulting in disability or death

2. Patient injury during treatment, often resulting in disability or death

3. Failure to treat a patient's condition, which can include failure to:

  • Assess and monitor a patient's condition
  • Perform required medical tests
  • Refer a patient to a specialist when necessary
  • Treat a medical condition in a timely manner or at all
  • Let the patient know about the available treatments for his/her condition
  • Treat a patient due to lack of insurance or the wrong insurance
  • Address heart attack or stroke symptoms in the emergency department
  • Adhere to accepted standards of care (this falls under every category)

4. Poor documentation (*write every note as if it's going to be seen by the patient's attorney and a 12-member jury panel; plaintiff attorneys always go after this part of the chart)

5. Medication errors, which can include:

  • Prescribing the wrong medication or the wrong dosage
  • Dispensing the wrong medication (in an emergency setting)
  • Dispensing medication at the wrong concentration (emergency and pharmacy)
  • Prescribing medications with dangerous interactions (and didn't reconcile the medication list)
  • Prescribing medications the patient is allergic to
  • Giving inadequate instructions for how to take a medication (giving appropriate instructions should always be performed prior to a patient leaving your facility)

Some experts say that APPs have lower malpractice risk because they spend more time with patients, especially in follow-up, and they score higher in patient satisfaction ratings. On the other hand, there are many medical organizations that consistently argue that APPs "don't have the same extensive training as physicians" and often practice well beyond their scope of practice. This is another ploy that plaintiff attorneys like to explore in discovery proceedings.

No one wakes up and thinks "I'm going to mess up the first patient I see today." Most medical errors are a combination of unfortunate events (especially in the emergency department). Yet statistical findings on malpractice claims against APPs shed a positive light on our utilization from a public health and safety and public policy standpoint. Recent research suggests that patient communication, compassion, and apologizing for mistakes are major deterrents of malpractice litigation.

References
  • Birkholz G. Malpractice data from the National Practitioner Data Bank. Nurse Pract. 1995;20:32-35.
  • Crane M. Malpractice risks with NPs and PAs in your practice. www.medscape.com/viewarticle/775746_3. Accessed May 21, 2019.
  • Dellabella H. PA malpractice case rates slightly increasing. www.clinicaladvisor.com/home/meeting-coverage/aapa-2016-annual-meeting/pa-malpractice-case-rates-slightly-increasing/. Accessed May 21, 2019.
  • Nicholson JG. Physician assistant malpractice history: comparing PAs to physicians and nurse practitioners. expertpages.com/news/Physician_Assistant_Malpractice_History.htm. Accessed May 21, 2019.
  • Paul. PA vs MD: malpractice, part I. www.mypatraining.com/pa-vs-md-malpractice-part-i. Accessed May 21, 2019.

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Filed under: Health Policy and Trends , Practice Management/Career , NPs & PAs

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