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• “The accusatory legal document begins with several remarks defaming the skills, education, ability, integrity, and honesty of the physician being charged.” [Donald May, State Policy Blog] But hey, don’t take it personally, lawyers say [Mark Crane, Medical Economics] Good luck with that [Chiaramonte/Examiner, KevinMD, more]
• Law throwing open Florida doctors’ peer review to lawyers was bad enough, but now state high court has applied it retroactively to records created before law was enacted [KevinMD guest post; background at PoL here, here, and here]
• Even the New York Times hails as “sensible” laws encouraging medical apologies by making them inadmissible as evidence of wrongdoing [editorial]; but see counterexample to the usual reportage [Berlin/Am. Journal of Roentgenology via Buckeye Surgeon]
• A med-mal defense attorney says plaintiffs would win more often in proposed “health courts” than they do in the cases he handles [Medical Economics, more, and similarly]
• More evidence, this time from study of orthopedists, that docs rated as cold or callous attract far more than their proportionate share of suits [Orthopedics Today]
• EMTALA, the law forcing emergency rooms to take all comers, “has created the very conditions it sought to avoid” [Edwin Leap, M.D.O.D.] Watch for “free-standing” ERs that dodge mandate by refusing federal dollars [Scalpel or Sword?, Health Care BS] Semi-defense of law [Over My Med Body]
• Besieged state of dispersed emergency rooms and specialists is one reason for use of those risky helicopters that fly patients to the big city [Williams/Health Business Blog, M.D.O.D.]
• Docs should stand up to family members demanding futile or inappropriate end-of-life care [Musings of a Dinosaur] Relatedly, daughter on dying father: “if you give him any more morphine, I will sue you.” [Fat Doctor]

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The story was that soon after [in-house hospital lawyer] Fred arrived, he was assigned to get on top of malpractice claims, and he sat down with six months’ worth of files. All of them, he discovered, began with a collection action for non-payment of a bill. So he ordered the accounting office to send him every overdue account before any efforts at collection, and invited the deadbeat patient into his office for a conversation. Invariably, the patient was withholding payment because he thought he had been mistreated. Often, the patient was right. The next meeting was with the practitioner accused of having screwed up, and the outcome was sometimes an apology and a promise to fix the problem for free (for example, another operation at no charge to retrieve the forgotten sponge), sometimes an expression of regret for a bad outcome with an explanation that the hospital hadn’t actually erred: not everything in medicine works every time. Of course this required that Sanders and Fred drive out fear, so the staffers could be honest and sympathetic.

The result of this was a really spectacular reduction in malpractice costs, even counting in the “warranty service” repairs; I don’t remember the numbers but it was on the order of more than half, partly in fees to defense lawyers, partly in claim payments. Frequently the bill even got paid. The reduction in lawsuits occurred both when the hospital was wrong and said so, and when it was right and said so; it turned out a lot of the injured patients just wanted to tell a live person what had happened to them and get an apology. Of course the public relations benefits are enormous, if hard to measure. And quality always goes up when your own people aren’t afraid to talk to each other about instructive mistakes.

It’s notable that Fred’s pay didn’t depend on how many cases he litigated….

Full post here. More thoughts on medical apology: Melissa Clouthier, May 19.

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More: Coincidentally, the Times covers the “medical apology” movement this morning: Kevin Sack, “Doctors Say ‘I’m Sorry’ Before ‘See You in Court’”, New York Times, May 18.

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“Two states, Colorado and Oregon, have created a little space for civility by passing laws that bar plaintiffs from introducing a doctor’s apology as evidence in a medical malpractice case. A great start, but why carve out an ‘apology privilege’ just for doctors?” — Jack Henneman of Tigerhawk (May 18). And see Cut to Cure, also May 18.

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