May 4, 2009 NEWSLETTER
Doug Wojcieszak, Founder & Spokesperson
Contact phone/e-mail address: 618-559-8168; doug@sorryworks.net
IN THIS EDITION:
- Live from Crittenden's
- Sorry Works! Editorial: Four (4) Things Every Doc Should Know About Disclosure
- Sorry Works! Editorial: Come on New York...You Can Do It!
LIVE FROM CRITTENDEN'S
Sorry Works! is coming to you live this morning from Tampa, Florida cite of the annual Crittenden's Med-Mal Insurance meeting - and we are attending the seminar named Sorry Works!...and we're not even officialy speaking at the event! Sign of the times and how far we've come when people are meeting and talking about us and we're not on the talking card. We've got momentum, and we're excited to be here and hear what med-mal insurers and industry experts are saying about disclosure and apology. Should be a great day! More in next week's newsletter!
SORRY WORKS! EDITORIAL: FOUR (4) THINGS EVERY DOC SHOULD KNOW ABOUT DISCLOSURE
Below is a new part of the Sorry Works! presentations before insured physicians, Grand Rounds, and other presentations at hospitals. These four points are truly the basics of disclosure every physician must understand and can begin practicing immediately. For information on Sorry Works! presentations and disclosure training, contact 618-559-8168 or e-mail doug@sorryworks.net.
- 1)Disclosure is good for doctors as well as nurses, hospitals, and insurers. An enormous & growing body of data is showing that disclosure coupled with apology (when appropriate) actually reduces lawsuits, litigation expenses, and settlements/judgments. The key is anger....disclosure and apology keep a lid on anger, whereas traditional deny and defend risk management strategies increase anger felt by patients & families, and increase the likelihood of costly litigation.
- 2)Five-Star Customer Service, Informed Consent, & Good Communication Lay the Ground Work for Successful Disclosure. For disclosure to work, you have to be credible. You also have to begin building positive evidence early in the process. Patients and families want to be treated with respect at all times, and they also want to see doctors and nurses treating each other with respect. Absent these feelings, disclosure after an adverse event might appear to a patient/family as a form of manipulation. "Why is Dr. McGod being nice to me now?" will be the skeptical question rolling around the heads of your patients/families. Also, procedure specific informed consent will aid in credible disclosure discussions, especially where there was no error. Sorry…sending your nurse in five minutes before the procedure with a bunch of forms to sign doesn't count! You have to invest the time and energy upfront.
- 3) Empathetic "I'm Sorry" Immediately After The Adverse Event. Doctors should provide an empathetic I'm sorry immediately after an adverse event coupled with a promise of an investigation and customer service assistance such as food, lodging, phone calls, transportation, etc. "I'm so sorry this happened Mrs. Jones...I feel bad for you and your family." Notice: Doctors should NOT prematurely admit fault or assign blame. Also, do NOT get defensive. Simply say you are sorry the event happened (as you should be!) and you feel bad for the patient/family, acknowledge their feelings, promise an investigation, and take care or assist with any immediate needs of the patient/family. Show you care! And document the chart accordingly without emotion or speculation. Write down what you said, what you promised, and any questions or comments by the patient/family.
- 4)Call Somebody! Call your risk manager, insurance company, defense counsel, etc. Inform them of the situation and tell them you need assistance with an investigation that will lead to a resolution of the situation - which may include a real apology (I'm sorry I made a mistake) or more empathy if no error occurred.
These are the four most basic Sorry Works! facts for doctors. Best part is doctors can do these four things now… immediately....today! And it won't get you in trouble, and in many instances improve the outcome of the situation.
SORRY WORKS! EDITORIAL: COME ON, NEW YORK...YOU CAN DO IT!!
Sorry Works! has done a lot of work, a lot of presentations in New Jersey, and we’re starting to reap the rewards. Hospitals and insurers in the Garden State are starting to embrace disclosure and already reporting some success stories. We have traction. However, we do not have traction across the water in New York. We've done a few presentations, sold some books, and many Empire State residents take this e-newsletter, but we don't have momentum....and it can be boiled down to this: "You don’t understand, this is New York and lawsuits and trial lawyers are out of control." Hmmm...the old parochial argument of disclosure won’t work here!
Interesting that New York and New Jersey are neighbors and have similar tort climates as far as trial lawyers and lack of tort reform. However, medical professionals in one state are embracing disclosure, while medical professionals in the other state remain skeptical, at best.
We bring this situation to the attention of the entire country – and world – because the parochial rebuttal is one of the most prevalent hurdles to disclosure. And the New York/New Jersey divide shows the parochial argument is an emotionally based excuse with no credibility.
The bottom line is patients are patients, and families are families, and they basically have the same hopes, fears, and expectations when they enter a hospital or medical practice. They transfer the same enormous amount of trust and respect to the healthcare professionals, no matter if the doctor is a Yankees fan, roots for the Seattle Mariners, or could care less about baseball and follows English "football." And when a doctor and his/her colleagues face an adverse medical event with stony silence, poor coordination of communication, lousy customer service, a cover up, etc, the anger experienced by the patient/family is the same no matter if those people hail from the Garden State or the Buckeye State. We’re all basically the same!
When something goes wrong, patients and families are not evaluating doctors and nurses on their legal skills....they are evaluating them on their customer service and communication skills. But if the customer service and communication are lacking (or non-existent), then - and only then - does the situation blossom into a med-mal lawsuit!
So, are emotional rebuttals such as parochial concerns getting in the way of your disclosure program? Read the story below to see if you, your hospital, your practice, your insurance company want to be like New Jersey or New York. If you are interested in hearing a presentation or receiving training like Sorry Works! has done in New Jersey, call 618-559-8168 or e-mail doug@sorryworks.net.
Hospitals offer new take on medical mistakes
Wednesday, March 4, 2009
BY MARY JO LAYTON
NorthJersey.com
All Donald Platt wanted was an apology.
The tumor on his kidney was the size of a baseball by the time his cancer was detected in a CT scan - five years after his doctor misdiagnosed his symptoms and failed to order the right tests.
Platt sued, angered as much by his doctor's attitude as by the mistake.
"He never apologized," said Platt, an Upper Saddle River resident. "If he had, I probably never would have sued."
Eager to resolve medical mistakes in a better way, some New Jersey hospitals and physicians are openly admitting errors to patients. They are offering sincere apologies and, sometimes, money.
Hospital officials hope saying "we're sorry" will cut down on lawsuits. It's a radical change from the "deny and defend" culture of medicine, which leaves patients angry and litigious.
"We want to try to do the right thing in these instances and resolve things more amicably, more efficiently and in a better way than blood-and-guts litigation," said Larry Downs, general counsel for the Medical Society of New Jersey. The society is evaluating "Sorry Works!" - a program that claims to have reduced litigation expenses by two-thirds at some of the nation's hospitals.
At The Valley Hospital in Ridgewood, officials report that lawsuits are down more than half since the hospital started its apology program. LibertyHealth, which operates Meadowlands Hospital in Secaucus and Jersey City Medical Center, say their program, "We're Sorry," has also had good results.
While the conversation can be unpleasant, patients appreciate the truth, said Dr. David Roy, who has offices in Wayne and Kinnelon and hopes more area hospitals promote openness.
"A patient feels doubly violated when something happens because of a medical error and then they can't get any answers," he said. "It's a breach of trust."
Linda Malkin, Valley Hospital's director of risk management and claim services, agrees.
"It basically comes down to doing the right thing," she said.
Valley Hospital had a case in which a woman in her late 60s never received a required blood thinner and ended up having to have stents inserted to prop open her arteries, she said.
"It was really important that the physician communicate immediately" with the patient, said Malkin, who said she also contacted the patient about the mistake.
Valley picked up the tab for the extra days the woman spent in the hospital and offered her compensation, she said. The patient countered and an agreement was reached, said Malkin, who declined to reveal the amount.
Dr. Paul Mendelowitz, senior vice president of Holy Name Hospital in Teaneck, had a case 18 months ago in which a sponge was left inside a patient. The patient needed additional surgery to remove it.
"People were upset and annoyed," Mendelowitz said. "Part of dealing with this is acknowledging that and taking the heat that will come your way. We understand they're not happy. We're not either."
While the hospital didn't charge for the additional care, no compensation was offered. The family never sued, he said.
New Jersey hospitals reported 456 errors —-including 72 that resulted in death - to the state in 2007, the last year data were available. Each year, up to 98,000 people are killed by medical errors in hospitals nationwide.
Reducing lawsuits is critical, especially in New Jersey, where 1,275 malpractice cases were filed last year. Millions are spent in payouts. Even when a hospital or doctor wins, they rack up costly legal bills.
The proponents of apology programs say they most certainly cut down on lawsuits. At the University of Michigan Health System, for example, lawsuits have been cut in half and litigation expenses have dropped by two-thirds, or $2 million, according to Doug Wojcieszak, founder of Sorry Works!
Attorneys insist it is rare for hospitals to admit errors to patients.
"In my 20-plus years of practice it never happened," said Glen Rock attorney E. Drew Britcher, who specializes in medical malpractice. "One of the biggest issues clients complain about is they can't get answers from anybody. It creates a lot of animosity."
"What drives people to seek lawyers is anger," said Lee Goldsmith, a physician and attorney who practices in Englewood Cliffs. If a doctor seems honest and contrite, patients are less inclined to sue, he said.
"I've looked at cases and told people we need to sue doctors A, B, C and D," Goldsmith said. "The client will tell me, 'not Dr. D, he tried to help,' and I'll tell them that it looks like Dr. D is the main problem. It's been said to me on more than one occasion: 'Then we won't bring suit.'"
Two recent cases put Jersey City Medical Center's apology program to the test.
In one case, a nurse failed to administer medication to a pregnant woman who had a blood type incompatible with her fetus. The woman had already left the hospital, so the hospital sent a nurse to her home to give her the injection, said Brenda Hall, a senior vice president and chief safety officer.
"They were grateful and understood," Hall said.
Another case involved a male patient in his 20s who died from an error last fall, Hall said. Despite repeated phone calls and certified letters, the family has not responded, Hall said.
While the New Jersey Hospital Association supports the apology concept, they, along with some physicians, worry it will give patients ammunition for lawsuits.
"There is still a feeling that if I say, 'I'm sorry,' that confers liability on a physician's or hospital's part," said Aline M. Holmes, senior vice president of clinical affairs.
"It's fantasyland," said Dr. Richard M. Winters, chairman of the medical board at Hackensack University Medical Center, where he says errors are disclosed to patients. "Until we have meaningful tort reform in this country and people can't sue for spilling coffee on themselves, we will have a |hard time bringing people to the table."
From a physician's perspective, when there's an adverse event, "I don't believe anyone feels as worse as the physician," said Dr. Kenneth Garay, chief medical officer for LibertyHealth. "Communication is the best way to heal any bridges. It's hard for a physician. We're not trained that way."
In fact, some doctors are warned by insurers that any acknowledgment of error can nullify malpractice coverage, said Steven I. Kern, an attorney who represents physicians.
"Once the patient becomes aware of an error, you have now ceded a malpractice case," said Kern, a former deputy attorney general assigned to the state Board of Medical Examiners. "The apology becomes the trigger for the patient visiting an attorney."
Thomas E. Ricker, a Hunterdon resident who settled a malpractice case with a hospital in 2006, sees it differently. Physicians failed for weeks to inform him that he had a life-threatening bacterial infection. He suffered a stroke, must wear a leg brace and takes anti-seizure medication.
"Three-and-a-half years of depositions, a lawsuit and trial, and then they settled," said Ricker. "Why didn't they just say I'm sorry and make an offer? Everybody would have made out better."
E-mail: layton@northjersey.com
|
