Peer Replies (Posts)

POST # 1 CARRIE

State of California

In 2017 a report was published that analyzed the rates of malpractice reports and adverse reactions and compared physicians, physician assistants (PA’s) and nurse practitioners (NP’s) and found that NP’s have the lowest rate of malpractice payments followed by PA’s and then physicians (Brock et al., 2017). However, when comparing malpractice allegations PA’s have the highest allegation rate followed closely by NP’s and then physicians (Brock et al., 2017). Lagasse (2018) highlighted the growing profession of NP’s and that by 2025 almost a third of the family practice workforce will include NP’s, and that NP’s can lead to improved productivity. In addition, it was found that NP’s and physicians share similar liability risks but found that many of the claims can be a result of failing to maintain the scope of practice for the NP or inadequate supervision by a physician (Lagasse, 2018). The most frequent malpractice allegation against NP’s is failure to diagnose, and accounts for almost a third of the claims (NSO, 2019). Hoffman and Wang (2019) found that NPs are more likely to be named as co-defendent with a physician and noted that the number of cases is trending upwards. 

According to data compiled by Joel (2018) the rate for reports of adverse events and malpractice suits and settlements were a rate around 1%, whereas for a physician the rate is closer to 35% and 12% (p. 450). In my state of California, the rate of malpractice settlements from 1990 to 2014 was near the top with 225 suits and settlements, only Florida (571), New York (372), Texas (331) and Pennsylvania (244) were higher (Joel, 2018, table 29.1). In addition, the rate of payments was also higher in California, Florida, New York, and Pennsylvania (Joel, 2018, table 29.3). This makes sense when one considers that those are the most populous states (IPL, 2021), and would have more NP providers and larger populations being served (Kaiser Family Foundation, 2021). However, when one looks at the number of adverse actions reported against NPs from 1990 to 2014 California is on the lower end with 35 and some states such as Alabama having 284, Washington with 157, Oklahoma with 156, Tennessee with 149 (Joel, 2018, table 29.2). In Alabama, a NP must have a collaborative agreement with a physician and the physician must be on site for 10% of the time and review 10% of the charts and interestingly are not recognized as primary care providers (Thrive Advanced Practice, 2013). One possibility for the higher rate of adverse actions could be a result of less supervision or an agreement that goes outside the scope of the NP practice. In malpractice cases in California the patient must prove that the provider misdiagnosed or failed to diagnose and illness, made a mistake during surgery, provided the wrong medication or dosage or failed to deliver an infant in stress in a timely fashion (Nield Law Group, 2021). Given that NPs are not able to perform surgeries or deliver babies it would make sense that NP’s have fewer claims against them than physicians purely due to scope of practice. Medical malpractice suits can have a negative impact on health care by increase the cost of healthcare, as well as making patients reluctant to seek help over concerns about negligence on the part of the provider (Texas A&M University, 2016). 

The adverse action against physicians also follows similar patterns to the adverse actions against NP’s but on a much larger scale (Joel, 2018, table 29.4). Joel (2018) also noted that physicians who spent longer time during encounters had few to no claims against them, the trend being the longer the time in the encounter the fewer adverse claims (p. 463). A study by the University of Texas (2015) found that NPs spent more time with patients allowing them to provide greater amount of information and have more frequent follow ups when compared to physicians. It is possible that due to the increase in time spent with patients and the trend that increased encounter time can lead to decreased adverse events and malpractice benefiting both the patient and the NP. 

References

Brock, D. M., Nicholson, J. G., & Hooker, R. S. (2017). Physician assistant and urse practitioner malpractice trends. Medical care research and review: MCRR, 74(5), 613–624. https://doi.org/10.1177/1077558716659022

Hoffman, J., & Wang, F. (2019, December 31). MPL risks associated with NP’s. Crico. https://www.rmf.harvard.edu/Clinician-Resources/Newsletter-and-Publication/2019/SPS-MPL-Risks-Associated-with-NPs

IPL. (2021). State Population and Size - Stately Knowledge: Facts about the United States. Ipl: Information You Can Trust. https://www.ipl.org/div/stateknow/popchart.html

Kaiser Family Foundation. (2021, September 22). Total Number of Nurse Practitioners. KFF. https://www.kff.org/other/state-indicator/total-number-of-nurse-practitioners/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

Lagasse, J. (2018). Medical malpractice: Doctors and nurse practitioners face surprisingly similar risks. Healthcare Finance News. Retrieved 03–13, from https://www.healthcarefinancenews.com/news/medical-malpractice-doctors-and-nurse-practitioners-face-surprisingly-similar-risks

Nield Law Group. (2021). What constitutes medical malpractice in California? Nield Law Group, APC. https://www.nieldlaw.com/articles/what-constitutes-medical-malpractice-in-california/

Nursing Service Organization. (2019). Nurse practitioners’ medical malpractice - Failure to diagnose. https://www.nso.com/Learning/Videos/Failure-to-Diagnose-Case-Study

Texas A&M University. (2016). Malpractice and Its Effects on the Healthcare Industry. Tamucc. https://online.tamucc.edu/degrees/business/mba/healthcare-administration/malpractice-and-its-effects-on-the-healthcare-industry/

Thrive Advanced Practice. (2013, October 16). Nurse practitioner scope of practice: Alabama. ThriveAP. https://thriveap.com/blog/nurse-practitioner-scope-practice-alabama

University of Texas. (2015). Patients using nurse practitioners are less likely to have avoidable hospital admissions: Patients who use a nurse practitioner for primary care are less likely to have potentially avoidable hospital admissions, study shows. ScienceDaily. https://www.sciencedaily.com/releases/2015/10/151013155436.htm