EP 8: Malpractice Insurance Demystified

In Episode 8 of NP Launchpad, Christopher moderates a practical, no-jargon conversation with Vanessa and Jason to demystify malpractice insurance—especially the real differences between occurrence and claims-made coverage. They break down tail coverage, nose coverage, policy limits, shared vs individual policies, and key contract details that can quietly impact your financial and professional future. You’ll also hear insider tips on consent-to-settle clauses, license protection riders, moonlighting gaps, and the critical questions to ask before you change jobs or resign. The episode wraps with a Fact or Fiction round, listener mailbox questions, and a “Landing Checklist” to help you confirm exactly what coverage you have today—and what happens the day you leave.

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Transcript

Voiceover 0:01

Welcome to NP Launchpad, presented by Fitzgerald Health Education Associates, the podcast created for newly graduated nurse practitioners navigating the transition from school to clinical practice. Hosts Jason Gleason, Christopher Gleason, and Vanessa Pomarico-Denino deliver real talk, real experiences, and practical guidance to help you succeed from day one. So if you're ready, let's jump right in.

Christopher Gleason 0:28

Hey friends, this is Christopher, tuning in with you from Big Sky Country. I'm joined by my colleagues, Vanessa and Jason. This week we dive into malpractice insurance demystified. Important to note that the information we provide as your friend is not a substitute for legal advice. If you need that, please reach out to your professionals and your community. All right. So, Vanessa, how was your week this week?

Vanessa Pomarico 0:53

Not too not so bad. How about yourself?

Christopher Gleason 0:56

Not bad, not bad. Busy, but not bad. Between school and everything else, busy.

Jason Gleason 1:02

Well, it was going pretty good until I got a notice I'm getting sued. I'm getting sued for being part of the most amazing podcast on the planet because the two of you. Really? For real. I am.

Vanessa Pomarico 1:13

I don't know if there's malpractice coverage for that.

Jason Gleason 1:16

There's no malpractice coverage for you two being so awesome. I'll tell you that right now. Uh-huh.

Christopher Gleason 1:22

The corniness can go away now. Thanks.

Jason Gleason 1:24

Come on. Come on.

Christopher Gleason 1:25

All right. So, V, what is your understanding of malpractice insurance that focuses on occurrences versus claims made? What are you really buying?

Vanessa Pomarico 1:34

So, you know, it's really important for people to understand the different types of malpractice insurance. And you really need to know what you're what you are buying. So you need to know how you're going to be insured, who's going to pay for those premiums. And that's something that is non-negotiable. Your employer should be giving the employee at the same limits of liability that your physician colleagues are getting, which should be 1 million, 3 million. And then the we can talk, we need to talk about the self-insurance coverage. So there's lots of other insurance companies out there. One of them is NSO. I don't have any financial affiliation with them, but there's several other ones. But if if you're doing any kind of work outside of your job, um, like for my for example, with me, I carry a separate coverage that will uh cover me if, God forbid, I should get sued, but it covers me for all of my consulting work. Um, it would also be partial coverage that if I lost my job for some reason, there's different types of coverage for each type of insurance. Um so we'll get into that a little bit more in the program. But one of the things that I always tell people to do when you're getting hired is to ask for that face sheet, that malpractice face sheet, and keep a copy in your records because you just never know when you're going to need it.

Christopher Gleason 2:57

But so um at last episode, we talked a little bit about contracts and things like that. Do you think this should be something that is included in the in the contract negotiations, Vanessa?

Vanessa Pomarico 3:06

Absolutely needs to be a part of the contract. So, for example, I actually worked um for a different practice other than the one that I'm at now. And when I was there, uh the doc started getting, you know, on the a little bit greedy and said he wasn't going to cover my malpractice anymore. But he understood that I could get a much cheaper malpractice on my own. And I told him that wasn't going to happen, that the malpractice insurance that I carry as a supplemental policy is exactly that. It's a supplemental policy. And it's not, doesn't cover the same things that the practice covers. And again, if they're going to cover the physicians in the practice, why would they not cover the nurse practitioners? So my advice to the to the listeners out there is that if you're while you're in the negotiation process, this is a non-negotiable fact that they need to cover your malpractice. And it has to have the kind of um malpractice coverage, the claims made coverage that has tail when you leave. So tail coverage, what it does is it covers for any claims that are filed when the policy is active. And then you need that tail coverage when you leave. The problem is, you know, the claims made can have that tail expense, but your the employer that you're leaving should be the one that that pays for that. Um, that's not something that you should have to do, you know, anything with that. Conversely, you know, when you give your notice, many practices will hold you to the full notice. And we had talked about that in one of our previous podcasts. Um, but if when you give notice, they may escort you to the door that day because they don't want you to take your patient panel with you, but then you have to inquire about the um the malpractice coverage after you leave.

Christopher Gleason 4:56

Okay. Makes sense. Jason, what are your thoughts on that?

Jason Gleason 4:59

You know, I I love this topic because I uh, you know, I thankfully have never had a lawsuit against myself for over 20 years of practice as an NP, thank goodness. But you know, we have listeners out there that I think are maybe facing that right now, and I cannot imagine the emotional toll, the financial toll that that would take on somebody unless you live through it. I don't think any of us could understand that. And I don't personally know anybody that's had to go through a lawsuit, but I I've heard of some colleagues that have, and it's devastating for them. You know, do either of you, I I'd be curious, like, how do you what advice do you give to one of your colleagues that comes up to you and says, gosh, I have this lawsuit going on? What should I do, you know, emotionally to get through this? How do I find strength to get up every day and get through this and live my life and come back to a profession that I love and enjoy? Any any advice do you give somebody that you've told colleagues in the past?

Christopher Gleason 5:47

I think the the biggest advice is you know, seek the support of your friends, seek the support of your family because you're gonna need that core group. But also, I mean, if it's if it's becoming overwhelming for you, then obviously seek professional counseling services, anything like that to help you kind of get through those moments. V, what do you think?

Vanessa Pomarico 6:04

So I I I completely agree with that, Chris. I think it it's so important to have that emotional support system because it does an awful lot. We've worked so hard to become nurse practitioners and to have somebody question our integrity and everything that we do uh for a living, uh it it really can rock you to the core to be sued by somebody. So, you know, I've I I will share a story that happened to me when I was a staff nurse. Um, that there was a patient that I was working night shift, and that was back in the days when we used to give seconal for sleep. And the patient accused me of forcing a seconal down her throat. And I was so mortified. She actually, the first I knew about it, and she had been giving me a hard time every time I was taking care of her, and I took care of her for her whole hospitalization. And the next thing you know, I got a letter from the Department of Public Health, and I was being called into question, and I had to go before the attorney, the state's attorney. And I didn't sleep, I was terrified. And thank God we had a wonderful attorney at Yale who, you know, said she told me what to wear, how to dress, and that kind of thing. And um, she was absolutely wonderful, and she really helped me because the emotional aspect of it, I was still able to work. There was, there was, it was just an accusation. And unfortunately, what people need to understand is that anytime a patient sends um an accusation or a complaint, everything has to be investigated. Uh, it did not help that the attorney that was representing me had just won a really big case against the state's attorney that was gonna be get questioning me. So, you know, she had prepared me on the way up there. And but emotionally, I have to say, it was it was really awful because you start questioning everything. You know, I I let's face it, mistakes can happen. But if anybody knows me, they know first of all, I would never force, I don't, if you're sleeping, why am I gonna give you a sleeping pill? So there were so many holes in this woman's story, and it all came out in the hearing, which I was very happy about. And there was nothing ever held against my license. But you know, you always walk away wondering, is that gonna happen again? You know, when is that shoe gonna drop? Um, I since then I've I've made it uh, you know, really a part of my my cause and my passion to reach out to nurse practitioners that I know who are going through this just to give them some of that moral support. And I do know somebody, I've actually known several nurse practitioners that have gotten sued uh, you know, in the course of their uh their entire career. And it is, it's very um, it's very disheartening, not just emotionally, but financially as well, because if you do get sued and your license is suspended, you can't work as a nurse practitioner. And so some of them had to go back to being a staff nurse, some of them couldn't get a job as a staff nurse because they'd been a nurse practitioner for too long. So it really that support is really going to mean a lot. And if you know somebody that's going through it, you know, just reach out to them, send them a card, send them a text, send them a gift card for groceries and just, you know, put it in a card and send it off in the mail to them, send it anonymously because they're having loss of wages. And that's one of the other reasons why you want to have that supplemental policy, because many of the other policies don't give you a little bit of a stipend to kind of live on. And there's no license protection with some of the insurances. So you really have to make sure that you're looking not just at the face sheet to make sure that you're getting the 1 million, 3 million coverage like the physician colleagues, but you need to know what are the details of your malpractice coverage. You don't want to find out the day you get sued.

Christopher Gleason 9:49

Right.

Jason Gleason 9:49

Absolutely, absolutely. You know, and as you mentioned, you know, they have to investigate everything. I guess one of the things that experiences that I've I've had over the years, when I was initially a new nurse practitioner out there, I think in my first five years of practice, and and I was devastated. It wasn't a lawsuit, but a report to the Board of Nursing, and that that's just as intense, right? Because your license is on the line. And I remember it was a Friday and getting this letter in the mail from the State Board of Nursing, and you open up this letter and it says, you know, a uh complaint has been made against you that could result in the revocation of your license. I mean, that heavy chain letter that they sent everybody. It's like it's a Friday afternoon, you can't call anybody to find out what this is about, you have to wait until Monday. And so I did, but when you say they have to investigate any complaint, you know, the state board or legally, if it's a legal issue, but I in in that case, it came down to this. It was so ridiculous because I had seen this child in the emergency department for otitis media, and the grandmother brought her grandchild in to see me. And I thought, gosh, did I do something wrong clinically? And they sent me the records, and I did nothing wrong clinically. She actually was in agreement that her child was treated appropriately from a medical and nursing standpoint. But her big beef was the bill was too expensive, and she didn't think I should be charging her $400 for an ED visit. And it's like, I'm an employee of the hospital. But I'll tell you what, the State Board of Nursing said nope, it has to go through a hearing because they have to consider everything, right? And I, in a way, I appreciate that they do that. They investigate every claim because that's that's their purpose. But talk about stress, though. And I knew I was gonna be fine. I knew that. And in the hearing, it took like five minutes. The board said this is not even relevant, it's a financial issue. I have her call the billing office. And I get it, the ED visits are so expensive, but it stresses you out beyond. And I can't imagine the stress of a lawsuit, and lawsuits take forever. I that process like was like a month, right? But Vanessa, wouldn't you agree some of your friends are going through this stress for like a year even or more? Yeah.

Vanessa Pomarico 11:45

The people that I know, you know, not just in my state, but you know, elsewhere, um, they've been going through this for well over a year. And you know, you can't do anything. You're really kind of in a uh in a limbo because you've lost your license, you lose your hospital privileges, and now you're thinking, and some of these people are the the they they hold the benefits for their family, or they are the breadwinners, or they're single parents, they've got kids that they have to support, or parents that they have to support. And so it really, it really does an awful lot um to the psyche. So really just reach out to them, you know, send them what you can because again, they're not making the kind of money that they're making. And some of them, and depending on the state you live in, they may not be eligible for getting unemployment. So, you know, that's something that they have to check out as well. And, you know, like you said, Jason, we both had very similar, you know, um, you know, experiences where, you know, the patient, it was really like we go in there and the same thing, you know, they sat down and they're like, we have to investigate this, but it sounds like you had everything. And I was very fortunate that the surgeon who had done this patient surgery and the other partners in the practice, uh, they had worked with me long enough and they all came out in full force, writing letters of support. Two of them, the the main surgeon and his partner, actually showed up at my hearing. Um and they were they were getting a little huffy with the judge, and they're like, You are wasting everybody's time here. But you know, they they were able to, again, it was just a process and it's a very nerve-wracking process, but not everything ends badly. So, you know, you have to just the the majority of the time if you dot your I's and crush your T's and you follow standards of care, you know, people can file a complaint, but it doesn't necessarily mean it's going to result in losing your license.

Jason Gleason 13:39

Yeah, consistently do the right thing and recognize that as human beings, we can all make a mistake. Right, exactly.

Christopher Gleason 13:45

Um uh V, actually, so I I had a similar experience to what you had, actually. I was working as a floor nurse um in an inpatient uh psychiatric unit, and I I had a patient complaint that came against me, and they and they complained to the state, so I got that lovely letter in the mail that says there's been a complaint against you, and your heart just drops, and you're like, am I gonna lose my license? Am I gonna, you know, all of these thoughts just kind of flood your flood your mind in that instance, and then they have to they have to go through that investigative process. So, you know, while my license wasn't suspended while I was, you know, going through this process, it still was a lengthy process because they had to interview not only the patient that made the complaint, but they interviewed, you know, all of the staff that were on on during that day and all of these things. And you know, similar to you, Vanessa, like nothing came of it, but still going through that experience is just emotionally draining, to say the least.

Vanessa Pomarico 14:36

Yeah, it sure is.

Jason Gleason 14:38

We can connect with our our listeners out there that are going through this right now. We can connect with you and empathize with you, and and and honestly, we are there for you, and and more importantly, your your close friends are there for you as well. So reach out to them.

Vanessa Pomarico 14:50

Absolutely, absolutely. Give them that, give them that support.

Christopher Gleason 14:53

Absolutely.

Vanessa Pomarico 14:54

So I guess the the thing that I really kind of want to make clear about is that when you do get malpractice, you have to think about there's two different types you can get. There's occurrence versus claims made. I don't know if either one of you want to kind of jump in on any of this. Um, but the claims made is the type of insurance that covers the employee when the policy is active, regardless when the incident occurred. So, you know, um, you have to have that policy, even if you leave that place of employment. And that's where that tail coverage comes in. Now, occurrence is what covers any incident that occurred while you were insured. So if you leave that place and you go work somewhere else, and five years down the line somebody sues you, as long as you had the occurrence insurance, it's going to cover you for when the incident occurred while you were under that particular employer's insurance.

Jason Gleason 15:50

You don't need a tail, you don't need a tail with the occurrence, then would you?

Vanessa Pomarico 15:55

You don't, but when you leave the practice, you always want to make sure that you have that tail. It's it's advisable to have that tail coverage when you leave. That's why claims made is a little bit better to have. Um but I I want our listeners to understand that um when you get sued, again, not everything ends up, you know, in a bad situation, you know, you know, with a bad ending. But when people sue for malpractice, what they're looking for is that they have to prove that the nurse practitioner used what they called reasonable and ordinary care skill and diligence that any other nurse practitioner would use in a similar type of practice. So, you know, those are things like, you know, if you missed a diagnosis, um, if you had a patient that got maybe they were having abdominal pain and you did a CAT scan and then you failed to refer the patient, that's malpractice. Um, inappropriate medication prescribing or adjusting the medications. So I'll give you a good example. Uh I had a patient very recently that came in to see me, and she was clearly in a serotonin syndrome. And she had gotten a therapist, a psychiatric nurse practitioner, on one of those, you know, um, those hers kind of things that they're advertising on TV all the time. Now I don't know, they have one for him and they have one for hers. And the they started her on a hundred milligrams of sertraline. So let's like not start at 25. They put her on at 100 and she was a little bit of a thing. And when I tell you, she was so tachycardic and she was had pressured speech, she couldn't even drive herself because her sister-in-law had to drive her. And it was, she was shaking and she couldn't sit down. And you know, she said, I can't sit here, I can't stand. She was pacing around my exam room. And that would have been a perfect example of malpractice because I said to her, Where did you get this medication? And she said, I did something stupid. I said, Listen, I'm not here to judge you, but just tell me what happened because I don't understand. Like, I don't have you on these medications why they would start you out at 100 milligrams. We start people at 25. So, you know, using, you know, um unreasonable, you know, out of standards of care, um, that is inappropriate medication prescribing. And that person could have been sued for malpractice. I didn't, I didn't say anything to her, but her sister-in-law drove it home and said, this is why you don't call people on TV. You know, you have to call your provider. Um, and then the other thing that people can get sued for is um, believe it or not, failure to provide preventative care for routine screening. So if you have a patient who has a family history of, let's say, colon cancer, and you don't put in the referral for that routine screening, and they get colon cancer, they can sue you because even though the, you know, I have a little problem with that, the patient needs to have some accountability as well. Absolutely. You know, um, but you're you have to put it in there and you have to document it.

Jason Gleason 18:58

Yeah.

Christopher Gleason 19:00

So we talked a little bit earlier about um having having these coverages and and doing it during or talking about it during the contracts uh stage of things. Um, a couple things that you really want to keep in mind is you know what type of insurance, uh, what type of malpractice do they have, what are the limits? Um, is it individual or is it shared coverage? And the other things to look at too, know the policy holder is the is it employee policy versus your own policy? Can you change control and protection during the policy? And then um, Vanessa, we touched a little bit on tail coverage. Is there anything else that needs to be really said about it, or how do you feel about it?

Vanessa Pomarico 19:37

Don't resign until you know what the tail coverage is.

Jason Gleason 19:41

Oh, you bet, you bet.

Vanessa Pomarico 19:42

You know, because you need to know that you don't want to leave that, that leaves you wide open. And and I do know of somebody that didn't have tail coverage, and when they got sued, they actually went after her house, all of her assets. Yeah, and it was really it was an awful situation. She was working in a pain management clinic and uh they got investigated and it was just such a mess. And it was really the physician she was working with. She, you know, she all of her documentation was in place, but while that was happening, they went after everything. And it took a long time. And let me tell you, I I think it was probably three to five years that they were going back and forth, back and forth, back and forth. Because you know the legal system moves very, very slowly. So don't resign until you know how that tail is handled. And make sure when you get hired, you get a copy of that face sheet. That face sheet is so important to have in your file. We had talked about having a professional file, but it's got to be in there with um your licenses and you know, all of your other important documents is what you need to have in there is that malpractice face sheet and your tail coverage.

Jason Gleason 20:48

Well, and I think it's important to consider too, you know, we think of tail coverage like if you're going from one job to another, but also other times would be like if you're retiring. Yeah. Wouldn't that be a shame if you were you're going into retirement to enjoy it and yet you get sued, you have no tail coverage, and you lose like all your retirement, you know, everything there. So yeah. So all those uh big changes in life. And and like you said, matching up the dates from your last day of employment, make sure it starts before that time, right?

Vanessa Pomarico 21:15

So right. And so we talk about tail coverage, but we also have to think about nose coverage. So a lot of people don't know about nose coverage. Um, you know, the like when you join the practice, you want to ask them if it's gonna cover anything, you know, like when you first or right before you get started, is your coverage gonna start right then? Because you don't want to have a delay in that coverage. That needs to be active the day you walk in the door before you even put your hands on that first patient.

Jason Gleason 21:40

Now that that that's really interesting because I always thought about nose coverage. I I'm learning this for the first time because I always thought that nose coverage was for, you know, if those people that tend to brown nose a lot, you know, it's coverage for them.

Vanessa Pomarico 21:52

Not right.

Jason Gleason 21:53

As you can tell, I'm the smart aleck out of the three, right? Yeah. Why do you guys put up with me?

Vanessa Pomarico 21:59

We love you.

Jason Gleason 22:00

Come on.

Christopher Gleason 22:02

All right. So um speaking of tail coverage again, one of the things that you want to know about tail coverage is you know who's paying who's paying for the um who's paying for it? Is your employer paying for it? Is it a shared cost? And is it written and have it written into the contract? You know, if you want to if you want it to that shared cost, then have that written to the contract. If you want your employer, which I would recommend to cover that, then you know, definitely have that written in the contract as well.

Jason Gleason 22:26

You know what? I've asked for tail coverage from employers over the years, they've dec declined that a lot of times. I and I think I mean even if you have the expense of having to pay for it yourself, it's so worth it. It's a tough one, though. It's tough to put all that money down.

Vanessa Pomarico 22:39

Well, but it's not something that we should have to pay for. It's something that the practice, it's it's a it's a business expense, and it is right up there with not having, you know, when you go for those that negotiation in that contract, you have to have in there that they're gonna pay for your license, they're gonna pay for your certification renewal, and they're going to pay for your malpractice. So remember that your malpractice is not gonna cover you if you moonlight. So, for example, with my job, if I leave, let's say I'm I'm I'm working 40 hours in primary care. If I start moonlighting in an urgent care, I I'm not so sure I have to have my head examined. But let's just say I wanted to moonlight in an urgent care that was part of my, you know, my hospital system. I don't have to worry about the malpractice because it's all still within the the um the guise of the hospital system that I'm working in. Let's say I decide that I want to moonlight and maybe do Botox and fillers and weight loss medicine at you know some med spa. I have to have my own policy for that because your malpractice at your day job is not going to cover when you moonlight. And people forget that they have to get a separate policy. So make sure that you understand that if you decide you're going to moonlight or if you're if you're working two part-time jobs, both of those jobs have to give you the appropriate coverage. Now, part-timers tend to not get the 1 million, 3 million. I don't know why. You can certainly ask for it, but they usually get half of that if they're part-timers. I'm not sure what the justification is there, but um, you have to just make sure that you get the same limits of liability that your physician colleagues get.

Christopher Gleason 24:18

Absolutely, absolutely. And the speaking of the one and three, that leads into our next question, Vanessa. What coverage protection or what coverage limits have you had over the, you know, over your course as a nurse practitioner, right?

Vanessa Pomarico 24:29

So I learned and I was talking about one of my preceptors in another podcast. She said to me, you never practice without 1 million, 3 million. She drilled it into my head. And I remember back then thinking, that's a lot of money. But when you have shared coverage, it's it's it's really not a lot of money because most of the nurse practitioners and PAs, they're covered under an umbrella for the practice. So it's not a huge amount of money. We're not talking $80,000, $90,000 a year. It's a lot less than that. Um, but you absolutely want that $1 million, $3 million. And then you need to know if for some reason, now let's say one of the physicians gets sued, the attorneys will sue everybody who had their hands in that patient's record. So you need to know how it's shared because the shared limits then can dilute the limits of protection that you have. So you need to do to know that as well. Another thing that people need to think about too is there's so many people that are moonlighting doing telehealth. And if you're doing, even though in the compact states, excuse me, um, you still need to ask about the coverage for telehealth because it's not just in the state that you are physically in, you have to have your enough coverage for whatever state you're going to be seeing patients in. Oh, sure.

Christopher Gleason 25:49

Yeah, absolutely. So um, Jason, as we stated earlier earlier, you know, we both work for the VA. So we're both covered under the Federal Tort Act. Yeah, I'll touch a little bit on that.

Jason Gleason 25:59

Yeah, you know, it I it it's been, gosh, I think 10 years since I've had to have malpractice insurance of my own because of the VA, you know, and being covered under under the Tort Act. And that doesn't say that people at the VA cannot bring legal suits and and get uh you know remedy for those things if malpractice is in play. We're certainly held to a standard of care and uh that's very similar in the civilian world. But yeah, I agree. It's good protection. But and this is such a good review for even our listeners out there that are in similar aspects where you're covered under a federal government um policy of some kind or different laws. That's very important. You know, one of the things with um when you talk about getting your insurance, one of the questions I always have, Vanessa, maybe you can clarify this for us and our our listeners out there inside and outside coverage, like if you have a settlement against you, are the attorney fees included inside or outside your limits? You know much about that for our audience and what they should be.

Vanessa Pomarico 26:55

Some some of them do, but up to a certain limit, which is why having a supplemental policy is always a good idea. I always encourage people to take a look, and we'll have some of the references or the resources for the listeners, but you really want to compare and contrast the different insurances that you have. Um, and and it's a myth that people will get sued or more likely to get sued if an attorney finds out that the person carries a supplemental policy. I hear that all the time.

Jason Gleason 27:24

Oh, right.

Vanessa Pomarico 27:25

And that really is a myth. I mean, you know, what are they gonna go after? A little $3,000 policy. Yeah, I mean, they can try, I mean, it's it's it is what it is, but you know, as far as I'm concerned, you can't have too much coverage.

Christopher Gleason 27:38

Absolutely. And I think you know, it's important to stress too, we talked about a little bit about the Federal Tort Act and that we're covered underneath it, but it's always important, or you can always carry a supplemental policy as well, which you know, V touched on earlier, and that can you know help you in the long run, especially if things aren't covered under the tort act for whatever reason, or if you're out of work for you know an extended period of time during investigations, things like that. Supplemental coverage can come in handy for that.

Jason Gleason 28:02

You know, I think uh what another thing to consider too that's so important is your type of practice. Like obviously, primary care is gonna be a lot cheaper for insurance, and maybe you can carry a lower, lower amount versus it like if you're doing OB or nurse midwife. Right. Nurse midwife. I had a good friend that was a family physician, and he said that many of his colleagues that did OB, they delivered babies, and then they also provided family uh practice care for families. They had to drop the OB part because the insurance rates were too high, and the same thing for nurse midwife's out there. So I think it depends on what kind of practice you're in as well, which will determine your coverage. Absolutely, absolutely.

Vanessa Pomarico 28:35

That that is so true. And and I was actually working uh with a lot with the gynecologist uh when I got out of school. She just did office gynecology and she was doing surgeries, but it was also at a time when some of the um the OBGYNs were not delivering just for that reason because the malpractice had gotten so high. And she said something really um really interesting to me. She said, I realized I had to do X number of surgeries in order to cover my malpractice. And I didn't want to have to look at a patient and go, it's the end of the year, I got to cover my malpractice. And she said right then and there she realized she needed to stop doing OB.

Jason Gleason 29:13

Which is which is awful. It's really so sad. Yeah.

Vanessa Pomarico 29:16

It is, but we live in a very litigious society. I hate to say it, but people sue at the drop of a hat.

Christopher Gleason 29:24

They do. Absolutely. And I think, you know, a couple of the other tips too to keep in mind is you know, confirm coverage uh for procedures. If you work in like an urgent care practice or you work in specialty clinics, it's important to, you know, do you have coverage for joint injections, IUDs, biopsies, et cetera, things of that nature. And another important tip too is make sure to document your malpractice carrier and policy number in your credentials packet. So um, and another question, what is um what is your experience with common riders, Vanessa?

Vanessa Pomarico 29:55

So common riders really have to do with um what I was talking about before, moonlighting. Um sometimes they cover license protection. So that, you know, um that helps sometimes when you have to go uh with your defense costs. But again, there's a cap on that. So you have to really look at that and make sure that you know your assets are not, you know, are not going to be your personal assets are not going to be called in there. Um there's also things, there's something that's called consent to settle. And that's what um prevents a settlement without your agree agreement. And that's really important for your your not only your reputation, but for your licensure as well. Absolutely. Absolutely very and you know, I just want to make mention that you said something before, Chris, about joint injections and IUDs and biopsies. One of the things that you really need to make sure is that if you're going to do any type of procedure that you did not learn in school, you don't do one of those see one, do one, teach one. You go to a course. Like, I do I know how to do injections? Sure. Does that make me a uh an expert in Botox or fillers? Absolutely not. If that's something I'm gonna do, I have to go and get the right training for it. So for anybody that's going to do any type of um procedures outside of what you learned in school, do yourself a favor because in a court of law, they'll say, Christopher, so you did a joint injection on a patient in the urgent care. Tell me what uh kind of training you had for that. And when you say, Well, I learned it when I was doing my ED rotation, it's not gonna fly. So you have to make sure you're getting the right education.

Jason Gleason 31:36

And especially in this day and age, because everything's online, and I think some folks out there get so excited, like, I'm gonna start doing Botox, I'm just gonna go to this weekend conference, and then I'll be able to do it. You know, that that'll be all the training I need. And you know, I I went to a conference once and I sat in on uh cosmetics and and uh you know things like Botox procedures and things, and it was great, great content. I thought, wow, this could be something, you know, somebody could make a niche and you know make a business out of. And but then they got to the slides at the very end of facial necrosis. And I'm thinking, like, screw this, I would never take this on. But some people out there, you don't know what you don't know, right? And so they're they're excited, they're getting into this, and then there's people out there, I believe, they're advantageous in taking advantage of these people because it's a business that they run and they want to sell the education and and and everything that goes with it to these folks out there, and they think that they're prepared when actually they're not. They're really not. So I agree with you 100%. I think credentialing is so important. Make sure your credential, make sure everything's documented because lawyers will tear you apart, as you mentioned. Absolutely, absolutely. You know, consent to settle. I think one uh interesting aspect about that for our listeners out there to really know what that's about and make sure that that's in your malpractice, because here's the the uh issues that may come up with that. Let's say a lawsuit comes up against you and you know you're in the right. You absolutely 1,000% know that you're in the right, and there's evidence to even prove that you're in the right, that there was no wrongdoing. But depending on the circumstances of the case and the lawyers involved, they could decide among themselves, both sets of lawyers, uh, for the person suing you and for yourself, they can get together and decide without including you that you know, let's just settle the case because we don't have the time, we're not gonna waste the money on medical experts and paying for all that. Let's just settle the case. And even if every bone in your body knows that you did nothing wrong, they'll settle it. And as you mentioned, your life could be destroyed, your license, your reputation, all of that. So make sure that that consent settles in any kind of malpractice insurance that you carry. Absolutely.

Vanessa Pomarico 33:33

Because you don't want to get on the list, you don't want to be on that list, you know. And it says, and let's face it, patients can Google anything, and your name comes up, the next thing you know, your social media fodder, and again, your your reputation, it's really hard to gain that back. I remember there was um a pulmonologist in this area who was very highly regarded. And you know, I don't know, I wasn't in the room, but uh somebody came forward and said that he sexually assaulted her in the room. Um and this poor man stopped practicing. Um, and none of us could believe it because, you know, again, we don't know, we weren't in the room. I'm not saying, you know, who was right or who was wrong, but this was somebody who was so well regarded and so well respected by his peers, and at like 50 years old, ended up giving up his medical license because of this allegation. So you know, and you just don't get that back. So you don't want to just and even if the attorneys press you and say, Settle this, you want to ask the question, why are you so quick to settle? I am innocent and I'm gonna prove that I'm innocent. You know, why why do you not want to go all the way for me? And you might have to get another attorney if if they're just going to settle without your agreement. You just don't want to consent to settle. Right.

Jason Gleason 34:54

Well, and the dynamic to that is from the the law firm standpoint, I would I would believe would be, you know, they invest a lot of money in cases a lot of times. And if they don't win the case, they lose all that that they've invested, right? So I can see their motivation to settle. Plus, uh, attorneys are wonderful people and they want the best for their clients and everybody involved, I'm sure. But yeah, so it's such an interesting dynamic. You know, I I think our listeners out there are probably scared to death right now. They're probably looking online, Googling and I'll practice insurance as we talk. But here's here's an interesting aspect to consider as well. You know, I had a family member pass away due to some serious mistakes that were made in their health care, devastating mistakes that resulted in their death and contributing to that. And the attorneys that I worked with, um, and trust me, as a healthcare provider myself, I do not bring a case, you know, light-handedly at all. It took a lot of decision making. But I'll never forget the attorney told me, you know, we only accept usually, we and other attorneys only accept about three to five percent of cases that are brought to our attention because most of them have big issues with them where there's no way that they can prove that there is malpractice or they're frivolous in nature. So so when when a case comes, there's there's a lot of evidence there because a law firm is not going to invest the time and resources into a case that is not gonna go anywhere. So yeah, so that should give many providers out there, you know, some comfort in knowing that you know, everybody that wants to bring a case against you, a lot of attorneys' offices will say, nope, this is not legitimate or it's not enough, you know, to have a case there. So about 5% of cases that they take on. And every law firm is different. Other law firms might take on more.

Christopher Gleason 36:29

So um going back to our some tips for our listeners, um, Vanessa talked about this a little earlier, uh, the importance of cyber coverage if you're doing any sort of telehealth, um, telehealth medicine, if you're handling sensitive patient data via telehealth, things of that nature. The other thing we touched on a little bit is about moonlighting and a moonlighting rider. And what that means is that this is gonna cover if you're moonlighting, if you're working that full-time job and you're covered by your office at that full-time job, but you decided, you know, as Vanessa stated earlier, you want to work in an urgent care, you know, on the weekends or or whatever, make sure that you have that rider that's gonna cover you for that moonlight position because your your weekly job or your regular job may not cover anything for any sort of moonlighting. So the um one of the other things that's important too is know how to report incidents. Late reporting can create headaches later. Um so we got we've got some resources that we're gonna actually list here. Um, starting off with the American Association of Nurse Practitioners, the professional liability insurance. Um, that's what I was referring to earlier, V. Yeah. Um and then, you know, this is uh uh NSO, which is one of the ones that uh Vanessa uh um touched on earlier. Again, we have no financial connections to any of these people. So next up we have factor fiction, one of our favorite parts of the show. So occurrence policies typically cover incidents that happen during the policy period, even if the claim is later. Wait, let's let's hold the forward here.

Jason Gleason 37:53

Let's just slow down a minute because you know what? We do this fact and fiction stuff during every episode, but we're we're not giving out any prizes. Do we get a prize if we get this right? No. I tried V. Sorry. All right, go on, go on.

Vanessa Pomarico 38:05

We need to we need to talk to the higher-ups about that.

Jason Gleason 38:08

We need to get prizes and little buzzers. Yeah, I want a buzzer and a prize.

Vanessa Pomarico 38:14

We need to raid the gift closet.

Jason Gleason 38:16

That's right, that's right. Give me a mug at least, something. I'm just gonna give you my stickers. That's right. I'm gonna get you guys stickers. I'll get you gold stars to give you. Gold stars, gold stars.

Christopher Gleason 38:26

We're going back to elementary school. There we go. All right, carry on, Chris.

Jason Gleason 38:30

Let's hear the claims.

Christopher Gleason 38:31

No, not come on. Let's hear it. All right, so next question. Occurrence policies typically cover incidents that happen during the policy period, even if the claim is later. Lee, what's your take on that?

Vanessa Pomarico 38:43

Yes, because it covers any occurrence while the nurse practitioner was insured.

Christopher Gleason 38:48

Excellent. Excellent. All right. Next question. Tail coverage is irrelevant if you have claims made coverage.

Jason Gleason 38:55

Jason, tail coverage is irrelevant if you have claims made coverage. You still should have tail coverage. You need tail coverage. It's vital. You've got to have it. Yes. You don't quit that job until you know. Don't quit your job and don't be brown nosing because you're going to need some nose coverage. Right? All right.

Christopher Gleason 39:15

All right. So, V, consent to settle clauses can affect how lawsuits are resolved.

Vanessa Pomarico 39:20

True.

Christopher Gleason 39:20

Fact or fiction.

Vanessa Pomarico 39:21

Yeah, true.

Christopher Gleason 39:22

Absolutely. All right. Jason, higher policy limits automatically mean better coverage in every situation.

Jason Gleason 39:29

No, don't be paying high priced prices for coverage without really doing a deep dive in because often they're overpriced and they don't include a lot of stuff that you need that others may have. But compare the policies.

Vanessa Pomarico 39:40

Yeah, do your homework and compare them. So, you know, why is it that one of the other uh companies is cheaper than another company? Look item by item to see what is it that they're covering, what is it that they're not covering, and honestly, don't cheap out on it. I know I remember the first time I had to write that check for $2,700 of my own policy, but and every year it goes up, but you know what? You just it's insurance. It's like it's like driving your car without insurance. You just don't want to take that chance.

Christopher Gleason 40:11

True at all. True at all. So next up is one of our other favorite parts of the show. It's the uh launchpad mailbox where we answer your questions that you have emailed in. And our email address is nplaunchpad at fhea.com. So that's nplaunchpad at fhea.com. So, first up, first question is Does your contract have tail coverage? And if not, can you add it after the fact? And V, what's your take on that?

Vanessa Pomarico 40:36

So you cannot add it after the fact. You need to know when you walk in the door, when you have that initial interview and you're talking about malpractice, you need to know right then and there. And you want to ask them, even though you know you're you're just starting the job and you're you're not thinking about leaving, but upon termination, what type of TL coverage do they offer? And it's a very common question asked in interviews. It's not anything that's going to be adversarial, but it is just a fact of life. So nobody should be afraid to ask that question.

Jason Gleason 41:08

Well, and I and I think at the end of the interview, you know, in your job interview, when they ask that awkward, do you have any questions for us? And this, these kind of elements come up, I think they would appreciate it if you ask these kind of questions because it knows you're critically thinking and that tells them a lot about you. And that might raise your prospects of getting the job, even if you ask intelligent questions like this.

Christopher Gleason 41:27

So I agree. That's excellent. So, Jason, this next question is for you. If an MP moonlights, what suggestions would you have to avoid malpractice coverage gaps?

Jason Gleason 41:37

You know, everything we've been talking about, I think the dates are so important they line up from day one that you would moonlight anywhere. Because I I think there's this thought out there, oh, it's just moonlighting, I'm just gonna pick up a shift here and there. I really don't need insurance, but absolutely have the coverage in place from day one. And like you said, Vanessa, we I made fun of nose insurance, but actually, or nose coverage is part of your policy. But I think it's so important from day one and don't blow that off because that's that's where they get you, you know, and include that tail in your moonlight coverage too.

Christopher Gleason 42:05

And I think one of the important factors too is to know your retroactive date. So your retroactive date is the it should be your date of hire, it should be your retroactive date, but that's the date that your coverage starts. So make sure that you know that. Yeah, that's very important. It's really so these are just a couple of take-home tips for you. So you need to confirm whether your policy is occurrence or claims made. You know, we've touched on that a lot throughout the throughout the program. And also clarify tail coverage, who pays for it, when it triggers, and what it covers. You know, know what coverage you have today and what happens the day you leave. And we touched on that too. That's the tail or the nose coverage. Um all right, so what's your take home? Home, what's your homework for the week? So confirm your policy type and whether trail is covered in your contract. That's for all our NP colleagues out there. Thanks so much for your time. It's been an honor for all three of us to connect with you during our show this week. So, can you please do us a favor? These simple actions will help us grow this podcast, broaden its reach so all of us can help and support more of our NP colleagues and friends across the country and around the world. It's easy. Please drop a five-star rating, hit follow, tap subscribe, and most importantly, share this podcast with your colleagues, family, and friends so we can continue to build a community of friends looking out for, supporting, and strengthening each other. That's what it's about. As we sign off, stay tuned for our next episode, focus on one of the most important parts of your practice, your very first clinical day as a full-fledged NP. Have a great day, friends, and again, thank you for tuning in. See you later. Bye now.

Voiceover 43:36

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