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Healing sound of a word: 'sorry'

Doctors and hospitals are learning to disclose their mistakes. Patients often respond with lowered demands for damages.

March 24, 2003|Valerie Reitman | Times Staff Writer

When Duke University surgeons last month transplanted an incompatible set of organs into teenager Jesica Santillan, who would later die, the doctors and hospital publicly confessed the mix-up and apologized.

Such candor is part of a growing trend among hospitals to own up to the truth when patients are harmed by the medical care that is supposed to help them. Saying "I'm sorry," along with acknowledging the error, can also help ease the pain for patients and their families.

Not only is it the ethical thing to do, hospitals that are doing it say, but some studies show that it also pays off financially: The patients still may sue if they feel the hospital doesn't offer enough compensatory damages, but they may seek less money. An analysis of settlements made by the Veterans Affairs Hospital in Lexington, Ky., which has fully disclosed errors since 1987, found that its liability was no higher than comparable veterans' hospitals without a full-disclosure practice. An analysis in the Annals of Internal Medicine in 1999 concluded that the medical center's honesty and compensation policy diminished the "anger and desire for revenge that often motivate patients' litigation." The federal government, which operates the Veterans Affairs Hospital, also saved in legal defense fees.

The American Hospital Assn. and its accrediting agency maintain that physicians and hospitals are ethically obligated to disclose everything that happens in a patients' care, including mistakes.

Nevertheless, it often doesn't happen. Hospitals and physicians fear disclosure will prompt legal action and damage the reputation of the institution and its physicians. The instinct is to say as little as possible.

Medical errors happen surprisingly frequently in hospitals: An Institute of Medicine report in 1999 estimated that 48,000 to 98,000 errors occur every year. Most common are medication mistakes: giving the wrong drug or the wrong dosage perhaps at the wrong time. But doctors also have vastly misdiagnosed conditions, amputated the wrong limbs or breasts, been provided with incorrect pathology reports and left instruments or cotton at the site of the operation. In addition, an estimated 90,000 patients a year in the U.S. die of infections they acquire in hospitals, many of which are preventable, according to the federal Centers for Disease Control and Prevention.

In 1998, a Marin County surgeon performed bypass surgery on the wrong artery of actor/comedian Dana Carvey. The physician attached a healthy segment of Carvey's artery not to the damaged arterial section nearby but to a healthy diagonal vessel. A few months later, Carvey had to undergo an emergency angioplasty to clear the dangerously clogged artery that hadn't been repaired. He sued for $7.5 million. What he wanted, he said in a television interview describing his ordeal, was an apology from the doctor and an acknowledgment that the surgeon had erred.

Said Carvey, "It was only because in his deposition he said, 'I didn't make a mistake.' Total, you know, denial. So I had to" sue, Carvey said in the interview. Instead, the doctor's attorney claimed in court papers that the doctor could have been misled by the unusual anatomy of Carvey's heart. But Carvey's second surgeon said in the same interview that Carvey's anatomy was "pretty ordinary." Carvey, through a spokesman, declined to comment for this article.

Jill McDonell, a Los Angeles attorney who has represented consumers in medical malpractices cases, concurs. "Clients say they never would have sued, they are just so angry when they [medical officials] deny it. Particularly in small suits. If the guy left their baby brain-dead, they probably would still sue. But in a smaller case, they figure if he can't even give me an apology, at least he can pay for his damage."

Patients want answers

Patients are looking for three things when mistakes happen, says Leonard Marcus, director of the Program for Health Care Negotiation and Conflict Resolution at Harvard University's School of Public Health. They want to find out what happened, get an apology from the doctor or hospital and be assured that the mistake will not happen again. Marcus and his research team formed these conclusions after analyzing several dozen mediations between patients and caregivers after the patients filed complaints with the Massachusetts medical board that oversees physician licensing and discipline.

"There are positive outcomes in immediately sitting down and talking to patients and family after the error," Marcus said.

In one complaint, for example, a young child stuck herself on a discarded syringe. The mother had complained to the state medical board but wasn't interested in winning monetary compensation so much as preventing similar incidents. The doctor assured her that the wastebasket where the syringe had been discarded had been placed high enough that the incident wouldn't be repeated.

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