DISCLOSURE

DISCLOSURE

There is evidence to support that people who are the recipient of a medical error want information about the error, in detail and rapidly, after the event occurs. This early disclosure may help to offset litigation. Mistakes occur, but what people find troublesome is the attempt to hide information after an error.

To Disclose or Not to Disclose?

Dr. Karl Shipman was admitted to a Colorado hospital in September 1997 with a broken wrist. The healthy, active 64 year old had fallen off a ladder. Dr. Shipman had practiced at the Colorado hospital as an internist and he had formally been the chief of medicine.

Dr. Shipman’s injury required surgery to repair his wrist. After surgery an infection set in. The infection spread to his spine and he developed incapacitating pain. Two months after the fall from the ladder, Dr. Shipman died in the intensive care unit.⁴¹ “Dr. Shipman’s daughter, Debra Malone, an ICU nurse at another hospital later stated, “He died from a broken wrist - in his own hospital". The hospital would not admit the error, apologize or address change." Malone eventually filed legal action against the hospital.⁷³

A DECISION TO CHANGE

Jason Fransen, an active teenager was admitted to Children’s Hospital in Minneapolis with persistent pain in his right hip. After a battery of tests, Jason was diagnosed with a curable non-cancerous disease that required eight month of treatment. Although the disease resembled a cancer, it was not. Jason was declared cured. He was given a T-shirt that said, “Jason You’re Cured.”

Over the next eighteen months, Jason’s pain returned and continued to increase. Another biopsy was performed. This test was sent out to a special children’s pathologist. The results were devastating. Jason had Ewing’s sarcoma. Ewing’s tumor invades the bones. The cancer - also known as Peripheral Primitive Neuroectodermal Tumors (PNET) occurs most frequently in children between 10 and 20 and develops within the bones and/or certain muscle tissues – it can be very vigorous.

Jason went through aggressive chemotherapy, but in September 1998, the Fransen’s lost Jason.

The Fransen’s filed a lawsuit against the hospital. A group of outside medical experts reviewed Jason’s case. The panel found that the Ewing’s Sarcoma was hard to diagnose. A law in Minnesota existed that said if a patient’s survival was less than 40% at the time of diagnosis that the lawsuit could not continue. The case was dismissed.

The Fransen’s were devastated and extremely angry about the misdiagnosis. They asked to meet with the Chief Executive Office, Brock Nelson. The family wanted answers and an apology. Although sympatric, the CEO offered no further information, nor admitted responsibility.

The meeting was a life changing experience for Brock Nelson. He came out of the meeting feeling horrible saying, “it was the worst meeting I’d ever been in. We were stonewalling them.”

That was the day Brock Nelson made a decision to change the culture at Children’s Hospital. Mr. Nelson launched a patient safety revolution, starting with the practice of honest disclosure when an error occurred, who, what, where, when and how. Safety became everyone’s job with a focus on a blame free environment and safer system designs.

Brock Nelson met with the Fransen’s, apologized, acknowledged what happened and what steps the hospital had taken to prevent future situations like Jason’s. According to the Fransen’s they also received a settlement from the hospital.¹⁰⁰

TO REVEAL

Disclose, or reveal, is a term used in hospitals and in legal arenas to signify an unveiling of the facts related to an incident. There are hospitals leaders that strongly embrace disclosure to patients and those hospitals have used this practice for years. For most hospitals, the practice is new territory. There are no hard data to quantify if outright disclosure about injuries and deaths will result in reduced liability, but some of the early studies are promising.

HUMANISTIC RISK MANAGEMENT

The VA was one of the first organizations to move toward humanistic risk management. Traditional risk management utilizes methods to track and prevent liability claims for hospitals. Risk management attempts to defend against potential and actual litigation and often results in defensive stands against lawsuits; this often creates an adversarial role with patients and their families.

Humanist risk management is an approach that responses to medical errors with several principles, including full disclosure and compensation as appropriate. Most importantly, the focus is to maintain a compassionate hospital and patient relationship, with a continued strong role as the patient’s caretaker.⁷⁶There are missing links for patients when they are not told the details around an adverse event. Anger may be dispelled if the patient and family are informed and involved in action steps surrounding the medical error. Certainly, this type of involvement would enlighten the patient to the facts about the situation. Additionally, disclosure may clarify misinformation that can lead to anger and uncertainty and ultimately litigations. Disclosure may benefit all parties involved.

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