Many of us are now accustomed to seeing physician’s assistants (PAs) and nurse practitioners (NPs) when we go to see our primary doctors. These so-called “mid-level” professionals rank high on customer satisfaction surveys, in part because they tend to spend more time with patients. They may also actually help reduce the risk for malpractice claims against the doctors they work with.
But there are two common areas of negligence claims against nurse practitioners and physicians’ assistants themselves: inadequate supervision and acting beyond the scope of their authority.
The use of mid-level professionals has been growing:
Physician Assistants – The number of physician assistants has more than doubled over the last decade, according to the American Academy of Physician Assistants. As of 2013, there are about 85,000 certified PAs in the U.S. All states have authorized PAs to prescribe medications, but they always must be under a physician’s supervision.
Nurse Practitioners – The number of nurse practitioners has grown from over 110,000 in 2003 to about 155,000 today, according to the American Academy of Nurse Practitioners. Nurse practitioners also work under the supervision of a doctor, and typically work for primary care practices, hospitals and clinics. Nurse practitioners can see patients without direct involvement of a doctor in 18 states and D.C., although in some of those cases they may need a formal collaborative arrangement with a physician.
Types of Claims Against NPs and PAs
Many typical malpractice claims against mid-level professionals occur in cases where a patient was seen multiple times. Over time, the patients either didn’t improve or worsened and yet the doctor was not consulted. In those cases, the NP and the PA can be held liable for acting beyond their scope, and failing to consult their supervising physician. But also, the physicians can be found liable (vicarious liability) for mid-levels’ negligence, even if the doctors never saw the patient.
Questions to be considered in a liability case include:
- When is it appropriate for the mid-level to consult the doctor?
- Was the doctor reviewing the mid-level’s notes?
- Why wasn’t there more communication?