Due to the shortage of physicians and the increase in demand for medical care, physician assistants, or PAs, are medical professionals that work to meet this demand. PAs work closely with supervising physicians and help diagnose and treat patients. They practice in every specialty and can be found in every medical setting. As with any medical professional, physician assistants face a set of legal risks. Often times, PAs are more likely to be named in a malpractice suit because they are the ones who serve as a patient’s principal healthcare provider. Because of this, it is imperative that PAs have liability insurance in order to protect themselves. As the PA industry grows, it is important to understand the different types of liability insurance available to PAs, malpractice trends shown among PAs, specific cases of malpractice in different specialties, and how physicians are often liable for mistakes of a PA.
There are many different types of liability insurance for PAs, which all focus on different coverage and benefits and vary based on state. However, it is necessary that physicians notify their malpractice carrier when hiring a PA. Although physicians can include their PA in their liability insurance, the American Academy of Physician Assistants recommends PAs to insist on their own personal policy (Johnson, 2001). While PAs can buy a $100,000/$300,000 policy for less than $600 a year, rates are higher for PAs who work in high risk specialties, like OB or surgery (Johnson, 2001).
There are two types of liability among physician assistants; direct liability and vicarious liability. Direct liability is when, “a physician’s legal responsibility for a PA can result from the physician’s own actions” (Jackson, 2012). Vicarious liability is the more expansive type and is, “…an indirect legal responsibility that arises in several circumstances” (Jackson, 2012). The most common type of vicarious liability is known as ‘respondeat superior,’ meaning “let the superior respond” (Berlin, 2001). This means that employers are responsible for any hard caused by their employees (PAs) who are assigned specific duties. In order to find a physician liable for this type of liability, the PA must have committed a negligent act and it must show that the supervising physician was in a position to control the activity of the PA. The second type of vicarious liability is through “borrowed servant” (Berlin, 2001). This theory shows that although physicians are not liable for employees who are not theirs, they can be liable if they “borrow” an employee and obtain a right of control over them.
The Healthcare Providers Service Organization (HPSO) provides insurance solutions to over 80 healthcare professionals and provide 14 different coverage types to PAs. One type of insurance is the professional liability coverage. This coverage type covers the PA for “…up to $1 million each claim, for amounts that [the PA] is legally obligated to pay as a result of a professional liability claim arising out of a covered medical incident” ("Professional Liability," n.d.). Finally, this coverage type also covers the PA up to $5 million annual aggregate, for all covered claims in the policy period ("Professional Liability," n.d.). An aggregate is the maximum amount an insurer will pay for covered losses during a policy period. Another type of coverage includes the license protection. This type of coverage is for if an individual complains to the state licensing board about a PA. Because the PA faces the challenge of defending their practice and license, this policy through the HPSO will reimburse PAs up to $25,000 annual aggregate for the defense of disciplinary charges as well as other covered expenses ("Professional Liability," n.d.). Finally, there is information privacy coverage (HIPPA) which covers up to $25,000 annual aggregate ("Professional Liability," n.d.). This type of coverage reimburses PAs for not only costs to notify patients of a breach of confidentiality, but also HIPPA fines and penalties that the PA is required to pay.
These types of liability insurance, as well as others, are necessary because of the recent physician assistant trends. A study showed that from 2005 to 2014, malpractice reports and adverse actions have risen by 366 for PAs (Brock, 2017). 3,064 PAs were included in this study and almost two-thirds of the reports were malpractice reports, while approximately 38.3% were adverse action reports (Brock, 2017). While PAs numbers are high, physicians had the highest number of reports between 2005-2014. 99,070 physicians were included in this study and there was a high of 13,992 malpractice counts, while there was a high of 8,226 for adverse action reports during this time (Brock, 2017). Because of the high number of malpractice reports on a physician’s end, it is very likely that physicians are often liable for mistakes of a PA. As mentioned before, PAs are under the supervision and direction of a physician, so they often take responsibility for a PAs mistake. There are four areas in which physicians are liable for the mistakes made by a PA: lack of supervision by a physician, untimely referral to a consultant, failure to diagnose properly, or inadequate examination (Gore, 2000). The first may occur when a PA has limited or no supervision from a physician. An example of this is at a clinic, where physicians are often not present and let their PAs do the job. The second area occurs with referrals. When PAs attempt to treat complicated cases that are beyond their training and skill level, physicians are liable for a PAs mistake. The third area, failure to diagnose, is related to lack of supervision and lacking of skills. Finally, the last claim, inadequate examination, results from PAs rushing through their examinations and missing information with their patients.
In order to decrease the number of liability claims, the Journal of Health Care Compliance outlines a list that physicians should use when working with PAs: physicians should hire only qualified PAs who meet all educational and professional requirements by their state, train and teach the PAs, have a compliance plan in place and review all policies yearly, supervise the PA and regularly review their work, set high standards, and finally, act as a positive role model for the PA (Moses, 2011). Overall, a properly supervised PA can lower the number of liability claims for themselves and their supervising physicians, while also increasing patient satisfaction and improving health care as a whole. Add conclusion/make flow better
There has been an increase in malpractice issues and legal implications of PAs in certain specialties, specifically cystoscopy and radiology. A task that was once performed strictly by physicians, are now performed by other health care professionals, like PAs. Because there are no formal guidelines or training programs for cystoscopy, there is a chance that PAs may be unsure of their scope when it comes to this specific specialty (Schultz, 2011). Therefore, it is imperative that PAs not only receive training specific to the specialty, but also inform patients that a PA is performing their procedure and not a physician. In order to improve upon risk management within radiology, it is necessary that PAs acquaint themselves with all rules and regulations of the specialty and ensure they have supervision of a physician to order and review radiologic tests (Berlin, 2001).
There has been a growing question of if the employment of PAs increase liability. However, studies have shown that there are no observations or trends that suggest this (Hooker, 2009). The National Practitioner Data Bank (NPDB) is a repository of reports about medical malpractice and adverse actions. When pulling information for PAs, results showed that PA reports were 1,535, while physician and advanced practice nurses (APN) reports were 320,034 and 2,715, respectively (Hooker, 2009). The top reasons for malpractice payments among PAs were diagnosis, treatment, medication and surgery (Hooker, 2009). Overall, PAs improve the delivery of health care services and may even decrease liability, as viewed through the NPDB system.
As mentioned before, it is particularly important that PAs receive direct supervision from a physician. The Physician Assistant Licensing Act (PALA) works to limit the scope of PA practice and ensures that there is a quality relationship between a PA and a physician who is licensed by the State Board of Medical Examiners (BME) (Jackson, 2012). The PALA describes two types of direct supervision: one in inpatient settings and one in outpatient settings. Direction supervision in inpatient settings is defined by, “continuing or intermittent presence with constant availability through electronic communications; regularly scheduled review of the practice of the PA and; personal review by a physician of all charts and records of patients and countersignature by a physician of all medical orders, including prescribing and administering medication, within 24 hours of their entry by the PA” (Jackson, 2012). This is compared to the rules of direction supervision in an outpatient setting: “constant availability through electronic communications; regularly scheduled review of the practice of the PA and; personal review by a physician of the charts and records of patients and countersignature by a physician of all medical orders, within seven days of their entry by the PA, except that in the case of any medical order prescribing or administering medication, a physician shall review and countersign the order within 48 hours of its entry by the PA” (Jackson, 2012). In addition to how direct supervision works in different types of health care settings, the BME requires that no more than two PAs are assigned to one supervising physician, in order to decrease the number of malpractice reports and adverse actions. These rules as well as others are created by the PALA and BME in order to ensure the safety of all patients and health care professionals.
Physician assistants are a great addition to health care and deliver high-quality care. Health care would not be where it is today if it were not for the PAs in the world. However, as with any health care professional, there are risks. PAs are encouraged to acquire liability insurance in case something goes wrong when delivering care to patients. In addition to this, many physicians often include their PAs in their liability insurance, as physicians are often liable for the mistakes of a PA, although this does not occur often. There are many rules and regulations that are set forth by state boards in order to ensure the health and safety of patients.