Family’s Disclosure Offer Rejected; Hospital Sued

Over the past month, we’ve shared with you the story of the Westhoff Family from Danville, California. In summary, the family lost their two-year old daughter, Morgan, to medical errors at Children’s Hospital Oakland (CHO) and the death was not handled in an empathetic or transparent manner.  Instead, the hospital sent the family fundraising letters, marketing magazines, annual reports, etc, which were frequent and cruel reminders of their daughter’s death.  The Westhoff family thoroughly investigated their daughter’s care, uncovered numerous problems, and eventually met with CHO’s leadership.  The family, who has been major donors to the hospital, requested an apology and a financial settlement which the family pledged to invest back into Children’s Hospital Oakland (CHO) to develop a disclosure and apology program.  The Westhoff family offered to partner with CHO to improve the hospital and also use their joint story to improve other hospitals.  Also, the Westhoffs asked for the marketing and fundraising letters to be stopped.

Initially, CHO was blown away by the Westhoff’s offer.  CHO admitted they didn’t have a formal disclosure program, and, yes, the hospital promised to stop sending mail.

However, over time the hospital rejected the family’s offer and refused to settle the case, and CHO’s fundraising and marketing mailers still continued to arrive in the Westhoff’s mail box.

Local media in Oakland & San Francisco picked up the story from the angle of the hospital continuing to send mail to the Westhoffs: http://sorryworksblog.net/?p=689.

And now the Westhoff family is suing….and it appears the law firm has uncovered some stuff even the Westhoff family didn’t know such as an autopsy that was never performed!  Here is the press release from the law firm summarizing the lawsuit: http://www.sorryworks.net/photos/File142.pdf and here is some media coverage:   http://www.insidebayarea.com/News/ci_25546950/Danville-family-of-braindead-girl-sues.

Perhaps when this case is finished CHO will look back with deep regret for rejecting the Westhofff’s initial offer…an offer that included the family putting the money back into the hospital.  The case will probably dwarf the expense of the Westhoff’s initial offer in litigation expenses, lost staff time, morale, and productivity, lost prestige in the community, including the philanthropic community, and so on.

The moral of the story is your hospital/insurer needs to develop a formal disclosure program where front-line docs and nurses are trained how to be empathetic and pro-active post-event, and risk, claims, and defense attorneys are expected to be pro-active post-event.  Here is the link for the column from the Westhoff family sharing their story and initial offer to CHO: http://sorryworksblog.net/?p=699.

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Who Qualifies as a “Consumer” for Healthcare?

Recently I authored an e-newsletter that ruffled some feathers at the National Patient Safety Foundation (NPSF).  I wrote that the NPSF’s recent report on consumer engagement only included five (5) consumers on the 37 person steering committee…roughly 13 percent.   Pretty paltry in my eyes, especially for a report about consumer engagement! The NPSF shot back and said no, the panel actually had 14 consumers!   Still not even close to 50 percent! The link for my original e-newsletter is below.

Casting aside the tit-for-tat battle over numbers and appearance, this is an important discussion because we need more consumer input in healthcare.  But, how exactly do you define “consumer?”  What makes a person a consumer?  And aren’t we all consumers of healthcare?

Well, yes, we are all consumers of healthcare, but not all consumers are alike!   Moreover, healthcare needs more input from “rank and file” consumers as opposed to healthcare executives who have a family or personal experience with bad care.  This is where NPSF and I disagree about the numbers and the point of this column: NPSF counted an additional nine people because their panel had some healthcare professionals who had their own personal stories with healthcare.   I didn’t count these folks as true consumers.

Now, don’t get me wrong, healthcare executives who have family or personal experiences with bad care can be powerful people.  They can be true agents within healthcare.  From the perspective of disclosure, I have written in the past that docs and nurses who have personally experienced cover up following a medical error can be some of our most effective advocates.  However, I’ve never written that these same people can be put on a committee and labeled as “consumers.”

A true consumer is someone who is from outside healthcare and is not depending on healthcare for a paycheck.  A true consumer will often tell you exactly what they think, whether you want to hear it or not.  A true consumer is not desensitized to all the problems in healthcare nor are they willing to put up with these problems “because that’s just the way it is.”  A true consumer is not worried about pissing off a certain Vice President or fellow physician.   And so on and so forth.

Look it at this way….when a Fortune 500 company does a consumer focus panel they get 10 or 12 customers in the room and let them speak their mind.  This is how products and services are improved or shelved.  If, however, the healthcare industry was running a focus group for the Ford Motor Company this would be the composition of that focus group: 7 Ford Engineers who happen to drive Ford cars, 2 Ford marketing managers, two Ford Vice Presidents, and one person who is not connected with the company is any way (aka the real consumer).  Follow?  Tell me which panel is going to give more authentic and valuable feedback to the Ford Motor Company?   Which panel will have consumer driven conversations and which panel will sound like “inside baseball?”

Healthcare needs to stop being afraid of engaging consumers.  Don’t be afraid to get honest and sometimes uncomfortable feedback.  To do that, you need real consumers!

For hospitals and other healthcare organizations, increase the number of true consumers on committees and panels.  Moreover, for hospitals, I strongly suggest developing patient/family councils which are populated in large majority (or entirely) by consumers.

Here is the link to the original e-newsletter about the NPSF’s report: http://sorryworksblog.net/?p=703.

 

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Confidential Med-Mal Settlements? Why??

During several Sorry Works! presentations for hospitals I’ve had nurses and doctors share some version of the following with me:

“Well, you know we have these adverse events, they are very sad, but then the family disappears, the lawyers swoop in and take over, and then….that’s it.  A year or two or three passes, and we never hear how the situation was resolved.  Nobody talks about it.  It just goes into a black hole.” 

How do you learn from events or even get emotional closure when situations are handled in this manner?  Answer is you don’t.

I’ve heard from some lawyer friends who say confidential settlements are just part of the process in settling a med-mal case.  It’s literally a check box that no one really thinks about other than making sure the box gets checked.  Well, it’s time to re-think this part of the process with disclosure become more prevalent.

At Sorry Works!, we tell hospitals and insurers that they should approach a settlement with the mindset that the final product will be OPEN AND TALKED ABOUT.  This is the new check box.  Only if there are really good reasons, such as the family wants it closed, do we have a confidential settlement.   We plan to share the resolution of cases with staff, including what we learned, and, if possible, involve the staff and consumers who were involved in the adverse event.  This is a critical part of how we improve our culture and encourage other clinicians to come forward after adverse events.  Literally, an additional check box for a settlement should read, “Would you, the patient or family, like to come back to the hospital to tell the story of your adverse event with our staff?”  That’s powerful!

I know there will be pushback or excuses why this can’t work: “But local trial lawyers will learn about our mistakes and system errors or what we paid, and this will simply invite more litigation.”  My response to this is, “Hey, remember, as part of disclosure we are going to reach out to local PI lawyers, tell them about our disclosure program, and invite them to help us assist injured patients BUT we will NEVER pay a penny for cases that do NOT involve errors.”   Get rid of the secrecy because that it what drives consumers and lawyers to file lawsuits.  You’re an open, honest book and, to be frank, that is NOT a juicy target for trial lawyers.

To schedule a Sorry Works! talk for your hospital or group of insureds, call 618-559-8168 or e-mail doug@sorryworks.net.

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NPSF Report on Consumer Engagement Lacks Consumers!

Last week, the Lucian Leape Institute at the National Patient Safety Foundation (NPSF) released their report on getting consumers more involved in healthcare: “Safety is Personal, Partnering with Patients and Families for the Safest Care.”  Link is below.

I printed off this report (still a paper guy!), flipped a couple pages, and found the list of folks who helped develop the report.  I counted thirty-seven souls, many smart, high-powered people with lots of letters behind their names, but only found five true consumers: Ilene Corina, Helen Haskell, Linda Kenney, Sue Sheridan, and Deborah Wachenheim.  The rest were folks from the healthcare industry or associated posts in universities, think tanks, or consulting firms.  Five folks out of thirty seven equates to 13 percent.  Only 13 percent!

Given this lousy number – 13 percent! – jaded consumer advocates could not only complain about the lack of representation (13 percent!), but also the quality of said representation.  Now I know each of these five folks and they’re all great people, but they are associated with the healthcare industry.  If there were more consumers on this panel maybe this wouldn’t be a problem, but when the pickins are slim folks can get overly critical.  For example, Linda Kenney collaborates closely with the healthcare industry, including lots of work on the issue of “2nd victim of medical errors,” — which I believe is great work — but it makes some consumer advocates absolutely cringe.  “Patients are the only victim of medical errors…let the sloppy doctors and nurses suffer.  Who cares!,” jaded advocates often scream.  I know what I’m talking about because I’ve been on the receiving end of these barbs myself because I too am closely affiliated with the healthcare industry.  I charge hospitals and insurers fees for my speeches and consulting, and sell books and other content to healthcare professionals.   The paucity of consumer representation on this panel opens the report and the sponsoring organization – NPSF – to criticism on multiple fronts.

Unfortunately, what happened with this report is symptomatic of what happens on hospital quality and safety quality committees around the country. Too many hospitals put a patient or two on some committee and congratulate themselves for involving consumers.   Nah!

What I’m trying to say is let’s be smart.  You want to engage patients and families, well, let’s engage them.  On the national level with efforts such as this report and more importantly in local hospitals.    Don’t be afraid to truly engage consumers.

Readers of this space know that I reconciled with the hospital where my brother died from medical errors.  Catholic Health Partners of Cincinnati (CHP), the owners of Jewish Hospital where my brother died, apologized to me and my family, and then really engaged me.  I helped develop their disclosure program and was also invited to participate on a CHP board quality committee.  It was an awesome experience, and I have publicly thanked (and will do so again) Michael Connelly and the rest of the CHP team for everything they’ve done for me and my family.  My term on the quality committee concluded this past January (two months ago), and my parting advice regarding the quality committee to Michael and the team was to get more consumers on the committee and/or make separate panels for consumers.  In our committee, we had three consumers (including myself) out of a total of 20 to 25 people, the rest being healthcare professionals.  So, again, the consumer representation was about 13 percent.   I was able to contribute because of my background but a lot of stuff was over my head. I felt this was the same with the two other consumers.   Moreover, when you have that many docs and nurses in the room – and three consumers – you can’t help but have docs and nurses talk shop, use their terminology, etc.  The dynamic is inherently skewed.   You don’t get the full benefit from your consumers.

We can do better….unfortunately the NPSF report missed the mark.  Not only did it lack consumer representation on the panel that assembled the report, but the report didn’t push the envelop on getting consumers better represented on safety and quality committees.  To be blunt, a hospital executive with the standard one or two patients on some committee could read this report and say to him or herselves, “Hey, we’ve got consumer involvement!”  Nah!

Moreover, the report lacked good stories or examples to help folks.  Stories and concrete examples are so important.   This report was simply a laundry list of ideas, many of which the panel concedes are not new.  It was a rehash and will soon be forgotten.

Finally, what I found totally lacking in the report was the business case.  How is this going to help the bottom line?  Every idea that can be implemented in a hospital has to pass the smell test of the CFO.  And if all we got is “It’s the right thing to do!” that ain’t gonna cut it for the CFO.  Your typical CFO believes that simply keeping a hospital open is enough of the “right thing to do” when his or her financially driven mind knows that the capital required to own and operate a hospital could make a lot more money elsewhere (versus the low margin business known as healthcare).   There is an absolute business case for patient safety as well as disclosure, and we need to stop being embarrassed about making that business case.  Show the ROI not only in human terms but also in dollars and cents.

Here is the link for the NPSF report…judge for yourself: http://ww1.prweb.com/prfiles/2014/03/14/11672540/Safety_Is_Personal.pdf.

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Another Tragedy, Missed Opportunity at Children’s Hospital Oakland

This week we are offering our space to Wade and Jennifer Westhoff who lost their daughter to medical errors at Children’s Hospital Oakland and tried to reconcile with the hospital – even offering to help the hospital build a disclosure program – but were rejected.  Readers may remember the Westhoff family, as Sorry Works! featured them two weeks ago regarding mail – including fundraising letters – the hospital continued to send to them after their daughter’s death.  Below is their complete story.

Title: Another Tragedy, Missed Opportunity at Children’s Hospital Oakland

By: Wade and Jennifer Westhoff

The Jahi McMath tragedy at Children’s Hospital Oakland (CHO) is still fresh in the minds of many people.   Jahi’s story personally resonated with our family as we had lost our own daughter to equally tragic circumstances at CHO in 2013.  We are now coming forward to share our story with the hope of improving CHO.

Both our immediate family and extended family have provided significant financial support to CHO for many years.   As stakeholders in CHO, we want to report back to the community on how we have been treated by this organization.

Our twin daughters – Morgan and Hunter – were born in April 2011 with Patent Ductus Ateriosis, (PDA), which is a common heart defect in premature babies.   We felt good when the girls were referred to CHO for care of their condition.   After all, CHO is our hospital.

Hunter’s surgery was successful and she is thriving today, but, sadly, Morgan suffered major complications, resulting in catastrophic brain damage, and was declared brain dead a couple days later.

We have personally seen the best of CHO’s conduct with Hunter, and the worst with Morgan.

After Morgan died, CHO basically kicked us to the curb.  There was little empathy.   Hospital leadership did not seek us out to discuss why Morgan’s surgery went so terribly wrong.   CHO did, however, send mail to our house.   We received a patient care survey — “How can we improve Morgan’s care?”   We also received CHO’s annual report, marketing materials, and various fundraising requests…including one fundraising letter that was dated the day Morgan died!  Absolutely cruel.

We did our own research into Morgan’s operation, and we uncovered numerous medical errors that caused her death.  Simply put, the CHO doctors injured Morgan by using the surgical equipment against the manufacturer’s recommendations, and then the CHO doctors were slow to call for surgical back up to rescue her, leading to brain death.  Our beautiful two-year old daughter was dead, and Hunter will not grow up with her twin sister.

During our research, we spoke with countless experts across the country, including people in the disclosure movement.   Hospitals and insurance companies across American are now actually teaching doctors and nurses how to be empathic after something goes wrong, stay connected with families, and if a review shows there was a mistake, apologize and quickly address the financial and emotional needs of the family.  For too long, doctors have been told saying “sorry” will encourage lawsuits, but disclosure has actually been shown to reduce lawsuits.  Disclosure also improves patient safety because when doctors talk about mistakes, they learn from them.  Finally, disclosure promotes emotional closure for not only patients and families, but also doctors and nurses.

So, in Fall 2013 we requested a meeting with CHO’s leadership.  We discussed the errors that led to Morgan’s death.  We shared how the lack of empathy and communication from the hospital compounded our grief.  We also relayed how CHO’s continual mailings – including fundraising letters – were traumatizing our family.  Finally, we offered a proposal to the hospital.

We wanted a financial settlement from the hospital, but, we offered to invest this money back into the hospital.  We wanted to form a partnership with CHO to train their doctors and nurses on disclosure, and use our joint story to help other hospitals around the county.   We wanted to make CHO better for not only patients and families, but also their doctors and nurses.   Morgan was our investment in the hospital, and we simply wanted the hospital to make a financial investment in this endeavor.

CHO’s leadership was initially blown away by our proposal.  They said Morgan’s story was “transformative” and, yes, they wanted to partner with us.  They admitted to us that they don’t have a disclosure program, and they need help communicating with families after something goes wrong.   They also promised to stop sending mail to our house. We were elated.

But then the wheels fell off the cart.

Shortly after our Fall 2013 meeting, CHO leadership refused to commit any funds and basically rejected our proposal.  They didn’t take us seriously, and it felt like we lost Morgan all over  again.   An opportunity was missed.

We warned CHO that their hospital had safety problems and their doctors and nurses were ill-equipped to deal with angry, grieving families.   CHO was non responsive.  And then Jahi McMath happened.

We continue to receive CHO mail at our house, including most recently a personal invitation for a private preview of CHO’s annual fundraiser with the CEO, Bert Lubin, MD.  So, we have notified CHO that we intend to sue.  Moreover, our family no longer supports CHO, and we have been sharing our experience with the Bay Area philanthropic community.  Maybe CHO will take us seriously now.

Ultimately, we hope to be reconciled with CHO.  We want to work with CHO in Morgan’s memory.  We want them to improve, and, again, use our joint story to help other hospitals.  We stand ready to partner again with the hospital to improve their safety and culture.   The ball is in CHO’s court.

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Here is the link for the story published by Sorry Works! two weeks ago regarding how CHO continued to send mail – including fundraising letters – to the Westhoff family after Morgan’s death: http://sorryworksblog.net/?p=689.

 

 

 

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Grieving Mother Still Yearns for Apology 11 Years Later

Recently I was contacted by Lenore Alexander, a mother who lost her 11-year old daughter to an accidental overdose of painkillers following a successful surgery.  According to Lenore’s story, her daughter, Leah, was given ever increasing doses of narcotics to deal with unrelenting pain after the operation.  Leah died while Lenore fell asleep after being up continuously for 30 hours.  Lenore awoke to find her child dead in the hospital bed next to her.   The autopsy showed the epidural has been inserted in the wrong place.

Lenore established a foundation in Leah’s memory to advocate for mandatory electronic monitoring of patients on opioids.  So, she is trying to bring good out of bad….a lot of bad.

Lenore contacted me to share an article about her daughter’s death that didn’t receive much notice, and I offered to share the article with our audience.  Powerful article — link is below.  Also below is a link for a YouTube video of Lenore telling her story.  As a father of a little girl myself, I found Lenore’s video very moving.

In reading Lenore’s article and corresponding with her via e-mail, you see a person who after 4000+ days is still facing enormous grief and guilt over the death of her daughter to a situation that was entirely preventable.  She feels partially responsible for what happened.  What compounded the grief and continues to damage Lenore and her family is the total lack of accountability by the hospital and the clinicians.  Consider this excerpt from Lenore’s article:

“What might have helped? First, telling me the whole truth.  Admitting what happened.  Making an apology.  That might give me the ability to breath without the weight on my heart for the rest of my life.  Little to ask, it seems, for all they took.   And then I want them to help me to work with me and others like me, to use my experiences, my advocacy and my total commitment to together prevent one more family from having their lives ripped apart by the needless death of a child.”

When you fail to own a medical error, there is a chance you will literally interrupt the grieving process for patients/families and also caregivers.

Most folks are familiar with the typical grieving process which is taught as happening in stages, when it fact it typically bounces around and is different for every single person.  Some good days, some bad days, and back again to the good days.   As my dad puts it, the bad days are like a scab being pulled off.  However, over time, the good days outnumber the bad and the grieving person can envision a new life.   Perhaps they can even redefine themselves.  But when there is no accountability, no apology, the grieving process can literally be stuck or frozen for some people and the injury or death can continue to be a destructive force.  Think about this the next time you are deciding whether or not to disclose.

Also, think about the “closed cases” in your files where stakeholders – including your clinicians – still need true closure.  Consider my story in this regard, and see if you can make it yours too: http://sorryworksblog.net/?p=152.

Here the link to Lenore’s article: http://ppahs.org/2014/01/24/continuous-electronic-monitoring-could-have-saved-my-child-my-family-my-marriage-and-my-life-a-11-year-reflection-on-a-medical-travesty/

Here is the link to Lenore’s powerful YouTube video: http://www.youtube.com/watch?v=Kp_Jf65hp3M.

And here is the link to a story we ran last year of another mother – Dale Ann Micalizzi – still searching for apology following the death of a child many years ago: http://sorryworksblog.net/?p=472.

Forget the rhetorical question, “Can’t we do better?”   The real question is what are YOU doing right NOW to make disclosure a reality in your hospital, practice, or group of insureds?  Sorry Works! can help you…contact us today.

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Sending Mail to Family After Death in Hospital – True Story

Wade and Jennifer Westhoff lost their two-year old daughter, Morgan, to adverse medical events in January 2013.  To listen to the family’s story, the hospital – Children’s Hospital Oakland – was not empathetic nor proactive post-event and did not communicate effectively.  The family had to dig on their own for answers and information, and the family believes their investigation has uncovered errors that led to their daughter’s death.

While the hospital was neither pro-active nor empathetic post-event, they did send mail to the Westhoffs: Fundraising letters, annual reports, marketing materials, and surveys — How can we improve Morgan’s care?  One fundraising letter was dated January 18, 2013 — the day Morgan died.   The Westhoffs have been donors to the hospital.  The family met with the hospital late last summer to discuss the case, provide a proposal to resolve the situation, and make a simple request: Please stop the mail.   The hospital rejected the Westhoff’s proposal and the mail has kept coming, including a couple weeks ago when they received an invitation for a big-ticket fundraising dinner.  It’s like a continual slap in the face to the Westhoffs every time they open their mail box.

At Sorry Works, we’ve raised this issue in the past.  As you build out your disclosure programs, remember the Westhoff family.  When an adverse event happens, all mail – fundraising, marketing, billings, collections, surveys, etc – need to halt immediately, and all communications need to be re-routed through the disclosure team.  I’ve heard excuses why this can’t happen….”Well, that’s the foundation or marketing folks…they work in a different building.”  Simply unacceptable.  With one click of a button, you should be able to stop all mailings to a grieving family.

The local Fox affiliate in Oakland picked up this story…it speaks for itself: http://www.ktvu.com/s/news/2investigates/    Here is the link for the promo Channel 2 ran several times over the last couple days: http://www.ktvu.com/videos/news/tonight-on-the-ten-oclock-news-on-ktvu-channel-2/vCSYZt/.   Imagine this was your hospital or healthcare organization? 

And here is the link for a text version of Channel 2′s story: http://www.ktvu.com/news/news/local/2-investigates-family-solicited-hospital-donations/nd6f9/.

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Doing Disclosure & Apology Just to Avoid a Lawsuit?

 As you do disclosure, you may get hit with this question or allegation: “Well, you’re just saying sorry and being nice to me and my family to avoid a lawsuit!”

Answer: Yes, you are right. Be honest, ’cause that’s what disclosure is all about. Sit down, look the person or family in the eyes and say, “Yes, you are right…I am doing this to avoid a lawsuit. Because not only is a lawsuit bad for me, it’s gonna be a tough process on you and your family. Of course, you are free to call a lawyer or the state or the media…it’s a free country….do whatever you want, but why don’t we see if we can work through this situation together and address your concerns and needs? I might be able to get what you want right now without a protracted legal battle that may drag on for years. It won’t hurt you to listen to me and then make up your mind.”

That’s honest. It’s also candid, which many people find refreshing.

I learned this line of thinking from Leilani Schweitzer, a mom who lost who her son to medical errors at Lucile Packard Children’s Hospital at Stanford University. Leilani received disclosure and apology with her son’s case, and she now works with Stanford’s risk department on cases. Leilani wrote a very moving essay for Sorry Works! which we published in May 2012 — the link for that essay is below. Leilani basically wrote, Yes we are trying to avoid lawsuits but it doesn’t mean we are trying to dodge responsibility, financial or otherwise. This is still a HUGE disconnect with consumers as well as clinicians and especially claims managers…so many people believe if there is a true medical error that causes harm or death then there must be a lawsuit. Only way people can get paid, is the thought! No it’s not! Disclosure is about building new systems whereby clinicians, hospitals, and insurers work collaboratively to meet the legitimate financial and emotional needs of patients harmed by medical errors in a fair and quick process. Don’t need to litigate if disclosure is done right.

This leads me to a personal gripe of mine: Disclosure advocates who say disclosure is not about avoiding litigation. It’s only about “doing the right thing,” they say.

Baloney!

There is absolutely a business case for doing disclosure, and we shouldn’t be ashamed of stating that business case with internal audiences (healthcare, insurance, and legal professionals) and external audiences (the public, the media, etc). Avoiding litigation by solving problems in a pro-active, fair manner is not only good for clinicians it’s especially good for consumers.

I’m very concerned when some disclosure advocates (some who are friends of mine) try to sell docs on disclosure by telling them “It’s the right thing to do.” Man that scares me, because docs and nurses “do the right thing” just by being clinicians and what thanks do they get? More work, lower reimbursements, less time with their families, lawsuits when things don’t go right, burnout, etc, etc….and along comes Suzy Sunshine to say, “Docs, we want you to disclose and apologize because it’s the right thing to do!” Save it, lady.

Yes, we are “doing the right thing” but there is a business case for this behavior. Disclosure does reduce lawsuits and litigation costs. It’s working across the country. We also know doing “the wrong thing” – deny and defend – actually invites litigation, drives up litigation and settlement costs, impedes safety improvements, produces bad PR for hospitals and clinicians, and creates enormous emotional suffering for consumers and clinicians.

At Sorry Works! we have taught thousands of doctors, nurses, risk managers, claims managers, defense lawyers, and c-suite personnel how to do disclosure. We have taught many how to say sorry and stay connected with consumers post-event. We can help you too. Call 618-559-8168 or e-mail doug@sorryworks.net.

Here is the link for Leilani’s essay which was published last year: http://sorryworksblog.net/?p=464.

 

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“I am Mrs. Smith:” – True Story From Disclosure Training Session

I am now beginning my disclosure training sessions by sharing the following actual case with my audiences:

“Mr. Smith is a 53 year old man who went to the hospital for a CT guided biopsy of the liver.  Mr. Smith believes the test is no big deal and tells his wife to go shopping.  The technician assures the wife that they will call when the test is complete. 

Mrs. Smith is standing in Macy’s when her cell phone rings.  She hears a nurse frantically screaming, ‘Come quickly! Come quickly!’

Mrs. Smith runs back across the street to the hospital, but by the time she arrives her husband is dead.” 

After reading through this scenario I ask my audience members – MDs, RNs, risk managers, hospital administrators, etc – to tell me how they are going to communicate to Mrs. Smith.  I put it to them.  What are YOU going to say?  What issues will YOU discuss?  How will YOU say it?   What are YOU going to do for Mrs. Smith?

I am usually met with silence and lots of people squirming in their chairs and looking away from me.  It’s very uncomfortable for audience.

After some prodding from me, people will start offering some hesitant thoughts.  Some want to talk about informed consent.  Others want to start providing medical speculation.   And then others say – correctly – we just need to focus on empathy, promise a review, and meet the immediate needs of Mrs. Smith as well as the staff who were involved.  Can we help Mrs. Smith call her children?  Sit with her.  Make sure she can get home safely.  Tell Mrs. Smith we are sorry this happened and we will be doing a review.  One of the nurses during a talk said it is so important to simply have a presence with a family after something goes wrong.

It’s a great training case….because something bad happened but you don’t how exactly it happened.  The urge is to assume there was a mistake, but it could have also been a heart attack!  The point I drive home is doctors and nurses as well as patients and families aren’t ready to talk “medicine” post-event.  You need to focus on feelings….basically do grief counseling joined with intelligent, thoughtful customer service.  This case also does a great job demonstrating the need for disclosure training for front-line docs and nurses….the stony silence after sharing this case is proof positive that training is desperately needed!

So, after this case I run through a few more cases, then I go on with my slides about how we teach disclosure to front-line docs and nurses and also how we help risk, claims, legal, and c-suite think through cases, followed by Q&A.  At the end of one presentation, however, a female doctor raised her hand and said the following: “I am Mrs. Smith….I am the Mrs. Smith in the case you shared.”

You could have heard a pin drop in the room.

Now, the female physician wasn’t the actual Mrs. Smith from my case, but she lost her husband to a similar set of circumstances.   She shared a lot of the details of her story with me and the audience…it was tough for her.  I sat down and listened to her.  The female physician said that when her husband died the doctor muttured “sorry,” dropped his head, and immediately walked out of the room never to be seen again.  The nurses, however, stayed with the female physician – a new widow –  and her family.  They held hands, provided comfort, and were that presence.  What the nurses did for this woman and her family will never be forgotten.  Why couldn’t the doctor do the same?

You know when the science of medicine fails you (either because it was a known complication or an error), you have to rely on the emotional stuff to get you and your patient/family through the situation.  I’m talking about empathy.  Talking about having a presence.  I’m basically talking about basic grief support combined with some thoughtful customer service.   I know this stuff is uncomfortable for doctors and some nurses because you are trained to fix things, and you often can’t fix these situations.   You’re not Jesus Christ with Lazarus…your medical/scientific training is useless in this regard.  But it doesn’t mean your patients and families need you any less.   When a patient or family is emotionally traumatized, the best thing anyone can do is to simply be there, even in silence.   Don’t worry about the medicine.

After the female physician was done sharing her story, several other doctors in the room opened up and shared their feelings and a few stories.  One doctor told of a patient who died six weeks earlier and he wondered if it was OK to send a sympathy card to the family.  Absolutely.  Another doctor said when a patient dies he feels pushed to quickly get onto the next patient.  Don’t feel pushed.

Every audience gives me energy and hope.  This audience gave me a little extra energy and reason to get up early every morning.   We have A LOT of work to do, but it’s worth the effort!

Enjoy the rest of your day!

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Latest from Harvard Researcher on Disclosure for Medical Errors

Yesterday (Feb 13th) Harvard Researcher Michelle Mello, JD, PhD, wrote about the value of disclosure for patients/families for the Huffington Post.  Michelle’s column was in response to an anti-disclosure post written by prominent consumer advocate Joanne Doroshow.   I am sharing this information with the Sorry Works! audience because while responding to Doroshow, I think Michelle did a great job summarizing the work of her research team, including their recent articles in Health Affairs.  You’ll want to know this stuff.   Moreover, Michelle also nicely spelled out the challenges and hurdles we face in disclosure, most notably the need for disclosure training for front-line clinicians and the importance of compensating folks who have been injured by legitimate medical errors.

The links for Michelle’s post as well as Doroshow’s post are below.

There was an issue Michelle alluded to in her article but I want to address it head-on: Entrenched interests.   To get disclosure going at your hospital or insurer, you will need to eliminate entrenched interests.  These folks need to go.

Here’s what I’m talking about…..Joanne Doroshow is not just any consumer advocate…she is the “go to person” for the personal injury trial bar.  Whenever there is a fight over tort reform, Joanne will be there and her hefty consulting fees will paid either by trial lawyer organizations or individual lawyers.  To be blunt, Joanne is not that good and is constantly outclassed by the tort reformers, but she is always spoiling for a fight.  Joanne gets paid to fight….just like the tort reformers get paid to fight.   Disclosure is a dirty word to folks like Joanne, the tort reform community, and some elements of the defense bar and claims management world.  The more fighting and fussing that is going on, the more $$ they make.  Settle a case in two months? asks the befuddled defense lawyer.   But, but, but…we have to do some depositions.  And what about discovery?  The more that consumers and clinicians suffer post-event, the more dough these entrenched interests rake in.

Try the following…contact your local or even national tort reform group and ask them for their position on disclosure.  At best, they will say, “Dislosure is nice, but it really won’t make a difference…..you need tort reform….you need US.”  At worst, they will start backpeddling, say disclosure is pro-plaintiff, etc, etc.  The more tort reformers talk, the more you realize they actually know very little about med-mal.  Ask yourself…are tort reformers really for doctors and hospitals, or are they just in it for the fight?

This is such an important message for folks contemplating disclosure.  Internal and external entrenched interests will fight your disclosure efforts because they make money  - lots of money – from the current med-mal system.  And to be clear: While Joanne and some other consumer advocates don’t like disclosure, individual trial lawyers and even trial lawyer groups are warm to disclosure.  They really are.  I always say to hospitals and insurers you are right to worry about the lawyers, but your biggest challenge may be with your own defense lawyers along with their buddies in the claims department.  These are your internal entrenched interests.  Personal injury lawyers tend to appreciate disclosure…we just need to get them to quit writing checks to Joanne Doroshow.  Likewise hospitals and insurers need to quit writing checks to tort reform groups and also fire non-cooperative defense lawyers and claims managers.   Entrenched interests peddle fear and create strife for one reason: Make $$$.

Here is the link for Michelle Mello’s column: http://www.huffingtonpost.com/michelle-mello/medical-errors_b_4769554.html.

And here is the link for Joanne Doroshow’s column: http://www.huffingtonpost.com/joanne-doroshow/patient-safety-takes-a-ba_b_4598745.html.
Lastly, next Tuesday, Feb 18th is our next free webinar to preview our on-line disclosure learning courses.  This is the economic and scalable way to teach disclosure to front-line docs and nurses.  The webinar is at 1pm EST/10am PST this coming Tuesday.  To register, simply e-mail doug@sorryworks.net.

Happy Valentine’s Day!

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