Additional Reading and Resources

March 14, 2011

A Better Approach to Medical Malpractice Claims? The University of Michigan Experience
Journal of Health & Life Sciences Law, January 2009
By Richard C. Boothman, Amy C. Blackwell, Darrell A. Campbell, Jr., Elaine Commiskey, and Susan Anderson
Abstract: The root causes of medical malpractice claims are deeper and closer to home than most in the medical community care to admit. The University of Michigan Health System's experience suggests that a response by the medical community more directly aimed at what drives patients to call lawyers would more effectively reduce claims, without compromising meritorious defenses. More importantly, honest assessments of medical care give rise to clinical improvements that reduce patient injuries. Using a true case example, this article compares the traditional approach to claims with what is being done at the University of Michigan. The case example illustrates how an honest, principle-driven approach to claims is better for all those involved-the patient, the healthcare providers, the institution, future patients, and even the lawyers.  AHLA holds the copyright for this article.
For complete article, visit:
http://www.med.umich.edu/news/newsroom/boothman%20et%20al.pdf

Video: University of Michigan Health System Risk Management (Length: 8:02)
Produced by the University of Michigan Health System. (Note: This streaming video will open in a separate window. If you cannot see the video, disable your browser's popup blocker.) 

Apology in Medical Practice: An Emerging Clinical Skill
Journal of the American Medical Association, Sept. 20, 2006
By Aaron Lazare, MD
Extract: The idea that physicians should make full disclosure of medical errors to their patients has grown in importance since the late 1980s and early 1990s. This movement gained momentum following the 1999 Institute of Medicine report, To Err Is Human, an in-depth study of the extent of medical errors, and the 2001 Safety Standards of the Joint Commission on Accreditation of Healthcare Organizations on disclosure of patient harm.
As physicians were encouraged to disclose medical errors, offering an apology would inevitably seem to be the next step. What sense would it make to admit harm without acknowledging responsibility, offering explanations, expressing remorse, and discussing reparations-all parts of an apology? Without such offerings, most patients in response to such disclosures would more likely be offended than soothed. (continued)For complete article, visit:
http://jama.ama-assn.org/content/296/11/1401.full (subscription or purchase required)

Liability Claims and Costs Before and After Implementation of a Medical Error Disclosure Program
Annals of Internal Medicine, Aug. 17, 2010
Allen Kachalia, MD, JD; et. al.
Summary: The University of Michigan Health System has fully disclosed medical errors and offered compensation to patients since 2001. Other health systems have been hesitant to adopt similar programs for fear that disclosure could make things worse. This study found a decrease in new legal claims, number of lawsuits per month, time to claim resolution, and costs after implementation of the program compared with before implementation. This experience demonstrates that disclosure with an offer of compensation can be conducted without exacerbating liability claims and costs.
For full text:
http://www.annals.org/content/153/4/213.full.pdf+html 

Making Patient Safety the Centerpiece of Medical Liability Reform
The New England Journal of Medicine,  May 25, 2006
Hillary Rodham Clinton and Barack Obama
Extract:  We have visited doctors and hospitals throughout the country and heard firsthand from those who face ever-escalating insurance costs. Indeed, in some specialties, high premiums are forcing physicians to give up performing certain high-risk procedures, leaving patients without access to a full range of medical services. But we have also talked with families who have experienced errors in their care, and it has become clear to us that if we are to find a fair and equitable solution to this complex problem, all parties - physicians, hospitals, insurers, and patients - must work together. Instead of focusing on the few areas of intense disagreement, such as the possibility of mandating caps on the financial damages awarded to patients, we believe that the discussion should center on a more fundamental issue: the need to improve patient safety.
For full text:
http://www.nejm.org/doi/full/10.1056/NEJMp068100

Guilty, Afraid, and Alone - Struggling with Medical Error
The New England Journal of Medicine, October 25, 2007
Tom Delbanco, MD and Sigall K. Bell, MD
Extract:  Since 1999, health care professionals have been focusing on To Err Is Human, the Institute of Medicine report that sounded alarms about medical error. As we have strived to reduce the rate of errors, systems-based practices such as electronic order entry and procedure checklists have proliferated. Meanwhile, little attention has been paid to the second half of the adage - "to forgive, divine." How can we characterize and address the human dimensions of medical error so that patients, families, and clinicians may reach some degree of closure and move toward forgiveness?
In interviews that our group conducted for a documentary film, patients and families that had been affected by medical error illuminated a number of themes.1 Three of these themes have been all but absent from the literature. First, though it is well recognized that clinicians feel guilty after medical mistakes, family members often have similar or even stronger feelings of guilt. Second, patients and their families may fear further harm, including retribution from health care workers, if they express their feelings or even ask about mistakes they perceive. And third, clinicians may turn away from patients who have been harmed, isolating them just when they are most in need.
For full text:
http://www.nejm.org/doi/full/10.1056/NEJMp078104#t=article

Malpractice Reform - Opportunities for Leadership by Health Care Institutions and Liability Insurers
The New England Journal of Medicine, April 15, 2010
Michelle M. Mello, JD, PhD and Thomas H. Gallagher, MD
Extract: In February 2010, the Illinois Supreme Court ruled that the state's cap on noneconomic damages in medical malpractice cases violated the Illinois constitution.1 This development has contributed to growing pessimism about traditional approaches to medical liability reform. In some quarters, interest is shifting to innovative reforms that can be implemented by health care institutions and liability insurers without requiring changes in the law. These approaches provide a better balance between the interests of providers and those of patients and illuminate a path around the political gridlock over tort reform. They also afford opportunities for health care institutions and liability insurers to take the lead in reforming the processes for providing compensation for medical injuries.
For full text:
http://www.nejm.org/doi/full/10.1056/NEJMp1001603

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