You asked for any information on nurse malpractice in Connecticut, particularly involving advanced practice registered nurses.

We are unable to get specific and detailed nurse malpractice case information for Connecticut, due in part to confidentiality reasons. But the National Practitioner Data Bank (NPDB) has been receiving and reporting information on health care practitioners, including a category of “professional nurse,” which includes advanced practice registered nurses. There have been 40 Connecticut nurse malpractice payment reports made to the NPDB from 1990 (the start of the NPDB) through 2006. Nationally, of over 6,200 nurse malpractice payment reports over that same period, 13 have involved advanced practice nurses/clinical nurse specialists.

The National Practitioner Data Bank was established under Title IV of Public Law 99-660, the “Health Care Quality Improvement Act of 1986.” NPDB is an information clearinghouse to collect and release information related to the professional competence and conduct of physicians, dentists, nurses, and other health care practitioners. Congress passed the legislation because it believed that the increasing occurrence of medical malpractice litigation and the need to improve the quality of medical care had become nationwide problems that warranted greater efforts than any individual state could undertake. The law's intent is to improve the quality of health care by (1) encouraging state licensing boards, hospitals and other health care entities, and professional societies to identify and discipline those who engage in unprofessional behavior and (2) restricting the ability of incompetent health care practitioners to move from state to state without disclosure or discovery of previous medical malpractice payment and adverse action history.

The NPDB began collecting and reporting information in 1990.

Information reported to the NPDB is considered confidential and cannot be disclosed except as specified by regulation. The Privacy Act of 1974 protects the contents of federal systems of records such as those contained in the NPDB from disclosure, unless the disclosure is for a routine use of the systems as published annually in the Federal Register. The permitted routine uses of NPDB information do not allow for disclosure of information to the general public. But information in a form that does not identify any particular entity or practitioner is available to the public.

Most of the information that follows derives from the NPDB's 2006 Annual Report (the latest complete report available).

The NPDB classifies “professional nurses” into five licensure categories: nurse anesthetists, nurse midwife, nurse practitioner, clinical nurse specialist/advanced practice nurse, and non-specialized registered nursed not otherwise classified (referred to in NPDB tables as a registered nurse). NPDB notes that the Advanced Practice Nurse category was added in 2001, but no reports for them were received until 2002. The category was then replaced with Clinical Nurse Specialists late in 2002.

All types of professional nurses have been responsible for 6,208 malpractice payments (2.1 % of all payments) over the history of the NPDB (1990 to the 2006 report). Non-specialized RNs were responsible for 61.6% of the payments made for nurses. Nurse anesthetists were responsible for 19% of nurse payments, nurse midwives for 9.6%, nurse practitioners for 9.6%, and advanced nurse practitioners for 0.2% of all nurse malpractice payments.

The NPDB report indicates 40 malpractice payment reports in Connecticut for professional nurses since 1990. A more detailed breakdown was not provided in the report. New Jersey had the most reports (752), while Vermont had the fewest (7).

Table 1 provides more information on all states.

Table 1: Actual and Adjusted Medical Malpractice Payment Reports-

Reports by State-Professional Nurses (September 1, 1990-December 31, 2006)

Source: NPDB 2006 Annual Report

***Adjusted columns exclude reports from State patient compensation funds and similar State funds which make payments in excess of amounts paid by a practitioner's primary malpractice carrier. Two reports are filed with the NPDB (one from the primary insurer and one from the fund) whenever a total malpractice settlement or award exceeds a maximum set by the State for the practitioner's primary malpractice carrier. The States marked with asterisks have or had these funds. Thus, the adjusted columns provide an approximate number of incidents resulting in payments rather than the number of payments. These funds occasionally make payments for practitioner practicing in other States at the time of a malpractice event.

****The total includes reports for American Samoa, Guam, Northern Mariana Islands, Puerto Rico, U.S. Virgin Islands, and Armed Forces locations overseas (11 reports for nurses); additional reports that lack information about the State are also included (2 reports for nurses).

According to the 2006 report, monitoring, treatment, and medication problems were responsible for the majority of payments for non-specialized nurses, but obstetrics and surgery-related problems were also responsible for significant numbers of payments for these nurses. As would be expected, anesthesia-related problems were responsible for 82.4% of the 1,181 payments for nurse anesthetists since 1990. Similarly, obstetrics-related problems were responsible for 81% of the 596 nurse midwife payments nationally. Diagnosis-related problems were responsible for 44.9% of the 594 payments for nurse practitioners; treatment-related problems were responsible for another 24.9% for these nurses.

Of the 13 reports for clinical nurse specialists/advanced nurse practitioners, six were for treatment-related problems; two for diagnosis-related problems; and one each for medication, behavioral health, obstetrics, surgery, and anesthesia-related problems.

Table 2 provides more information.

Table 2: Number of Medical Malpractice Payments by

Malpractice Reason-Professional Nurses

Source: NPDB 2006 Annual Report

*Reporting using the “Advanced Nurse Practitioner” category began on March 5, 2002. The “Advanced Nurse Practitioner” category was changed to “Clinical Nurse Specialist” on September 9, 2002. Prior to March 5, 2002, these nurses were included in the “RN (Professional Nurse)” category.

**The “Behavioral Health” category was added on January 31, 2004. Reports involving behavioral health issues filed before January 31, 2004 used other reporting categories. Cumulative data in this category includes only reports filed after January 31, 2004.

The median and mean payments for all types of nurses in 2006, according to the NPDB report, were $112,500 and $277,341 respectively. The median nurse payment was $62,500 less than the median physician payment ($175,000) while the mean nurse payment was $34,534 less than the mean physician payment ($311,965). The NPDB report notes that the mean payment amount for nurses was likely larger because, since there were relatively few nurse payments, one significantly large payment can affect the mean more than if there were more nurse payments. The median payment amount, according to the NPDB, was more representative of typical payments.

The cumulative (1990-2006) figures show a mean payment for nurse malpractice of $282,297 and a median payment of $95,000.

Table 3 provides more information on nurse malpractice payments.

Table 3: Mean and Median Medical Malpractice Payment Amounts by Malpractice Reason,

2006 and Cumulative through 2006-Professional Nurses

Source: NPDB 2006 Annual Report

*The “Behavioral Health” category was added on January 31, 2004. Reports involving behavioral health issues filed before January 31, 2004 used other reporting categories. Cumulative data in this category includes only reports filed after January 31, 2004.

JK:ts