Denying malpractice can threaten patient safety

A decade has passed since the Institutes of Medicine released "To Err is Human," a groundbreaking report that brought attention to the problem of medical errors and launched the patient safety movement. Meanwhile, the high cost of insuring against malpractice claims continues to affect physicians in their practices.

Increasingly, patient safety and medical malpractice are being talked about in the same sentence. But the cause-effect relationship isn't as simple as "medical errors cause malpractice cases." In fact, many experts argue that the relationship is just as likely to be the other way around--that denying errors creates a culture in which they're permitted to continue.

"The biggest cost of 'defend and deny' isn't the legal cost, it isn't the lawyers' fees or the judgment," Richard Boothman, chief risk officer for the University of Michigan Health System, said at a forum in Washington, D.C., last week attended by FierceHealthcare. "The biggest cost is the chilling effect it has on any professional improvement." It's difficult to both deny responsibility and also look at what could have been done better.

The meeting, sponsored by Common Good and the Robert Wood Johnson Foundation, gathered leading medical liability and patient safety experts to discuss innovative ideas for addressing the two problems. 

Martin J. Hatlie, President of the Partnership for Patient Safety, said he sees the connection between patient safety and medical liability reform as an "exciting" development. "The tort system is a huge vector in patient safety," he said, pointing out that "patients want to see the connection to change, and the tort system doesn't offer that."

Some successful programs have included the following components:

• Establishing a "culture of safety" with patient safety improvement and error prevention programs.
• Full disclosure and open communication in the case of an avoidable error--this includes a sincere apology and explanation of efforts to avoid the error in the future.
• Compensation for avoidable injuries according to an established schedule without resorting to the courts.
• Alternative dispute resolution techniques, including mediation, arbitration, or the establishment of health courts--specialized administrative courts designed to handle medical injury disputes.

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