JAAPA Podcast: PAs in Legal Medicine
Episode Date: September 17, 2025
Host: JAAPA
Guests: Amanda Mallory Spohman, Susan Ferrero, Adam Broughton, Christopher (Chris)
Theme: Malpractice Prevention and Risk Management for Physician Assistants
Episode Overview
This episode of the JAAPA Podcast shifts from the typical literature review format to a roundtable discussion with leading Physician Assistants (PAs) from the Academy of PAs in Legal Medicine (APOM). The panel dives into the realities of malpractice, risk management, liability insurance, the national standard of care, best documentation practices, and practical strategies every PA should implement to reduce risk and practice confidently.
Guest Introductions & APOM Mission
[01:54 – 06:20]
- Amanda Mallory Spohman:
Transitioned from full-time academia to medical legal consulting, serving on APOM’s Board of Directors; combines PA clinical skills and education to advise on malpractice and personal injury cases. - Susan Ferrero:
Twenty years in various specialties, now a full-time consultant on medical legal matters; aims to educate PAs and students about malpractice and consultancy. - Adam Broughton:
Emergency medicine expert and full-time academic; combines classroom teaching with expert witnessing and legal medicine involvement via APOM connections. - Christopher (Chris):
President of APOM, over 22 years as a PA, mainly in emergency medicine. Inspired to focus on legal medicine after experiencing a malpractice case personally.
APOM’s Mission:
To grow a community and educational resource around issues of malpractice, legal consulting, and risk management for PAs, arming practitioners with the practical knowledge needed to minimize liability.
“We are really aiming to make a difference … to help educate PAs and PA students about malpractice.” — Susan Ferrero [03:52]
Most Common Causes of Malpractice Suits & Top Risk Management Tips
[06:41 – 13:08]
Key Causes of Malpractice:
- Missed/Delayed Diagnosis
- Failure to Treat
- Poor Communication (including faulty handoffs, medication errors)
Top Prevention Strategies:
- Thorough Documentation
- Especially document medical decision-making and thought process.
- Good documentation can prevent lawsuits from advancing—even before the provider is notified of a review.
“Your document is going to be what tells the story. Most suits don't come out until two or three years later…” — Susan Ferrero [06:41]
- Open, Clear Patient Communication
- Good rapport reduces litigation risk.
- Use interpreters and plain language as needed.
- Ensure Adequate Onboarding & Training, Especially When Changing Specialties
- Don’t hesitate to ask for help or additional training in a new area.
“When you start a new specialty … just ensuring that you’ve got a proper onboarding, that you’re comfortable with the procedures…” — Amanda Mallory Spohman [09:55]
- Proactive Handoffs and Transitions in Care
- Communication with other providers, clear discharge instructions, and post-care follow-up are crucial.
- Mindful Use of Documentation for Both Billing AND Legal Protection
“From a billing standpoint that's fine, but from a medical legal standpoint, it's terrible.” — Amanda Mallory Spohman [15:13]
Notable Quotes:
- “Thinking of documentation as communication, the top three things would be: communication, communication, communication.” — Adam Broughton [12:11]
- “Speak to your collaborating physician, document it … it's what the patient expects … there's no egos here. Just do the right thing.” — Christopher (Chris) [13:57]
Professional Liability Insurance: Understanding the Essentials
[16:37 – 20:57]
Types of Policies:
- Claims Made Policy
- Requires “tail” coverage for cases filed after employment ends.
- Leaving a job? Ensure tail coverage or a “nose” policy is in place.
- Occurrence Policy
- Covers incidents that occur during the coverage period, regardless of when the claim is filed.
- Often provided as an umbrella policy through healthcare employers.
Best Practices:
- Always request and keep a copy of your policy face sheet.
- Clarify who your attorney represents if covered by a group policy.
- Consider a supplemental policy to have your own counsel and independent protection.
“Never assume someone else is taking care of things for you.” — Podcast Moderator [19:59]
“You should be asking every year for a copy of your insurance policy, your malpractice insurance policy.” — Susan Ferrero [19:33]
The PA Standard of Care: What It Means in Practice
[20:57 – 25:33]
- Defined as “what a reasonably prudent PA would do under the same or similar circumstances. It's a national, not local, standard.”
- It is not about providing the “best” or “optimal” care every time, but care in line with competent PA peers.
- Evidence-based practice is increasingly the benchmark.
- Ignorance is not a defense: not recognizing when to consult or escalate is a red flag.
- Know the difference between state and practice-level rules—what matters most is how care is actually delivered at your practice.
“The standard of care is going to be what any reasonable PA would do in that situation…” — Amanda Mallory Spohman [21:25]
“PA that's in Massachusetts versus Kentucky versus Arizona versus Florida is going to be judged the same way.” — Christopher (Chris) [22:26]
Golden Rules: Expert Final Advice for PAs
[28:09 – 35:19]
Documentation:
- Avoid copy-pasting charts and templates without changes; errors damage credibility.
- Never alter records after the fact—there is a digital audit trail.
- Comprehensive, accurate charting supports continuity of care for the whole team.
“No cutting and pasting ... there are errors in there. It discredits the rest of your chart ... don't go back in the chart and change something.” — Susan Ferrero [28:09]
Professionalism & Communication:
- “Be kind, be patient, be professional.”
- If an error occurs, maintaining empathy and professionalism reduces the likelihood of being sued.
“If you're kind, professional, courteous, and communicate with the patient, they're less apt to file a liability lawsuit against you.” — Christopher (Chris) [29:39]
Patient Engagement:
- Small gestures (e.g., visible handwashing, sitting down with the patient) build trust.
- Share the thought process and rule-outs with patients.
- Perform and document patient handoffs and discharge planning with the patient present.
“It takes literally two seconds ... but the patients love it because you’re communicating in real time.” — Amanda Mallory Spohman [31:17]
Leverage—But Don’t Rely Blindly On—Systems:
- EMRs/EHRs are built for billing, not always safety—use them mindfully.
- Take photos when helpful; think about best practices for future clinicians accessing the record.
“Leverage your systems ... think of it as it's not there, you know, to speed you along. It's there to extract the money.” — Adam Broughton [32:32]
Technology, AI & Next Steps:
- Embrace but critically evaluate new technologies like AI in documentation.
- Technology aids but does not replace professional judgment or careful proofing.
“It doesn't replace proofreading and it doesn't replace your ability to care for the patient.” — Christopher (Chris) [34:14]
Memorable Moments & Notable Quotes
- “Just do the right thing. There's no egos here.” — Christopher (Chris) [13:57]
- “Documenting and documenting and documenting.” — Podcast Moderator [14:52]
- “If you saw what we saw on the back end … people would be embarrassed to see their notes…” — Susan Ferrero [28:09]
- “Be that provider that a family member would like to see … Always be professional and just zip it. Don't be a jerk.” — Christopher (Chris) [30:18]
Key Timestamps
- [01:54 – 06:20]: Guest introductions and APOM overview
- [06:41 – 13:08]: Common malpractice causes and prevention advice
- [16:37 – 20:57]: Understanding liability insurance
- [20:57 – 25:33]: Defining and applying the standard of care
- [28:09 – 35:19]: Golden rules for documentation, professionalism, leveraging systems, and technology
For more details on future topics, including AI in medical documentation, stay tuned for part two of this series.