Malpractice Suits Research Articles

Breast radiology malpractice suits: Characteristics of frequency and outcomes- national and statewide distinctions.

The purpose of this study was to determine the frequency and outcomes of breast malpractice suits among all enrollees in One Call Medical Inc.'s panel of interpreting radiologists nationally and to evaluate state-by-state variations. The 8401 radiologists enrolled had 4764 suits, of which 826 were related to breast disease. In New York and New Jersey, the ratio of breast suits to One Call Radiologists was 0.28 and 0.27, twice as much as in any other state. Breast suits in radiology have a wide variation in frequency across the country with New York and New Jersey far exceeding all others in relative frequency and number of radiologists with multiple breast suits.

Factors Associated With Physician Loss in Anterior Cruciate Ligament Reconstruction Malpractice Lawsuits.

Background:Anterior cruciate ligament (ACL) reconstruction is among the most common orthopaedic procedures, with its incidence doubling over the past decade. To date, no studies have analyzed litigation after ACL reconstruction.Purpose:To characterize the causes of malpractice litigation after ACL reconstruction.Study Design:Cross-sectional study.Methods:A retrospective review of malpractice lawsuits after ACL reconstruction was performed using VerdictSearch, a large legal claims database encompassing nearly 180,000 legal cases, from February 1988 to May 2015. Settlement rates and physician loss rates were calculated along with 95% CIs for each complication type, and analysis of variance was used to compare all indemnity payments.Results:Of a total 30 lawsuits, 5 (16.7%) settled out of court. The 3 most common complications leading to litigation were prolonged pain (n = 5, 16.7%), infection (n = 5, 16.7%), and malpositioned graft (n = 5, 16.7%). Of the 25 cases that went to court, 8 (32.0%) ended in favor of the plaintiff (physician loss). Damage to a neurovascular structure resulted in the highest indemnity payment (mean, $2,012,926 ± $1,076,530; P = .021). Lawsuits for which pain or loss of range of motion was the only complication were significantly more likely to end in a physician victory (P = .04) and lower indemnity payments ($87,500 vs $678,715, respectively). Cases that involved a surgical technical error were more likely to result in a physician loss (P = .01), with malpositioned grafts having a significantly higher loss rate than average (75% vs 32%, respectively).Conclusion:After ACL reconstruction, physicians are more likely to win malpractice suits if pain or limited range of motion is the only complaint and less likely to win if a surgical error was alleged. These findings may help to set patient expectations and provide adequate guidance during the informed consent process.

Minimizing Vulnerability to Malpractice Claims

This review provides strategies for avoiding lawsuits and advice for dealing with a lawsuit if one is ever filed. Medical malpractice is explained, as are the personal issues for the defendant physician. Strategies for preventing malpractice suits are presented, including those relative to communication and interpersonal skills, the informed consent process, and documentation. Advice is provided for what surgeons should do if sued or threatened with a lawsuit, including measures for assisting in the defense and settling claims versus trying a case. Preparing for a deposition is discussed. How a surgeon should act when serving as a defendant or witness in a courtroom trial is presented. This review contains 5 tables, and 23 references. Key words: claim, communication, defendant, informed consent, lawsuit, malpractice, medical records, negligence, suit

Minimizing Vulnerability to Malpractice Claims

This review provides strategies for avoiding lawsuits and advice for dealing with a lawsuit if one is ever filed. Medical malpractice is explained, as are the personal issues for the defendant physician. Strategies for preventing malpractice suits are presented, including those relative to communication and interpersonal skills, the informed consent process, and documentation. Advice is provided for what surgeons should do if sued or threatened with a lawsuit, including measures for assisting in the defense and settling claims versus trying a case. Preparing for a deposition is discussed. How a surgeon should act when serving as a defendant or witness in a courtroom trial is presented. This review contains 5 tables, and 23 references. Key words: claim, communication, defendant, informed consent, lawsuit, malpractice, medical records, negligence, suit

Minimizing Vulnerability to Malpractice Claims

This review provides strategies for avoiding lawsuits and advice for dealing with a lawsuit if one is ever filed. Medical malpractice is explained, as are the personal issues for the defendant physician. Strategies for preventing malpractice suits are presented, including those relative to communication and interpersonal skills, the informed consent process, and documentation. Advice is provided for what surgeons should do if sued or threatened with a lawsuit, including measures for assisting in the defense and settling claims versus trying a case. Preparing for a deposition is discussed. How a surgeon should act when serving as a defendant or witness in a courtroom trial is presented. This review contains 5 tables, and 23 references. Key words: claim, communication, defendant, informed consent, lawsuit, malpractice, medical records, negligence, suit

Lawsuits After Primary and Revision Total Hip Arthroplasties: A Malpractice Claims Analysis

BackgroundAs the prevalence of total hip arthroplasty (THA) expands, so too will complications and patient dissatisfaction. The goal of this study was to identify the common etiologies of malpractice suits and costs of claims after primary and revision THAs. MethodsAnalysis of 115 malpractice claims filed for alleged neglectful primary and revision THA surgeries by orthopedic surgeons insured by a large New York state malpractice carrier between 1983 and 2011. ResultsThe incidence of malpractice claims filed for negligent THA procedures is only 0.15% per year in our population. In primary cases, nerve injury (“foot drop”) was the most frequent allegation with 27 claims. Negligent surgery causing dislocation was alleged in 18 and leg length discrepancy in 14. Medical complications were also reported, including 3 thromboembolic events and 6 deaths. In revision cases, dislocation and infection were the most common source of suits. The average indemnity payment was $386,153 and the largest single settlement was $4.1 million for an arterial injury resulting in amputation after a primary hip replacement. The average litigation cost to the insurer was $61,833. ConclusionNerve injury, dislocation, and leg length discrepancy are the most common reason for malpractice after primary THA. Orthopedic surgeons should continue to focus on minimizing the occurrence of these complications while adequately incorporating details about the risks and limitations of surgery into their preoperative education.

Missed Acute Appendicitis on Multidetector Computed Tomography and Magnetic Resonance Imaging: Legal Ramifications, Challenges, and Avoidance Strategies

The failure to diagnose acute appendicitis (AA) is the third most common medical malpractice allegation related to gastrointestinal disease. There is a paucity of detailed data on this topic; however, publications by Whang et al and by Berlin and Berlin, which analyzed all types of malpractice suits against radiologists, have shown that the incidence of litigation has increased over time in the United States. This is likely true for cases of AA as well. The misinterpretation of cross-sectional imaging in patients with suspected appendicitis may be caused by suboptimal technique, errors of omission, i.e, missing key findings, failure to review a portion of the examination, and satisfaction of search error. This article summarizes the published legal, clinical, and imaging literature regarding litigation in cases of missed AA, and reviews optimized multidetector computed tomography and magnetic resonance imaging protocols for the diagnosis of AA, with examples shown of challenging cases.

Cross-sectional survey on defensive practices and defensive behaviours among Israeli psychiatrists

ObjectivePsychiatry is a low-risk specialisation; however, there is a steady increase in malpractice claims against psychiatrists. Defensive psychiatry (DP) refers to any action undertaken by a psychiatrist to avoid malpractice...

Minimizing Vulnerability to Malpractice Claims

This review provides strategies for avoiding lawsuits and advice for dealing with a lawsuit if one is ever filed. Medical malpractice is explained as are the personal issues for the defendant physician. Strategies for preventing malpractice suits are presented, including those relative to communication and interpersonal skills, the informed consent process, and documentation. Advice is provided for what surgeons should do if sued or if threatened with a lawsuit, including measures for assisting in the defense and settling claims versus trying a case. Preparing for a deposition is discussed. How a surgeon should act when a defendants or witness in a courtroom trial is presented. This review contains 13 references.

Privacy, disability, and health science students

We are often asked to address students' concerns about confidentiality and privacy related to their disability status in high‐stakes health professions programs. Some students may have expectations about confidentiality practices based on their experience in health care settings. Stigma can also be a barrier to seeking accommodations in these programs as students often describe concerns about who will know about their disability and who will have access to their disability documentation. As future health professionals, students are understandably concerned that their documentation and disability status could be used against them in their career (e.g., inability to get malpractice insurance, inability to get licensed, concern with documentation being accessed in malpractice suits).

No fault compensation in perinatal medicine in Japan-from results for 8 years.

No fault compensation in perinatal medicine has been established to provide aid to patients in the event of disability due to a medical accident during delivery and to strive to resolve disputes quickly that contributes to reduce medical malpractice suit in the field of perinatal medicine. Furthermore, this system is aimed to establish a mechanism that achieves higher quality of obstetric care by analyzing the causes of accidents. This system is operated by Japan Council for Quality Health Care and 99.9% of childbirth facilities in Japan registered with this compensation system. Compensation system has two major functions including compensation and cause analysis and recurrence prevention based on cases. Compensation eligibility is reviewed in the Review Committee at the organization in Japan Council for Quality Health Care and currently 1,717 cases are judged as eligible cases out of 2,250 since 2009. The cause of each eligible case is analyzed in the Cause Analysis Committee one by one. The Cause Analysis Committee has 7 independent subcommittee and each subcommittee members are consistent of obstetricians, neonatologists, pediatricians, midwives and lawyers. Original cause analysis report is sent to childbirth facility and patient's family. Questionnaire survey demonstrated that 73% of childbirth facilities and 65% of patient family were satisfied with the cause analysis report. The number of medical lawsuit in obstetrics and gynecology is significantly decreased compared to those in all medical departments since the compensation system was introduced suggesting that these cause analysis reports may contribute the decrease in medical lawsuits. The major purpose of the Recurrence Prevention Committee is striving to prevent future cases of cerebral palsy and to improve the quality of obstetric care. To accomplish the purpose, the committee routinely collect information from individual cases and analyze quantitatively and epidemiologically. Furthermore the committee choose subject from cases to discuss for future prevention and provide wide public disclosure of the information with recommendation. The committee issued 6 reports until now and these reports have been distributed to childbirth facilities, perinatal medicine-related scientific society and administrative agencies.

The Detection, Analysis, and Significance of Physician Clustering in Medical Malpractice Lawsuit Payouts

There is evidence that most adverse events result from individual errors and that most malpractice suits with payouts reflect both patient injury and error. There are outlier physicians with regard to the frequency and total amount of malpractice payouts. Using the public use file of the National Practitioner Data Bank (NPDB), we sought the percentage of physicians who lay above several cutoff points with regard to total amounts of payments and number of payments. We looked at the frequency with which outliers were likely to have additional paid claims and to be disciplined by their hospitals and state boards. Approximately 1.8% of physicians were responsible for half of the $83,368,588,200 reported to the NPDB over 25 years. Within that group, 12.6% had an adverse licensure action reported to the NPDB, and 6.3% had a clinical privileges action reported. Physicians who were in the high dollar payout category and had one malpractice claim payout had a 74.5% chance of another payout, more than twice the rate for all physicians who had a single payout (chi-square, P < 0.0001). The likelihood that that physician would have additional payments increased as the number of previous payments increased. Total dollar payouts per physician better predicted future payouts than numbers of payouts. (For 1, 2, and 3 payouts, the P value was less than 0.0001 for each category.) Limitations: Neither a prospective nor a randomized study was feasible. Sorting by specialty was not done. Malpractice cases are an indirect measure of adverse events. There is a clustering of payments in medical malpractice cases among a small group of physicians. These findings point up the need to oppose the negative impact of such outlier physicians on the safety of patients.

Navigating the Maze of New Regulations in the Final Rule

Navigating the Maze of New Regulations in the Final Rule

Lessons Learned From Reviewing Breast Imaging Malpractice Cases

There are very few, if any, winners in most medical malpractice lawsuits. The plaintiff, often the victim of disease, and the defendant medical personnel both suffer emotional, financial, psychological, professional, and opportunity costs through this avoidable experience. In year 2000, 86,480 malpractice claims were filed [ 1 National Association of Insurance CommissionersStatistical compilation of annual statement information for property/casualty insurance companies in 2000. Washington, District of Columbia, National Association of Insurance Commissioners2001 Google Scholar ], and in 2004, the financial burden of medical malpractice totaled $28.7 billion across all specialties [ 2 Tillinghast study: U.S. tort costs reach a record $260 billion. Insurance J 2006. Available at: http://www.insurancejournal.com/news/national/2006/03/13/66411.htm. Accessed April 28, 2014. Google Scholar ]. Specifically in radiology, there is a 50% chance that a radiologist will face at least one lawsuit by the age of 60 years [ 3 Baker S.R. Whang J.S. Luk L. et al. The demography of medical malpractice suits against radiologists. Radiology. 2013; 266: 539-547 Crossref PubMed Scopus (32) Google Scholar ]. The subspecialty of breast imaging is the greatest recipient of malpractice litigation, with claims of “failure to diagnose” or “delay in diagnosis” [ 4 Cannavale A. Mariangela S. Mancarella P. Passariello R. Arbarello P. Malpractice in radiology: what should you worry about?. Radiol Res Pract. 2013; (Available at:) (Accessed April 28, 2014)http://www.hindawi.com/journals/rrp/2013/219259/ PubMed Google Scholar , 5 Dick J.F. Gallagherz T.H. Brenner J.R. et al. Predictors of radiologists' perceived risk of malpractice lawsuits in breast imaging. AJR Am J Roentgenol. 2009; 192: 327-333 Crossref PubMed Scopus (42) Google Scholar , 6 Berlin L. Hall F.M. More mammography muddle: emotions, politics, costs and polarization. Radiology. 2010; 255: 311-316 Crossref PubMed Scopus (64) Google Scholar ]. Lessons Learned From Reviewing Breast Imaging Malpractice CasesJournal of the American College of RadiologyVol. 11Issue 12PreviewThere are very few, if any, winners in most medical malpractice lawsuits. The plaintiff, often the victim of disease, and the defendant medical personnel both suffer emotional, financial, psychological, professional, and opportunity costs through this avoidable experience. In year 2000, 86,480 malpractice claims were filed [1], and in 2004, the financial burden of medical malpractice totaled $28.7 billion across all specialties [2]. Specifically in radiology, there is a 50% chance that a radiologist will face at least one lawsuit by the age of 60 years [3]. Full-Text PDF

Robert J. Shalek, Ph.D., J.D.

We are saddened to report the death of Dr. Robert J. Shalek, who passed away at the age of 93 on April 20, 2015. Robert J. Shalek, Ph.D. was born in Chicago, IL in 1922. He earned his undergraduate degree in physics from the University of Illinois in Champaign. After graduating, he served in the US Army for 3 years as a Signal Corp officer. He returned home to Texas where his parents had moved and entered the graduate program at the Rice Institute (now Rice University). He earned two masters degrees (physics and mathematics) and went on to earn a Ph.D. in biophysics in 1953. Dr. Shalek was the second Rice Physics Fellow in the Department of Physics at the MD Anderson Hospital [currently The University of Texas MD Anderson Cancer Center (MDACC)]. During this time, he worked with Leonard Grimmett on one of the world's first 60Co units. Upon receiving his Ph.D. he spent a postdoctoral year at the Royal Cancer Hospital (now called the Royal Marsden Hospital) in London, England under the guidance of W. V. Mayneord, the Head of the Physics Department and author of the “Mayneord F factor.” After this postdoctoral year he returned to the Department of Physics at MDACC. He published over 100 scientific papers before retiring in 1985 after working at MDACC for 35 years. Among his many contributions to Medical Physics, he was Chairman of the Department of Radiation Physics (1961–1984) at MDACC following Dr. Leonard Grimmett and Dr. Warren Sinclair, both very experienced medical physicists from England. He and Dr. Gilbert Fletcher, the chairman of the Department of Radiation Therapy at MDACC from 1948 to 1981, recognized the need for medical physics quality assurance for national multi-institutional clinical trials and as such, along with the AAPM, proposed a center of physics quality assurance for clinical trials. He ultimately was awarded the first National Cancer Institute grant to create the Radiological Physics Center (RPC) and was its first Director from 1968 until 1985. He was one of AAPM's founding charter members and served as the AAPM's seventh president in 1966. He became a fellow of the AAPM and was awarded ASTRO's Gold Medal in 1996. He was the second recipient of the AAPM's William D. Coolidge Award in 1972 and the sixth recipient of the Marvin M. D. Williams Professional Achievement Award in 1994. His career has encompassed both basic research and the application of physics to clinical problems. His basic research included studies of oxygen reactions following radiation interactions1 and the proportion of direct and indirect radiation action in living cells.2 His clinically related work included the dosimetry of external treatment beams, brachytherapy dosimetry, and quality assurance in radiotherapy physics.3 In the 1960s he wrote one of the seminal papers4 on ferrous sulfate (Fricke) dosimetry that made chemical dosimetry available in the clinic. Also in the 1960s, he and his trainee (and later, colleague) Marilyn Stovall published a series of articles describing the MD Anderson method for implant dosimetry using computerized techniques.5–9 These publications helped disseminate these methods and enabled many institutions to introduce what were for the time very advanced brachytherapy calculation techniques. From right to left, Dr. Shalek, Dr. Hanson, and Dr. Ibbott at a reception in 2001 for Geoff Ibbott, the new RPC Director. While working at MDACC, Dr. Shalek studied law at the University of Houston during the evenings and received his J.D. in 1983. He lectured regularly on legal questions in medical physics and regularly gave professional legal advice to physicists. He also participated in medical malpractice suits, usually as an expert witness. Bob was especially proud of his book, Medical Physicists and Malpractice10 (authored with David Gooden) that outlines the legal framework of liability risk in radiation therapy, the impact on clinical physicists, and practical approaches for avoiding and managing such lawsuits. Dr. Shalek is survived by his wife Elaine V. Shalek, 6 children, 9 grandchildren, and 4 great grandchildren. His accomplishments in medical physics will be long remembered. Equally well known is the way he conducted himself throughout his career, always as a man of high principle and character. He truly was a credit to our profession and is remembered fondly by so many whose lives he touched during his incredibly successful and meaningful career.

Interpreting risk as evidence of causality: lessons learned from a legal case to determine medical malpractice.

Translating risk estimates derived from epidemiologic study into evidence of causality for a particular patient is problematic. The difficulty of this process is not unique to the medical context; rather, courts are also challenged with the task of using risk estimates to infer evidence of cause in particular cases. Thus, an examination of how this is done in a legal context might provide insight into when and how it is appropriate to use risk information as evidence of cause in a medical context. A careful study of the case of Goodman v. Viljoen, a medical malpractice suit litigated in the Ontario Superior Court of Justice in 2011, reveals different approaches to how risk information is used as or might be considered a substitute for evidence of causation, and the pitfalls associated with these approaches. Achieving statistical thresholds, specifically minimizing the probability of falsely rejecting the null hypothesis, and exceeding a relative risk of 2, plays a significant role in establishing causality of the particular in the legal setting. However, providing a reasonable explanation or establishing "biological plausibility" of the causal association also seems important, and (to some) may even take precedent over statistical thresholds for a given context.

A Legal Analysis of the Precedents of Medical Disputes in the Cosmetic Surgery Field.

BackgroundDisputes regarding medical malpractice occur between practitioners and patients. As patients have become increasingly aware regarding medical care, an increase in the unexpected side effects of procedures has been observed, thereby leading to an increase in disputes regarding medical malpractice. In this study, we reviewed trends in precedents involving cosmetic surgery-related medical disputes, with the goal of helping to prevent unnecessary disputes in the future.MethodsWe conducted a search of the judgments made in South Korean courts between 2000 and 2013 that were related to the field of plastic surgery. A total of 54 judgments were analyzed, and the selected precedents were reviewed and classified according to the kind of negligence involved.ResultsThe claim amounts ranged from under 8 million KRW (6,991 USD) to 750 million KRW (629,995 USD). The most common ratio of the judgment amount to the claim amount was 20%–30%. The judgments were classified according to the following categories: violation of the duty of explanation in 17 cases (29%), violation of the duty of care in 10 cases (17%), violation of both duties in 20 cases (35%), and no violation of duty in six cases (10%).ConclusionsCosmetic surgery-related suits require different approaches than general malpractice suits. The Supreme Court requires plastic surgeons to determine the type, timing, methods, and scope of their treatments when considering possible results. Therefore, practitioners should be educated on their rights and responsibilities to enable them to cope with any possible medical dispute that may arise.

Aspects of communication regarding medical malpractice suits

Due to problems experienced in health care, there is an increased amount of malpractice suits nowadays. Nevertheless, some physicians are more likely to be sued, or more frequently sued, than others. Numerous studies indicate that this phenomenon fundamentally results from a lack of interpersonal and communication skills on the part of the sued doctor, namely, deficiencies in questioning the patient, listening, conveying information, etc. Communication is of pivotal importance in patient care vis-à-vis medical errors as well. The majority of physicians aim to conceal the error, albeit this may lead to further deterioration of the patient's condition. In institutions where open communication regarding errors was introduced within the medical team and toward the patient and their family alike, the number of malpractice suits decreased. It is crucial to establish a means of support for doctors, and to promote communication trainings, as well as a supportive legal environment.

Retaining Patients’ Psychiatric Records

Back to table of contents Previous article Next article Legal NewsFull AccessRetaining Patients’ Psychiatric RecordsKristen Lambert,J.D., M.S.W., L.I.C.S.W., , Moira Wertheimer,J.D., R.N.Kristen Lambert,Search for more papers by this authorJ.D., M.S.W., L.I.C.S.W., , Moira Wertheimer,Search for more papers by this authorJ.D., R.N.Published Online:2 Mar 2016https://doi.org/10.1176/appi.pn.2016.3a20Psychiatrists frequently ask how long they must keep a patient’s medical records. Although it is not required by law, psychiatrists should retain their patients’ records indefinitely. Retaining the records may be important for a variety of reasons, such as what medications the patient was on previously and compliance with treatment, and, in the event of an adverse outcome, may be vital in the defense of a lawsuit. If storing patient records indefinitely is not an option, psychiatrists must at least retain their patients’ medical record for a required period of time under state law. The Health Insurance Portability and Accountability Act (HIPAA) does not include medical record retention requirements. Since most states have their own regulations, it is important for you to know your state’s required retention period. If you have questions, contact your local attorney, risk manager, or state board of medicine. Factors affecting the length of time that medical records must be retained may include the following:Whether the patient is an adult or a child/adolescentHow long you must retain a patient’s medical record after his/her deathWhether you are an independent provider versus employed by a hospitalSome states do not regulate how long providers are required to retain medical records. In those states, psychiatrists should keep the records for at least as long as the statute of limitations for filing a medical malpractice suit. Disposing of RecordsWhen it is no longer legally required and you no longer wish to retain the records, you should dispose of the patient’s protected health information (PHI) contained in the records in compliance with federal and state laws. Under HIPAA, covered entities (CEs) implement policies and procedures to address record disposal, both for electronic and paper records. Moreover, under HIPAA, any employee (or volunteer) involved in disposing of PHI must receive training on proper disposal.Although HIPAA does not specify a disposal method, CEs are expected to take reasonable precautions to protect PHI from improper disclosure during disposal and are not permitted to simply abandon/dispose of records in containers accessible to the public. Examples of proper disposal methods may include the following:Shredding, burning, pulping, or pulverizing the records so that PHI in paper records is rendered essentially unreadable and indecipherable and otherwise cannot be reconstructed.Maintaining labeled prescription bottles and other PHI in opaque bags in a secure area. Using a disposal vendor as a business associate to pick up and shred or otherwise destroy PHI.For electronic PHI, clearing (using software or hardware products to overwrite media with nonsensitive data), purging, demagnetizing, or destroying through methods such as disintegration, pulverization, melting, incinerating, or shredding.There may be other suitable methods for destruction, and psychiatrists should consult with a local attorney and/or risk management professional to determine current state and federal requirements for proper disposal of PHI. Additionally, if using an outside vendor to assist with the disposal, a business associate agreement should be in place prior to the vendor’s assuming possession of the PHI.For more information on this topic, see the online risk management courses, “Clinical Documentation after HITECH: It’s Back to Risk Management Basics” and “Clinical Documentation With a Jury in Mind,” available on APA’s Learning Center Risk Management page. ■This information is provided as a risk management resource and should not be construed as legal, technical, or clinical advice. This information may refer to specific local regulatory or legal issues that may not be relevant to you. Consult your professional advisors or legal counsel for guidance on issues specific to you. This material may not be reproduced or distributed without the express, written permission of Allied World Assurance Company Holdings, AG (“Allied World”). Risk management services are provided by or arranged through AWAC Services Company, a member company of Allied World.Kristen Lambert, J.D., M.S.W., L.I.C.S.W., is vice president of the Psychiatric and Professional Liability Risk Management Group, and Moira Wertheimer, J.D., R.N., is assistant vice president of the Psychiatric Risk Management Group at AWAC Services Company, a member company of Allied World. ISSUES NewArchived

Liability in Emergency Departments and Disciplinary Exposure for Nurse Practitioners

Nurse practitioners play a key role in providing care to the millions of Americans who visit hospital emergency departments each year. In the emergency department environment, pediatric, geriatric, and pain management cases are areas where nurse practitioners may encounter increased liability. Failure to act in accordance with the Nurse Practice Act or established standards of care not only creates an opportunity for legal risk, but may lead to a malpractice suit or disciplinary action by the state’s board of nursing. Utilization of risk control strategies can improve quality of care and avoid malpractice and/or disciplinary actions.