Honesty May Fight Malpractice Suits

Date: Wed, 22 Dec 1999 01:18:33 EST

By DAVID WILKISON

c The Associated Press

PHILADELPHIA (AP) - A hospital's policy of owning up to its mistakes shows health care facilities can be honest about errors and still reduce costly malpractice litigation, patient advocates say.

``You don't go to court unless you're angry, unless it's the last resort,'' said Ray McEachern, president of the Association for Responsible Medicine in Tampa, Fla. ``Most everybody would rather settle things man to man rather than go through some fantastic legal process.''

A study published today in the Annals of Internal Medicine suggests hospitals can forestall lengthy, expensive litigation by admitting mistakes and offering fair compensation before the patient or the patient's family even realizes the error.

The study looked at a policy in effect since 1987 at the Veterans Affairs Medical Center in Lexington, Ky. The policy calls for full disclosure to patients injured either accidentally or through medical negligence.

Doing so ``diminishes the anger and desire for revenge that often motivate patients' litigation,'' wrote Dr. Steve Kraman, the hospital's chief of staff. He said plaintiffs' attorneys become more willing to negotiate a settlement without trying to punish the institution with a large damage award.

The study compared the 407-bed hospital's liability payments with those of 35 similar veterans hospitals from 1990 through 1996.

The center paid $1.3 million during the period, an average of $190,113 a year, or $15,622 per claim. Liability payments at the other hospitals ranged from less than $1 million to $12 million.

Only seven had lower liability totals than the Lexington hospital; 28 had higher totals.

``We are projecting too much anxiety onto our decisions,'' said Dr. Albert Wu, associate professor of health policy and management at Johns Hopkins University School of Medicine. ``We are using, perhaps, the threat of a suit to help us justify keeping quiet.

``That defensive posturing infuriates patients when what they really want is an explanation, an apology and the hospital to take some corrective action,'' he said.

The Lexington policy arose after the hospital lost two malpractice judgments totaling more than $1.5 million. Administrators were unsure at first what to do when they encountered a case in which family members were unaware of problems that led to a death.

``We didn't want our closet to be cluttered with skeletons, so we contacted the family and told them the whole thing, and we settled with them,'' Kraman said.

Under the hospital's policy, a risk management committee identifies and investigates troublesome cases. If the committee finds malpractice resulted in loss of life, earning capacity or other functions, the patient or next of kin is notified. The family is even helped with filing claims.

``Very rarely does a case go to court,'' Kraman said. ``Our policy is to find out what's wrong, investigate it, apologize and offer compensation. Sometimes there is anger and surprise. In many cases, they get very emotional that someone cared enough about them, that they told the truth.''

During the seven-year period studied, the hospital had 88 malpractice claims. Seven proceeded to federal court and were dismissed before trial; one claim went to trial and was won by the hospital.

Five settlements involved cases that may have never come to light had the hospital not informed patients and families of errors.

A Senate health subcommittee held hearings last week on a report that said medical errors kill between 44,000 and 98,000 hospitalized Americans every year.

The Institute of Medicine, which advises the government on scientific matters, recommended an end to medicine's ``culture of secrecy'' and called for a mandatory national reporting system. The American Medical Association opposes such a system, saying doctors will still keep mistakes secret if they fear discussion can lead to punishment or lawsuits.