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April 20, 2006
From The Morning Call
Margie Peterson
One of the sad things about the medical malpractice crisis is that it has stifled the instinct toward decency.
From the time we can talk, people are taught that when we do something that hurts someone we should apologize.
But for years doctors, on advice from lawyers and insurers, were too often discouraged from apologizing when they made a medical error for fear it could be used as an admission of guilt if they were sued.
That's bad advice, according to Doug Wojcieszak, spokesman for Sorry Works, an Illinois-based coalition that encourages the medical community to adopt full-disclosure and apology policies.
An apology and an explanation would have gone a long way when Wojcieszak's brother died after a series of medical mistakes, he told me in a phone interview. Instead, when his father approached the hospital staff for an explanation and some sense of how the doctors planned to make sure it didn't happen to others, the staff told him their lawyers instructed them not to talk. Wojcieszak said his family sued and eventually recovered a settlement.
A better way can be found in the University of Michigan Health System, which dramatically cut the number of pending lawsuits against its hospitals after adopting a full-disclosure policy in 2002. It also reduced the costs of defending against suits from an average of $65,000 per case to $35,000 per case and cut the time it took to resolve cases from three years to about a year.
Under the policy, a hospital investigates suspected errors, and sits down with the patient and the patient's lawyer to review what happened. If the staff was found to have erred, they apologize and offer a settlement. If the treatment was shown to have been justified, the staff meets with the patient to explain why.
Should the patient decide to sue anyway, the hospital defends against the litigation. It's just as important that hospitals stand up for doctors and don't cave in and settle unwarranted lawsuits, Wojcieszak said.
A survey of trial lawyers in Michigan found that more are taking a pass on marginal medical malpractice cases because of the Health System's reputation for fairness, he said. ''Because if University of Michigan is saying, 'We didn't make a mistake,' they probably didn't,'' he said.
Such hospitals are catching up to Department of Veterans Affairs hospitals, which pioneered full-disclosure policies in the 1980s, said Dr. Jim Bagian, chief of patient safety for the VA. ''Most of the time people sue, they don't sue to collect damages,'' Bagian said. ''They sue because they're mad. They're mad about how they were treated after the injury. People want you to admit there was a problem and [want to know] what are you going to do to make sure that it doesn't happen to someone else.''
That last part is especially important, said health care consumer advocate Charles Inlander of Fogelsville, who is on the board of Sorry Works.
"This is really about making sure when errors occur, they're fixed and they're acknowledged," Inlander said.
On that he gets no argument from Dr. Ray Singer, a local thoracic surgeon and president of the Pennsylvania Association for Thoracic Surgery.
Pennsylvania already has a law that requires hospitals to notify patients within seven days if they made a serious error in their care, Singer noted. But patients don't generally sue doctors they like and those who have been upfront with them, he said. ''The fact that you've been so open and honest has probably decreased your risk of being sued in the first place,'' Singer said.
By appealing to all sides' better instincts, the Sorry Works approach undercuts the rhetoric about blood-sucking lawyers and quack doctors that usually accompanies the medical malpractice debate.
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