Midlevel Malpractice Rising

[Noyac]

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"Sheltered no more, nurse practitioners are finding their annual malpractice costs tripling" "Malpractice suits against advanced practice nurses are rising in number and increasing in severity, according to malpractice insurers"

http://www.nurseweek.com/news/Features/05-03/Malpractice.asp

 

[lord_jeebus]

I thought it was interesting that only one company is even willing to sell CRNAs malpractice insurance...

Without competition in that area, they could soon find themselves in a much less lucrative career than they had imagined.

 

[core0]

"Sheltered no more, nurse practitioners are finding their annual malpractice costs tripling" "Malpractice suits against advanced practice nurses are rising in number and increasing in severity, according to malpractice insurers"

http://www.nurseweek.com/news/Features/05-03/Malpractice.asp

If anything its gotten worse for NPs. This article is from Florida from 2006:
http://www.floridanurse.org/ARNPCorner/ARNPDocs/FloridaNursePractitionerScopeAugust2006final.pdf
Look toward the bottom of the second page.

David Carpenter, PA-C

 

[Pilot Doc]

The reason malpractice for doctors is so bad is that the business model supports it. Docs can pay tens of thousand of dollars annually and support occasional multi-million dollar verdicts as a cost of doing business.

As big bucks flow toward advanced practice nurses ... the plaintiffs bar if ready to hit the trough.

 

[Consigliere]

That's some damn good news!🙂

 

[toughlife]

What do you expect when you try to play doctor without appropriate training.

 

[RT2MD]

I know that I am just feeding the fire here... I don't know if the same situation can be found for physicians, but this just doesn't go over very well with me:

"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."

 

[jwk]

"Sheltered no more, nurse practitioners are finding their annual malpractice costs tripling" "Malpractice suits against advanced practice nurses are rising in number and increasing in severity, according to malpractice insurers"

http://www.nurseweek.com/news/Features/05-03/Malpractice.asp

The same is happening with "independent" CRNA's. Rates are on the way up. And why shouldn't they be?

 

[deleted126335]

.

 

[Faebinder]

"Sheltered no more, nurse practitioners are finding their annual malpractice costs tripling" "Malpractice suits against advanced practice nurses are rising in number and increasing in severity, according to malpractice insurers"

http://www.nurseweek.com/news/Features/05-03/Malpractice.asp

I didnt realize till later that the article is written in 2005. I wonder what is the aftermath of the meeting.

 

[radslooking]

A couple of points. Independent CRNAs tend to practice in one of two settings- Rural areas or physician offices or low level surgicenters, e.g. endo suites, cataract centers, etc.

Rural area residents tend to be people who tend to be more of a "self reliance" crowd and disinclined to put a bullet in what is frequently one of the town's biggest employers and only health care option for them and their families-The local hospital and its staff. Hence they are not good juries for the Plaintiff's bar.

Physician offices and low level surgicenters tend to have soft ball cases where risk is exceptionally low.

CRNAs and other midlevels who work under MDs in hospitals that tend to have restrictive bylaws which mandates that they work only under the supervision and control of the MD . This is a significant liability shield for the CRNA who works in an ACT setting who makes a bad decision that results in a lawsuit. It may be the CRNA or other midlevel's FAULT, but it is frequently the RESPONSIBILITY of the MD.

This is one of the AANA shrill cries, that malpractice premiums for CRNAs are frequently the same or less than for anesthesiologists. In their argument, because there is no difference in level of care or bad outcome. The above are the real reasons for the lack of significant disparity between anesthesiologist and CRNA medmal premiums.

that's a good point. perhaps somewhat akin to surgeons who decline tough cases to keep their stats good. hide behind the anesthesiologist on the tough cases, and then claim equivalent rates of complications on easier cases. and also your point about less litigation in country areas. excellent point doze.

 

[jwk]

that's a good point. perhaps somewhat akin to surgeons who decline tough cases to keep their stats good. hide behind the anesthesiologist on the tough cases, and then claim equivalent rates of complications on easier cases. and also your point about less litigation in country areas. excellent point doze.

As I've pointed out on this board and others, CRNA's, in general, aren't doing BIG cases by themselves, independently, with no anesthesiologist around. Open heart surgery, organ transplants, neuro (not spine), big-time peds, etc., are all types of cases that are done in facilities with anesthesiologists.

 

[jwk]

This is one of the AANA shrill cries, that malpractice premiums for CRNAs are frequently the same or less than for anesthesiologists. In their argument, because there is no difference in level of care or bad outcome. The above are the real reasons for the lack of significant disparity between anesthesiologist and CRNA medmal premiums.

Was this a typo? There IS significant disparity between anethesiologists and independently practicing CRNA's, but the disparity is indeed starting to decrease.

 

[toughlife]

I wonder if physicians have just found themselves a new job testifying as expert witnesses against midlevel malpracrice.

 

[Faebinder]

I wonder if physicians have just found themselves a new job testifying as expert witnesses against midlevel malpracrice.

Absolutely.... start with a low price per hour of consult. Have them send the paperwork to your office and review it on time. You'll develop a solid reputation (word of mouth between lawyers) and eventually you'll have to raise the price cause they are banging at your door to take a look at their case and give your opinion.

 

[core0]

Was this a typo? There IS significant disparity between anethesiologists and independently practicing CRNA's, but the disparity is indeed starting to decrease.

The disparity is still there. There may be some relationship to more physicians practicing pain. The other issue that is probably most responsible for increasing NPP malpractice rates is the pain and suffering limits. Previously the NPPs were dismissed early since presumably the physician had deep pockets. With limits on pain and suffering there is incentive to keep as many providers in the suit to get multiple claims of pain and suffering (if allowed by the state). Of course that pales compared to the latest trick. In the southeast in particular the new option is to sue NPs (and CRNAs in Louisiana) for operating outside of their scope of practice. This takes things outside of the normal malpractice channels and turns it back into a personal injury case.

David Carpenter, PA-C

 

[deleted126335]

.

 

[RAMPA]

that's a good point. perhaps somewhat akin to surgeons who decline tough cases to keep their stats good. hide behind the anesthesiologist on the tough cases, and then claim equivalent rates of complications on easier cases. and also your point about less litigation in country areas. excellent point doze.

thats what armygas states on one of his videos.

"in fact if you go look at it anesthesiologists have been sued more than CRNAs and thats just the truth"

 

[badasshairday]

What do you expect when you try to play doctor without appropriate training.

So true. I mean there are good NPs and they have an appropriate role, but playing doctor definitely is not one of them.

 

[Mman]

Maybe. Maybe not. A CRNA's lawyer would argue that an anesthesiologist is not qualified to provide expert testimony on the practice of NURSE anesthesia.
Looks better for the plaintiff when like testifies against like. Don't know the state law specifics.

A CRNA's lawyer wouldn't have much of a legal footing with that line of reasoning.

 

[jwk]

A CRNA's lawyer wouldn't have much of a legal footing with that line of reasoning.

Wanna bet?

I can just about guarantee you a defense lawyer in a malpractice case is going to have a CRNA expert witness involved in a case, whether for case review, depositions, or actually testifying.

 

[sevoflurane]

Wanna bet?

I can just about guarantee you a defense lawyer in a malpractice case is going to have a CRNA expert witness involved in a case, whether for case review, depositions, or actually testifying.

In the right circumstance. No doubt.

 

[Taurus]

The disparity is still there. There may be some relationship to more physicians practicing pain. The other issue that is probably most responsible for increasing NPP malpractice rates is the pain and suffering limits. Previously the NPPs were dismissed early since presumably the physician had deep pockets. With limits on pain and suffering there is incentive to keep as many providers in the suit to get multiple claims of pain and suffering (if allowed by the state). Of course that pales compared to the latest trick. In the southeast in particular the new option is to sue NPs (and CRNAs in Louisiana) for operating outside of their scope of practice. This takes things outside of the normal malpractice channels and turns it back into a personal injury case.

David Carpenter, PA-C

👍

 

[Faebinder]

Maybe. Maybe not. A CRNA's lawyer would argue that an anesthesiologist is not qualified to provide expert testimony on the practice of NURSE anesthesia.
Looks better for the plaintiff when like testifies against like. Don't know the state law specifics.

And yet it's the anesthesiologists that train the CRNAs and they are the ones called for backup.

 

[core0]

Wanna bet?

I can just about guarantee you a defense lawyer in a malpractice case is going to have a CRNA expert witness involved in a case, whether for case review, depositions, or actually testifying.

I can't testify specifically about CRNA's but the standard of care for PAs is the same as it is for a physician in that specialty. When I give expert testimony its basically to that effect. A defense lawyer would want a CRNA to testify that everything was right with the world. They would also probably want an anesthesiologist. On the other hand it would be inappropriate for a CRNA to testify about the medical practice of an anesthesiologist. I've had a few lawyers approach me about testifying for the claimant about a physicians medical practice and they don't seem to understand when I refuse. Generally you want someone with roughly the same training testifying about the medical care and someone with more training (if possible) to testify about the medical care. What amazes me is the number of physicians (and others) that are willing to prostitute themselves at the alter of the "expert witness".

David Carpenter, PA-C

 

[nutmegs]

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.

really?

 

[W222]

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.

This part right here is complete BS. If fewer physicians are going into practice then what are they going into? Biotech? I don't think so. Also, medical school applicant numbers are still rising and many med schools have increased their class size at the request of the AAMC so there will be no shortage of physicians in the near future.



A story about mid-level providers: Guy goes to an NP for a cough and chest discomfort, gets a cxr and some antibiotics and says its just pneumonia. Guy returns to the NP two weeks later with increasing SOB and gets a CT scan which isn't followed up and is then switched to a different antibiotic. He returns again a week later and is really SOB and has pleuritic chest pain, finally gets diagnosed with a massive PE. Long story short, the NP didn't suspect PE and any ER md worth their salt would have picked up on it. There is a level of training and intuition that was obviously missing in this case and it begs the question of whether mid-level providers actually offer quality medical care.

 

[engineer24]

And yet it's the anesthesiologists that train the CRNAs and they are the ones called for backup.

Yep, its all about hte $$$$. The only people who have made more money than CRNAs for this scope of practice incursion is, of course, the anesthesiologists themselves. Its incredibly profitable to "supervise" multiple ORs at the same time all stacked with CRNAs. Sooner or later insurance and Medicare will remove the ability to "supervise" multiple ORs in this fashion, and the gas profession will enter the darkest period in its history.

 

[ProRealDoc]

Yep, its all about hte $$$$. The only people who have made more money than CRNAs for this scope of practice incursion is, of course, the anesthesiologists themselves. Its incredibly profitable to "supervise" multiple ORs at the same time all stacked with CRNAs. Sooner or later insurance and Medicare will remove the ability to "supervise" multiple ORs in this fashion, and the gas profession will enter the darkest period in its history.

And how do you explain all MD/DO practices who are also very profitable without the use of any CRNAs?