RIC Advanced Practice Nurses & Health Care Workforce Discussion – Description
Question asked: Review Tables 29.1 and 29.2 in the Joel textbook (2022) and compare APRN adverse events and malpractice claims to MDs in your state of practice. Identify the differences, explain why you think there is a difference, and discuss how malpractice suits affect patient access. My state: TX
Reply to at least two of your classmates—from different states if possible—after reviewing the information provided in the initial post and comparing your state stats. Address some of the problems, if any, with the current malpractice legal system related to malpractice.
Kellys post:
Medical malpractice claims are common in healthcare, making it essential for providers to obtain professional malpractice and liability insurance. According to Joel (2022), advanced practice nurses have the autonomy to exercise independent clinical decision making as well as prescribe medications and provide complex care, which places them at a high risk for being sued for malpractice. The same can be said for MD’s and other healthcare professionals who are exposed to different types of liability. In Massachusetts, between the years 1990 and 2014, there were a total of 167 reports of medical malpractice suits and settlements and 33 adverse actions against Advanced Practice Nurses reported to the National Practitioner Data Bank (Joel, 2022). In contrast, there were 6,363 total reports of medical malpractice suits and settlements and 2,550 adverse actions against physicians (MD’s and DO’s) reported to the NPDB (Joel, 2022).
These numbers greatly differ and highlight the fact that Advanced Practice Nurses have lower rates of malpractice suits and reported adverse reactions than physicians. This difference may exist for a number of reasons. First, I believe that APRNs may come across as more caring and compassionate than physicians because of their nursing background and holistic approach to care. This can lead to patients having more trust in APRNs compared to other providers. Further, McMicahel et al. (2018) notes that many NP’s can pass a substantial portion of their liability to their supervising physician or healthcare professional. In Massachusetts, a Nurse Practitioner must be supervised by a qualified healthcare professional, such as a physician, for a minimum of two years. Further, many physicians may feel less of a need to perform to the highest of their abilities with the increase in qualified nurse practitioners.
Malpractice suits can affect patient care and access because many providers will reduce the scope of their services and practice “defensive medicine” due to fear of legal liability (McMichael et al., 2018). Further, many providers will retire early or relocate to states with more favorable medical malpractice environments, which will only add to the physician shortage that already exists. These factors affect patients who require high quality, and often complex, care because they ultimately don’t get the care they need or deserve. Dahlawi et al. (2021) note that medical negligence and malpractice suits can pose a significant risk of patient injury, disease, disability or death.
Carmens post:
Advanced Practice Nurses (APNs) are held accountable for the care they offer. They practice independently, make clinical decisions autonomously, deliver complex care treatments, and prescribe or administer medications, all of which raise their risk of being sued for malpractice (Joel, 2022). APNs ought to strive to stay clear of three main exposures: monetary liability from court decisions or settlements resulting from civil lawsuits; licensure or certification by the appropriate state agencies or private associations; and civil or criminal penalties, including the exclusion from federal health care programs for fraud or abuse (Joel, 2022). On a national level, there is no reliable means to compile data on the number of lawsuits filed. Regardless of the validity of the claims made against the providers, there is also little to stop a patient from filing a malpractice claim. The National Practitioner Data Bank (NPDB) of the UDHHS, HRSA is the most complete source of reports on verdicts and settlements stemming from malpractice lawsuits against healthcare providers (Joel, 2022). Tables 29.1 and 29.2 in the Joel textbook (2022) demonstrate that more APNs have been sued in the last decade, but data on physicians suggests the opposite: allegations of physician malpractice have dropped in the last decade. Although reports of malpractice claims and settlements, as well as reports of adverse actions, have increased for APNs since 1990, the increase is comparable with the overall growth in the number of these providers (Joel, 2022 & Brock et al., 2016).
Using the NPDB data analysis tool to generate datasets for the Adverse Action Report (AAR) and the Medical Malpractice Payment Report (MMPR). Data from 2011 to March 31, 2023, showed that APNs in Massachusetts had 83 Medical Malpractice Payment Reports and 16 Adverse Action Reports, compared to 1593 and 845 respectively for physicians (MD and MO) during that time (National Practitioner Data Bank [DPDB], 2023). Although the number of APNs receiving these reports is small, the settlement costs for damages and defending claims have risen (Joel, 2022). Communication is one of the biggest reasons for the difference in the number of reports between APNs and physicians. Researchers contrasted the number of time physicians used with patients with a history of malpractice claims and discovered that primary care doctors with two or more malpractice claims against them spent 15 minutes on average with each patient, while doctors with no malpractice claims against them spent 18.3 minutes on average with each patient (Buppert, 2021). Quality of care for the sued physicians was comparable to evaluations for physicians who had not been sued. Experienced APNs understand that effective provider-patient communication improves results and increases patient satisfaction. Less litigation also results from effective communication, a satisfied patient is unlikely to sue (Buppert, 2021). Physicians treat many patients daily to increase their practice’s revenue stream. As a result, less time is spent with individual patients, increasing the risk of liability (Joel, 2022). The other distinction is the specialty; neurosurgery had the highest rate of claims against physicians, followed by plastic surgery and orthopedics, and finally obstetrics and gynecology. APNs do minimal surgery and are not subject to the same surgical liability concerns as surgeons. Finally, physicians may be more vulnerable to litigation than APNs and PAs due to their legal supervisory function or because they see more high-risk patients (Joel, 2022). Regarding APNs, 1715 paid NP malpractice claims were paid between 1990 and 2014, and the basis of the allegation was diagnosis-related; within this allegation group, failure to diagnose and delay in diagnosis was predominant. The most common treatment-related error was treatment delay. Most of the diagnosis and treatment claims were made in the outpatient setting (Sweeney et al., 2017).
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