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Malpractice risks when receiving care from a non-physician practitioner

 Nurse practitioners and physician assistants have traditionally had low rates of medical malpractice for various reasons:

  • They typically worked under the supervision of a physician, who carried the bulk of the liability in the event of a bad outcome

  • They typically are assigned lower-risk patients with less complex medical conditions

But while many NPs and even PAs are now practicing independently and taking care of more complex patients, malpractice case law has not yet caught up to the new reality. In many cases, NPs/PAs still carry lower levels of malpractice insurance than physicians, and often, patients will not receive justice in the event of a malpractice case, because NPs/ PAs are not always held to the standard of care of a physician.

  • Fein v. Permanente Medical Group (1985): “The jury should be instructed that the standard of care for a nurse practitioner must not be measured by the standard of care for a physician or surgeon when the nurse is examining the patient and making a diagnosis.”


  •  Simonson v Keppard (2007): physician not permitted to testify regarding the standard of care for a nurse practitioner who failed to diagnose a cerebral hemorrhage


  •  Lattimore v Dickey (2015): A “nurse’s conduct must not be measured by the standard of care required of a physician and surgeon, but by that of other nurses in the same or similar locality and under similar circumstances.

HOWEVER, malpractice cases against NPs/PAs are increasing:

85% of malpractice cases against NPs were due to diagnosis (41.46%), treatment (30.79%), and medication errors (12.77%). The malpractice cases due to diagnosing errors were further stratified into failure to diagnose (64.13%), delay to diagnose (27.29%), and misdiagnosis (7.59%).

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), and payment was more likely when APRNs were defendants (1.82, 1.09-3.03)

Boards of Nursing slow to act to stop bad actors

Another factor in receiving justice involves the supervision of nurse practitioners by the Board of Nursing, not the Board of Medicine. Many Boards of Nursing are slow to act despite complaints against NPs.

VIDEO: Texas Board of Nursing slow to sanction NP even after overprescribing testosterone results in patient deaths

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