Might Full Disclosure of Medical Error be the Best Policy?

The overwhelming majority of hospitals will not admit mistakes to patients if there is little chance of patients finding out, and may not even discuss the mistakes after the patients do find out. Of course, hospitals do this to fend off the threat of lawsuits.

Yet Dr. Steven Kramm, former chief of staff at the VA hospital in Lexington, Kentucky, argues that the opposite approach might be best from everybody’s perspective. A PowerPoint file of Dr. Kramm’s report entitled “Victim Compensation Without Litigation–the Lexington Experience” can be found on the SorryWorks website. To find it, scroll down and click on the link that says “Download.”

Some of the key points of Dr. Kramm’s assessment:

-As mentioned above, most hospitals say nothing to patients if something has gone wrong. If the patient does know and wants compensation, the hospital takes the same action regardless of whether it is at fault or not. That action often involves cutting off all contact with the patient; even where this is not the case, the patient is usually kept at a distance and given little information. (Slides 3-4)

-From 1987 onwards, the Lexington VA took the opposite approach and offered full disclosure even when the patient did not know anything had gone wrong.

-The process involved practitioners and administrators identifying cases where compensation might be justified, discussing the possibility of disclosure in those cases together, and finally making the disclosure to the patient with a presentation of compensation options. The hospital would also suggest that the patient might retain an attorney, as this would prevent the patient from having “buyer’s remorse” or feeling cheated. (Slides 9-11)

-The result was that, from 1987 to 2003, the single largest payment made by the Lexington VA was $341, 000 for a wrongful death case and the average settlement was $16,000. They negotiated over 170 settlements and took only three cases to trial, out of which they lost two and won one. (Slide 15)

-By contrast, the mean malpractice judgment for VAs across the nation in 2000 was $413,000, the mean pre-trial settlement was $98,000 and the mean at-trial settlement $248,165.

-The overall mean payment for Lexington (regardless of whether the case was settled or went to trial) was $36,000 as of 2000.

Clearly, Lexington comes out as the financial winner, in addition to having a policy that gives more consideration to accountability and sympathy.

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