With great power, comes great liability


By Amber Knouff

As medical advancements and patients in need of medical care continue to increase, the role of mid-level practitioners becomes even more crucial. While there have been many turns of phrase for these medical professionals, the term mid-level practitioner is meant to encompass those non-physician providers, which include advanced practice nurses and physician assistants, among others.

In Kentucky, there has been a shortage of primary care providers, which is particularly problematic in the state’s many rural areas. This in turn has led to the push for more autonomy to these integral medical providers. While there are many reasons why this development is an improvement for patients and providers alike, this also leads to more liability exposure.

Primary Care Shortage

The concept of primary care shortage is reflected in The Health Resource and Services Administration (HRSA) report, which estimates that there will be a shortage of 20,400 primary care ­physicians by 2020.

However, this number could be drastically reduced, by over half, with a significant increase in the autonomous practice of mid-level providers. Kentucky is currently characterized as a “reduced practice” state by the American Association of Nurse Practitioners.

The ongoing trend in Kentucky is increased autonomy for these mid-level practitioners. Since nurse practitioners have been afforded the ability to write prescriptions, the creation of independent clinics has become more of a reality, affording rural areas with more access to primary care. While these mid-level providers continue to push for more autonomy in the provision of medical care, especially related to prescribing, this development also opens the door for more liability concerns.

Prescribing Concerns

In the wake of the opioid epidemic, the prescribing of controlled substances has been the focus of many debates and licensing board actions and inquiries. Although nurse practitioners do have prescribing powers, prescriptions for controlled substances such as Adderall and Hydrocodone still require a collaborative agreement with a licensed physician.

In the past, in addition to violations for the standard of care, claims involving mid-level providers have often also included claims for failure to supervise, failure to have appropriate written protocols and failure to follow the same. These claims are still populating the legal realm and are increasing as the number of medical malpractice cases trends upwards. While claims against mid-level providers often also include one for failure to supervise against the collaborating physician, this avenue for shared liability will decrease as autonomy increases.

Given all these changes, it is more important than ever for mid-level practitioners and healthcare providers to be aware of the ever-evolving scope of practice rules and regulations in their area or specialty. Educating oneself and ensuring the education of any staff regarding adherence to these requisite policies and regulations will contribute significantly to limiting risk of exposure.

-Amber Knouff is an associate practicing in the Lexington office of McBrayer, McGinnis, Leslie & Kirkland.