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What is a Qualified Health Care Provider in New Mexico and Why Does it Matter?

This question is frequently asked in New Mexico medical malpractice cases.  It is very important and should be asked at the very least by the attorney handling the claim

The first part of the question is pretty straightforward.   The second part is far more complicated and raises a host of other issues and questions regarding medical malpractice claims in New Mexico.  As such, the second part is addressed in summary fashion meant only as a brief overview.

So what is a “qualified healthcare provider”?  It is essentially a doctor or other medical provider that has opted in to protection under the New Mexico Medical Malpractice Act (MMA) by meeting a few minor insurance requirements.

There are fairly nominal requirements to qualify as a “qualified healthcare provider” under the MMA.  To qualify under the MMA, the medical provider need only provide proof of financial responsibility which essentially amounts to proof of insurance in the minimum amount of $200,000 per occurrence.

Failure to opt in and provider the proof of financial responsibility/insurance means that the medical provider will not enjoy the many protections under the MMA.   This brings us to second part of the question which is “Why does qualified healthcare provider status matter to an injured patient?”

There are a number of protections afforded qualified healthcare providers in New Mexico.  First, and most important, are the caps placed on damage awards for medical negligence claims against qualified healthcare providers that do not exist for those outside the MMA.  The cap for any one claim is set at $600,000.  A provider’s individual liability is limited to the $200,000 minimum insurance coverage.

In addition to the cap, the MMA specifically states there will be no monetary award for future medical expense.  Because of the nature of injuries in these claims, this can be extremely harmful to an injured patient who must have (pay for) continuing medical care related to the negligence of the medical provider.  This of course raises many policy issues, the most obvious of which is why must an injured patient (or more often taxpayers through Medicare or Medicaid) bear the costs of a medical provider‘s negligence?

The next important aspect of qualified healthcare provider status is the process by which a claim must be initiated against a qualified healthcare provider.  Unlike other personal injury cases, an injured patient cannot simply file a lawsuit against a qualified healthcare provider.  Instead, under the MMA, the patient must first take the case before a Medical Review Panel.  This means the plaintiff must first present his or her case to the Panel for review and findings regarding the alleged negligence.  The panel consists of doctors and lawyers.

Though it is required that the case be presented to the Panel, the Panel’s decision is not binding on the injured patient.  The injured patient may still file suit even if the panel finds against him or her.   This is a good thing since the Panel typically sides with the medical provider.

In short, the determination of whether the medical provider is a qualified healthcare provider is critical.  It should be done very early in a potential case.  The determination will dictate the course of the case.

Keep in mind that these issues can be quite complicated.  This is particularly true of the caps issue.   The caps raise a host of challenges in these cases which must be met in order to achieve meaningful compensation for an injured patient.

Medical malpractice claims in New Mexico (and elsewhere) have many complexities, obstacles and limitations that other cases do not have.  It is extremely important that you immediately consult with an attorney experienced in medical malpractice if you have been seriously injured and have reason to believe that medical negligence was to blame.