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THIS WEEK'S EDITION:
- Duke Disclosure Story to be Featured at National Meeting
- Wall Street Journal Story on apology and disclosure
- Missouri Center for Patient Safety Speaking Engagement
- Health Care For All Speech
- Associated Press story
- Question and Answer
DUKE DISCLOSURE STORY TO BE FEATURED AT NATIONAL MEETING
Two weeks ago we informed you, our readers, about an upcoming national conference on disclosure and transparency being hosted by The Risk Management & Patient Safety (RM&PSI), a Sorry Works! partner. The conference is being held at the beautiful Bellagio Resort and Casino in Las Vegas March 19th and 20th. The meeting will feature many prominent and important speakers, including Douglas Borg, Director of Insurance for Duke University Hospitals.
Mr. Borg will speak about a tragic event at Duke University Hospital that many of you will remember: The heart/double lung transplant with the wrong blood type that led to the death of a teenage girl. Duke disclosed the error to the family, admitted full responsibility for the incident, and the story became national news. Mr. Borg will share the disclosure story surrounding this tragic event with attendees of the conference. Mr. Borg will discuss both the positive and potentially negative aspects of disclousre and work with conference attendees to think through all the factors that need to be considered when doing disclosure.
"Disclosure is the right thing to do, but a lot of thought needs to be put into it. Thanks to the growing disclosure movement many organizations are beginning the process of developing disclosure programs, and that's good for our patients. We hope telling our story through this conference can help these organizations plan carefully," said Borg.
We hope you will be able to come listen to Mr. Borg, the other speakers, and also take advantage of unique networking opportunity with like-minded professionals. For more information, contact RM&PSI at (517) 886-8226 or visit this link.
WALL STREET JOURNAL STORY ON APOLOGY AND DISCLOSURE
Doctors Learn to Say 'I'm Sorry'
Patients' Stories Of Hospital Errors Serve to Teach Staff
Wall Street Journal
Laura Landro, The Informed Patient
January 24, 2007; Page D5
When 6-year-old Jill Hartel was hospitalized toward the end of a long battle with leukemia, her mother woke up from a fitful sleep at her daughter's bedside, horrified to find a nurse administering an intravenous dose of Benadryl, though a medication allergy was clearly marked on her medical chart.
More than 12 years after Jill's death from complications unrelated to the error, her parents, Lisa Alecci and Steve Hartel, who work and live in the Boston area, say they can't forget the cold treatment they suffered at the hands of hospital staffers, who among other things, failed to transfer her medical chart from the emergency department, and excoriated her distraught father for failing to alert them to the allergy. "I still double over in tears when I think of the way they tried to blame us," says Ms. Alecci. "No one ever came back to apologize either for giving the drug or for the way it was handled, which was as bad as the error."
The couple are among a number of families and patients who agreed to share such experiences -- without identifying themselves or the hospitals involved -- for "When Things Go Wrong: Voice of Patients and Families," a new training film for medical staffers financed in large part by Crico/RMF, the patient safety and medical malpractice company that covers 18 hospitals and 10,000 physicians affiliated with Harvard Medical School. Though their harrowing stories about being stonewalled or ignored after suffering grievous injuries such as botched operations and life-threatening medication errors are sure to make doctors uncomfortable, the film's creator, Tom Delbanco, a Harvard medical professor and physician at Boston's Beth Israel Deaconess Medical Center, says the "bad news" stories make the most powerful teaching cases to show clinicians how they often avoid and isolate patients at the time they are needed most.
"We need to shock doctors out of their complacency about what's happening from the patient's perspective," adds Luke Sato, chief medical officer of Crico/RMF, which will provide copies of the DVD and training manual free for seminars and courses within the Harvard system and sell it to others for $237 to $395 based on the number of copies via its Web site (rmf.harvard.edu1). Dr. Sato says the aim is to help doctors better understand the impact of medical errors and the importance of apology, but also to prevent such errors from happening in the future.
Over the past few years, the "disclosure and apology" movement has spread rapidly in health care, as a growing number of states pass laws protecting a doctor's apology from being used at trial, and as more hospitals adopt policies requiring that doctors and nurses promptly disclose errors and apologize to patients and families when warranted. But getting doctors and other medical staffers to drop their traditional reluctance to face patients they've harmed, and to overcome their fear of reprisal, has proven a tougher task -- especially since the very legal departments and risk managers that are now encouraging open communication have long stressed "defend and deny" policies that often threw up a wall of silence after a medical error.
Now hospital risk managers and insurers are taking a different tack, in part because of mounting evidence that disclosure and apology programs, which often include an up-front offer of a financial settlement, can sharply reduce malpractice costs.
At the University of Michigan Health System , which adopted new policies encouraging full disclosure of errors and apologies to patients when warranted, the number of presuit claims and lawsuits has dropped from 260 pending in July 2001 when it implemented the new approach to malpractice claims, to fewer than 100 pending at present. The average legal expense per case is also down more than 50%, according to chief risk officer Richard Boothman, whose department works closely with physicians after a medical error or adverse event to discuss how to handle communication with patients. "Many doctors really want to be open and apologize to patients, but are led to believe it can end up in financial disaster, when the truth is quite the opposite," Mr. Boothman says.
Using real patients in training programs to get the message across can be more effective than dry lectures or simulations using actors, which often don't pack the same emotional punch. Mr. Boothman is asking patients who have experienced a medical error or other problem such as a delay in diagnosis to speak about their experiences on video for use in training workshops, including a woman whose breast cancer went undiagnosed for 2 1/2 years and hired a lawyer to explore a claim, but later agreed to a settlement that included a college fund for her children. "When I talk to doctors, it is these personal stories that affect them far more than a power-point presentation with numbers and grids," Mr. Boothman says.
Another effort, the Sorry Works! Coalition, a nonprofit group that includes doctors, lawyers, insurers and patient advocates, was launched in February 2005 by Doug Wojcieszak, a political and public- relations consultant whose brother died after a medical error in a Cincinnati hospital in 1998. Though the family won a lawsuit, "We still grieve that the doctors never sought us out and apologized," he says. The coalition (sorryworks.net) works with state pilot programs and insurance companies to promote full disclosure and apologies as a solution to the malpractice crisis, focusing on a protocol that requires health-care providers and their insurers to apologize if an analysis shows that an error took place or a standard of care wasn't met -- admitting fault, providing an explanation of what happened and how the hospital will ensure the error isn't repeated, and offering compensation.
For patients and families such as the parents of Jill Hartel who have been affected by medical error, the opportunity to educate doctors about how to admit fault and express remorse through such educational programs as "When Things Go Wrong" can help ease the pain of feeling victimized by the health-care system. "Doctors have had it drilled into them for so long that if they ever admitted any kind of mistake, they would get sued, and they desperately need to understand that isn't the case," says Mr. Hartel, "Anything I can do to help one or more doctors get the importance of compassion will benefit me and hopefully will benefit them."
MISSOURI CENTER FOR PATIENT SAFETY SPEAKING ENGAGEMENT
Sorry Works! spokesperson Doug Wojcieszak will be speaking at the March 28th conference of the Missouri Patient Safety Center . If you are interested in a Sorry Works! speaker, please e-mail doug@sorryworks.net or call 618-559-8168
HEALTH CARE FOR ALL SPEECH
Last week, Sorry Works! spokesperson Doug Wojcieszak visted Boston and spoke before a meeting of several interest groups assembled by Health Care For All, which is the non-profit organization chiefly responsible for passage of mandatory healhtcare coverage in Massachusetts. Several groups were present, including the Massachusetts Medical Society, Massachusetts Nursing Board, MITTS, Massachusetts Coalition for Prevention of Medical Errors, and others. It was a great crowd and the speech was well-received.
There are at least two pieces of legislation in the Massachusetts legislature promoting apology and disclosure.
Also, the Massachusetts Medical Society and others will be holding a state-wide conference on apology and disclosure later this year. We applaud the efforts and progress of folks in the Bay State .
ASSOCIATED PRESS STORY
Bill Would Prevent Doctor Apologies From Being Used In Court
Opinions Differ On Apologies' Effect On Malpractice Claims
January 22, 2007
Associated Press
LINCOLN , Neb. -- A bill before the Nebraska legislature would allow doctors to apologize to their patients without the threat of a lawsuit.
LB373 would prevent an apology or other expression of fault, sympathy or condolence by a doctor from being used as an admission of liability in court.
According to the apology-law advocacy group Sorry Works!, 29 states already have such laws.
Sorry Works! spokesman Doug Wojcieszak said apology laws bring down the number of malpractice claims filed in states that have them.
American Medical Association trustee Rebecca Patchin said apology laws help the patient-physician relationship.
Patchin said doctors in states with apology laws feel freer to discuss the details of a procedure with a patients and say they're sorry if things go amiss.
But Lincoln lawyer Vince Powers said doctors' apologies have no bearing on medical-malpractice cases.
Powers said rather than serve as an admission of guilt, they show that a doctor is human.
He said he knows of no cases that have been decided because a health- care provider said he or she was sorry.
QUESTION & ANSWER
Below is a question submitted by Deb Ankowicz, president-elect of the Wisconsin Society of Healthcare Risk Managers. Thanks, Deb! If you have a question, please e-mail to doug@sorryworks.net or gamori@rmpsi.
"Would you please clarify what the Sorry Works Coalition really means by saying facilities should apologize and compensate patients when they know a medical error has occurred. Are you saying facilities should offer money even if the error had nothing to do with the patient's outcome? Some facilities are meeting resistance from a claims perspective, if this is the basis of Sorry Works. We would greatly appreciate clarification on the true goals of the Sorry Works Coalition. The other issue for those of us in WI is the Injured Patient and Families Compensation Fund statement that there may be no fund coverage if liability is admitted."
Geri: The true goal of the Sorry Works Coalition is not to compensate people for injury when there is no error. It's not a no- fault program like Workers' Compensation, but truly an early resolution program for validated error that has clearly contributed to the patient's injury. Sorry Works! is open communication for known errors and resolution without the need for litigation to precipitate the discussion. Where there is a Fund as in Wisconsin, it is important that the organizations and their claims representatives engage in frank discussion with the fund administrators about the goals of the program and agree upon the process for initiating discussions about compensation. Discussions like these are happening across the country with insurers. Part of the challenge is that many claims representatives, attorneys and insurers have not been involved directly in conversations with patients/families at the early stage of anger and fear and may not realize the power of the willingness to be proactive. Sometimes healthcare organizations believe that any error, even when not directly related to the patient injury is compensable under the Sorry Works approach. That is not the intention of the Sorry Works program. When there is no error, or when there is no error that results in injury, we do not advocate compensation. In all cases, we do advocate open, honest, and fair communication with patients and families. That includes discussions about limitations we might face in our ability to work with them or to meet their demands.
Doug: Good question...Sorry Works! is not no-fault (I know, a double negative...but you get the point!) In fact, Sorry Works! involves many of the same "mechanisms" and practices currently employed by risk and claims managers. An adverse event happens, the medical professionals notify risk and/or claims, an investigation is launched to determine what happened and then a decision is made if there is a valid error that is compensable or not. Indeed, Sorry Works! is pretty much the same process with a lot of the same players involved, except there is a differnt mind set and a couple extra steps. First, someone - whether it's the medical staff or administration - will stay in close contact with the patient/family before and during the investigation. Patients and families are never allowed to feel abandoned. If the investigation shows that an error occured, then a meeting will be scheduled with the patient/family and their counsel and an apology, admission of fault, and explanation of what happened will be offered along with discussions about fair compensation. On the flip side, if there was no error, a meeting is still scheduled with the patient/family and their counsel, the results of the investigation are shared along with all records. The patient/family is emphathized with ("we are sorry this happened.") but no settlement is offered and any lawsuits are contested all the way to jury verdict and never settled.
If, however, there was an error that reached the patient (say, a dosing mistake) but there was no damage (physically, emotionally, fiscally, or otherwise), then the patient/family should know about the mistake but no compensation is necessary.
As far as working with the Compensation Fund, remember we advocate a program with Sorry Works! Part of establishing a true Sorry Works! program is meeting, discussing, and agreeing on a plan of action ahead of time with all the necessary players, including insurers and compensation funds.
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