Study Shows Nurse Practitioners and Physicians Face Similar Liability Risks

David B. Troxel, MD, Medical Director, The Doctors Company

The Doctors Company analyzed 67 claims—written demands for payment—against nurse practitioners (NPs) that closed over a six-year period from January 2011 through December 2016. These claims arose in family medicine (FM) and internal medicine (IM) practices. To provide context, we compared the NP claims with 1,358 FM and IM claims against physicians that closed during the same time period. If a claim was against both the FM or IM physician and the NP, we eliminated it from this study to avoid counting the same claim twice.

We included cases that closed within the study's time frame regardless of how the claim or suit was resolved. This approach helped us to better understand what motivates patients to pursue claims and to gain a broader overview of the system failures and processes that resulted in patient harm.

Our approach to studying these malpractice claims began by reviewing plaintiffs'/patients' allegations, giving insights into the perspectives and motivations for filing claims and lawsuits. We then looked at patients' injuries to understand the full scope of harm. Physician and nurse practitioner experts for both the plaintiffs/patients and the defendants/nurse practitioners/physicians reviewed claims and conducted medical record reviews. Our clinical analysts drew from these sources to gain an accurate and unbiased understanding of the events that lead to actual patient injuries.

Nurse practitioner or physician reviewers evaluated each claim to determine whether the standard of care was met. The factors that contributed to claims included clinical judgment, patient factors, communication, clinical systems, clinical environments, and documentation.

Our team studied all aspects of the claims and, using benchmarked data, identified risk mitigation strategies that nurse practitioners and their physician partners can use to decrease the risks of injury, thereby improving the quality of care.

When NPs worked in FM and IM practices, the three most common claim allegations against NPs accounted for 88 percent of their total claim allegations. The top three allegations in claims filed against FMs and IM physicians accounted for 89 percent of their total claim allegations.

The diagnosis- and medication-related allegation percentages were similar for both NPs and primary care physicians, while medical treatment–related allegations were more common for primary care physicians (see FIGURE 1). The small number of NP claims may lack statistical significance.

Contributed by The Doctors Company. For more information about the Nurse Practitioner Closed Claims Study, go to www.thedoctors.com/NPstudy.