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By Christina Orlovsky, senior staff write
NurseZone.com
October 7, 2005
As hospitals across the country begin to realize the value of full disclosure about medical errors, new legislation has been proposed to encourage physicians, hospitals and health systems to take extra steps toward fair negotiations with patients and their families with the help of two little words: I’m sorry.
On Sept. 28, Democratic Sen. Hillary Rodham Clinton, of New York, and Democratic Sen. Barack Obama, of Illinois, introduced the National Medical Error Disclosure and Compensation (MEDiC) Act, designed to propel the medical community to universally adopt a policy of disclosure of medical errors, apologies for these errors and early compensation for patient injury. Further, the MEDiC program would provide grant money and technical assistance to help doctors, hospitals and health systems implement these policies.
In a statement introducing the legislation, Clinton spoke of the relationship between full disclosure of medical errors and improved patient safety.
“Patients and physicians are paying the price for a health care system that discourages the kind of communication needed to find and correct the conditions that lead to medical errors,” she said. “We need to do everything we can to put patient safety first and bring a fresh idea to the table. I am introducing legislation that will provide incentives for doctors, hospitals and health systems to create a culture of safety that will reduce medical errors and lower malpractice costs.”
The MEDiC Act was modeled after several policy changes that have already been implemented across the country. One initiative, the Sorry Works! Coalition, is leading the charge in the promotion of full disclosure.
“We are a group of doctors, lawyers and insurance industry representatives—all the players in the medical malpractice crisis—who have come together to advocate the middle ground solution: Apologies for medical errors and quick, up-front compensation reduce lawsuits for doctors while providing swift resolutions for attorneys,” explained Doug Wojcieszak, spokesperson for Sorry Works! “By infusing honesty into hospital systems, you have a better chance of reducing errors and medical malpractice lawsuits.”
The Sorry Works! protocol works by practicing full disclosure immediately after a medical error occurs. The patient and/or family is contacted and encouraged to retain counsel and a meeting with the doctor and hospital is scheduled. An apology and explanation is provided and a settlement offered. If it is determined that a medical error was not to blame for a bad outcome, open communication is still practiced through the provision of medical records and answering of questions or concerns from a patient and their family.
According to Wojcieszak, the benefits of Sorry Works! for doctors, hospitals and insurers include fewer lawsuits, lower settlement and defense litigation costs, overall savings, better control over liability exposure and a maintenance of relationships with patients and families. Patients, plaintiffs and plaintiffs’ attorneys benefit from quicker justice, maintenance of their constitutional rights and a reduction of medical errors.
Since its creation in Feb. 2005, Sorry Works! has garnered interest from numerous states that are eager to get involved in implementing new policy. A bill was passed in Illinois for a pilot program that allows two hospitals to take a risk-free approach to full disclosure and report costs differences between the Sorry Works! efforts and the traditional defense method after a two-year period.
Wojcieszak is hopeful that the proposed legislation will encourage similar efforts in a greater number of health systems nationwide. Still, he pointed out, legislation is not necessary for hospitals to initiate these positive changes.
“We applaud the legislation, but our message is that you don’t have to wait for legislation to pass,” he said. “All of the hospitals that have done this successfully have done so without a mandate from Washington—that’s from government hospitals and university health systems to private hospitals. It has worked very well.”
One hospital system that has had success with its full disclosure policy is the University of Michigan Health System, in Ann Arbor, Michigan. Under the direction of Rick Boothman, J.D., chief risk officer, the hospital has implemented numerous changes in the way the staff addresses medical errors and their consequences.
“The first thing we did was establish a benchmark to compensate fairly and quickly any patient who was harmed through medical care; to vigorously defend our staff when we were convinced the care was reasonable regardless of the outcome; and to learn from patients’ experiences and complaints, regardless of whether or not we thought our care was reasonable,” Boothman explained.
Boothman also visited with plaintiff firms and explained to them that if they had a medically supported case, they wouldn’t need to sue the hospital. They simply had to sit down with the hospital and share the situation, and the hospital would promise them “a fair shake.” Boothman then created a committee comprised of nurses and doctors to help determine what cases involved reasonable and unreasonable medical care.
“It gave me the credibility to move forward and resolve cases that we could resolve and defend those we needed to defend,” Boothman said.
“We’ve also reformed our risk management department to include all experienced nurses, reasoning that I needed people in my department who are intimately familiar with how care is delivered,” he added.
Since the implementation of the new policy in 2001, the University of Michigan Health System has seen the number of malpractice claims fall from roughly 265 per year to 114, levels Boothman said the hospital hasn’t seen since the 1980s.
What pleases Boothman further is the change in culture among the doctors and nurses, who had learned through the years to keep quiet about errors.
“Our staff has really embraced something that all along they have wanted to do,” he said.
“Caregivers have the natural tendency to identify with patients, even when bad things happen. It’s only been the legal system that has prevented it,” Boothman added. “We have gotten so defensive that we forgot what it was to do the right thing. Now, we have lots of support—we need to be open and honest with our patients to keep them on board.”
For more information, visit the Sorry Works! Coalition Web site.
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