Psychiatric care is among the fastest-growing fields for nurse practitioners (NPs) and physician assistants (PAs) today, reflecting broader trends in mental health awareness and the increasing demand for mental health services. Projected growth will lead to a much-needed 67% overall increase in the national psychiatric NPs and PAs workforce by 2030, according to the Behavioral Health Workforce Projections.
Psychiatric care offers tremendous rewards for providers working in the field, as well as risks. “It can offer a deeply rewarding career path, allowing you to build strong connections with patients and witness their mental health improvement firsthand. However, it’s important to recognize the unique legal challenges inherent in this field,” says Brittney Stinnett, BSN, MS, a commercial insurance advisor at HUB International who works with PAs and NPs.
Understanding common risks and liabilities of psychiatric care as an NP or PA
Psychiatric care has inherent risks that aren’t as common in other NP or PA work. Complex medical needs can mean patients require multiple medications, leading to a risk of polypharmacy. At the same time, some patients may be unable to follow treatment protocols.
A 2018 lawsuit in Idaho highlights the collision of three of the most significant risks psychiatric PAs and NPs face: assessing suicidality, informed consent and incomplete documentation.
In June of that year, Terri Mattson parked her car in the lot of the Idaho Department of Health and Welfare, retrieved a gun from her glove compartment and attempted to end her life. What led to this tragic event was a series of alleged medical oversights and failures that culminated in a lawsuit against a certified PA and the Department of Health and Welfare.
Mattson had been diagnosed with recurrent, severe major depressive disorder (MDD) and struggled with anxiety and substance abuse. Her concerns were inadequately addressed when she reported worsening symptoms and adverse effects from prescribed medication to her provider.
The lawsuit hinged on three primary claims:
- Failure to obtain informed consent: The Mattsons argued the PA didn’t adequately inform about the potential risks of fluoxetine, including the increased risk of suicide.
- Duty of care: Despite a history of depression and suicidal ideation, the PA failed to conduct a comprehensive suicide risk assessment before prescribing the medication.
- Incomplete documentation: Discrepancies in the documentation regarding treatment and the information provided about fluoxetine were a focal point.
The case, Mattson v. Idaho Department of Health and Welfare, is a stark reminder of the legal and ethical responsibilities PAs carry, particularly in psychiatric care.
3 areas of liability in psychiatric care and how to protect your NP or PA license and practice
Mistakes can happen when a PA or NP treats hundreds of patients each year. Stinnett, who previously worked in an OB/GYN clinic and saw an average of 40 patients, emphasizes the human factor in healthcare, stating, “We’re bound to make mistakes. Therefore, we need to set clear guidelines and safeguards.
Protecting yourself from being named in a lawsuit or a licensing claim requires knowing the top risks of NP or PA psychiatric care and taking steps to avoid them. Stinnett sees the most common ones in her NP and PA risk management work.
1. Duty of care and informed
Nurse practitioners and physician assistants have a duty to provide a standard level of care to their patients. Breaches of this duty, such as failing to warn patients about potential side effects or risks associated with treatments, can lead to legal action. It’s crucial to document all patient interactions and communications meticulously.
Stinnett recalls a client whose patient came to the facility and was misdiagnosed and discharged. Within 24 hours, that patient harmed themselves. “As a healthcare professional, care involves a thorough patient assessment and adherence to protocols to guarantee a reasonable standard of care, which minimizes the risk of misdiagnosis. ,” she says.
2. Medication management
Psychiatric care often involves prescribing medications that can have significant side effects or interactions with other drugs. Proper medication management includes thorough patient assessments, knowing the complete medical history and regular follow-ups.
Patients must be informed of any possible side effects. Informed consent should then be documented in the patient’s medical record. “Prescribing incorrect medications, dosages or drug combinations can lead to severe consequences. These errors are a frequent topic in the news, highlighting the critical importance of medication management, says Stinnett.
3. Confidentiality breaches
Maintaining patient confidentiality is a cornerstone of psychiatric care. Unauthorized disclosure of patient information can lead to legal repercussions and damage professional reputations. Ensuring robust protocols for data protection and patient privacy is non-negotiable.
“Medical malpractice insurance carriers may cover some defense costs, but it’s not guaranteed. It’s best to have proper protocols in place to prevent medical malpractice claims,” says Stinnett.
Questions to consider for NP or PA professional liability insurance
Besides taking precautions to protect yourself from common risks of psychiatric NP or PA care, professional liability insurance, or malpractice insurance, is a must. This insurance covers legal defense costs and any awarded damages if a patient sues for malpractice. Even if your employer offers medmal coverage, it’s a good idea to have your own policy as well.
Coverage specifics can vary, so it’s essential to understand what your policy covers and its limits.
Understanding policy limits and exclusions
Be aware of your policy limits for defense costs and damages. Are these limits sufficient for your practice’s risk level? Additionally, understand your policy’s exclusions, such as those for punitive damages, and how they could impact your coverage.
Claims-made policies and tail coverage
If a claims-made policy covers you, ensure you have tail coverage when leaving one facility for another. Tail coverage protects you against claims made after your original policy ends. Discuss these details with your insurance advisor to avoid gaps in coverage.
Read more about claims-made policies and tail coverage.
Choosing the right insurance agent
Select an insurance agent who understands the nuances of psychiatric care. An experienced agent can provide tailored coverage to meet your needs and help you navigate complex insurance terms and conditions.
Besides providing coverage, your professional liability insurance agent should also consult with you to help you avoid NP or PA psychiatric care risks. Work with legal and insurance experts to review your practice’s policies and procedures. Regular consultations can help identify potential risks and ensure you are adequately protected.
By understanding the risks and liabilities, maintaining comprehensive documentation, and securing appropriate insurance coverage, nurse practitioners and physician assistants can protect themselves and their patients, ensuring a safe and effective practice environment.
