Ever increasing demands are being placed on the American health care industry by our growing population and the complexity of medicine. In response, our health care system is seeing an explosion in the ancillary health care professions, including advanced practice nurses. In Indiana, an advanced practice nurse (APN) may be authorized by law to independently evaluate and treat patients. Physicians who are in collaborative arrangements with APNs need to be aware of potential liability exposure arising from the actions of the APN.
In Indiana, advanced practice nurses include nurse practitioners, nurse midwives and clinical nurse specialists. The Indiana State Board of Nursing has the power to issue nursing licenses and to adopt rules applicable to APNs. While an APN may be licensed to independently provide medical services to patients, in order for an APN to prescribe legend drugs, the APN must be in a collaborative relationship with a licensed practitioner, typically a physician, and have a written practice agreement in place documenting this relationship. This Collaborative Practice Agreement (CPA) describes the manner in which the providers will cooperate and consult with each other in rendering medical services to patients. The CPA requires that the physician be available for consultation by telephone and that the physician randomly review the prescribing practices of the APN on a regular basis.
Does the CPA make the physician legally responsible for the health care decisions of the APN? The Indiana Court of Appeals addressed this issue several months ago, finding that a physician was not liable to a patient simply by virtue of a CPA between the physician and the APN who had actually provided the medical care.
In this case in which the physician was represented by a KDDK attorney, the facts were undisputed that the physician had never seen the patient, provided any medical care to him, or participated in any way in the patient’s health care. When the patient died, his estate brought a medical negligence claim against the physician, but not against the APN. The claim alleged that the physician owed a duty to the patient simply by virtue of the fact that the physician had entered into a CPA with the APN who had actually provided the medical care.
The Court, however, pointed out that the physician had no relationship with the patient and that the CPA itself did not give rise to such a relationship. Therefore, the Court determined that the patient’s estate could not pursue a claim against the physician simply because the physician served as the collaborating physician with the nurse practitioner who was not employed by the physician.
The facts of each situation may lead to a different outcome. For example, a physician who employs an APN is generally vicariously responsible for the acts of the APN performed in the scope and course of the APN’s employment. In addition, the terms of the CPA may specify whether the physician is assuming any liability for the actions of the APN.
The lesson to be applied is that any physician entering into a CPA with an advanced practice nurse must carefully draft the agreement and have a clear understanding of the responsibilities and liability exposure encompassed by the Agreement. Any physician who employs an APN should make certain that appropriate liability coverage is in place for the physician, the APN, and any corporate entity in which the physician has an ownership interest.
For more information about collaborative practice agreements, liability coverage or any related topic, please contact KDDK at (812) 423-3183.