Errors and Apologies

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Last month, Pennsylvania became the 36th state to adopt a “benevolent gesture” law following its unanimous approval by the state’s House of Representatives and the signature of Gov. Tom Corbett. As noted in an article in The Pennsylvania Record, a legal journal, the law allows medical professionals to discuss medical errors with patients — including apologizing for mistakes — without the risk of their words being used against them in a lawsuit, if the patient (or his or her family) decides to sue over the matter. Despite the overwhelming support that the measure ended up receiving, its supporters in the legislature had been working on passing it for eight years — an indication of the powerful competing interests, from trial lawyers to hospitals, that seek to influence the legal landscape surrounding medical malpractice claims.

As quoted in the Record article, the law’s main sponsor in the legislature, Sen. Pat Vance (who happens to be a registered nurse), noted that since the University of Michigan began to encourage its medical staff to apologize for mistakes starting in 2001, the rate of malpractice claims has fallen by about 50%. She expressed her hope that Pennsylvania would see similar results following its adoption of the new law. According to a statement in the article by the Pennsylvania Health Care Association, a group representing long-term care providers, many patients file malpractice claims out of anger against what they perceive to be an uncaring institution, rather than because of the potential financial reward.


But some medical errors are so shockingly tragic, and shockingly preventable, that an apology may seem almost beside the point. In one of her series of blog posts on preventing medical errors in 2010, Jan Chait wrote about a woman whose hospital feeding tube went into her lungs instead of her stomach. It is standard procedure to perform an x-ray whenever a feeding tube is inserted to make sure that the tube is in the right place, but someone forgot to do this, and the woman died when her lungs were filled with liquid meal replacement. This incident took place at a major teaching hospital with an excellent reputation. It is possible that as a result of a lawsuit in cases like this, such a hospital might be moved to institute a system of tighter checks — perhaps adopting checklists for procedures that, in this case, would require an x-ray technician’s initials before any liquid meal replacement could be dispensed.

And hospital procedures can make an enormous difference in the rate of errors. One study, published in 2011 in the International Journal of Health Care Quality Assurance, found that the rate of medication errors in hospitals — the most common type of error — ranged from 6.43% with a single-dose dispensation system to 13.59% with a traditional dispensation system. A study from 1995 found that in a British hospital, where pharmacists make rounds and review patients’ medication charts, medication errors were as low as 3.0%. Perhaps if their financial incentives were great enough, hospitals could greatly reduce the number of deaths caused by preventable medical errors — a number greater, by one estimate, than that of deaths caused by diabetes or Alzheimer disease.

Have you ever been, or known someone who was, the victim of a preventable medical error? If so, was an apology and/or explanation provided, or did the health-care provider hesitate to admit wrongdoing? Did you, or the person in question, ever consider filing a lawsuit? Other than the threat of lawsuits, what could motivate more hospitals to adopt rigorous anti-error procedures and training programs? Leave a comment below!

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