1. The Catholic University of America Reason. Faith. Service. Interviewing Strategies and Liability Insurance: Important Considerations for Nurse Practitioners Pat McMullen, PhD, JD, CNS, WHNP-BC FAANP Dean – School of Nursing The Catholic University of America mcmullep@cua.edu

2. The Catholic University of America NP Career Day 2013 Competencies Explain why liability insurance is important to NPs Differentiate between types of liability insurance Apply knowledge of liability insurance principles to selected cases

3. The Catholic University of America NP Career Day 2013 Source: Miller, K.P. (2011) Malpractice: Nurse Practitioners and Claims Reported to the National Practitioner Data Bank. Journal of Nurse Practitioners, 7(9), 761- 67.

4. The Catholic University of America NP Career Day 2013 2007–2008 (N = 501)2009–2010 (N = 550) Failure to Diagnose (N = 72) Failure to Diagnose (N = 80) Delay in Diagnosis (N = 28) Delay in Diagnosis (N = 26) Improper Perf. (N = 15) Improper Mgmt. (N = 24) Failure to Recognize a Complication (N = 14) Improper Perf. (N = 13) Wrong or Misdiagnosis (N = 13) Wrong Medication (N = 12) Failure to Monitor (N = 13) National Practitioner Data Bank – Nurse Practitioner Claims Source: Miller, K.P. (2011) Malpractice: Nurse Practitioners and Claims Reported to the National Practitioner Data Bank. Journal of Nurse Practitioners, 7(9), 761-67.

5. The Catholic University of America NP Career Day 2013 NP 2012 Liability Update from NSO (www.nso.com) NP Specialty% of Closed Claims Total Paid Indemnity Average Paid Indemnity Pediatrics1.0%$1,050,000$525,000 WH (Obstetrics)2.5%$2,185,000$437,000 Emergency Medicine3.5%$1,915,292$273,000 Adult/Primary Care52.0%$26,349,319$253,359 WH (Gynecology)5.0%$2,357,833$235,783 Occupational Health0.5%$225,000 Behavioral Health6.5%$2643,750$203,365 Family Practice23.5%$6,904,296$146,900 Gerontology1.0$272,500$136,250 Anesthetics/cosmetics4.5%$476,500$51,944 Source: NSO NP 2012 Liability Update, p. 12.

6. The Catholic University of America NP Career Day 2013 NSO Liability, p. 15 Allegations Related TO % of Closed ClaimsTotal Paid IndemnityAverage Paid Indemnity Monitoring1.5%$965,000$321,667 Diagnosis43.0%$21,573,135$250,850 Medication Rxing16.5%$7,660,197$232,127 Tx and Care Management 29.5%$13,005,408$220,431 Equipment3.5%$640,000$91,429 Assessment1.5%$271,250$90,417 Abuse/pt rights/Prof Conduct 3.5%$216,000$30,857 Communication0.5%$27,500 Scope of Practice0.5%$12,000 Overall100%$44,370,490$221,852

7. The Catholic University of America NP Career Day 2013 Types of Liability Insurance Occurrence Insurance-Provides coverage for a claim based on an episode that occurred during the policy period. Claims Made Insurance-Provides coverage ONLY for suits and claims that are filed or made during the period when the policy was active.

8. The Catholic University of America NP Career Day 2013 Other Important Terms Tail-Coverage when a claims-made policy ends. It extends the period of coverage for incidents that happened when the policy was active. Usually costs 150-%-200% of the annual claims-made premium. Nose-Insurance to cover prior acts. Usually needed when you leave a job where there was no tail coverage available.

9. The Catholic University of America NP Career Day 2013 Examples-Case One You worked as an NP at X Primary Care. You had occurrence insurance as follows:  May 1, 2011-May 31, 2012 Insured by The Saint Paul Insurance Company  June 1, 2012-Present Insured by NSO. Named as a defendant for an incident that happened on July 17, 2011. Who should you contact?

10. The Catholic University of America NP Career Day 2013 Example Two You are an NP at Friendly Hospital’s Clinic. You have claims-made insurance as follows:  May 1, 2011-May 31, 2012 The Saint Paul  June 1, 2012-Present NSO Who do you contact?

11. The Catholic University of America NP Career Day 2013 Keep in Mind…. When you are negotiating your employment contract, discuss:  Who will pay the premiums?  Who will pay the tail when you leave or retire?  Are you covered for “outside” work?  Can you select the attorney who will represent you if a claim is filed?

12. The Catholic University of America NP Career Day 2013 Keep in Mind Can you select an insurer who is different from the insurer for the practice? Have you investigated the rating of the insurer (National Association of Insurance Commissioners- http://www.naic.org/state_web_map.htm) http://www.naic.org/state_web_map.htm If you must pay for the premiums and/or tail, can you use a payment plan?

13. The Catholic University of America NP Career Day 2013 Keep in Mind Most payments on malpractice insurance are a tax deductible business expense. Check with your accountant or the IRS on how to include this on your tax return.

14. The Catholic University of America NP Career Day 2013 QUESTIONS?

15. The Catholic University of America NP Career Day 2013 Strategies to Improve Patient Care and Diminish Liability Update policies/procedures regularly. Primary care to increase continuity and establish rapport. Encourage patient/significant other input.

16. The Catholic University of America NP Career Day 2013 NP Strategies Document patient deviations from the norm, your interventions and PATIENT’S RESPONSE TO YOUR INTERVENTIONS. When in doubt, “check it out”. And, go up the chain of command, if necessary.

17. The Catholic University of America NP Career Day 2013 NP Strategies Chart calls or consultations and note physician response. Use teaching materials to reinforce information you provide and chart them.