TUESDAY, Aug. 17 (HealthDay News) -- When doctors make mistakes,
admitting the error, saying "I'm sorry" and offering compensation
may go a long way toward preventing malpractice lawsuits, new
In 2001, University of Michigan Health System launched a program
encouraging health workers to report medical mistakes. The program
included a procedure for telling patients and their families about
errors; explaining who made the error, how it occurred and what
steps were taken to prevent a similar mistake in the future; making
a sincere apology to the patient or their family; and offering fair
compensation for harm when at fault.
The result was a reduction in the number of lawsuits and other
compensation claims, a faster resolution of disputes and lowered
legal costs overall.
Traditionally, doctors and risk managers have feared that
admitting fault invites lawsuits and amounts to handing over a
"blank check" to attorneys, explained study author Allen Kachalia,
medical director of quality and safety at Brigham and Women's
Hospital in Boston.
"Lots of people say that if we do the right thing and disclose errors, malpractice claims and liability will ruin it," Kachalia said. "What our findings show is it can be done, and in fact, liability costs and claims actually got better."
Researchers from the University of Michigan Health System,
Brigham and Women's Hospital, and colleagues analyzed records on
1,131 malpractice claims, or requests for compensation due to
medical error, between 1995 and 2007, which covered several years
before and after the program was implemented.
After health care providers began admitting mistakes,
apologizing and offering compensation, the monthly rate for new
claims fell from just over seven per 100,000 patient encounters to
4.52 per 100,000, or 36 percent.
The average monthly rate of malpractice lawsuits filed against
the hospital fell by more than half, from 2.13 per 100,000 patient
encounters to 0.75 per 100,000.
The median time it took to resolve claims also dropped by
several months, while the mean costs for liability, including
compensating patients and paying attorneys, fell by about 60
percent. The average cost for lawsuits that were filed decreased,
from nearly $406,000 to $228,000.
The study, funded by the Blue Cross Blue Shield of Michigan
Foundation, is published in the Aug. 17 issue of the
Annals of Internal Medicine.
Before the disclosure program began, the health system did what
many still do: assigning the claim to a defense lawyer, according
to the study.
So the health system was taking a risk when it decided to change
its policies. While prior research suggested transparency and
apologies might avert lawsuits, there was no guarantee, Kachalia
"The program started with the belief that doctors had an ethical obligation to disclose mistakes, and it followed that making a fair offer of compensation was also the right thing to do," Kachalia said. "They really didn't know what it was going to do to costs."
Though the program appears to be successful, Kachalia noted that
medical malpractice claims in general fell throughout the state
during that period. Researchers also could not distinguish whether
the disclosures of errors originated with medical staff, or were
offered in response to a patient complaint.
But even with those caveats, it makes sense that patients would
appreciate health workers who take responsibility for errors,
"The sincerity, the honesty and the transparency are the three big drivers," he said. "There is a lot of research that has shown when people are upset, or when they feel there is a lack of honesty, they are more likely to sue. Our study does not prove a 'disclosure-and-offer' program will reduce liability. What it shows is [doctors and hospitals] can do this and not break the bank."
A. Russell Localio, an associate professor of biostatistics at
University of Pennsylvania who wrote an accompanying editorial,
called the findings "promising."
Research suggests that fears of lawsuits prompt doctors to order
more diagnostic tests than may be necessary, Localio said. Reducing
the fear of being sued could potentially help lower costs of health
care in general, he said.
But one obstacle to making such a program work elsewhere is
that, unlike the University of Michigan Health System, much of the
nation's health system is fragmented. Errors usually aren't caused
by one person, but instead can involve communication problems
between internists, surgeons, anesthesiologists, nurses and
technicians, Localio said.
"If you have a unified system, when you approach a patient, you can do it on behalf of everyone involved," Localio said. "But if everybody is working independently and has their own insurance and [their] own lawyers, it can be much more difficult."
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