Do Govt. Healthcare providers have PLI?

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tomwood
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Do Govt. Healthcare providers have PLI?

Post by tomwood » Fri Nov 15, 2019 7:27 am

Are there any healthcare providers on this forum who work in healthcare for the federal government? If so, do you have a personal Professional Liability Insurance (PLI). Why or why not? As I understand it, there isn’t need for personal malpractice insurance when working for the VA Hospital, as that’s covered by the VA. But is there any benefits to a personal PLI? Even those who don’t work in healthcare, if you can offer help, I welcome your reply

IMO
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Re: Do Govt. Healthcare providers have PLI?

Post by IMO » Fri Nov 15, 2019 3:49 pm

tomwood wrote:
Fri Nov 15, 2019 7:27 am
Are there any healthcare providers on this forum who work in healthcare for the federal government? If so, do you have a personal Professional Liability Insurance (PLI). Why or why not? As I understand it, there isn’t need for personal malpractice insurance when working for the VA Hospital, as that’s covered by the VA. But is there any benefits to a personal PLI? Even those who don’t work in healthcare, if you can offer help, I welcome your reply
It is my understanding at Federal healthcare facilities, that employees are covered by the Federal Tort Act, but if one is a contractor it is my understanding that one isn't covered by that and would need one's own insurance (but you'd have to verify that).

What is important to understand that one would not be covered if one was acting outside their approved scope of practice or doing something that may not be specifically covered under one's particular approved credentials/privileges. So if one were a PA and one performed care/procedures not within one's approved credentials/clinical privileges, and malpractice was claimed, it could be feasible that one would not be covered under the Federal Tort Act.

Now if one had Professional Liability Insurance, there could be a scenario where the procedure/care of concern (malpractive) would be considered within a PA's normal scope of practice (even though the VA or other Federal facility did not grant privileges for that-essentially putting it not covered under the Federal Tort Act). In other words, the VA credentialing level for a PA could be less than what a typical PA is trained/licensed to perform. The question for which I don't have an answer, is would the Professional Liability Insurance cover the PA in this situation?

daheld
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Re: Do Govt. Healthcare providers have PLI?

Post by daheld » Fri Nov 15, 2019 4:18 pm

I think the above advice you've received is good, but I just wanted to add that any coverage provided by the Federal Tort Act (I'm assuming) would not apply to a "side-gig". I'm a healthcare professional who works for VA. It's very common for people in my field to freelance in different ways, and I'm guessing that any coverage that applies to my federal employment would not apply to this freelance, side-gig type work.

Something to keep in mind.

Topic Author
tomwood
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Re: Do Govt. Healthcare providers have PLI?

Post by tomwood » Fri Nov 15, 2019 5:57 pm

daheld wrote:
Fri Nov 15, 2019 4:18 pm
I think the above advice you've received is good, but I just wanted to add that any coverage provided by the Federal Tort Act (I'm assuming) would not apply to a "side-gig". I'm a healthcare professional who works for VA. It's very common for people in my field to freelance in different ways, and I'm guessing that any coverage that applies to my federal employment would not apply to this freelance, side-gig type work.

Something to keep in mind.
This is good to keep in mind

Topic Author
tomwood
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Re: Do Govt. Healthcare providers have PLI?

Post by tomwood » Fri Nov 15, 2019 6:00 pm

IMO wrote:
Fri Nov 15, 2019 3:49 pm
tomwood wrote:
Fri Nov 15, 2019 7:27 am
Are there any healthcare providers on this forum who work in healthcare for the federal government? If so, do you have a personal Professional Liability Insurance (PLI). Why or why not? As I understand it, there isn’t need for personal malpractice insurance when working for the VA Hospital, as that’s covered by the VA. But is there any benefits to a personal PLI? Even those who don’t work in healthcare, if you can offer help, I welcome your reply
It is my understanding at Federal healthcare facilities, that employees are covered by the Federal Tort Act, but if one is a contractor it is my understanding that one isn't covered by that and would need one's own insurance (but you'd have to verify that).

What is important to understand that one would not be covered if one was acting outside their approved scope of practice or doing something that may not be specifically covered under one's particular approved credentials/privileges. So if one were a PA and one performed care/procedures not within one's approved credentials/clinical privileges, and malpractice was claimed, it could be feasible that one would not be covered under the Federal Tort Act.

Now if one had Professional Liability Insurance, there could be a scenario where the procedure/care of concern (malpractive) would be considered within a PA's normal scope of practice (even though the VA or other Federal facility did not grant privileges for that-essentially putting it not covered under the Federal Tort Act). In other words, the VA credentialing level for a PA could be less than what a typical PA is trained/licensed to perform. The question for which I don't have an answer, is would the Professional Liability Insurance cover the PA in this situation?
This last paragraph is a great example and question. Are VA privileges typically a smaller scope than training for healthcare professionals and possibly smaller scopes than what State licenses would grant ?

rooms222
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Re: Do Govt. Healthcare providers have PLI?

Post by rooms222 » Sat Nov 16, 2019 12:32 am

It varies. For example, for CRNAs, the scope of practice is less than allowed by State law in independent states, as the VA has chosen to not give full practice authority to any CRNAs, even in states where it is allowed. For other advance practice nurses, it has given generally greater practice authority in its Federal practice authority than many states allow. The Federal Government sets its own standards. That is why you only have to have a license from any state or territory to work in any VA hospital, and you do not have to ever get licensed in the state or territory you are working in to practice your profession inside the Federal system.

Discussion of the examples cited above:

https://journals.lww.com/ajnonline/Full ... ity.9.aspx

This is also the case for other professionals. Psychologists and Attorneys for the Federal Government just have to be licensed in any state or territory to do Federal work. Both can appear in state court as experts and attorneys respectively on cases involving the Federal government without being licensed in that state. When working under the scope of Federal authority or "scope of VA employment," state practice standards are preempted under the Supremacy clause of the Constitution.

This is discussed in the Advanced Practice Nursing Guidelines Regulation for the VA, the Federal Register defines it as such for the VA:


Proposed § 17.415(e) would expressly state the intended preemptive effect of proposed § 17.415, to ensure it is clear that conflicting State and local laws related to the practice of APRNs would have no force or effect when such APRNs are working within the scope of their VA employment. In circumstances where there is a conflict between Federal and State Law, Federal law prevails in accordance with Article VI, clause 2, of the U.S. Constitution (Supremacy Clause). It is a well-established principle of constitutional law that Federal law is supreme, and States may not regulate or control the lawful actions of the Federal Government, absent Congressional consent. Therefore, where there is conflict between State law and Federal law with regard to full practice authority of APRNs working within the scope of their federal VA employment, this regulation would control. Accordingly, State disciplinary actions that would penalize, or otherwise interfere with, an APRN's full practice authority in the performance of their official VA duties, would likewise be effectively preempted. However, where there is no conflict between this regulation and State law, the State would retain authority to impose State regulations on its APRN licensees and take disciplinary action for any violations. We emphasize that this preemptive effect would only pertain to APRNs when they are acting within the scope of their federal VA employment; this rule would not have any effect on individual State efforts to either permit or restrict full practice authority for APRNs who are not working within a VA scope of employment.


Similar language is used for other professions in the Federal Government. There can occasionally be conflicts as to whether there is no conflict between State and Federal law with regards to licensing and discipline when working on Federal matters.

Topic Author
tomwood
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Re: Do Govt. Healthcare providers have PLI?

Post by tomwood » Sat Nov 16, 2019 12:27 pm

rooms222 wrote:
Sat Nov 16, 2019 12:32 am
It varies. For example, for CRNAs, the scope of practice is less than allowed by State law in independent states, as the VA has chosen to not give full practice authority to any CRNAs, even in states where it is allowed. For other advance practice nurses, it has given generally greater practice authority in its Federal practice authority than many states allow. The Federal Government sets its own standards. That is why you only have to have a license from any state or territory to work in any VA hospital, and you do not have to ever get licensed in the state or territory you are working in to practice your profession inside the Federal system.

Discussion of the examples cited above:

https://journals.lww.com/ajnonline/Full ... ity.9.aspx
Thank you

Arlington2019
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Re: Do Govt. Healthcare providers have PLI?

Post by Arlington2019 » Sat Nov 16, 2019 2:05 pm

I am a healthcare risk manager of 36 years experience, and I do malpractice insurance and malpractice claims for a living. One of my positions has been at a FQHC. All employees at a deemed FQHC are covered by the Federal Tort Claims Act, just as are civilian employees at a Federal healthcare facility, such as the VA, DOD or USPHS.

As a general rule, pretty much anything you typically do in your practice will be covered by the FTCA. The FTCA does have some notable exclusions from coverage, so I purchase 'gap' insurance to cover the potential gaps in the FTCA coverage. Although the Government does not publish a comprehensive list of exclusions for medical liability matters, the most common FTCA exclusions in the medical setting include intentional acts of wrongdoing, criminal acts, moonlighting, and boundary violations. Some of these exclusions are also found in commercial malpractice insurance, most notably the intentional wrongdoing, criminal acts and boundary violations. So if you are an employed civilian healthcare provider working for the Federal Government, you have adequate coverage under the FTCA. I would not recommend that you go out and purchase a private malpractice liability policy. If you do, be aware that it will be excess coverage, and only come into play if and when you are involved in a claim and the Government officially notifies you that you are not covered by the FTCA or any other insurance for the claim. The chances of that happening are infinitesimal in my opinion, for the typical provider in the typical scope of practice. I do this for a living, and if my spouse was a civilian physician/advanced practice provider for the Federal Government, would not go out and buy her a separate policy.

Topic Author
tomwood
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Re: Do Govt. Healthcare providers have PLI?

Post by tomwood » Sat Nov 16, 2019 3:58 pm

Arlington2019 wrote:
Sat Nov 16, 2019 2:05 pm
I am a healthcare risk manager of 36 years experience, and I do malpractice insurance and malpractice claims for a living. One of my positions has been at a FQHC. All employees at a deemed FQHC are covered by the Federal Tort Claims Act, just as are civilian employees at a Federal healthcare facility, such as the VA, DOD or USPHS.

As a general rule, pretty much anything you typically do in your practice will be covered by the FTCA. The FTCA does have some notable exclusions from coverage, so I purchase 'gap' insurance to cover the potential gaps in the FTCA coverage. Although the Government does not publish a comprehensive list of exclusions for medical liability matters, the most common FTCA exclusions in the medical setting include intentional acts of wrongdoing, criminal acts, moonlighting, and boundary violations. Some of these exclusions are also found in commercial malpractice insurance, most notably the intentional wrongdoing, criminal acts and boundary violations. So if you are an employed civilian healthcare provider working for the Federal Government, you have adequate coverage under the FTCA. I would not recommend that you go out and purchase a private malpractice liability policy. If you do, be aware that it will be excess coverage, and only come into play if and when you are involved in a claim and the Government officially notifies you that you are not covered by the FTCA or any other insurance for the claim. The chances of that happening are infinitesimal in my opinion, for the typical provider in the typical scope of practice. I do this for a living, and if my spouse was a civilian physician/advanced practice provider for the Federal Government, would not go out and buy her a separate policy.
I absolutely appreciate your expert thoughts and the quality/length of your post. If you don’t mind a follow up. Is malpractice insurance the same as professional liability insurance? A police officer I know who used to work as a federal employee suggested I get Professional liability insurance. I assumed there was no reason for me to have this, as I am most at risk of a malpractice claim. But if you wouldn’t mind just confirming this Professional insurance is also not recommended in my position, I would be greatful.

Arlington2019
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Re: Do Govt. Healthcare providers have PLI?

Post by Arlington2019 » Sat Nov 16, 2019 4:29 pm

In medicine, healthcare professional liability insurance and malpractice insurance are the same. Were I in your shoes, I would not find it cost-effective to get this coverage.

Topic Author
tomwood
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Re: Do Govt. Healthcare providers have PLI?

Post by tomwood » Sat Nov 16, 2019 4:40 pm

Arlington2019 wrote:
Sat Nov 16, 2019 4:29 pm
In medicine, healthcare professional liability insurance and malpractice insurance are the same. Were I in your shoes, I would not find it cost-effective to get this coverage.
I thank you much for this great advice

IMO
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Re: Do Govt. Healthcare providers have PLI?

Post by IMO » Sat Nov 16, 2019 8:38 pm

Arlington2019 wrote:
Sat Nov 16, 2019 2:05 pm
I am a healthcare risk manager of 36 years experience, and I do malpractice insurance and malpractice claims for a living. One of my positions has been at a FQHC. All employees at a deemed FQHC are covered by the Federal Tort Claims Act, just as are civilian employees at a Federal healthcare facility, such as the VA, DOD or USPHS.

As a general rule, pretty much anything you typically do in your practice will be covered by the FTCA. The FTCA does have some notable exclusions from coverage, so I purchase 'gap' insurance to cover the potential gaps in the FTCA coverage. Although the Government does not publish a comprehensive list of exclusions for medical liability matters, the most common FTCA exclusions in the medical setting include intentional acts of wrongdoing, criminal acts, moonlighting, and boundary violations. Some of these exclusions are also found in commercial malpractice insurance, most notably the intentional wrongdoing, criminal acts and boundary violations. So if you are an employed civilian healthcare provider working for the Federal Government, you have adequate coverage under the FTCA. I would not recommend that you go out and purchase a private malpractice liability policy. If you do, be aware that it will be excess coverage, and only come into play if and when you are involved in a claim and the Government officially notifies you that you are not covered by the FTCA or any other insurance for the claim. The chances of that happening are infinitesimal in my opinion, for the typical provider in the typical scope of practice. I do this for a living, and if my spouse was a civilian physician/advanced practice provider for the Federal Government, would not go out and buy her a separate policy.
Can you clarify what you mean by "boundary violations" ?

Arlington2019
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Re: Do Govt. Healthcare providers have PLI?

Post by Arlington2019 » Sat Nov 16, 2019 11:28 pm

Boundary violations is a term popularized in behavioral health. It refers to a healthcare provider violating professional boundaries and having a romantic or sexual relationship with a patient or client. It generally leads to the state disciplinary board doing unpleasant things to your license. Lawsuits for this are typically not covered by malpractice insurance policies, although some will provide a legal defense for you if you deny the allegations. In some states, such as mine (Washington) it is a criminal offense for which you can be jailed.

Especially when I am lecturing students or residents and explain this, there can be much consternation from people who thought they were going to find Mr. or Ms. Right from their future patient pool. For some reason, it is the student dental hygienists who are most shocked by this.

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