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When doctors say they're sorry

RECENT NEWS stories report that Harvard Medical School's major teaching hospitals are actually encouraging their doctors to apologize for medical errors. Given our litigious culture, this unusual move looks like a ready-made gift for greedy trial lawyers -- or is it?

Actually not. In fact, apologizing for medical errors has been shown to reduce lawsuits and liability costs in hospitals across America.

The first hospital to implement apologies for errors was the Lexington, Ky., Veterans Administration Hospital. After being stung by two multimillion-dollar lawsuits in the mid-'80s, hospital leaders instituted a policy of apologizing for all medical errors and offering fair, upfront compensation to patients, families, and their attorneys.

Conventional wisdom said they were crazy, but the Lexington staff happily reported in the December 1999 edition of Annals of Internal Medicine that their facility ranked in the lowest quartile of VA facilities for malpractice payouts; their average settlement per case was $16,000 compared with the national VA average of $98,000. The Lexington approach spread to VA hospitals in Los Angeles and Las Vegas and then to the University of Michigan's hospital system, which has cut its lawsuits in half. Michigan also reports saving $2 million in defense litigation expenses annually because cases are being settled in months instead of dragging out for years. Similar positive results have been reported at 28 Kaiser hospitals and 39 hospitals in the Catholic Healthcare West System.

Honesty programs vary from hospital to hospital, but they usually follow a similar protocol.

After a bad outcome (unanticipated death, unsuccessful surgery), hospital administrators and doctors determine whether the standard of care was met.

If the investigation shows that the standard of care was not met (i.e, error or negligence), the hospital schedules a meeting with the patient and family at which time the doctors apologize, provide explanations, and offer fair, upfront compensation for the injuries.

If, however, the investigation determines that the bad outcome was not caused by error (i.e, the patient was simply too sick), the hospital staff still meets with the patient/family and their legal counsel. They explain what happened, open medical charts, and answer all questions. Simply put, they prove their innocence, which reduces the nonmeritorious cases that account for 60 to 80 percent of all medical malpractice lawsuits.

Dealing with patients and families honestly turns litigation strategy on its head, and doctors are perhaps the greatest beneficiaries. How often have we heard doctors complain about being forced to settle a case where they had not committed an error but the insurance company insisted settling was cheaper than fighting the charges? Yet how many times have we wondered why a hospital was fighting a case of obvious gross negligence, such as amputating the wrong foot?

Everything works in opposite with apologies and honesty. Cases of gross negligence are settled quickly and fairly, while bad outcomes with no error are appropriately denied compensation. Those denials are defended in court if necessary. Hospitals save money both ways.

Patients, too, benefit from honesty. They are provided a quick and fair alternative to litigation, and their safety is enhanced. Michigan says that honesty has helped its doctors improve medical care because they can learn from their mistakes.

Honesty and apologies for medical errors has grown into a movement; doctors, lawyers, and patient advocates have formed a group which advocates apologies and upfront compensation for medical errors. The coalition is positioning the honesty approach as a middle-ground solution to the medical malpractice crisis and has already caught the attention of legislators in Illinois, Kentucky, Vermont, South Carolina, Tennessee, and New Jersey.

The addition of Harvard Medical School's teaching hospitals to the movement will only fuel the fire and teach more people that sorry really does work.

Doug Wojcieszak is spokesman for the Sorry Works! Coalition.

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