A description of medical malpractice claims involving advanced practice providers

Abstract

This article is ASHRM CE eligible. Earn 1.0 credit hours of Continuing Education by passing an online quiz based on your reading at ASHRM.org/JournalCE. [This article is updated on November 10, 2020, after first online publication, to identify it as a CE article.] Background: The number of physician assistants (PAs) and advanced practice registered nurses (APRNs), together known as advanced practice providers (APPs), has risen dramatically. The goal is identifying characteristics of paid medical malpractice claims, in which APPs are defendants. Methods: Retrospective cohort study using Harvard's malpractice insurer's national database. Closed claims (2007-2016) with PAs, APRNs, or physicians as defendants. The primary analysis compared claims by role group by patient-, provider-, and claim-level characteristics. Supplemental analyses compared claims naming APPs with and without physicians. Multivariable logistic regression identified variables associated with claim payment. Results: Of 54,772 claims, PAs were defendants without APRNs or physicians in 26 claims; APRNs were defendants without PAs or physicians in 63; physicians were defendants without PAs or APRNs in 37,354. Approximately 75% of claims naming APPs co-named physicians. More claims naming PAs and APRNs were paid on behalf of the hospital/practice (38% and 32%, respectively) compared with physicians (8%, P < 0.001). Payment was less likely for inpatient care (OR 0.89, 95% CI 0.85-0.93, P < 0.001) but higher when APRNs were defendants (1.82, 1.09-3.03), when procedure-related (1.31, 1.25-1.38, P < 0.001) or patients died (1.09, 1.03-1.16, P = 0.003). Conclusions: These results can inform patient safety initiatives to prevent future harms. The target is outpatient airway procedures performed by APRNs.

Characterizing malpractice cases involving emergency department advanced practice providers, physicians in training, and attending physicians

“…Recently published data using the Candello database from all medical specialties found that the highest median indemnity paid was among PA claims ($353,000; interquartile range [IQR] $98,725–$1,327,975) compared with no‐extender claims ($192,334, IQR $55,065–$489,039) and NP claims ($57,674; IQR $15,417–$619,626) 11 . This significantly higher indemnity paid on PA claims relative to NP claims is inconsistent with our findings.…”

“…Little is known about medicolegal and cost risks of emergency practice with APPs despite their increasing presence on multidisciplinary ED care teams 10,11 . Characterizing the malpractice cases among these practitioner types has important implications for workforce development, ED staffing, patient safety, and risk mitigation for supervisory physicians.…”

An analysis of medical malpractice claims against medical oncologists from a national database: Implications for safer practice

“…This outcome was selected as it was deemed by the authors relevant to motivating practice change and had face validity as a marker of malpractice environment, as well as consistency with methods used in other studies of malpractice environment. 11,[22][23][24] We chose variables a priori to include in the model. For claimant age, the odds ratio is per year.…”

“…The outcome used in the regression analysis (Tables 2 and 3) was a case closing with an indemnity payment. This outcome was selected as it was deemed by the authors relevant to motivating practice change and had face validity as a marker of malpractice environment, as well as consistency with methods used in other studies of malpractice environment 11,22–24 …”

Impact of Physician Extenders and Midlevels in Plastic Surgery

“…Physicians are held legally responsible for the acts of their physician extenders and in most cases are sued along with them on the premise that it is the responsibility of the physician to train and supervise physician extenders. [31][32][33] The three legal theories commonly attributing to physician liability are vicarious liability, negligent supervision, and hiring. 31 It is imperative to enhance safe patient care by having systems in place for working with PAs or NPs.…”