Health care executives say the disclosures can solidify public trust and help improve patient safety. Some doctors worry about the public exposure.

Published in: American Medical News
Issue/Volume: August 11, 2008
Written by: Kevin B. O’Reilly

8/3/2008 – The surgical site had been marked, and the surgeon and operating room team did the recommended “time out” briefing to confirm the plan before surgery. The problem: Weeks before the surgery, the side of the patient’s body with the diseased kidney was wrongly identified in the patient’s medical chart.

Officials at Park Nicollet told the patient and family about the error and apologized for it. Days later, the Minneapolis Star Tribune ran a story headlined, “Wrong kidney removed from Methodist Hospital cancer patient.” But the scoop was not planted by an aggressive trial lawyer or dug up by a resourceful investigative reporter. Rather, officials at Park Nicollet decided to go public with the mistake.

The Minnesota hospital is not alone. In the last year, at least five other health care organizations faced with incontrovertible errors causing serious patient harm publicly disclosed their mistakes and apologized for them.

These public mea culpas come on the heels of intense pressure on physicians and hospitals to improve patient safety and transparency, admit mistakes to patients and apologize when things go wrong. While apology and disclosure is still far from the norm, experts say, it is becoming more common as a majority of states now protect expressions of empathy, regret and apology from admissibility in court.

Meanwhile, five states mandate some form of adverse-event disclosure to patients. Eleven states require public reporting of 28 “never events,” such as wrong-site surgery, identified by the National Quality Forum.

The Joint Commission requires disclosure to patients in sentinel events. AMA ethical opinion states that when a doctor errs, “the physician is ethically required to inform the patient of all the facts necessary to ensure understanding of what has occurred.” It also states liability concerns should not impede disclosure.

In July, Boston’s Beth Israel Deaconess Medical Center publicly disclosed a wrong-site surgery. Paul Levy, the hospital’s CEO, said talking openly about such mistakes can help the public put them in context.

“People want to trust the doctors and the hospitals they go to,” he said. “And I think people also know that we’re not infallible and that by admitting our mistakes and demonstrating our desire to improve, it helps the public understand that we really care about them.”

But some doctors are concerned that such openness might make them think twice about reporting errors or near misses.

Jo Shapiro, MD, believes there is a danger that public apologies could make it easier for reporters and trial lawyers to uncover the physicians involved and hit them with bad press and lawsuits, perhaps making other doctors more secretive.

“If you’re going to be transparent with patients and society about everything, you have to always turn around and ask, ‘Will this impact the clinician’s ability to be transparent?’ ” said Dr. Shapiro, chief of otolaryngology, head and neck surgery at Brigham and Women’s Hospital in Boston. She has talked publicly about her emotional struggles after a technical mistake she made in surgery harmed a patient.

Many patient-safety advocates, however, are hailing the incipient trend as a big step forward. Public disclosure of serious errors is a “great idea” because “it facilitates transparency,” said Leah Binder, CEO of the Leapfrog Group, an employer-funded patient safety organization.

“Hospitals — like any other human-run institution — make mistakes, but for a long time hospitals have tried to cover that up a little bit,” Binder said. “Going public with mistakes and talking with the community about them is a very positive move for hospitals and the community.”

Crisis management experts said the public apologies are a savvy way to get ahead of negative news media scrutiny.

“If it’s a really juicy story and a major screwup, the word will get out,” said Steven Fink, president of Lexicon Communications Corp. in Pasadena, Calif. “Then the only question becomes whether you, the hospital, want to play offense or defense.”

Doing the right thing

But health care executives leading the disclosure trend say it is not driven by public-relations strategy.

“Doing the right thing is always the right thing to do,” said Jane T. Schumaker, senior associate dean and CEO of faculty practice at the University of Florida College of Medicine. With the family’s permission, UF officials held a news conference last October to discuss a medication overdose that killed a 3-year-old at its outpatient clinic in Gainesville.

Schumaker said UF has disclosed errors to patients and families for more than 30 years and wanted to do it publicly this time to highlight the importance of being honest with patients. “There may be other effects [of going public], both positive and negative,” she said. “But first and foremost, we should do the right thing and let a family know what happened.”

Others said publicizing mistakes is not the best way of handling them.

Daniel J. Schulte, a Detroit health lawyer, said the idea behind public disclosure is “noble” but added that safety lessons should be shared internally through the legally protected peer-review process.

“These matters ought to be handled directly with the individuals involved and not anybody else,” he said.

Bob Wachter, MD, chief of the medical service at the University of California, San Francisco, Medical Center, said the organizations going public with errors are “brave.” But he said there are other ways of sharing safety lessons.

For example, he edits Web M&M, an online patient safety journal that analyzes real cases of medical errors and near misses. The journal, published by the Agency for Healthcare Research and Quality, draws 2,500 visitors a day. Dr. Wachter added that absent standards of what gets disclosed and when, going public could “give patients a mistaken view about the lack of safety.”