A recent study shows that conflict resolution programs (CRPs) can be successful in preventing both litigation and monetary settlements for adverse medical events not involving negligence, reports MedPage Today The study was led by Michelle Mello, Ph.D., J.D., of Stanford University. Mello and her colleagues reported their findings in the October issue of Health Affairs.
Dr. Mello and her team studied the efficacy of the Communication, Apology, and Resolution (CARe) program implemented at Boston’s Beth Israel Deaconess Medical Center and Baystate Medical Center in Springfield, Massachusetts. Each academic center also implemented the program at one of its community hospitals in the state.
Run by the hospitals’ respective risk management departments, the CARe program contained several key elements. It began with disclosure, investigation, and referral to insurers when certain criteria were met. Hospital staff then communicated the results of the investigation and proposed steps to resolution to the patient and/or family.
Of 989 CARe events identified between 2013 and 2015, 81 percent resulted in communication with the patient. When conversations did not take place, it was usually because the hospital found nothing to report or was unable to contact the patient at the time.
Just 9 percent of the patients received monetary compensation, with a median payout of $75,000. Another 5 percent filed a malpractice claim or lawsuit.
“By providing explanations and expressions of sympathy for harms not arising from negligence, [conflict resolution programs] may avert lawsuits springing from misunderstanding,” the authors wrote. “Malpractice claims frequently involve injuries not caused by substandard care, and plaintiffs are often motivated by perceptions that providers communicated poorly or attempted to cover up negligence,” they said.
The authors theorized that CARe discussions provided better context for patients and their families around why untoward events occurred. They also thought it possible that after meeting with hospital staff, unhappy patients chose not to file a malpractice claim because they believed they couldn’t prevail.
“Getting an attorney to take a case is difficult when one must explain that the hospital has investigated and explained that no settlement offer is warranted. This makes it all the more important that hospitals’ CRP evaluations be made in good faith after diligent investigation,” Mello’s team wrote.
Another possible reason for CARe’s success is that Massachusetts law removes several roadblocks to successful conflict resolution programs. In 2012, the state enacted a statute that requires all healthcare providers to disclose adverse events and provides legal protections if they apologize. It also requires that malpractice plaintiffs give providers written pre-litigation notice (PLN) 180 days before filing a suit. This gives the defendant ample time to try to resolve the suit without going to court.
The Stanford team’s research echoes results reported in Clinical Orthopaedics and Related Research in 2012. In that study, the authors found that early apology and disclosure programs help providers avoid litigation between 50 and 67 percent of the time. When mediation was added, the success rate climbed to between 75 and 90 percent. Hospitals in Michigan, California, and Illinois have seen similar results from conflict resolution programs since 2001.
Despite reservations expressed by many providers, it appears that “ disclose and apologize,” when handled appropriately, may be a logical way to avoid lengthy litigation and reduce settlement costs. What’s more, disclosing and investigating medical errors is the only realistic way to learn why they occur. And in a country where 250,000 people die due to preventable medical errors each year, improved patient safety should be everyone’s first concern.
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