NP, PA, APP... What's the difference??

If you are an attorney or paralegal handling personal injury or medical malpractice cases, Advanced Practice Providers are already in your medical records and the way you review those charts may be costing you more than you realize. 

In this episode, legal nurse consultant an NP, Linda Acker, breaks down the critical differences between nurse practitioners and physician assistants, why the documents that govern each provider type are not interchangeable, and what most legal teams get wrong when an APP appears in a case. 

With the physician shortage projected to reach 124,000 by 2034, APP involvement in medical care is not slowing down. What you do not know about NP and PA scope of practice in discovery could be the difference between a strong case and one that falls apart. 

This episode covers: What an Advanced Practice Provider is and why the provider type matters in litigation.

 The difference between a practice agreement (PA) and standardized procedures (NP) and why requesting the wrong one in discovery is a problem. 

The three-layer structure that governs APP scope and why most firms never get past layer one. 

Real cases including Lopez v. Ledesma (California Supreme Court, 2022) and Collip v. Ratts (Indiana, 2015) and what they reveal about documentation gaps and supervision liability. 

What questions to ask when an APP appears in your medical records. 

Whether you handle PI, medical malpractice, or insurance defense, this episode is for any legal professional who wants to understand what the medical record is not telling them. 

References and case citations are listed below. 

References: Physician Shortage Data — PMC/NCBI 

Learning from Real-World Malpractice Cases — AAPA Collip v. Ratts, 49 N.E.3d 607 (Ind. Ct. App. 2015) 

Lopez v. Ledesma, California Supreme Court (2022) 

Have a case with an APP involved and not sure where to start? 

Send a message. That is exactly the conversation I want to have with you. 

The information provided in this podcast, and any associated materials—including our e-books and templates—is for educational and informational purposes only. 

While we strive to provide the most accurate and current data available at the time of release, science and law are constantly evolving. 

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment, nor does it constitute legal advice or the establishment of an expert-witness relationship. 

For Attorneys: Always consult with a qualified medical expert regarding the specific facts of your case. For the General Public: Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. 

Never disregard professional medical advice or delay in seeking it because of something you have heard on this show. 

Reliance on any information provided by Linda Acker, FNP, or Clear Advantage LNC is solely at your own risk.

https://clearadvantagelnc.com/

LindaAckerFNP@ClearAdvantageLNC.com

209-560-6414

Transcript

Introduction

SPEAKER_00 0:00

Hey guys, I'm Linda, a lawyer's NP, and I want to ask you something before we get into it today. When you pull a medical record and you see the name on the notes, a provider who's not a physician, how confident are you that you know what you're actually looking at? Not what their title is, not what they documented. I mean the actual framework that was supposed to govern everything they did, the agreements that were or weren't in place, the oversight that was or wasn't happening, the documents that nobody pulled. By 2034, the physician shortage hits 124,000. The system has already been filling that gap for years, which means those providers are already in your cases. And the question I keep coming back to is does your team actually know what it's looking at when they show up in a chart? Let's talk about it. Advanced practice providers or APPs are medical professionals who can diagnose, manage care, and prescribe. They're not physicians. And on paper, a lot of what they do looks identical to what a physician does. That's the part most people get. Physical exams, ordering tests, interpreting results, managing conditions, referrals. From the outside, the encounter can look exactly like a physician encounter. Here's what people don't get. The type of APP matters. And the documents that govern what each type can legally do are not interchangeable. Asking for the wrong one in discovery is not a minor administrative issue. It means you don't have the document that actually defines the boundaries of that provider's authorized scope. And you may not know you're missing it. Most legal teams operate as if what an EPP can do is determined by state law. And yes, state law is a part of it, but it's only one layer of a structure that goes considerably deeper than that. Each layer can be more restrictive than the one above it. And the layers that most firms never reach are the ones that tend to hold the actual story. There's a document that almost no one requests. It doesn't live in the medical record. It doesn't come with a standard records request. You have to know it exists, know what to call it, and know exactly where to ask for it. When you have it, you can answer a question that changes the entire shape of a case. Was the physician even authorized to direct this APP to do what was done? Most firms never ask the question because they don't know there's an answer somewhere. Let me show you what it looks like when that question doesn't get asked. Lopez versus Ledesma, California Supreme Court 2022. A four-year-old died. The providers involved had valid agreements on paper, every signature in the right place. The trial court found that the actual oversight never happened. Not even once. The family won on liability. Someone worked that case for years. 4.25 million was reduced to $250,000 under the micra cap because the defense had a piece of paper. And the piece of paper held. I want you to sit with a question of what it would have looked like to know before that trial whether that paper actually said what it needed to say, whether the right questions were asked of the right documents, whether the documents that were never requested may have told a different story. Those aren't philosophical questions. Those are discovery questions, and they have answers. Collat vs. Rats, Indiana 2015. A collaborating physician was held liable for a patient he had never treated and never reviewed. His name was on an agreement. The agreement created a duty he didn't fulfill. The duty became the liability. The exposure in both cases was not buried. It was documented. It just wasn't read by someone who knew what they were reading. When you see an APP's name on a medical note, there are questions worth asking that have nothing to do with what is written in that note. The answers don't live in the chart. They live in documents that govern the relationship between the APP and the physician whose name is attached to their practice. And in documents that most discovery requests never touch. How you read a case changes completely when you know where else to look. I talk to nurses and nurse practitioners regularly who are not clear on their own scope of practice. People inside the system every day. It shifts by state, it shifts by institution, and each agreement is different. I want you to hear this without any pretense. The complexity you're starting to feel right now isn't an exaggeration. You're not misreading the room. There's more to be found here. And the part that matters for your case is not something you get to by reading the chart more carefully. It requires knowing where else to look, what to ask for, and how to read what you find. That's a specific kind of fluency. It comes from having worked inside the system, not from studying it from the outside. And just because you know something exists doesn't mean you know what to do with it, even when you have it in front of you. So if you have an APP case in your current load or one coming, reach out. Email me, send me a DM. That's where the actual work happens. Links in the show notes. As we wrap up today's episode, I want to talk about something every law firm is short on. Time. I talk to attorneys every week who are frustrated by standard chronology send-out services. They're slow, they're expensive, and honestly, they often miss the subtle clinical nuances that win cases. That's why at Clear Advantage LNC, we shifted entirely to a flat rate pricing model. We rival the big services on price, beat them on turnaround time, and inject an NP lens into every single page. It's one consistent investment, meaning zero financial surprises for your billing department. It's been a game changer for the firms we partner with. By letting us do the heavy lifting on the medical deep dive, their internal teams are free to focus on what they do best. Moving cases towards resolution. If you're ready to streamline your record review process, email me at lyndaackerfnp at clearadvantagelnc.com and let's connect. Alright, we made it to the end. There are three documents that define whether what an EPP did was within the bounds of what they're authorized to do. Most firms go into litigation with two of them, sometimes one. The one they don't have is the one that answers the question nobody thought to ask. 4.25 million became 250,000. Email me before your next APP case. If there's something you want me to get into, you know where to find me. I love hearing what you're working through, and it's always more interesting than people think it will be. Until next time, stay medical legal ready.