The Full Disclosure / Early Offer Movement: What it Could Mean for You if You Ever Suffer a Medical Mistake
by www.SixWise.com
A concept called "full disclosure / early offer"
is spreading through the health care field like a wildfire.
In short, the movement encourages -- and in some states even
grants legal rights to -- doctors and other health care personnel
to apologize after they've made a medical mistake.
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It's anger, not greed, that drives most patients to
take legal action when a medical error occurs, according
to the Sorry Works! Coalition.
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Traditionally, doctors were discouraged, to put it lightly,
from saying much of anything about a medical mishap for fear
that it could be used against them in litigation.
Instead of "full disclosure / early offer," the
preferred course of action was more like a policy of "defend
and deny."
It was commonplace, meanwhile, for patients to receive only
partial information or misinformation altogether regarding
what occurred, for instance being told they had an allergic
reaction to anesthetic when, in reality, too much had been
given.
Medical errors in hospitals alone cause 44,000 to 98,000
deaths in the United States each year, according to the Institute
of Medicine. This makes them the eighth leading cause of death
in the country.
By allowing doctors to apologize for mistakes, and take any
necessary remedial action right away, the theory is that it
will cut back on the amount of medical practice lawsuits.
Further, this practice also makes reporting medical errors
much easier, since the mistake is already out in the open.
Many medical errors currently go unreported, even though becoming
aware of the mistakes that are occurring would likely help
to prevent them from happening again in the future.
In fact, while most doctors say they do want to be honest,
fewer than half will reveal serious errors they have made,
according to an August 2006 study in the Archives of Internal
Medicine.
Health care providers "willing to admit when they have
made an error and quickly get on top of it ... cut down on
the anger that leads to litigation ... Patients bring lawsuits
when they can't get answers," says Doug Wojcieszak, founder
of The Sorry Works! Coalition, an advocacy group aimed at
publicizing and implementing the full disclosure / early offer
concept.
Full Disclosure / Early Offer Spurs Positive Changes
More than 30 states have adopted laws that will protect a
doctor's apology from being used in a trial. Further, hospitals
across the United States are adding policies that actually
require doctors and nurses to disclose medical errors and
offer apologies to the patients and families affected. In
many cases, financial settlements are also offered upfront.
The University of Michigan Health System is one such hospital
that has begun using a policy that encourages full disclosure
of medical errors and apologies to patients.
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Upon adopting a full disclosure policy for medical
errors, the University of Michigan Health System saw
pre-suit claims and lawsuits decrease from 260 in July
2001 to fewer than 100 in January 2007.
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Since they have implemented these changes, the number of
pre-suit claims and lawsuits has decreased from 260 pending
in July 2001 to fewer than 100 in January 2007. Further, the
average amount spent on legal fees for each case has fallen
more than 50 percent.
In all, litigation costs fell from an average of $65,000
per case to $35,000 per case, which resulted in a total average
annual savings of $2 million to the hospital.
The average time it took to resolve claims and lawsuits also
fell dramatically, from 20.7 months in 2001 to 9.5 months
in 2005.
Similarly, the largest malpractice insurer in Colorado, COPIC,
enrolled 1,800 physicians in a program that required them
to express remorse to patients for medical care gone wrong,
along with explain in detail what happened. Meanwhile, the
insurer paid for the patients' related expenses.
As a result, malpractice claims against the 1,800 doctors
dropped by 50 percent from 2000 to 2005, and the cost of settling
the doctors' claims fell by 23 percent.
"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," according
to Michigan Health System's chief risk officer Richard Boothman
in a Wall Street Journal article.
The MEDIC Bill: A National Policy for Apology
The full disclosure /early offer programs have been so successful
that they're receiving national attention.
Sens. Barack Obama (D-Ill.) and Hillary Rodham Clinton (D-N.Y.)
have proposed national legislation known as the National Medical
Error Disclosure and Compensation Bill (the MEDIC bill) that
would "provide federal grant support and technical assistance
for doctors, hospitals, and health systems that disclose medical
errors and problems with patient safety and offer fair compensation
for injuries or harm."
They believe the MEDIC bill would:
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Promote open communication between patients and providers
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Reduce the rates of preventable medical errors
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Ensure patient access to fair compensation for medical
injury, negligence, or malpractice
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Reduce the cost of medical liability insurance
What Does This Mean for Patients?
Experts agree that full disclosure is the best policy to
help institutions learn from their mistakes. As a patient,
this means that hospitals and doctors may eventually be able
to bring down the number of medical-error-related deaths each
year (which, remember, is now as high as 98,000).
The ultimate goal, optimistically, would be to provide a
safer, more open and honest setting for health care in the
United States.
"We like to educate people that disclosure is simple
common sense," writes the Sorry Works! Coalition. "Reducing
anger among patients and families and avoiding the appearance
of cover-ups decreases the number of lawsuits, defense litigation
expenses, and health care providers' settlement costs."
"When the emotions of patients and families are acknowledged
and constructively addressed," they continue, "money
becomes a secondary issue."
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Sources
The
New England Journal of Medicine May 25, 2006, Volume 354:2205-2208
The
Sorry Works! Coalition
ChicagoTribune.com
August 19, 2007