Opening Statement of
Doug Wojcieszak
The Sorry Works! Coalition, Glen Carbon, Illinois
ASQ Health Care Panel
For the 21st Century Health Care Caucus
Washington, D.C.
April 26, 2006
For the record: My name is Doug Wojcieszak (pronounced Woe-ches-zak) and I am the spokesperson for The Sorry Works! Coalition. We are a national non-profit group based in Illinois. Our membership is comprised of doctors, healthcare providers, lawyers, and patient advocates.
As a former legislative staff member for the Illinois House Republicans, I am going to briefly discuss why Sorry Works, apologies for medical errors, and full-disclosure is not only a middle ground solution to the medical malpractice crisis, but also the most comprehensive solution to the problem.
I am going to talk to you as a person who lost his oldest brother to medical errors, and as a person who has worked for both tort reformers and the plaintiff’s bar in the fight over medical liability reform. From a personal and professional perspective, I believe Sorry Works! to be the best all-around solution for the med-mal crisis.
I will show how Sorry Works! lowers lawsuits and liability costs for doctors and insurance companies while providing swift justice for victims and their attorneys without constitutional limits. Furthermore, by infusing honesty in hospital systems, doctors learn better from errors, thus increasing patient safety and further reducing liability exposure.
The story of Sorry Works! begins in Lexington, Kentucky at the Veterans Administration Hospital.
In the mid-80’s, the hospital had lost two multi-million dollar lawsuits. Not only did these lawsuits cost large sums of money, but they also turned doctors and patients into enemies. It wasn’t the way they wanted to practice medicine.
So, they implemented a new, unconventional policy: apologies and upfront compensation for medical errors.
Here’s how their program works:
After an adverse medical event - i.e, a bad outcome, unanticipated death, unsuccessful surgery, etc - doctors and hospital staff perform a root cause analysis. The analysis seeks to determine if the acceptable standard of care was met. The analyses sometimes involve the assistance of outside experts and usually take a few weeks to a couple months to complete.
During the analysis the hospital staff stays in close contact with the patient and/or family so they don’t suspect a cover up or feel abandoned.
If the root cause analysis shows that the standard of care was not met, the doctors and medical staff meet with the family and their attorney, apologize, provide explanations of what happened, tell how they will fix the processes so the error doesn’t happen again, and offer fair, upfront compensation.
However, if the standard of care was met (i.e, no error or negligence), the doctors and hospital staff still meet with the patient, family, and their attorney to provide explanations, open medical charts, answers questions, and basically prove their innocence. The hospital will empathize with the patient, but no settlement will be offered under any circumstances. Furthermore, the hospital will defend itself and their doctors to the death if a lawsuit develops - no settlements will be offered!
Conventional wisdom said they were crazy, but the Lexington staff happily reported in the December 1999 edition of Annals of Internal Medicine that their facility ranked in the lowest quartile of VA facilities for malpractice payouts; their average settlement per case was $16,000 versus the national VA average of $98,000. The Lexington approach spread to other VA hospitals in Los Angeles and Las Vegas and last fall was mandated in all VA hospitals nationwide.
The University of Michigan Hospital system adopted the Lexington program and has cut their lawsuits in half. Michigan also reports saving $2 million in defense litigation expenses annually - or 2/3 of their defense litigation budget - because cases are being settled in months instead of dragging out for years.
Michigan ’s lawsuits are back to pre-1990’s levels, and they also report having “excited actuaries.” In fact, their actuaries are so excited they just released $50 million from their reserves.
Michigan is reporting other exciting results…
When they started their program four years ago, the majority of the medical staff thought the hospital leadership was “crazy” for offering apologies and compensation for errors.
Today, in a recently completed survey, ninety-three percent of Univ. of Michigan medical staff support the program.
Better yet – in another voluntary survey, the Michigan trial bar said the program is changing their behavior. Better than 70% of trial lawyers surveyed said they are settling cases for less than they would normally seek in trial & they are declining cases they would have taken a “flier” on in the past. The Michigan trial bar says they are changing their behavior out of respect for the positive behavior changes implemented by the University of Michigan Health System . Indeed, good feelings beget good feelings – all of this without any legislative initiative or tort reform.
Similar positive results have been reported at 28 Kaiser hospitals, 39 hospitals in the Catholic Healthcare West System, and Stanford University Hospital system.
Harvard Teaching Hospitals are joining the program this spring.
COPIC insurance of Colorado reports similar results. Malpractice claims against their 1,800 doctors have dropped by 50 percent since 2000 and settlement costs have fallen 23 percent.
So, how does this honesty program work? Why has it produced these results?
These honesty and disclosure programs reduce anger with patients and families….anger – not greed – is what drives most patients and families to file medical malpractice lawsuits. Patients and families become angry when the medical wall of silence descends after adverse medical events, and questions are not answered, phone calls are not returned, and they are basically stonewalled.
If you can reduce anger – which Sorry Works! does – you reduce lawsuits, both meritorious and non-meritorious lawsuits.
If you improve communication with families and among healthcare providers – which Sorry Works! does – errors are learned from, patient safety is improved, and liability exposure is further reduced.
Rick Boothman of the University of Michigan spoke at a press conference held by Senators Clinton and Obama last fall in this capitol building and told the media that his hospital will be the safest teaching hospital in the United States because of this disclosure program.
*****************
Now there many emotional knee-jerk responses to Sorry Works! Without question, what we are proposing with Sorry Works! goes against conventional wisdom, but it makes all the sense in the world. The data is there to support it, and common sense says it works too. However, the doubters continually offer up knee-jerk emotional responses to Sorry Works! and I want to address the most common rebuttal today:
Challenge: What if sorry doesn't work? A doctor has just admitted guilt.
Response: So, a doctor apologizes for an error and offers compensation, but the compensation is rejected and a lawsuit is initiated.
Classic story from the University of Michigan hospital system: They gave the wrong type blood to a patient, and the patient went into shock. Fortunately, they caught the mistake quickly and corrected the situation, but the patient did have to endure some pain and suffering and extra time in the hospital.
The Michigan staff apologized and offered $10,000 in upfront compensation. The patient and his attorney thought they should get $250,000. They went back and forth, and Michigan ’s final offer was $40,000, which the patient and attorney rejected.
The case went to trial and the Michigan lawyer began the trial by admitting fault for the mistake, apologizing, explaining how Michigan was going to fix the problem so it wouldn’t happen again, and telling the judge and jury the whole reason for the trial was to simply determine fair compensation for the plaintiff.
The jury awarded $0.
As I close my presentation, I want to leave you with legislative suggestions.
As legislators you have an opportunity to provide leadership on this issue and encourage healthcare and insurance organizations to adopt Sorry Works!-type programs.
The Clinton-Obama bill (S. 1784) along with a similar bill introduced by Senators Enzi and Baucus (S. 1337) provide grants and other support to help healthcare and insurance organizations to introduce Sorry Works! type programs. I hope House members will pick up these bills and work with the Senators to advance them.
These legislative ideas can push and promote the idea of disclosure in your state.
One last idea – as you may have noticed from comments and testimony NONE of the hospitals and insurance organizations I spoke about had a legislative mandate to do Sorry Works! They just did it on their own and have been very successful.
This is the beauty of Sorry Works….while legislation can help encourage Sorry Works, hospitals and insurers don’t have to wait for the legislature to act. They can do Sorry Works! on their own –today!
So, the next time a medical, hospital or insurance organization asks you as legislators to fix the medical malpractice crisis, your response should be a question: “Tell me, have you implemented Sorry Works!-type disclosure programs yet?”
View more statements…
