[arkades]

The NP in this story is one of the people that fucked up. A, because she should have sent them to the ED. B, because hospitalists have nothing to do with the ED, and she was trying to /bypass/ the ED. C, because she didn't need her supervising physician's permission to send the patient to the ED. D, just for kicks, diabetes absolutely causes a white count bump, especially during uncontrolled episodes, with the degree of one correlating to the other - something every med student is expected to know, and it's ridiculous that the NP didn't.

"Legally motivated to do the right thing"? She's significantly more guilty than the hospitalist, who is a red-herring in this entire discussion ("I'm not the ED attending. Send her to the ED. The ED attending decides who gets admitted for non-elective admissions. Also, she might need urgent care, so she shouldn't wait the 12-24 hours hold-up that would occur if I admitted her directly." would have been the response of any hospitalist I've worked with) and yet he's vulnerable to a malpractice suit, and the NP is not. What legal motivation?

[dragonwriter]

> The NP in this story is one of the people that fucked up.

And was sued for it and presumably (the case with regard to her was settled on undisclosed terms) forced to pay. But she fucked up by passively accepting the judgement of the MDs involved, so the upthread comment that this case might encourage (or “legally motivate”) NPs to act more independently is reinforced rather than negated by the fact that the NP fucked up and was held to account here.

> and yet he's vulnerable to a malpractice suit, and the NP is not.

You mean “he got out of even having to face malpractice liability at the trial and first appellate level, while the NP was forced to settle before even reaching trial.”

[fencepost]

Not a medical professional, but if you're positive that the patient is going to be admitted then bypassing the ER may make a lot of financial sense for the patient. Going to the ER is expensive, so moving directly to admitting cuts a lot of cost.

If you don't believe me and are in the US, call your insurance company and ask "what's my out of pocket if I'm admitted to the hospital for 1 night going through the ER vs going through an urgent care center?" There's a pretty good chance the ER route will be at least $1000 higher.

[arkades]

Urgent Care centers do not have hospital privileges and cannot admit to the hospital. If they think you need hospitalization, they send you to the ER.

Bypassing the ER is a good way to have your insurer try and deny coverage, since you’re giving them a plausible case that it wasn’t an emergency.

[fencepost]

Urgent Care centers do not have hospital privileges and cannot admit to the hospital.

That surprises me since (at least in my area of the Chicago suburbs) all of the urgent care centers I've seen are associated with hospitals or hospital networks. I have no experience with their admitting capabilities though, having never actually used one.

[Scoundreller]

I dunno how independently NPs can practise in MN. Sometimes they’re always under an MD and anything that happens is that MD’s responsibility. This can be relatively more true if they’re an employee vs. a contractor (at least where I live, dunno about MN).

The NP settled their case out-of-court. So they were held liable, and we don’t know how much.

The consulted MD felt like fighting it in court, and lost.

That’s what makes this case a bit unusual because something bad happened and one person involved thought they weren’t accountable.

[arkades]

It depends on how many hours they've practiced. Initially, under a physician. Eventually, completely independent. The article describes the second doc as a "collaborating physician," but I went to the underlying court documents and, no, they were just a second informal consult - this NP was practicing independently.

The case isn't that unusual. Malpractice lawyers name everyone even tangentially related to a case, because malpractice insurance has a cap on payouts and you'll never go to court and win more than that cap, so you want to pull in as many people's policies as possible. Everyone that wasn't directly involved in the care of the patient gets their names dropped from the suit pretty quickly. Normally.

So, it's not unusual that the person that actually fucked up (the NP) settled, and someone not part of the patient's care said screw that (the MD).

Docs also don't choose for themselves whether they fight it in court. The malpractice insurer does. If you go against the insurer's wishes, you basically give up your malpractice coverage. In this case, I'm guessing that the fact that this is a slam-dunk "get thrown out of court" situation is why they didn't settle, as they do the vast majority of the time, regardless of the underlying merits of the case. Usually settling is cheaper than litigating, but a single "get this thrown out" motion is cheaper than settling.

The unusual thing here is just that MN is somewhat unique as one of the few states that doesn't explicitly require a doctor-patient relationship for its malpractice suits, so instead of getting thrown out, the case is going ahead.

[hermitdev]

Umm, he hasn't lost, at least not yet.

What he lost was the appeal of the dismissal of the case. The MN Supreme Court ruling merely means the case will go to trial. He may yet prevail, but from what I read in the article, seems to me that it's unlikely he will prevail.

Edit: spelling