The second-largest malpractice award in US history involved a PA who misdiagnosed cerebellar stroke as sinusitis in a man at a hospital ED in 2000. The 44-year-old mechanic entered the hospital with a headache, nausea, dizziness, confusion, and double vision. He had a history of hypertension, diabetes, and elevated cholesterol and had a family history of stroke. The PA ordered blood tests and CT scans, which were approved by the ED physician. Two CT scans came back negative for stroke, so the PA diagnosed sinusitis, prescribed a painkiller and an antibiotic, and discharged the patient. The next day, the man awoke with a severe headache, slurred speech, nausea, confusion, and trouble walking. A new CT scan showed that he had suffered a stroke. A shunt was inserted into his brain, but the damage was irreversible. The man was left a paraplegic. During an investigation, lawyers found out that the PA was unlicensed and had failed the state licensure test for PAs 4 times. The ED physician claimed that he assumed the PA was licensed and that he didn’t need to redo the history and examination on the man. In 2007, a jury awarded the man $217 million, including $100 million in punitive damages.

As the PA profession has matured, there has been an increasing concern over the medical care being delivered by non-physician providers. Is being in the care of a PA more dangerous than a doctor or nurse practitioner?

According to a study that collected 17 years of data from the National Practitioner Data Bank, the answer is no. The study looked at the level of safety among physicians, PAs and advanced nurse practitioners (APNs) by analyzing and comparing civil lawsuits, Medicare program exclusions, etc. During the 17-year period from 1991 to 2008, there were fewer incidents of medical malpractice and lower average payment amounts related to PAs compared to MDs and APNs. In addition, there was 1 malpractice payment for every 32.5 PAs, whereas there was 1 for every 2.7 physicians. The study did show, however, that the rate of malpractice is increasing for PAs and APNs, which has been attributed to the major increase in the number of PAs and APNs entering the workforce. The most common reasons for malpractice claims were the same for PAs and APNs and included errors in diagnosis, treatment, medication, and surgery.

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It’s also a misconception that PAs can’t get sued because they are a physician’s responsibility. Medical law states that PAs can and do make errors for which their supervising physicians are not responsible. In the US, anyone can get sued for anything, and when patients find the need to file a lawsuit, they will usually sue anyone and everyone who may have played a part. Thus, it would be wise for PAs to get medical liability insurance, in addition to the coverage supplied by their employer. AAPA’s preferred medical liability insurance carrier’s cost for PAs runs between $2000 and $6000 per year. This seems high, but compared to the rates for physicians, which run between $11,000 and $55,000 per year, it’s worth it.


  1. Crane M. Malpractice risks with NPs and PAs in your practice. Medscape website. January 3, 2013.
  2. Nicholson JG. Physician assistant malpractice history: comparing PAs to physicians and nurse practitioners. Expert Pages website.
  3. PA vs MD: malpractice, part I. Inside PA Training website. July 18, 2011.