Understanding Medical Liability & Malpractice Insurance For Nurses In Pennsylvania

A recently filed lawsuit revealed that thousands of patients had exposure to a nurse with tuberculosis at the University of Pittsburgh Medical Center. The emergency room nurse was believed to have been contagious for up to a four-month period. Physicians are the most common type of medical professional to face claims of medical malpractice; therefore, the potential medical liability that nurses may encounter is often overshadowed. Nurses can be potentially liable for medical errors, although often claims of negligence are imputed to the tending physician or organization that employs them.

Data Regarding Malpractice Claims Against Nurses

The Nurses Service Organization published a report about exposure to professional liability with findings that included:

• Roughly 88.5% of claims involved Registered Nurses (RNs) and 11.5% involved Licensed Practical Nurses (LPNs)
• The average claim against RNs totaled $165,491 and was $157,598 for LPNs
• The two nursing specialties with the most costly claims are neurology and obstetrics
• Approximately 19% of such claims were related to pregnancy or complications associated with OB
• Those in a Director of Nursing (DON) role tend to encounter claims relating to management, such as negligent hiring

Common Causes of Claims

Claims against nurses that result from a patient fall are common. Claims stemming from falls may be costly, particularly if the patient endures head injuries or broken bones that lead to death. In recent years, clinical settings such as hospitals and long-term care have been increasingly focused on uniform safety procedures such as incident reporting protocol and reducing medication-related errors. Many of the current claims of negligence are related to a lack of communication between nurses and other practitioners.

Pennsylvania’s MCARE Program

The state implemented a statute known as the Medical Care Availability & Reduction of Error Fund (MCARE) in 2002. The MCARE program regulates professional medical liability statewide. The program seeks to protect victims of medical negligence by making sure they are fairly compensated, as well as to maintain the affordability of malpractice insurance for providers. For example, certain medical providers are required to maintain $500,000 in coverage for injured patient claims, with MCARE providing additional funds for severe injuries that exceed this amount.

Claims Made Policies

A “claims made” type of malpractice policy is one that only covers claims that arise during the period of an insurance policy. For example, if you enrolled in a new policy at the beginning of the current year, any claims that arise stemming from incidents during the prior year would not be covered. These policies require what is known as “tail coverage”. Tail coverage for the insured spans an additional period of time beyond the insurance policy termination date. The statute of limitations in Pennsylvania for claims of medical malpractice is generally two years; therefore, the tail coverage simply must apply for one additional year in most cases.

Occurrence Policies

An occurrence policy differs from a claims policy because it covers any claims that arise from actions that occurred during the policy period. This protects the medical provider from claims that arise later on regardless of whether the policy is still currently in place. This would be critical if a nurse were to change employers and thus be covered under a new insurance plan. It is important for nurses to review the details of coverage offered through their employer to be certain that they are covered by an occurrence policy, or that tail coverage exists if under a claims policy.