Nevada RNformation: "Avoiding Malpractice: Is Insurance Really Necessary?"

If you think it will never happen to you, think again! Many nurses are gambling with their license when they practice unprotected. They are assuming that if they do everything right they will not have to worry about being sued. Various healthcare providers choose not to carry malpractice insurance fearing such policies will merely give plaintiffs another "deep pocket" to go after. Some even advise nurses not to obtain malpractice insurance because they erroneously believe they will be safer without it. Given the rise in malpractice suits being filed today, this has to be the worst advice anyone can give to a nurse who is currently practicing in Nevada. You simply cannot work as a nurse in any capacity and expect to be completely immune from litigation.

Tracy L. Singh is a Nurse-Attorney dedicated to serving nurses and other health care providers throughout the state of Nevada. Her Las Vegas firm provides personal and professional legal support to all health care providers. Her mission is to improve provider-patient relations, and reduce medical malpractice claims in Nevada.

Mrs. Singh's career began as a patient. While recovering from major back surgery, she was inspired by those who cared for her. As a Registered Nurse she held many positions which included caring for children with aids as a home health nurse, working as a medical-surgical floor nurse, a charge nurse, an office manager, and as a nurse-liaison for Cardiovascular Surgery of Southern Nevada, in Las Vegas. Throughout her nursing career, Mrs. Singh was most noted for her high standards and dedication to improving patient care.

She attributes her passion for nursing to her experience as a patient. It is her success as a Registered Nurse that gave her the strength to follow her dream of becoming an attorney: When asked why she left nursing, her response is always the same, "I did not leave nursing, I brought it with me."

Recent changes in the Nevada Revised Statutes were meant to place limits on medical malpractice claims. However, Mrs. Singh advises, some changes may have actually increased the risk of exposure for nurses.

The most significant legislative changes in medical malpractice litigation were the removal of the mandatory peer review panel, the decrease in the statute of limitations, and the caps placed on non-economic damages. Once these new rules took effect, the number of medical malpractice cases filed in Nevada increased almost immediately.

Elimination of the Peer Review Panel:

Previously, plaintiffs were required to present their medical malpractice claims to a peer review panel prior to filing suit in a court of law. Given the time and expense required to prepare for the panel, physicians and other healthcare providers who were wrongfully accused of malpractice had a much better chance of being released.

For example, upon determination that the wrong doctors had been named, or where no liability could be found, continued pursuit of a case against them made little economic sense. Filing medical malpractice claims required advanced knowledge and experience. Plaintiff. attorneys were less likely to pursue frivolous lawsuits in court.

With the elimination of the mandatory peer review process, plaintiff attorneys are able to file medical: malpractice claims with much less preparation and expense. Attorneys without medical knowledge or experience are now less hesitant to take medical malpractice cases. Plaintiffs and their attorneys must now decide whether or not their cases have any merit without the guidance of an objective panel of experts. Hence, the increase in number of suits filed in Nevada today.

Statute of Limitations:

Under the old legislation, plaintiffs had two to four years to file their claims, depending on when they "knew or should have known" that a health care provider committed malpractice. Currently, however, once plaintiffs discover the alleged malpractice, they must decide which health care providers they intend to sue and file their causes of action within one year. Barring special circumstances, all claims must now be filed within three years from the time of the occurrence, regardless of discovery.

This puts more pressure on plaintiffs to determine who to sue. When time is of the essence, they prefer to be safe, not sorry. This brings about the "shot-gun" approach to litigation, which is to sue everyone remotely involved and let the chips fall where they may. The odds are definitely in the plaintiffs' favor.

Caps on Non-Economic Damages:

It used to be up to the judge or jury to determine how much to award the plaintiffs in medical malpractice cases. Some claim that it was the infamous large jury awards that ultimately prompted legislative change in Nevada. Without any limit to what plaintiffs could collect in court, the insurance companies claimed they had no choice but to raise medical malpractice rates for physicians. Coverage rates doubled and tripled for most Nevada physicians. Some insurance companies ,even pulled out altogether which left fewer carriers to choose from.

Plaintiffs now face a cap of $350,000.00 on noneconomic damages. The "insurance crisis" has begun to turn around. However, caps do not come into effect until the end of a case when the jury deliberates on damages or it settles out of court. By then, the costs of defending a lawsuit may reach or exceed the cap amount.

Caps do not discourage plaintiffs from suing multiple parties, either. In fact, there is an incentive to name as many parties as possible. Plaintiffs certainly do not make a list of who has or does not have malpractice insurance before they decide who to go after. The cost of defending lawsuits begins to mount as soon as papers are served. Furthermore, just filing the initial response to a lawsuit can be costly, even when a motion to dismiss is successful. Once a lawsuit has been filed, the courts are reluctant to release health care providers, even when defendants can prove they were wrongfully named in a cause of action.

The odds are against the defendants because when plaintiffs name a few extra people just to be safe, they suffer no real additional costs or risks. However, each and every person served with a lawsuit must respond. Otherwise, a default judgment may be issued against them and the plaintiff will automatically win. Even parties who never saw the · patient will need the assistance of an attorney to properly defend themselves. In medical or nursing malpractice claims, you will not be released from the case by merely saying, "it wasn't' me." You have to prove it and defending a lawsuit can be very financially and emotionally expensive.

Avoiding Malpractice Claims:

With plaintiffs having less time to sue, and no peer review panel to weed out frivolous lawsuits, nurses are at risk no matter what position they hold. Whether a nurse is named directly or brought in under an employer, the risk of being involved in litigation begins with the first patient and does not end until years after the last patient of his or her career.

There are several ways nurses can minimize the risk of exposure. The first and most important way for you to protect yourself is to carry adequate malpractice insurance at all times. Do not assume that you are covered as an individual for malpractice under your employer's insurance. Ask for your own copy of the policy. You must know the details of your policy and how long your coverage will last. The cost of having your own policy is nominal and one should be considered if you are not personally named on your employer's policy.

Nurse Attorney, Mrs. Singh will be presenting specific ways to help minimize your risk of malpractice in a series of articles. Look for her first article in our next issue, "Avoiding Malpractice: Communication is Critical" to learn how mastering this important skill can reduce malpractice claims for health care providers. In the meantime, Mrs. Singh is available for questions or comments at via email at tsingh@tlsinghlaw.com.

by Tracy L. Singh, Nurse Attorney