Activity 5 Memo - Physician Extenders Tort Liability

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Seton Hall University *

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6008

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Medicine

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Jan 9, 2024

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docx

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Uploaded by jadamarie123

Memorandum To: Physician Owners, State Chain Urgent Care Centers From: Jada Porter, Director of Risk Management Re: Potential Tort Liability for Physician Extenders Date: December 16 th , 2023 Question  What is the nature and scope of potential medical malpractice liability for physicians and physician extenders? What is the recommendation regarding the potential employment of physician assistants and nurse practitioners in this medical business? Brief Answer  The nature and scope of potential medical malpractice liability for physicians and their extenders is complex. Physician extenders can be held liable for negligence similarly to their physician counterparts. It is heavily influenced by legal theories and state & federal regulations. There are several areas within medical practice where errors or negligence can result in legal liability for both parties. Facts  The Physician Owners of this statewide chain of urgent care centers are considering hiring multiple physician assistants and nurse practitioners to work at each of the care center locations. The physician owners require a summary of the nature and scope of potential medical malpractice liability for the physician extenders in the practice and for the physicians with regard to adding these service providers to the business. An informed

recommendation will be provided to the physician owners regarding the potential employment of physician assistants and nurse practitioners. Discussion  Physicians often hire physician extenders such as physician assistants and nurse practitioners to increase the efficiency of their healthcare practice. These job roles are intended to assist in alleviating a portion of physicians’ work responsibilities when their medical care is in high demand. In a study concerning the employment of physician extenders, several physicians reported increased flexibility upon their hire (National Library of Medicine, 2013). Physicians have noted that their assistants and nurse practitioners allow them “to focus more time on complex patients” which has contributed to less stress as well (National Library of Medicine, 2013). With the assistance of a physician assistant or nurse practitioner, more patients have quality healthcare services made accessible to them. From a financial business perspective, hiring these physician extenders can potentially be a smart choice because they can often “generate similar revenues at considerably less compensation than a physician” (American College of Physicians, 2010). The employment of a physician assistant or nurse practitioner would essentially be more cost effective than hiring additional physicians to assist at the urgent care centers. However, physician extenders can potentially increase medical malpractice liability risks for the practice. Liability risks typically create a strain on the finances and credibility of medical practices. To determine a physician or physician extender’s liability, the nature of their work relationship must be established first. The specific regulations that define this work relationship is governed by state law which typically varies. The physician is required to formally review the state and board protocols with

their extender employee to determine how they are permitted to practice. Also, the physician is typically required to create a “written delegation agreement” with physician assistants and nurse practitioners that is signed by both parties (NJ Consumer Affairs, 2019). This agreement describes the specific duties that the physician extender is permitted to complete under the direct supervision of the physician. “There are essentially three legal theories commonly used to ascribe liability to the physician for errors from their non-physician provider: vicarious liability, negligent supervision, and negligent hiring” (American Journal of Gastroenterology, 2007). Under the vicarious liability cause of action, physicians are held responsible for the negligent actions of their employees. The physician owners can be held liable for negligent hiring if the plaintiff proves that the employer failed “to exercise reasonable care in the hiring process” (Journal of Urgent Care Medicine, 2013). It is the physician owners’ responsibility to ensure that their physician extender employee has an adequate amount of education and training that is required by state statutes to complete their assigned tasks. The physician owners must adhere to an appropriate screening process to verify the credentials of their extender candidates. It is most common for “claims against physicians for mistakes of non-physician providers to stem from five areas: lack of adequate supervision by a physician, untimely referral to a consultant; failure to diagnose properly, inadequate examination, and negligent misrepresentation” (American Journal of Gastroenterology, 2007). The physician owners are responsible for ensuring that their physician extender only performs tasks that were assigned within their scope of practice. The physicians must also provide appropriate supervision over their extenders to ensure a high quality of care. The amount of supervision that physician extenders require is set by state law

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