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Legislation introduced in March would lift restrictions on advanced practice registered nurses (APRNs) that require them to contract with a physician in order to practice. APRNs say that permitting them to practice independently would expand the accessibility of care to more Ohioans, especially in rural areas. Doctors argue that there should be supervising docs to ensure standards of care and avoid potential medical malpractice issues.

What is an APRN?

According to the Cleveland Clinic, an APRN is a nurse who has earned a master’s degree or above in a nursing specialty and practices medicine in collaboration with a physician. In addition to a required master’s degree, an APRN must obtain a national certification in a nursing specialty. APRNs must be approved by the Ohio Board of Nursing. The Board defines “nursing specialty” to mean a certified registered nurse anesthetist, clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner.

An APRN can conduct exams, advise on preventive health care, diagnose and treat illnesses, order tests, prescribe medications, and even perform routine medical procedures.

Depending on their specific role and training, an APRN can conduct physical exams, counsel on preventive health care, diagnose and treat illnesses, order lab and radiology tests, and prescribe medications. Some APRNs with more advanced training are able to perform routine medical procedures. APRNs can be found in hospitals, urgent care clinics, doctor’s offices, ambulatory clinics, surgical centers, and doctor’s offices providing primary and specialty healthcare.

HB 177 Proposed Changes

Existing Ohio law requires practicing APRNs to have a written contract with a physician known as a Standard of Care Arrangement (SCA). HB 177 would give APRNs who complete 2,000 clinical practice hours under an SCA the option to practice independently, without physician oversight. Nurse practitioners currently have full authority to practice independently in 23 states and Washington, D.C.

The Ohio Association of Advanced Practice Nurses (OAAPN) says in a talking points memo supporting the bill that SCAs are “unnecessary and duplicative” because they don’t really give supervision and mirror numerous other oversight measures, such as those from healthcare systems and the state nursing board, that ensure quality of care. OAAPN also says that SCAs limit expanding access to care in areas where physicians are in short supply. Data released in March indicates that 81 of 88 counties in Ohio lack access to primary care services in their community, reports AARP.

Physician groups oppose the legislation, which has been unsuccessfully introduced in past years. Generally, doctors point to differences in education and training between medical doctors and nurse practitioners. Testimony provided in opposition to a previous version of HB 177, for example, noted that doctors typically receive a four-year medical degree and train in residency programs that require a minimum of 12,000 hours. Nurse practitioners, in contrast, receive as little as two years of post-graduate education that can be completed entirely online with no more than 500 training hours.

More than 16,000 APRNs are licensed to practice in Ohio, including around 1,800 at Cleveland Clinic. APRN employment is forecasted to grow 35 percent from 2014-2024.

Could HB 177 Lead to a Rise in Medical Malpractice Claims?

It’s been more than a year since Ohio lifted COVID-19 restrictions allowing medical providers to resume non-essential surgeries and procedures. However, Ohio is still dealing with a healthcare issue that predates the pandemic: a shortage of primary care providers.

Ohio temporarily lifted the physician oversight requirement for hospital-based practitioners from December 2020 to May 2021, as patients struggled to receive care during the height of the pandemic. HB 177 would make those changes permanent.

The frequency of nurse practitioner malpractice claims has gradually increased.

Rep. Tom Brinkman (R-Mt. Lookout) co-sponsored the bill along with Rep. Jennifer Gross (R-West Chester). Brinkman told the Zanesville Times Recorder that the temporary SCA pause did not lead to a big jump in medical malpractice claims.

A recent nationwide study found that the liability risks faced by nurse practitioners and primary care physicians do not differ greatly. In fact, the study found that nurse practitioners get sued less often than doctors for medical malpractice, although the frequency of nurse practitioner malpractice claims has gradually increased. In the study, the most common patient allegations against nurse practitioners were diagnosis-related, medical-related, and medical treatment-related.

The latest data from the Ohio Department of Insurance shows a total of 3,000 closed medical professional liability claims from a single calendar year. Over 75 percent of these claims resulted in no payment to the plaintiff. The 25 percent that did result in a patient payout had an average payment of $305,610.00 per claim.

Free Medical Malpractice Case Reviews

From a legal point of view, it doesn’t matter who provides medical treatment. Doctors and nurse practitioners can both be held liable for malpractice if they fail to deliver quality care. But these are notoriously hard cases to win due to the high burden of proof on the plaintiff. Medical malpractice lawsuits are subject to strict filing deadlines as well.

Suspicions of medical malpractice should be discussed promptly with Graham Law’s experienced Ohio personal injury lawyers. Call or Contact Us to schedule free consultation.

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