Update & Thoughts on Reforming National Practitioner Data Bank

Last Spring (2012) Sorry Works! launched a campaign to kick start a discussion on reforming the National Practitioner Data Bank (NPDB) and state licensure boards.  In short, we argued (and still argue) that the NPDB and state licensure boards need to be changed/reformed to reflect the reality of the growing disclosure movement.  A clinician who makes an honest mistake, admits fault, and apologizes and compensates should be treated differently than a clinician who attempts to cover up a mistake, and much differently than a clinician engaged in reckless or even criminal behavior.  The NPDB basically has a "one-size fits all" approach to paid claims, which hospitals and insurers try to work their way around.  Whereas overworked, underfunded state licensure boards could see disclosure cases as low hanging fruit and, to appease consumer groups, get tough on honest docs.  Clearly we need to do work on both fronts.

This past Spring (2013), Oregon became the first state to successfully address disclosure and licensure boards, and Sorry Works! supported their efforts.  At least one other state is contemplating similar language, and more will surely follow.  This is good.

As for the NPDB, word on the street is that federal leaders are considering changes/updates to the NPDB in light of the disclosure movement.  This is good.   A few thoughts for federal leaders: 1) The original premise of NPDB of not allowing deficient clinicians to skip from state to state without tracking is good; 2) One study says, on average, 1 in 5 physician hiring or retention decisions are provided more information (i.e, information left out by the applicant physician) due to the NPDB; 3) As I travel the country I think where the rub comes with NPDB is all clinicians are lumped together -- "bad" and "good."  Sure, nobody - including MDs - wants to see deficient clinicians skip from state to state harming countless patients and families.  The problem is when a otherwise competent/good doctors makes a mistake they can be put in the NPDB too -- and data shows since the NPDB's inception settlements are down and time to resolve cases has gone up.  Good docs are digging in their heals more often when hit with a claim.   Cases take longer to settle or reach trial - if ever - and learning from mistakes is slowed, meaning more patients are needlessly harmed.  This is not good.   The NPDB apologists like to say "the NPDB is only a messenger...only a data base."  That's a lazy answer.  Very lazy!  In my book, that answer ranks up there with the response I get from my seven-year old when I inquire how his day was at school: "I dunno know.  I forgot."   In its current state, the NPDB represents reputational harm to docs.....and reputation is everything for docs, especially the good ones! 

So, how do we preserve the original intent of the NPDB - keeping deficient clinicians from skipping state to state - without smearing otherwise good docs, especially with disclosure taking root?  How do we track the bad apples while not creating an impediment to settlement in cases involving otherwise good docs and honest mistakes?  Also, how do we account for system failures as opposed to individual failings?

It's not easy...lots to think about.  Lots of politics too.  To accomplish this task there will probably need to be some parameters put in place and other ways to make the NPDB (and also state licensure boards) more sophisticated in evaluating cases.  As part of our campaign we offered suggestions for changing the NPDB (and also licensure boards), which ignited a bit of a firestorm among some patient safety advocates.  My reaction to these folks was in their singular focus on chasing truly bad apples they are a) delaying justice in many cases, which hurts consumers as well as providers, and b) chilling the disclosure movement which hurts patient safety efforts.   Interestingly, many plaintiff's lawyers and risk managers agreed with my arguments.  I also argued that our criminal courts routinely differentiate cases....honest mistakes with contrition are handled much differently than cases involving no remorse, frequent flyers, etc.  Can't we expect the same level of sophistication with the NPDB and licensure boards? 

I'm glad the discussion is happening with the NPDB.  Hopefully this post will provide more fodder for the discussion.   Sorry Works! is ready to help that discussion, and we encourage others to let their voices be heard.  This is important!

Canadian Hospital Apologizes Following Death of Child

The Winnipeg Regional Health Authority recently apologized after the death of a 10-year old girl following a hernia surgery --- and the family has accepted the apology.  The parents of Ashuza Halisi issued the following statement: "The passing of our beloved daughter was not easy on the family, but we have decided to accept the apology and move on in our effort to find closure and heal from this tragedy. We kindly ask that you request and honour our privacy."

The full article on this story can be found here.

This is another powerful example of disclosure --- and a great teaching tool for clinicians.  We don't know the final disposition of this case, but look at the wording in the family's statement.  It screams one thing: Not all patients & families are litigants.  In fact, very few consumers are litigious....folks only become litigious when doctors and nurses abandon them post-event, and communication, information, and accountability are absent.  Conversely, I don't know how many times caregivers have told me some version of the following:  "After the event, I met with the family, explain what happened, empathized and maybe even apologized, and answered all their questions....and that was it.  I never heard from the family again...and that was five years ago."  

Consumers actually have an amazing capability to forgive and move on.....we understand mistakes.  We really do.  But doctors and nurses have to be pro-active post-event.  The doctor or hospital needs to take that first brave step.  It's called leadership.

Train your doctors and nurses TODAY on empathy and disclosure...help them be pro-active post-event.  It's not enough for leadership, risk, and legal to understand disclosure; the front-line docs and nurses need to be taught how to embrace disclosure.  Sorry Works! is always here to help with your training efforts.  We've literally trained thousands of physicians and nurses on disclosure.  Just drop as an e-mail or call 618-559-8168 anytime.   

Boston Hospital Publicly Airing Medical Mistakes

This hit the news wires yesterday: Brigham and Women's is now publicly airing their medical mistakes.  Very powerful story which can be found here.  This is another example of the disclosure movement gaining steam, and the folks in Massachusetts doing a lot of great work to promote disclosure and make it a reality nationwide.  

One of the things we really need to think about in disclosure is taking disclosure outside the walls.  For several years, we have encouraged our readers to reach out to the PI Bar -- and we still need to keep doing this!  Now, we also need to think about educating consumers about disclosure...about the new & growing ethical movement in medicine.  To help with this effort, not only look at the story above but also the Massachusetts state-wide effort to educate the public about disclosure and apology, which is linked to the Sorry Works! campaign to educate the public.  Due to decades of deny and defend, the public along with the media, politicians, and regulators expect doctors and nurses to hide post-event.  Disclosure gives us a chance to change this perception in a way that benefits all stakeholders. 

I really encourage you to look at these links, read the story and look at these resources, and think how you can do the same with your disclosure efforts.

Have a great day!

Massachusetts' Disclosure Education for the Public & Sorry Works!

Recently, Sorry Works! launched the campaign to educate patients and families about disclosure and apology after medical errors.  We believe it is incredibly important to teach consumers about disclosure, and what disclosure can mean for them after a potential medical error.  In our campaign effort, we provide a number of resources, including a new book entitled, "Did the Doctor Make a Mistake?" which is available both in hard copy and e-book formats.   We hope that hospitals and insurers will participate in this campaign, and do more outreach with consumers.

A great example of consumer outreach can be found in Massachusetts.  As many of you know, several major Massachusetts hospitals and insurers joined arms last year with the hospital association, medical association, and bar association to make disclosure the norm in the Bay State.  Truly a comprehensive effort involving all stakeholders.  Part of Massachusetts' push for disclosure includes an educational website for patients and families.

The Sorry Works! educational campaign for patients and families and the Massachusetts educational website are now linked.   We hope this campaign and educational effort will serve as a model or template for others around the country, and lead to more educational efforts focused on teaching patients and families about disclosure and apology.  

Milbank Quarterly Article on Disclosure Calls for Broad-Based Educational Campaign

The recently released Milbank Quarterly Article entitled, "Disclosure, Apology, and Offer Programs: Stakeholders' Views of Barriers to and Strategies for Broad Implementation" is a very interesting read for people working on implementing disclosure programs within individual hospitals and insurers as well as those advocating for disclosure across a region or state. 

The paper clicks through all the commonly perceived barriers to disclosure, and I think it does a good job of dispelling these supposed barriers.   It's an important paper for the disclosure movement.  Good paper to keep handy the next time someone says, "Well, disclosure can't work because....." 

When reading the paper, I was especially heartened by the authors' call for a broad-based educational campaign to educate stakeholders about disclosure.  Well, as you know, there has been a pretty good PR and education campaign with healthcare, insurance, and legal professionals over the last seven years.  The one missing piece of the puzzle has been patients and families, until now.  

Last week Sorry Works! launched a comprehensive campaign to educate patients and families about disclosure, apology, and life after potential medical errors.  Not only will this campaign be valuable for patients and families, but it can also be a valuable third party resource for hospitals and insurers struggling to deal with patients and families angered after potential medical errors.  You know, many patients and families don't know want to do post-event...many don't understand what is truly (and truly not) a medical error, and sometimes they run away just like doctors and nurses.  This campaign will be a huge help.  

At the heart of our educational campaign is the book, "Did the Doctor Make a Mistake," available both as an e-book and hard copy.

We also have a downloadable flyer as well as large collection of YouTube videos geared towards patients and families. 

Please check out our campaign materials and help spread the word, so they we educate all stakeholders, especially the patients and families.