What Liability Insurance should an APRN have to cover the costs involved in this case? What could the APRN have done differently to avoid the lawsuit? Did the APRN exercise due care under the circumstances? Could the collaborating physician be held accountable and sued as well? Finally, could the APRN be brought before the BON for professional disciplining?

On 6/12/00, the decedent presented to the defendants' office with complaints of left sided chest, shoulder and back pain that had originated in her lower left side. She was seen and assessed by the defendant nurse practitioner. It was noted that the decedent denied shortness of breath but reported that it hurt to take a deep breath. She also complained that she was very uncomfortable, was unable to sleep and that it hurt to move around.

That defendant nurse practitioner performed a physical exam which revealed that the decedent was hypertensive (blood pressure 150/90) and tachycardic (pulse 120). An EKG was performed and confirmed sinus tachycardia (a heart rate greater than 100 beats per minute. ) No further testing was performed after the EKG. The defendant also found that the decedent's lower and mid back were mildly tender. The defendant nurse practitioner diagnosed the decedent with diffuse myalgia and prescribed Naprosyn. The defendant physician co-signed the defendant nurse practitioner's notean indication that he had reviewed the note and agreed with the assessment.

Two days later, the decedent was found at her home in respiratory distress and with a blood pressure of 60/palpation. She was given oxygen and transferred to the Lahey Clinic Emergency Department for further evaluation. When the decedent arrived at the hospital, she was noted to be mottled and in shock. An emergency echocardiogram revealed evidence of massive pulmonary emboli. The decedent quickly deteriorated, suffered a cardiac arrest and was pronounced dead due to massive pulmonary emboli.

The plaintiff was expected to present evidence that the decedent was suffering from small pulmonary emboli at the time that she was seen by the defendant nurse practitioner. The plaintiff expected to present expert medical testimony showing that the decedent's sudden complaints of chest pain along with her rapid heart rate were clear signs that she was suffering from pulmonary emboli. There was expected to be further evidence that the decedent would have survived had she been worked-up properly and given medications to prevent the formation of the massive blood clots that ultimately caused her death.

The case settled two weeks before trial for $1,700,000.