PIAM Practice Bulletin July 2016



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Important Professional Liability Insurance Alert

We are aware that certain insurance salespersons have encouraged medical practices to dispense with providing separate medical professional liability insurance limits for their Advanced Practice staff, in the interest of reducing malpractice insurance costs. Please do not make a change of this nature without consulting with your own insurance broker or insurance carrier.

Though there is a modest premium charge for providing either a separate limit of insurance or a separate policy of insurance in the individual APRN or PA name, that specific insurance not only protects the advanced practitioner, but may provide a layer of coverage to buffer the physician's or practice's primary insurance limit.

The Massachusetts Board of Registration in Nursing regulation 244 CMR 4.09 reads:

An APRN with direct patient care responsibilities must obtain and maintain professional malpractice liability insurance with coverage of at least $100,000.00 per claim, with a minimum annual aggregate of not less than $300,000.00. ...do not apply to APRNs whose practice in Massachusetts is limited to professional services rendered at or on behalf of federal, state, county or municipal health care facilities.
The regulation also applies to Nurse Midwives, Psychiatric Nurse Specialists, and Nurse Anesthetists, though not to Physician Assistants at this time. Many PAs do, in fact, maintain medical malpractice insurance.

You may be aware that your employees “share” in your medical malpractice insurance coverage. You are therefore sharing your insurance limit and may find that there is insufficient coverage in place for you or your entity in the event of a claim naming your employed PA or NP. This is especially concerning when we note that, under the provisions of “respondeat superior,” the employer, be it medical practice or solo physician, will very likely be added to the claim or allegation brought against the employed advanced practitioner. In that case, your individual limit of $1 Million or $2 Million, or the annual aggregate, runs the risk of being exhausted with multiple claims.

According to a study in the Journal of Medical Licensure and Discipline from 2009, over a 17-year period, countrywide the number of PA malpractice reports saw a continual increase, indicating an upward trend (Hooker & Nicholson, 2009, p. 13). Over this same 17-year period, there were 1536 malpractice reports against PAs with 1222 payments, and 2715 brought against APRNs, resulting in 2608 payments (Hooker & Nicholson, 2009, p. 8). More recent data provided by Coverys Insurance for all states (28) they serve reflect increased claims experience, and trending upward, for both APRN and PAs during the 2011-2015 time frame.

Overall, the incidence of claim reports directed to Advanced Practitioners is relatively low when compared to that of physicians. However, when the work being done by NP and PA providers closely parallels the role of the physician, the exposure to medical malpractice allegations naturally increases. Providing each APRN and PA with their own limit of insurance, or requiring them to provide you with annual evidence that they maintain their own insurance, is one of the practical approaches to managing your own risk.

Separate limits of insurance under a physician policy, or individual APRN policies can be purchased for very reasonable sums, averaging under $2,250 for a full time Physician Assistant and $1,300 or less for a Nurse Practitioner here in Massachusetts. Call on PIAM to learn more.

*Hooker, R., & Nicholson, J. (2009). Does the Employment of Physician Assistants and Nurse Practitioners Increase Liability? Journal of Medical Licensure and Discipline, 95(2), p. 6-16

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