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Diagnostic Errors by Physician Assistants and Nurse Practitioners

Excerpt: As mid-level providers take on more diagnostic responsibilities, PA and NP errors are an increasing cause of medical malpractice. This guide explains who is liable when a mid-level provider misdiagnoses.

The Rise of Mid-Level Providers

Physician Assistants (PAs) and Nurse Practitioners (NPs) — collectively known as "mid-level providers" or "advanced practice providers" (APPs) — have taken on increasingly prominent roles in healthcare delivery. In emergency rooms, urgent care centers, primary care offices, and hospital wards, patients are frequently evaluated, diagnosed, and treated by mid-level providers rather than physicians.

This trend is driven by:

• Physician shortages — Particularly in primary care and emergency medicine
• Cost reduction — Mid-level providers are less expensive than physicians
• Patient volume — Emergency rooms and urgent care centers need to see more patients
• Corporate medicine — Healthcare systems optimize for efficiency over expertise

While PAs and NPs provide valuable care, the expansion of their roles has led to an increase in diagnostic errors — particularly when they are assigned tasks beyond their training, given inadequate supervision, or placed in high-pressure environments without adequate backup.

If you or a loved one was misdiagnosed by a PA or NP in New York, this guide explains your legal rights.

[Link to: /medical-malpractice/misdiagnosis]

The Scope of Practice for PAs and NPs in New York

Physician Assistants (PAs)

In New York, PAs are licensed under Education Law Article 139. They practice medicine under the supervision of a physician. Key requirements:

• Master's degree from an accredited PA program
• National certification (PA-C) from the NCCPA
• Practice agreement with a supervising physician
• Delegated medical duties within the scope of the supervising physician's practice

Nurse Practitioners (NPs)

In New York, NPs are licensed under Education Law Article 139. They practice as Advanced Practice Registered Nurses (APRNs). Key requirements:

• Master's or doctoral degree in nursing
• National certification in a specialty (e.g., family practice, acute care, pediatrics)
• Written practice agreement with a collaborating physician — OR — practice independently after 3,600 hours of clinical experience under New York's NP Modernization Act

Common Diagnostic Errors by Mid-Level Providers

1. Failure to Recognize Serious Conditions

PAs and NPs may have less training and experience than physicians in recognizing serious or rare conditions. Common missed diagnoses include:

• Heart attack — Attributing chest pain to musculoskeletal causes
• Stroke — Attributing neurological symptoms to migraine or vertigo
• Appendicitis — Attributing abdominal pain to gastroenteritis
• Sepsis — Failing to recognize the systemic signs of infection
• Pulmonary embolism — Attributing shortness of breath to anxiety or asthma
• Meningitis — Attributing headache and fever to viral illness

[Link to: /blog/failure-to-order-diagnostic-tests-malpractice-ny]

2. Failure to Consult a Physician

The standard of care requires PAs and NPs to consult their supervising physician when they encounter:

• A patient with complex or unclear symptoms
• A patient who is not improving as expected
• A patient with red-flag symptoms (chest pain, severe headache, etc.)
• A condition beyond the PA/NP's scope of practice

Failure to consult a physician when indicated may be negligence — both by the PA/NP and by the supervising physician.

3. Failure to Order Appropriate Tests

PAs and NPs may not order the same diagnostic tests that a physician would order for the same presentation. This can lead to missed diagnoses.

4. Premature Discharge

In emergency rooms and urgent care centers, PAs and NPs may discharge patients who should have been admitted or observed. This is particularly dangerous when:

• The diagnosis is uncertain
• The patient has red-flag symptoms
• The patient has significant comorbidities

5. Inadequate History-Taking

A thorough history is the foundation of diagnosis. PAs and NPs under time pressure may not take an adequate history, leading to missed diagnoses.

[Link to: /blog/doctor-failed-to-listen-to-symptoms-lawsuit]

Who Is Liable When a PA or NP Commits an Error?

The PA or NP

PAs and NPs are individually licensed and can be held personally liable for their own negligence. However, they typically do not have significant personal assets and are usually covered by their employer's malpractice insurance.

The Supervising Physician

In New York, the supervising physician may be liable for the negligence of a PA under the theory of vicarious liability or negligent supervision. The physician is responsible for:

• Adequately training the PA/NP
• Providing appropriate supervision — Including being available for consultation
• Establishing appropriate protocols — For when to consult a physician
• Monitoring the PA/NP's performance

The Hospital or Clinic

The hospital or clinic that employs the PA or NP may be liable under theories of:

• Vicarious liability (respondeat superior) — For the negligence of employees
• Corporate negligence — For inadequate staffing, training, or supervision
• Negligent credentialing — For granting privileges to an unqualified provider

The Staffing Model

Many hospitals and clinics use a "fast track" model in emergency rooms, where PAs and NPs see patients with seemingly minor complaints, while physicians see more complex cases. This model can be dangerous if:

• Triage decisions are incorrect — A patient with a serious condition is triaged to the fast track
• The PA/NP fails to recognize that the patient's condition is more serious than it appears
• The PA/NP fails to escalate the patient to a physician

Proving a Mid-Level Provider Malpractice Claim

Key Evidence

• Medical records — Documenting who saw the patient, what was evaluated, and what was decided
• Triage records — How the patient was triaged and to whom
• Supervision records — The practice agreement between the PA/NP and supervising physician
• Hospital policies — On mid-level provider supervision and escalation protocols
• Expert testimony — From a physician in the relevant specialty

Expert Witnesses

Mid-level provider cases require testimony from:

• A physician in the same specialty — On the standard of care and whether the PA/NP should have consulted a physician
• A PA or NP in the same specialty — On the standard of care for mid-level providers
• A healthcare administration expert — On staffing models and supervision

Statute of Limitations

Under CPLR 214-a, the statute of limitations is 2.5 years from the date of the malpractice.

Frequently Asked Questions

Can I sue a PA or NP for misdiagnosis?

Yes. PAs and NPs are individually licensed and can be held liable for their own negligence. The supervising physician and the employer (hospital or clinic) may also be liable.

What is the difference between a PA and a physician?

PAs complete approximately 2-3 years of post-graduate training (after a bachelor's degree), while physicians complete 4 years of medical school plus 3-7 years of residency. PAs practice under the supervision of a physician.

When should a PA or NP consult a physician?

The standard of care requires PAs and NPs to consult their supervising physician when they encounter complex or unclear symptoms, a patient who is not improving as expected, red-flag symptoms, or a condition beyond their scope of practice.

Can the supervising physician be liable for the PA's error?

Yes. In New York, the supervising physician may be liable under theories of vicarious liability or negligent supervision. The hospital or clinic may also be liable.

How long do I have to file a claim?

Under CPLR 214-a, the deadline is generally 2.5 years from the date of the malpractice.

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If you or a loved one has been affected by a diagnostic error by a physician assistant or nurse practitioner in New York, contact MDLaw Firm at 347-524-5777 for a free consultation.

This article is for informational purposes only and does not constitute legal advice. Prior results do not guarantee a similar outcome. No attorney-client relationship is created by reading this article or contacting MDLaw Firm.