Preventing lawsuits: Coalition pushes apologies and cash up-front

A new coalition of patients, attorneys, doctors and hospital administrators across the nation has an idea to keep liability costs and medical errors down at the same time.

The group is called the Sorry Works! Coalition. Its members describe the idea like this:

• Hospitals and physicians review every adverse incident.
• Hospital administrators and physicians sit down with patients and families to explain what happened.
• The hospital and doctor apologize if a mistake was made and offer the patient or family fair compensation if the investigation finds that there was a medical error. They explain how the problem will be corrected.

It's a step beyond the commonly called "I'm sorry" laws that several states have passed in recent years that allow doctors to apologize without it being used against them in court as admitting liability.

Organizers believe that the full disclosure and up-front settlements will have a big impact on the medical liability climate.

"More patients get justice; there are fewer lawsuits, so it lowers liability costs; it reduces errors in the long run; and the constitution isn't altered," said Doug Wojcieszak, an Edwardsville, Ill., resident who founded Sorry Works! "It's truly a middle-ground solution."

The organization -- set to officially kick off Feb. 9 -- comes at a time when the issue of how to lower physicians' medical liability insurance costs so they won't retire early or cut high-risk services has been an issue for debate at the state and federal level.

Physicians have lobbied lawmakers for reforms that include caps on the noneconomic portion of jury awards. Lawyers have opposed that position, saying insurance reforms are needed to change the system under which physicians have seen double-digit increases in their liability insurance premiums.

The Sorry Works! Coalition adds a new voice to the mix. With several hospitals already apologizing to patients and offering compensation up-front, the coalition plans to be a centralized place people can come to for information on the model. It also plans to push state legislatures to create Sorry Works! pilot programs.

"We cannot say this is just theory," said Don Wolfram, MD, a Granger, Ind., emergency physician and Sorry Works! board member. "People are doing [what Sorry Works! does] in big places. Influential places."

Movement already under way

The Illinois Senate passed legislation that would create a pilot Sorry Works! program, and several hospitals have used the model for years. The result, those involved say, has been better physician-patient relationships and lower legal costs.

Patients are compensated faster for injuries, and physicians and patients avoid spending the time and money it takes to prepare to go to court.

Johns Hopkins, Children's Hospitals and Clinics in Minneapolis and the University of Michigan Health System are among facilities that created disclosure policies in recent years that are similar to what Sorry Works! is advocating. The University of Michigan Health System saw legal costs drop to $1 million annually, down from the $3 million it used to spend.

But the first program dates back to 1987, when the Veterans Affairs Medical Center in Lexington, Ky., began investigating incidents and offering patients settlements up-front. The center began the investigations so it could better defend itself against lawsuits. But after an investigation showed there was negligence that a patient didn't know about, the hospital decided it had an ethical obligation to tell the patient.

It went so well that the hospital continued the policy, said Steve S. Kraman, MD, who was chief of staff at the Lexington veterans hospital when the program began.

The hospital made the full disclosure because it was the right thing to do for the patient, Dr. Kraman said, but it had side benefits. Claims that the Lexington facility paid were comparable, and in some cases less, than other VA facilities, according to a study in the December 1999 issue of the Annals of Internal Medicine.

"We paid for more claims, but the average claim was smaller," Dr. Kraman said. He also said the VA was taken to court only three times in his 16 years there -- a far lower number of cases than would have been likely without the program.

A coalition is born

Wojcieszak, a public relations professional, started the Sorry Works! Coalition after he worked on the medical liability issue for both physicians and trial lawyers and after a personal experience with a medical error.

After his brother died as the result of a mistake, his family had to sue to find out what happened. He said the lawsuit wasn't about the money, but about finding out what happened and ensuring it didn't happen again.

"This is about staying out of courts in the first place," Wojcieszak said of Sorry Works!

David Patton, a Sorry Works! board member and a plaintiff medical malpractice attorney in Scottsdale, Ariz., said many of the clients that come to him are simply searching for answers.

"I've heard it so many times: 'If only they explained to me what happened, I wouldn't be here seeking information,' " Patton said.

Doctors agree that patients have a right to know.

The American Medical Association encourages physicians to be honest. If a medical error is made, the patient should be told how it happened and what can be done to fix the problem, said AMA Immediate Past President Donald J. Palmisano, MD.

But it can be difficult with the broken medical liability system, he said. Even in states with "I'm sorry" laws, insurance carriers sometimes tell physicians that they can't use direct language to say they are sorry.

"The AMA is saddened the legal system invites so much animosity," Dr. Palmisano said. "We need to get rid of the current medical liability system that benefits a small number of people."