June Volume Number he overheated political debate surrounding the medical malpractice - PDF document

344 June 2006 Volume 32 Number 6 Veterans Affairs (VA) Hospital in Lexington, KentuckyThis article describes The Sorry Works! Coalition, anEnter The Sorry Works! CoalitionThe Sorry Works! Coalition (http://www.sorryworks.net) Doug Wojcieszak The Sorry Works! Coalition, an organiza-apologize to the patient/family, admit fault, provide ansation. The Sorry Works! protocol is based on the disclo-sure program developed at the Department of VeteransAffairs Hospital in Lexington, Kentucky. The coalition’s goals are to (1) educate part, the coalition’s educational efforts are intended todoctors are to enjoy the benefits of Sorry Works! andSorry Works! entails changing the cul- Dr. Steve Kraman is a board member of The Sorry Works! Coalition. 345 ability to sue but will rarely choose to do so. Finally, weSorry Works! as the gateway to the patient safety move-ment. The Sorry Works! middle ground should meet thefamily, admit fault, provide an explanation of what hap-If, however, the standard of care was met—there wasinnocence. However, the providers do not settle or offercommitted no error. (Providers are never “sold out” tosettle a claim quickly and cheaply.)The Sorry Works! protocol is based on the disclosureprogram developed at the VA Hospital in Lexington,Kentucky,The Sorry Works! Coalition believes that full disclosureprogram currently offered. Sorry Works! (1) restores thedeath or injury wasn’t their fault. Preliminary experienceSorry Works! Coalition emphasizes that up-front com-The goals of The Sorry Works! Coalition are to (1)tion and lobbying are not The Sorry Works! Coalition’snumber-one priority. After all, the medical malpracticetures, right? Wrong. The Sorry Works! pilot programs and other legislativetiative. Health care providers can do Sorry Works! rightThe coalition’s educational efforts are represented inthe Sorry Works! Web site, which provides resources,gies, download a presentation on the Lexington VA’sJune 2006 Volume 32 Number 6 346 June 2006 Volume 32 Number 6the Web site received more than 350,000 hits. The coali-Perhaps the largest part of the coalition’s educationalgoing to say, “Why aren’t we doing this?” At the LexingtonVA, during a seven-year period, the hospital sank to theVA’s average payout was $16,000 per settlement, versusthe national VA average of $98,000 per settlement, andThe UM chief risk officer, Richard Boothman, report-openness pervades all of the system’s dealings, it is better1.We will seek to compensate quickly and fairly when2.We will defend our staff and institution vigorouslya patient injury.3.We will seek to learn from our mistakes and ourreported, for example, by Jeff Driver, chief risk officer at, chief risk officer atOmbudsman/Mediator Program (MEDIC+OM). First imple-mented in 2001 at the National Naval Center in Bethesda,Maryland, the ombuds/mediator program is now used indozens of Kaiser Permanente hospitals. In thousands ofcases, skilled and highly trained ombuds have been resolv-ing disputes, restoring trust, and preserving resources—aswell as avoiding litigation. Patients and families have beenreceiving the answers they seek, physicians have been dis-closing honestly, and hospitals have been making neces-sary quality improvements to increase patient safety.save money, and, most importatnly, “do the right thing.” full disclosure was that it can work only at VA or gov-as the VA, it is necessary to get buy-in from only oneinsurance companies. However, the private Kaisercontractors, Sorry Works! and other full-disclosure pro-Recently, Catholic Healthcare West persuaded severalWorks!–type) program, at the Children’s Hospitals andAlthough The Sorry Works! Coalition advocatesThe Wall Street Journal, 347 Works! board member Dr. Rick Van Pelt apologized to asuffering. The woman forgave Van Pelt and decided notto sue, and she and Van Pelt are now friends and workWe like to educate people that disclosure is simpleand families and avoiding the appearance of cover-Deny and defend also gives the perception of a cover-up,every year. David Patton, a medical malpractice plain-tiffs’ attorney and another Sorry Works! board member,has stated, “We never sue the nice, contrite doctors.A large part of the Sorry Works! Coalition’s educa-s educa-increase the likelihood of the patient filing a malpracticesuit and be used against the doctor in court if they do sue.However, this assertion, which on the surface seems rea-We now address some of the most common chal-Sorry Works! will only lead to more law-news. That’s no way to live. If a mistake occurs, doctorshave to ask themselves one question: “Would it be betterSorry Works! provides the protocol to constructively andWhat if sorry doesn’t work and a doctorfrom attacks by the trial lawyer. The jury will becomeangry, but not at the doctor. Many states have or are plan-Sorry Works! Coalition supports such laws and legislation. in my hometown for Sorry Works! to be successful here. providers to implement Sorry Works! Doctors, hospitalble to make sure that patients and families don’t leavetheir offices angry in litigious regions. Sorry Works! pro-sive trial attorney is powerless without an angry, yetresult of errors.Sometimes people just die or areinjured, despite the medical staff’s best efforts. Wecan’t be handing out checks every time someone diesor doesn’t heal completely. June 2006 Volume 32 Number 6 348 June 2006 Volume 32 Number 6cumstances. However, they still need to communicateperception of a cover-up produces lawsuits even whenSorry Works! stresses communication with patientsdid not occur. Medical records and charts should beinsight, and empathize with the patient and family, but aand not settle. This is where Sorry Works! pays dividends.Hospitals that practice Sorry Works! develop a reputationI believe the word is out that if they [the plaintiff’s bar]family. I also believe that if they have a marginal or ques-Dr. Kraman developed Sorry Works! ina VA hospital. It will never work in a private or not-for-As discussed earlier, Kaiser Hospitals andCatholic Healthcare West show this to be untrue.insurers, Sorry Works! will become easier to implement. Sorry Works! increases settlements,Not necessarily. According to thedisclosure is rigorous, forthright, and speedy, then aAvoiding the database is an important topic for manyhealth care providers; however, there is considerablesubject, including many members of The Sorry Works!doesn’t become an easy out for bad doctors. doctors are to enjoy the benefits of Sorry Works! andthe harmed party, while the second is for the welfare of, while the second is for the welfare oftive] will be to avoid precisely what moral reflectionand action require, namely, confronting the reality ofway.for it, however, runs the immense risk of seeming , runs the immense risk of seeming rationalized version of what occurred to the harmedparty, that communication might well strike the listener 349 A professional’s rationalizing or minimizing responseIndeed, the greatest hurdle to Sorry Works! will medical community. Cultural change will take years, However, the economic benefits of full disclosure will,hopefully, cause health care, legal, and insurance lead-medical community. Sorry Works! Coalitionhowever, the full-disclosure movement is not yet fully organized. The number-two priority of The SorryWorks! Coalition is to serve as an organizing force andSorry Works! conference and is seeking additional lead-The Sorry Works! Coalition has recently gained attentionWorks! pilot program in Illinois.Works!—with the state paying for any excessive liabilitytal’s normal liability costs. are considering similar legislation. Tennessee is con-sidering Sorry Works! pilot program legislation (SB3325), while Vermont legislators are reviewing legisla-Works!–type programs. Also, legislators in SouthAlthough The Sorry Works! Coalition welcomes andSorry Works! entails changing the culture of medicine,must be taught that Sorry Works!–type disclosure J June 2006 Volume 32 Number 6 Doug Wojcieszak,is Spokesperson, The Sorry Works!Professor, Department of Bioethics, Emory University,Atlanta, and a Board Member of The Sorry Works! Coalition.L.L.C., Washington, D.C. Please address reprint requests toDoug Wojcieszak, doug@sorryworks.net. 350 June 2006 Volume 32 Number 6 Oakbrook Terrace, IL: Joint Commissionthe best policy. 3. Kraman S.S., et al.: John M. Eisenberg Patient Safety Awards.Advocacy: The Lexington Veterans Affairs Medical Center. meeting of the Greater New York Hospital Association, New York City,5. Hall S.: UM docs say sorry, avert suits. 32:7,10, Mar.–Apr. 2006. Center. Lecture given at the annual meeting of the Greater New YorkHospital Association, New York, May 13, 2005.8. Personal communication between the author [D.W.] and CarolBayley, Director of Risk Management, Catholic Healthcare West, San10. Gebhart F.: Federal bill would promote apology after medicalDrug Topics, Health System Edition, Nov. 21, 2005, p. HSE16. 11. Zimmerman R.: Doctors’ new tool to fight lawsuits: Saying I’m sorry.The Wall Street Journal,12. Personal communication between the author [D.W.] and David32:16–18, Mar.–Apr. 2006. http://www.npdb-hipdb.com/npdbguidebook.html (E. Reports) (lastaccessed Apr. 14, 2006).Sudbury, MA: References