Fear of litigation either stifles hospital efforts to improve patient safety or drives them underground, according to the latest article in a journal series that harnesses the power of individual case presentations to educate health care providers about medical errors.
The article "Patient Safety and Medical Malpractice: A Case Study" appears in the August 19, 2003, issue of the Annals of Internal Medicine and can be accessed through the link below.
The article is seventh in the series called "Quality Grand Rounds," which is co-edited by Dr. Robert Wachter, associate chair of the UCSF Medical Center department of medicine. Due to the popularity of the series, which began in June 2002, the California HealthCare Foundation (CHCF) has renewed funding for another year.
The case study features a physician who has to make a split-second judgment call about how to manage a critically ill patient. The patient sustained serious neurological damage, although the doctor's actions were not negligent, according to Wachter. The article explores both the plaintiff-patient and defendant-physician's points of view.
"The conflicts between the legal system and hospital error reduction programs are fundamental and severe — particularly as physicians' concerns about being sued or losing their liability insurance reach a fever pitch," said lead author Troyen A. Brennan, M.D., J.D., M.P.H., professor of law and public health at Harvard School of Public Health and professor of medicine at Harvard Medical School and Brigham and Women's Hospital.
"Fears of malpractice lawsuits not only chill the critical exchange of information that providers need to make care safer, but also drive underground broader efforts to improve patient safety," said Brennan.
The case study points out that the system's fundamental flaw is not simply that it costs health care providers too much. It is also that it tends to overcompensate some patients while under compensating others. Brennan believes a no-fault approach to medical injury may be the answer.
In a no-fault system, the injured patient would only have to demonstrate that medical management, as opposed to the disease process, caused a disability. There is not a need to prove negligence, according to the study. Similar programs in workers' compensation and vaccine liability operate at less than one-half the cost of tort litigation, largely by minimizing the role of lawyers, say the authors.
According to Mark D. Smith, M.D., M.B.A., president and CEO of the California HealthCare Foundation and case study co-editor, "Patients deserve innovative approaches that will reduce their chance of being injured by errors and lead to fair compensation if an avoidable injury occurs. And providers deserve an environment in which being open about medical errors does not put them at risk of financial and professional ruin."
This case study was co-authored by Michelle M. Mello, J.D., Ph.D., M.Phil., assistant professor of health policy and law at Harvard School of Public Health. Future articles in the series will include cases studies of ICU, outpatient, and diagnostic errors along with house-staff work-hour limits, communication and teamwork, and the role of media in patient safety.
In addition to the case studies, CHCF also funds live grand rounds-style presentations at several California hospitals.