APRNs - What Happens if You are Sued?

Okay as the title states, I have been sued, been found at fault and the suit settled. It was a very trying experience both in terms of my personal and professional lives. And...it took a long time…. Specialties Advanced Article

APRNs - What Happens if You are Sued?

Over on the Nurse Practitioner forum, we've been discussing lawsuits - this is something very real and worrisome for providers. While nurses can get sued; most often they are dragged into a suit along with others; while APRNs by virtue of being providers can "stand alone" and take the brunt of the lawsuit themselves.

Unfortunately I can speak to this firsthand. I've been an APRN for over ten years now and I still shudder when I remember the incident that completely changed my practice. For privacy sake, I will keep it general. I made a prescribing error.

So...began the odyssey of lawyer visits, depositions, court appearances, meetings with my boss, with the practice president, and many many years of endless waiting wondering: would I have a job, would I have a license, would my house be taken, my wages from whatever job I could ever get be garnished, would I have to declare bankruptcy and on and on my imagination wandered?

It was very stressful on me, my family, my co-workers. And oh yeah...did I say you can't talk about it to anyone??? Me...who talks all day long! To worry in silence for many years was another stressor.

In the end...an out of court settlement was reached for what I considered to be a lot of money but for what the attorneys patted themselves on the back for negotiating. I came out with my job intact.

On the day I signed the settlement, I received the final blow - oh yeah didn't we tell you that this has to be reported to the board of nursing and the National Practitioners Data Bank? Uh...what???

More worries, more time...in the end after I hired an administrative law attorney to appear with me for the BON hearing, my license was cleared. My name does appear in the NPDB and will always show a payout for a malpractice suit. However, it is possible to get a job with this and it is possible to get credentialed with this on your record.

Some things I've learned along this bumpy road:

  1. Always be scrupulously honest with everything. If you are in the NPDB - everyone will find out anyway.
  2. Keep your own . Although your practice will cover your lawsuit expenses, it will usually not cover your licensure protection and you will need that if you are found at fault.
  3. If you find yourself being sued, realize this is a long haul adventure. Get yourself some support which can be difficult as you will be told "don't talk to anyone." You can talk to clergy, or a counselor or your spouse with the expectation of privacy as long as you don't discuss the case itself but rather your feelings and emotions.
  4. Be kind to yourself - this is stressful. It can happen to anyone at anytime. It does NOT mean you are a bad person, a bad provider or that you made a poor career choice.
  5. We always want to do the best for our patients but we are human - we do make mistakes - sometimes our mistakes don't cause harm, but unfortunately sometimes they do.

And to those of you reading this saying, "that would never happen to me, I'm too cautious, I'm too smart, I would never harm a patient," until ten year ago I was thinking the same thing....

It happens....be prepared...

And...if it happens to a colleague...please be very supportive. Realize they can't discuss the details but let them know you care, invite them for lunch, remind them of all the positives they bring to their job. And...remember to keep supporting them thru the long haul - realize when they are gone for a court date, deposition, meeting and touch base with them and let them know you care.

This is a caring profession but sometimes we are least kind to each other...

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traumaRUs

About traumaRUs, MSN, APRN

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Specializes in Healthcare risk management and liability.

Speaking as someone who does medical malpractice claims for a living, I endorse these comments. I would also point out that the malpractice insurer, your employer, or the state medical or nursing associations may offer what we call 'second victim' support activities, ranging from speaking with a therapist or peer, to group support meetings. I have run many of these activities, and they can be very helpful.

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I'm sorry that this happened to you. This must have been a terrible experience.

I understand the need for , but I have three questions that perhaps someone will know the answer to in regard to APRN practice, which I have contemplated from time to time: 1) Does the Practice one works for usually cover one's lawsuit expenses, and what typically would be covered? It appears APRN's are employed/working under a variety of different employment arrangements, from self employed to partnerships to employee status, and probably others that I haven't mentioned, where different company and employment laws prevail for the varying situations, and of course these laws would vary from state to state. 2) Does "lawsuit expenses" include sums one is liable for that one's malpractice insurance does not cover, for example settlement costs that are judged to be one's responsibility? or 3) Does this just pertain to expenses such as attorney fees or does this mean other costs in regard to the lawsuit, and if so, what types of costs?

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Specializes in Education, FP, LNC, Forensics, ED, OB.

I understand the need for malpractice insurance, but I have three questions that perhaps someone will know the answer to in regard to APRN practice, which I have contemplated from time to time: 1) Does the Practice one works for usually cover one's lawsuit expenses, and what typically would be covered? It appears APRN's are employed/working under a variety of different employment arrangements, from self employed to partnerships to employee status, and probably others that I haven't mentioned, where different company and employment laws prevail for the varying situations, and of course these laws would vary from state to state. 2) Does "lawsuit expenses" include sums one is liable for that one's malpractice insurance does not cover, for example settlement costs that are judged to be one's responsibility? or 3) Does this just pertain to expenses such as attorney fees or does this mean other costs in regard to the lawsuit, and if so, what types of costs?

Employer policies will/may have limitations and/or issues concerning conflict of interest.

Some examples of covered benefits included in most individual policies:

  • Medical expenses to those injured
  • Sexual misconduct and/or abuse
  • HIPAA penalties
  • BON disciplinary expenses

The policy will define the terms. All policies have limits of liability. When purchasing insurance, one needs to: (1 - research the professional liability coverage which is the amount you are legally obligated to pay, (2 - research if a Defense attorney is provided.

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Specializes in Healthcare risk management and liability.
I'm sorry that this happened to you. This must have been a terrible experience.

I understand the need for malpractice insurance, but I have three questions that perhaps someone will know the answer to in regard to APRN practice, which I have contemplated from time to time: 1) Does the Practice one works for usually cover one's lawsuit expenses, and what typically would be covered? It appears APRN's are employed/working under a variety of different employment arrangements, from self employed to partnerships to employee status, and probably others that I haven't mentioned, where different company and employment laws prevail for the varying situations, and of course these laws would vary from state to state. 2) Does "lawsuit expenses" include sums one is liable for that one's malpractice insurance does not cover, for example settlement costs that are judged to be one's responsibility? or 3) Does this just pertain to expenses such as attorney fees or does this mean other costs in regard to the lawsuit, and if so, what types of costs?

1. If the ARNP is an employee of the practice or healthcare system, the practice or system generally purchases the malpractice policy that covers all employees of the practice or system. If the ARNP is an independent contractor, or is otherwise not an employee, then the ARNP needs to purchase an individual policy. The policy pays for the indemnity (amount of any settlement, award or verdict) and expenses (legal costs, expert witness fees, depositions, travel, etc.) that are incurred in defending the lawsuit.

2. The malpractice policy generally pays for all indemnity and expenses related to the defense of the lawsuit. This would include any indemnity paid because the ARNP committed malpractice. The only notable areas of indemnity that would not be paid by the policy are punitive damages and an award based upon sexual misconduct. It is generally against public policy to have insurance policies cover these areas of indemnity, so the defendant would have to pay for any allocation of damages along these two areas out of pocket. Note that an individual nursing policy also will not pay these two areas of indemnity.

3. In terms of expenses paid, the actual defense attorney costs are the largest portion paid for by the insurance policy. Other typical expenses include expert witnesses, copies of medical records, deposition costs, travel to take depositions, preparation of trial exhibits, mock jury panels, trial consultants, marketing research, private investigators, video testimony perpetuation, etc. All of this is paid for by the insurance policy. You wish to avoid a policy that has only one set of limits for both indemnity and expense. All the expenses are deducted from the combined policy limits, thus reducing the amount of money available to pay for indemnity. If you have a one million dollar combined limits policy, and $ 200,000 is used for expenses, you only have $ 800,000 to pay for any indemnity award, settlement or verdict.

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Specializes in Psych.

Thank you for this gentle reminder, and I'm so sorry that this happened. This is a very brave post. I have a question for you, and I mean for it to apply to all levels of health care providers: We are human, we cannot be held to a standard of perfection. Do you feel that there should be an established pattern of incompetence before disciplinary action can be taken with the respective Boards? I know that people have a right to sue, and in each case the factors will determine if there is merit. But even legally, it seems like nobody wins when providers are pushed to perfection every single time, and the same with patients who suffer consequences of human error. Is there such a thing as ' good faith' anymore?

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Specializes in NICU.

Thanks for posting this. I've thought about getting the insurance before and definitely will now. I know you can't recommend a company for this insurance, but any tips on evaluating companies and the coverage? There doesn't seem to be much info on the subject that I've been able to find that is objective.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

Thank you for this article. We all strive to be the best provider we can be but we're also human. It is so important to acknowledge the second victim phenomenon in these situations and that these providers need our support.

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Specializes in Nephrology, Cardiology, ER, ICU.

@SunnyPup - good question. Yes - there should some sort of standard. The National Practitioner Data Bank contains records of healthcare providers that have been sued and have had a suit settled on their behalf. It is required that this be check when a provider is being credentialed or re-credentialed. There is also a Form C (I believe that is the letter) that must be filled out each and every time a provider is credentialed and re-credentialed. It contains info in every case where you have been even NAMED in a suit, whether you were dropped from the suit, the suit settled or any other outcome. Patients/families have a right to expect competent care. There is also the notion of transparency where if there is a mistake made, the provider readily admits it and apologizes and offers amends. Brigham and Women's Hospital has a public blog about their errors. The New England Journal of Medicine offers this. And of course, we have all seen and been upset (and rightfully so) over the crying parents or families that take to social media or the press to beg for reform after a family member is hurt or killed by medical error.

I also know of healthcare providers who agonize over mistakes they have made - good people who simply made a mistake - no malice intended, just being human. What standard are we all being held to? Perfection? Obviously I'm not there...

@babyNP - as a personal aside - I've had NSO since 1990 and they have always been very quick to answer questions and their customer service has been excellent.

@juan - yes - the second victim phenomena is very real. When you are sued, you are told "don't talk to anyone about it" yet EVERYONE knows. If you are fortunate (as I was) you have very kind colleagues that will understand, allow you to cry on their shoulder and make you realize that you WILL get thru this. The long haul stress is very real - nothing in the legal world moves fast and for a type A person like me, it was agonizing. My boss got tired of me asking "anything new yet?" Year after year with sometimes many months passing by with no word of anything happening.

Thanks everyone for your kind comments. I didn't post this for sympathy - I waited until I could tell the story as dispassionately as possible but wanted everyone to know that it is possible to get beyond this. Since this was all settled, I have been on job interviews, offered jobs, received raises, promotions and it is not the end of your professional career.

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So sorry this happened. Thank you for posting this. I am an RN. I was given great advice from my first Director of Nursing at a Major Hospital in North Carolina. She advised all of us to get our own . She said your employer will cover you for a certain amount, but it may take more money that what you are covered for. I have had insurance through NSO for 20 years. Have not had to use it, but it gives me piece of mind to know that I am covered. My employer covers me also. So I hope and pray if ever needed, I would not lose everything.

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Specializes in Healthcare risk management and liability.
Thanks for posting this. I've thought about getting the insurance before and definitely will now. I know you can't recommend a company for this insurance, but any tips on evaluating companies and the coverage? There doesn't seem to be much info on the subject that I've been able to find that is objective.

I generally recommend the CNA policy, as sold by NSO and others. I always like to point out that NSO is just the agent who sells you the policy. CNA is the actual insurance company that writes the policy.

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Because of this post. I'm sure majority of the nurses are renewing their . =)

The good news is... it sounds like the OP is now fully recovered! Thanks for sharing your story!

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