Hospitals Find Honesty Really is the Best Policy

11/17/2008 | Medical Malpractice

A while back I wrote in one of our newsletters about "The Power of the Apology" in the medical setting.  Many healthcare facilites have adopted policies that focus on being honest with patients when medical mistakes have been made.  While most facilities still practice behind the "white wall of silence" and bury most of their mistakes, some innovative and courageous hospitals have decided to break with business as usual and acknowledge their mistakes.  Many of them are finding honesty is resulting in fewer lawsuits.  Here is an article from the Lexington Herald leader on the subject.

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MANY HOSPITALS HAVE ADOPTED POLICY

JWARREN@HERALD-LEADER.COM 

[...]It was an afternoon in 1987. The two grown children of a Kentucky woman who had died a few weeks earlier at Lexington's VA Medical Center arrived to hear details of their mother's death.The children, who thought their mother had died of natural causes, had been asked to bring a lawyer.

When they sat down, Dr. Steve Kraman, then chief of staff at the VA hospital, made a startling admission: their mother had died because of a medication error made by a hospital staffer.

That meeting was the first major test of a pledge that Kraman and officials at the Lexington VA had adopted about a year earlier: the hospital would disclose all medical errors Ð even if it meant the threat of a malpractice lawsuit.

Today, that seemingly simple concept has become a model for many hospitals, medical insurers and health facilities around the country, as well as in some foreign countries. Major university medical centers -- including Johns Hopkins, Stanford and the University of Michigan -- have adopted all or parts of the program that started here. It also is standard policy at VA medical centers across the country.

The American Medical Association and the Joint Commission, the agency that accredits hospitals, both encourage disclosure of medical mistakes, following the general outline of the Lexington VA policy. And stories about the policy that started in the Bluegrass have recently appeared in the New York Times and other major newspapers.

The idea of a hospital "doing the right thing" by voluntarily admitting devastating medical errors might sound like insanity in today's litigious medical landscape. But hospitals that have tried the idea say it actually saves money by heading off expensive malpractice lawsuits and fostering rapid settlements of claims, often at amounts far less than would have been paid in protracted court battles.

For example, the University of Michigan Health System's chief risk officer recently told the New York Times that existing claims and lawsuits in the system dropped from 262 in August 2001 to only 83 in August 2007 after the university adopted a policy of full disclosure.

But things looked much less clear cut when Lexington VA officials made their first major disclosure that day in 1987.

Kraman recalls that the woman's children at first were shocked, then tearful, when they heard the story of how their mother had died. But if they had not made the admission, he said, the two almost certainly would never have known how their mother's death actually occurred.

"It was a situation where, in the tumult of taking care of a lot of patients, something was overlooked by somebody who otherwise was quite competent, and no one caught it," he said. "Once we had the evidence in front of us ... we knew we couldn't just sit on it. Our responsibility to the family outweighed the potential financial concern for the hospital."

'That felt good'

Ginny Hamm, who attended the meeting as regional counsel for the VA, said the family members were so grateful to get the truth that they and their attorney rapidly agreed to a settlement that cost much less than a lengthy lawsuit would have.

"The family members naturally were tearful and we had some moments of our own," she said. "But we told ourselves, 'That felt good; that felt right; this is the way we're going to do it from now on.'"

Linda Cranfill, quality director at the VA, says the disclosure policy actually grew out of a very down-to-earth goal -- saving money.

The Lexington VA had been hit with some large malpractice judgments in the early 1980s, totalling almost $2 million. Prompted by that, officials for the first time had launched a risk management program. The admission of the woman's death was the program's first big test, Cranfill said.

"We had started looking for a better way of doing things," she said. "Initially, the focus really was on protecting the institution. But it quickly moved to the next level of putting the patient and the patient's family at the top of the equation."

The Lexington VA made no public announcement of the new policy. Word really didn't start to spread until December 1999, when Kraman and Hamm wrote a report on the program for the medical publication Annals of Internal Medicine. Its title was "Risk Management: Extreme Honesty May Be the Best Policy."

The article got lots of attention -- partly because it came out right after a stunning federal report showing that medical errors were causing up to 98,000 deaths annually.

'Sorry Works!'

Suddenly, lots of doctors, hospital managers and news reporters wanted to know more about what the Lexington VA hospital was doing. Kraman recalled that news crews from around the country came calling, as did numerous hospital representatives, some from as far away as Australia. Hamm was invited to speak before medical groups, hospital associations and insurance companies in 39 states over the next two years.

Kraman said that while some doctors, and lawyers representing doctors, initially were taken aback at the idea of admitting errors, it began to catch on and facilities started adopting the VA program, or similar policies.

The Lexington VA never gave its program a name. But an Illinois publicist, Doug Wojcieszak, launched a program called "Sorry Works!" in 2004 that incorporated some of the main features of the VA program and advocated that doctors and hospitals fully disclose and apologize for medical errors.

Kraman, who now practices at the University of Kentucky, says some medical officials resist the idea of admitting errors. He noted that it's unclear just how many hospitals and medical groups have adopted disclosure policies because those that do often don't announce the fact.

"Some just don't want to talk about medical errors happening in their hospitals, no matter how they're handling it," he said.

Nevertheless, Kraman thinks medical disclosure will continue to be adopted by many hospitals and medical organizations.

"To me, the proof of the pudding is, would you do this even if you knew you could absolutely get away without admitting anything," he said. "If you could lock the information in a cabinet and walk away, would you still disclose it, even if you knew if might cost you half a million dollars?

"That's the question that really goes to the morality of a company or organization."