In this blog, I’ll be communicating key findings specific to the 2022 Nurse Practitioner Professional Liability Exposure Claim Report.  Key findings that will be highlighted will be specific to the specialty that has the highest total incurred (funds that have been paid out) of closed claims, distribution of the top closed claims by allegation, top license defense (protection) closed matters and risk management recommendations. 

KEY FINDING: Highest Total Incurred By Specialty

The neonatal specialty represents the highest average total incurred in the 2022 and 2017 datasets. 

Many of the neonatal and pediatric claims have indemnity (compensation for damages or loss)
payments in the mid-to-high six-figure range. These payments were due primarily to the cost of lifelong, one-on-one nursing care required by the injured party.

Example of allegations against Nurse Practitioners that resulted in patients requiring lifelong, one-on-one nursing care includes:

• Failure to diagnose pertussis

• Failure to recognize contraindication and/or known adverse
interaction between/among ordered medications

Examples of a neonatal claims involving the cost of lifelong and
one-on-one nursing care for the patient includes:

1. A Neonatal Nurse Practitioner (NNP) was providing care to an infant immediately following premature birth at 32 weeks.  At the time of birth, the infant was in respiratory distress and needed
resuscitation measures. The NNP successfully resuscitated the infant and contacted the perinatologist due to the infant’s metabolic status. Twenty minutes after the birth, the perinatologist arrived to assume the care of the infant. The perinatologist and NNP were preparing the infant for transfer to a higher acuity
facility while she continued to experience difficulty breathing, as well as severe hypotension and hypovolemia. In the rush to transfer the infant, the NNP failed to timely initiate normal saline
boluses and inotropes (medications that tell your heart muscles to contract with more power increasing the amount of blood your heart can pump; increases cardiac output) to address her severe hypotension and hypovolemia, which led to brain injury. The parents alleged that this delay in treatment caused permanent neurological issues in the infant. The claim resolved with a total incurred of greater
than $240,000

2. A Women’s Health Nurse Practitioner (WHNP) provided prenatal care to a 35-37 week gestational age patient. Prior to 35 weeks, the patient had an uneventful pregnancy with normal weight gain, blood pressure readings and fetal growth. At 35 weeks, the WHNP documented a three pound weight gain from the previous week, blood pressure of 122/85 and a uterus measuring 35 cm. At 36 weeks, the WHNP documented another three pound weight gain, blood pressure of 129/89 and uterus measuring 36 cm.
At the 37 week appointment, the patient’s blood pressure was 132/92, with a fundal height of 35 cm and 1+ protein in her urine. The WHNP documented that there was positive fetal movement and fetal heart rate. At 38 weeks, the patient was seen by the co-defendant OB/GYN. The OB/GYN documented an
additional three pound weight gain, a blood pressure of 130/93 and a fundal height of 36 cm The OB/GYN ordered a contraction stress test (CST) and biophysical profile (BPP). The BPP was 0/10,
leading to an emergent caesarean section being performed with delivery of a neurologically compromised infant. The WHNP was added as a co-defendant to the lawsuit following the OB/
GYN’s deposition which stated that the insured WHNP should have notified him of the patient’s intrauterine growth restriction at her 37 week office visit Despite supportive testimony on behalf of the WHNP, the claim was resolved with a total incurred of greater than $975,000

KEY FINDING: Top Closed Claims By Allegation – Inaccurate or missed patient diagnosis accounted for the greatest number of closed claims (37.1).  The allegation resulting in the highest total incurred was patient assessment ($484,680.00).

KEY FINDING: Top License Defense (Protection) Closed Matters – Professional conduct, medication prescribing and scope of practice complaints account for more than half of all license protection closed matters at 58.4%

Risk Management Recommendations: Implementation of the below recommendations specific to every day practice, the diagnostic process, and documentation will reduce the risk of liability.    

Reference: ANA, CNA. (2022). Nurse Practitioner Professional Liability Exposure Claim Report. 5th Ed. Minimizing Risk, Achieving Excellence

P.S. Comment and Share: How do you plan to integrate this information into medical, nursing and/or legal practice?