The idea was the brainchild of Chief of Staff Dr. Steve Kraman and Ginny Hamm, legal counsel for that V.A., and is detailed in their report in the Annals of Internal Medicine (Ann Intern Med. 1999; 131: 963-967.) They noted that medical malpractice claims were much like divorce proceedings, in that the plaintiffs were often angered at what they perceived as a betrayal of trust, and that families of patients often sought financial revenge for what they viewed as cover-ups of inadequate care.
Dr. Kraman and Ms. Hamm therefore set a new proactive policy for the Lexington VAMC. They asked medical and nursing staff to report to a committee all incidents which might reasonably be considered negligent practice. Importantly, "when investigation identified an incident of negligence of which the patient or next of kin was apparently unaware," the VA then proceeded to "notify the patient of the committee’s findings."
That proactive component of going up to the patient and his family and saying "we screwed up and we're sorry and we'd like to make it up to you" had apparently never been done before. They found that even though their policy seemed on the surface to "be designed to maximize malpractice claims," that patients and families expressed much less anger and desire for revenge:
In our experience, plaintiffs’ attorneys, after first confirming the accuracy of the clinical information volunteered by the facility, are willing to negotiate a settlement on the basis of calculable monetary losses rather than on the potential for large judgments that contain a punitive element.In effect, by avoiding courtroom disputes, they were able to pay out more money to the patients and families, and less to prosecuting and defense attorneys.
Those interested in this subject matter should read the Kraman and Hamm article (pdf). The broader implications are discussed in the NYT article.
How sensible! If more businesses of all kinds would adopt the policy, we could move to a more civilized society.
ReplyDeleteFile this under "DUH!"
ReplyDeleteI've had doctors own up to mistakes, even serious ones. It's amazing how that simple act can remove nearly every trace of a desire to fight about it. Unfortunately doctors' counsel have been advising them some time now never to admit to anything for fear of being sued. It's true that, while most patients won't sue a doctor they like and who they feel has treated them honestly, there are still grifters out there who are only looking to seize on any admission as an excuse for a strike suit.
ReplyDelete