New in the Annals of Internal Medicine: “Fear of litigation either stifles hospital efforts to improve patient safety or drives them underground, according to the latest article in a journal series …” In the case under study, a critically ill patient suffered permanent brain damage while under hospital care; the authors, both with the Harvard School of Public Health, consider it “unreasonable” to blame the attending doctor but a suit was filed nonetheless. In the incident’s aftermath, the hospital did not take vigorous measures to involve its staff in any debate about whether procedures needed to be changed — a logical enough course of action given that “generally, hospitals must confine discussions about adverse events to small committees of insiders” if they are to avoid losing their privilege against turning over the results of peer review investigations to hostile lawyers. In the case at hand, “it seems that it would have been beneficial for the hospital and staff to have openly evaluated issues of seamless cross-coverage, protocols for emergent intubation on the floor, and timely transfer to the ICU. Unfortunately, it appears that nothing of this sort occurred.” (“Fear of Litigation Stifles Hospitals’ Efforts To Improve Patient Safety”, press release, California HealthCare Foundation, Aug. 19; Troyen A. Brennan and Michelle M. Mello, “Patient Safety and Medical Malpractice: A Case Study”, Annals of Internal Medicine, Aug. 13; CHCF case study series)

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