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Creating a Legal Assist/Lobbying Org to Assist Patients damaged by Doctor-Nurses

Discussion in 'Topics in Healthcare' started by MedicineDoc, May 29, 2008.

  1. MedicineDoc

    MedicineDoc 5+ Year Member

    Feb 13, 2008
    I am thinking an organization could be set up to help protect the public from inappropriate licensures using the legal system and possible pro bono work by physicians in testifying in malpractice suits. An organization that could help lobby congress and inform the public.
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  3. zenman

    zenman Senior Member 7+ Year Member

    Apr 1, 2004
    Great idea. There's already much focus on the "real" doctors and their mistakes. National Quality Forum is one group.:rolleyes:
  4. kronickm

    kronickm even par. 2+ Year Member

    Feb 20, 2007
    I read this 5 times and I still have no idea what you're talking about.

    edit: Wait so are you suggesting an organization be set up to help patients sue doctors? Because if so, you will not find support here.
  5. MedicineDoc

    MedicineDoc 5+ Year Member

    Feb 13, 2008
    Hi. I am talking about nursing boards creating licenses to practice medicine independently of physicians with drastically reduced and or completely inadequate curriculum such as the doctorate of nursing which consists of courses such as "the philosophy of science". Good luck in you premedical studies.
  6. kronickm

    kronickm even par. 2+ Year Member

    Feb 20, 2007
    In that case there are organizations, the AMA for one. Most of this stuff (nurse-doctors and what not) is speculation, as far as I know, there are no nurse-doctors, who can practice independently of a physician, in this country.
  7. Miami_med

    Miami_med Moving Far Away Moderator Emeritus 7+ Year Member

    1. There are nurse doctors that can practice independently in this country.
    2. There are a lot more that practice almost independently.
    3. The AMA is largely useless. If we needed another organization to bleed their hearts for the "uninsured," we don't need to pretend its a professional organization. At the last AMA attended meeting at my school, they spoke about reimbursement and student loans, offered no solutions to any of it, and then proceeded to go on about how they were going to get soda out of high school vending machines and help cover the uninsured. That does not help me. Other organizations can worry about that stuff if they so choose, but a professional organization should actually protect the profession.
  8. kronickm

    kronickm even par. 2+ Year Member

    Feb 20, 2007
    I am sorry for being uninformed. Are these nurse doctors really harming people at such an alarming rate that we need to create a lobbying organization to help the public sue them?
  9. Miami_med

    Miami_med Moving Far Away Moderator Emeritus 7+ Year Member

    Well, I didn't actually say that I agreed with the idea. I was simply pointing out that they do practice independently. Oh yeah, and I was taking an opportunity to lash out at the AMA, because it's really easy.
  10. Jack Daniel

    Jack Daniel In Memory of Riley Jane Moderator Emeritus 5+ Year Member

    Oct 12, 2005
    To read some of the posts on various SDN threads, you'd think so, because the posters all seem to know instances of a NP seriously jeopardizing patient care.

    Funny thing, despite all the anecdotes, few--if any--studies exist that suggest NPs harm their patients. I can, however, find many studies suggesting they do quite well treating patients.

    So, no. IMO, we don't need a lobbying organization to help the public sue them.
  11. Jack Daniel

    Jack Daniel In Memory of Riley Jane Moderator Emeritus 5+ Year Member

    Oct 12, 2005
    FWIW, There are also eleven states that allow just plain, regular nurse practitioners (no DNP required) to practice independently, without any physician involvement. Granted, these eleven states tend to be very rugged/rural (like AK and NM) or progressive (like NH, WA, OR).
  12. BMBiology

    BMBiology temporarily banned~! 15+ Year Member

    Feb 26, 2003
    This is a great idea! I am creating an organization with the same mission but I am doing it for self-interest reasons not because I care about my patients. I dont want these nurses to take away my business...I mean my patients!
  13. MedicineDoc

    MedicineDoc 5+ Year Member

    Feb 13, 2008
    This is the second time that you have cited the literature despite obviously not having read any literature as shown here: .

    If you in fact have read any literature please cite it now. The last time you cited an article in The American Journal of Nurse Practitioner that was devoted to giving the state legal scope of practice broken down by state and this was only after pressed for your sources. That article in fact had nothing to do with the topic. I can tell you that this is a very bad trait in a medical student and you will get busted hard for making up statements like this with nothing to back it up. If you make bold grand statements you had better have some sources. This is not the way to conduct yourself.
    Last edited: Jun 5, 2008
  14. MedicineDoc

    MedicineDoc 5+ Year Member

    Feb 13, 2008
    In fact the scope of malpractice being committed by nurse "practitioners" and the like is only just now becoming apparent as they become more autonomous and are not able to hide behind physicians as well as in the past. There are many other factors that determine who the malpractice attorney's go after including who is thought to have the deeper pockets. The only article I was able to find came from a nursing journal and is cited in this forum here which indicated that insurance agencies are tightening up as it is becoming apparent how risky it is to insure one of these nurse "practitioners". I reiterate that you have a very serious under appreciation for the difficulty of performing as a primary care physician. You are obviously very early in your training.

    This is a degree that can be obtained online as shown here:

    Here is the article:
    Advanced Nursing and Malpractice Trends Including Possible UnderReporting

    Nurses once were, for the most part, outsiders in the physician-led fight to reduce malpractice insurance rates. Sheltered no more, nurse practitioners are finding their annual malpractice costs tripling, nurse-midwives are facing annual premiums as high as $35,000, and only one company is willing to write policies for nurse anesthetists, says Janet Selway, RN, DNSc, CRNP, instructor at Johns Hopkins University School of Nursing, Baltimore.

    Selway, a state affiliate representative and board member of the American College of Nurse Practitioners, was among the nurse leaders who, out of concern, quickly convened a recent meeting in Washington on the topic.
    "We wanted to have a dialogue between the insurance industry and representatives of the major national nursing organizations, just so we had a clear idea of what was going on," Selway says.

    Nursing industry legal experts, representatives from the American Association of Nurse Anesthetists and American College of Nurse Midwives, as well as representatives from three nurse practitioner malpractice insurers, met to discuss the problem of rising rates and why rate hikes are hitting advanced practice nurses. Representatives from several nursing associations attended, including the American Association of Critical Care Nurses, the National League for Nursing, and the Emergency Nurses Association.

    The meeting was successful in that representatives of the national nursing organizations in attendance are now armed with information to take back to their memberships, Selway says.

    Some key points from the roundtable:
    • Malpractice suits against advanced practice nurses are rising in number and increasing in severity, according to malpractice insurers. APNs need to learn about the basics of malpractice, including their liability, options with malpractice coverage, and legislative issues like tort reform. Associations, colleges, and societies are often good resources.
    • Some 20% to 30% of nurse practitioner care is delivered by phone, exposing APNs to a liability that they might not have previously considered.
    • In deciding these cases, courts must establish what's reasonable for a prudent APN. They establish "reasonable" by looking at policies and procedures and the literature existing at the time of the event, then look at national standards and causation: Was the action or inaction actually caused by the APN?
    • APNs named in lawsuits should consider calling the American Association of Nurse Attorneys for counsel or advice even if they are covered under their employers' malpractice policies. Nurse attorneys might have a better grasp of the legalities involved with nursing practice.
    • Malpractice insurers' profitability in covering APNs has dropped, perhaps because more nurses are being sued these days.
    • APNs working in practices and clinics should ask to see their employers' malpractice policies to make sure they're named in the documents. They should consider having their own policies as well, especially if they moonlight.
    • APNs should be aware that if they practice with a physician who is under- or uninsured, the nurse might become the deep pocket — the one who is covered for the highest amount and, therefore, is the more attractive to name in a lawsuit. Lawyers representing the injured have been known to go after anyone who might have provided care to the patient — anyone whose name is on the chart.
    • Factors resulting in more malpractice claims and higher premiums aren't all due to big jury awards — experts say the nursing shortage is putting undue stress on hospital staffs, increasing the chances for drug errors and medical mistakes. What's more, fewer physicians are going into practice nowadays, which means a bigger patient load for current health care workers. The greater the patient load, the greater the chance for error and, ultimately, liability.
    Sadly, state boards of nursing may be underreporting unprofessional behavior and incompetence to the National Practitioner Data Bank, according to one government representative who spoke at the meeting. APNs who've had a lot of claims against them and have settled out of court can often work in different states without fear of retribution because of confidentiality agreements.
    In short, the Washington roundtable was an eye-opener for many nurses. Selway herself is quick to admit to that. "I think I have a better understanding of why the premiums are going up, and it's not just greed," she says. "The sad fact is that [because of increased lawsuits] we're not a profitable group to insure anymore."
    Last edited: Jun 5, 2008
  15. Jack Daniel

    Jack Daniel In Memory of Riley Jane Moderator Emeritus 5+ Year Member

    Oct 12, 2005
    Doc, I wasn't citing a study! You were asking me to cite my study, but I was referencing no study. I was stating a fact--and you don't need to cite a study for common knowledge: that nurse practitioners practice independently in many states. I also said that by querying the NPDB, you can find the number of malpractice claims by NPs and physicians. It seemed that NP claims weren't at a higher ratio than physicians. You kept asking me for my study, so I posted the Pearson Report as a document which listed the numbers.

    You posted that article about NP malpractice rising, which is interesting, but it doesn't show that NP malpractice claims are at a higher proportion than physician claims. I also acknowledged that the accusation of underreported claims in the database was very serious and could, if true, suggest that NPs were not safely treating patients.

    I realize I'm being baited here, but as to literature supporting NPs, I searched medline and Cochrane using various terms ("nurse practitioner" + Indedpendent, "nurse practitioner + outcomes") and found lots of studies, some nursing journals, some not, that according to abstract were favorable. The point is, I couldn't find any that showed they were consistently missing stuff.
    Last edited: Jun 5, 2008
  16. Jack Daniel

    Jack Daniel In Memory of Riley Jane Moderator Emeritus 5+ Year Member

    Oct 12, 2005

    I completely agree that, the longer nurses practice independently, we'll know more about their outcomes.

    I couldn't disagree more strongly. I think that medical school training is very rigorous and that primary care can be very difficult. By supporting independent NPs, I don't devalue the training of a physician or the importance of primary care.

    I completely agree that it would be misleading for APNs to introduce themselves as "Dr.", but IMO, the DNP is just another example of doctorate devaluation.

    Aside from that, the DNP is irrelevant because it's not needed to be an independent nurse practitioner. So, really it doesn't matter that it's an online degree because nurses can practice independently with a Masters--and I doubt they can earn that online.
  17. TRR in ATL

    TRR in ATL NP student

    Jul 3, 2008
    Atlanta GA
    So when the PhD geneticist friend of mine that works for the institution comes to speak to a pregnant mother about a possible Downs Syndrome fetus (because she has a Downs child herself and is a GREAT resource), she shouldn't be allowed to introduce herself as Doctor?

    When the PharmD comes by to discuss home TPN and supplemental nutrition with a patient who's FINALLY getting to go home with home health, she shouldn't be allwoed to introduce herself as a Doctor?

    When the local school superintentant with is Ed D comes by to let a mother of a young trauma patient know that he has arranged home schooling and wants to check on the student, he shouldn't be allowed to introduce himself as a Doctor?

    When the toxicologist from the local poison controll calls to check on a Digoxin overdose in a toddler at the local childrens hospital, he shouldn't be allowed to introduce himself as Doctor?

    When the Dean of the local university calls to inform your parents that you are the "student of the year" at the school and have been asked to speak at graduation, she shouldn't be allowed to introduce herself as a doctor?

    Or is it that someone is just nervous about NURSES attaining DOCTORATE status?
  18. MOHS_01

    MOHS_01 audemus jura nostra defendere Physician 10+ Year Member

    Oct 2, 2005

    The title of "Doctor" in a medical setting should be reserved for those holding a doctorate of medicine. In other settings different rules apply.
  19. GassiusClay

    GassiusClay PGY-2 2+ Year Member

    Jan 23, 2007
    A pharmacist is a pharmacist. A nurse is a nurse. A geneticist is a geneticist. All these folks calling themselves doctors are assuming a role clinically, not necessarily by educational progress. I guess all these doctors should try to take care of a bread and butter admit from the ER. Or they should each using their powers to unite and become a super power ranger doctor?

    Once again, doctors in a clinical setting should have a medicine degree. Otherwise, you are a supporting member of the medical team. Why is this important? Because most laypeople get confused. I wouldn't mind, but people already have trouble with their regular versus heart doctor.
  20. Instatewaiter

    Instatewaiter But... there's a troponin 10+ Year Member

    Apr 28, 2006
    The idea is that, in a hospital, the term doctor to the lay person=physician, while in academia it just means the level of training. So outside of a clinical setting i dont think anyone is going to complain. Inside the hospital is a different story.
  21. Dr.Millisevert

    Dr.Millisevert Senior Member 7+ Year Member

    Aug 4, 2004

    When you wear a white coat and work in a hospital or other CLINICAL medical environment. ... and you introduce yourself as a "Doctor". It is misleading the public that you are in fact a physician.

    When you walk into a pharmacy or when you go to see the "dean" you know who you are speaking to. Not true in the hospital or clinic. I think there is a difference.
  22. emedpa

    emedpa GlobalDoc 10+ Year Member

    Aug 25, 2001
    Taking an Away team....
    actually there are several online masters level np programs as well. for example:

    "Twice during each semester, students are required to convene on campus for an intensive weekend of instruction."

    They also offer a 30 unit online dnp....

    I precepted(and failed) a student from this program.....she couldn't recognize blatant strep pharyngitis as a cauase of fever her last day of clinicals.
    her other preceptor( a very strong np from the UWa program who I respect greatly) agreed with me that she should fail....
    bottom line: clinical education requires supervised classroom preparation with instructor feedback.....and I don't mean 1 -2 weekends/semester.....
    Last edited: Jul 4, 2008
  23. oldpro

    oldpro MS IV 5+ Year Member

    ANd there are not good studies to say that patient outcomes are better, worse or the same as if Physicians were taking care of these patients.

    If so can you post the links?

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