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Washington Examiner
June 29, 2005

Medical honesty is the best policy

Here's a rare story from the Philadelphia Inquirer. One day in 1999, Lloyd Brown, a 77-year-old veteran, lost vision in his right eye. His wife phoned a triage hotline at the Veterans Administration hospital in Lexington, Ky., but the hospital failed to relay her message to a doctor.

Two more episodes and six weeks later, Brown and his wife visited the medical center. The doctor said a blood vessel had been blocked by a stroke and Brown would never recover sight in the affected eye.

Here the story takes a surprising turn. The doctor admitted the hospital's mistake. He said he could have saved the eye if he'd treated Brown within four hours of the first episode. The hospital was plainly at fault for not relaying Mrs. Brown's initial call for help.

What do you suppose happened next? No, not a lawsuit. The hospital advised the Browns to get a lawyer so they could discuss a settlement. VA officials helped Mr. Brown apply for full disability benefits. And the chief of staff met with the Browns and apologized, expressing sincere remorse.

"We think a lot of them," said Mrs. Brown. "They're taking responsibility. I never had experience with it, but I've never heard of a hospital admitting a mistake."

Had the mishap occurred before 1987, the Browns wouldn't have heard such an admission. The hospital's standard response to error had been adversarial - short on disclosure and long on opposition. But after losing two lawsuits in one year with verdicts totaling $1.5 million, the Lexington VA changed that policy. Staff at all levels were encouraged to report mistakes to the risk management committee. If a mistake caused harm, the patient was to be informed - even if he wasn't aware of it.

In addition, the chief of staff would apologize personally for the mistake and the hospital would provide medical aid and arrange for payment of benefits. In short, when the hospital made an error, it would take full moral responsibility.

As it turns out, honesty really is the best policy. From 1990 to 1996, annual malpractice claims against the hospital averaged about $190,000, one of the lowest in the VA hospital system. The University of Michigan Health Systems began a similar policy in 2002, reducing annual legal fees by $1.5 million and cutting the number of lawsuits in half.

Why such remarkable results? Studies show that it comes down to the simple human exchange of apology and forgiveness. When people are harmed, they often value a sincere apology more than money.

The simple expedient of apologizing and taking responsibility is spreading. Seventeen states have enacted legislation that prohibits apologies from being used against a doctor in court. You can learn more at www.sorryworks.net.

Opposition comes, as you might guess, from trial lawyers. Their money-grubbing hearts are bared on their Web sites. One boasts of winning $80,000 for a passenger who sustained only cuts and bruises in an auto accident. Another announces: "We can put an end to medical misdiagnosis by informing the public and filing claims and suits against the medical practitioners at fault."

Nonsense. No one can end medical errors. Humans will always make mistakes and sometimes even do grievous harm. How we handle those errors is one of the moral choices that define us as a people.

The sad truth is that we've been redefining ourselves since the 1960s, moving steadily away from taking responsibility and toward litigiousness — not in spite of the civil law, but often because of it. Harvard law professor Mary Ann Glendon wrote in 1994 that "lawyers, like architects and builders, create structures in which human beings must live, love and work. It's plain soon enough if the materials are cheap, the work shoddy, the dwelling unsuited for habitation."

So we see. That's why stories like Lloyd Brown's and reforms such as apology legislation are important. They are signs of a nation putting its house back in order.

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