Forum on Apology and Disclosure HighLights Progress in Massachusetts
MACRMI (The Massachusetts Alliance for Communication and Resolution following Medical Injury) held its 3rd annual CARe Forum yesterday. MACRMI works to advance the development of Communication, Apology and Resolution (or CARe) programs in Massachusetts hospitals. These programs are intended to foster openness and transparency following the occurrence of a medical error or an unanticipated outcome. There are many resources on the MACRMI website.
Yesterday’s forum included updates on the CARe program in Massachusetts, which has so far been implemented at pilot sites at Beth Israel Deaconess Medical Center, Baystate Medical Center, and the affiliated hospitals of both institutions. Also Sturdy Memorial Hospital and Atrius Health have been added as pilot sites.
The highlight of the day was the afternoon panel which focused on a specific error that occurred at BIDMC. All parties involved spoke about the error and the CARe process that followed, including the patient, her attorney, the hospital’s attorney, staff from the patient safety division of the hospital, and the chief surgeon of the department within which the error occurred (though he was not directly involved in the incident). The patient and her attorney both spoke via pre-recorded videos. The patient (named Tricia) had been at BI for gallbladder surgery. A number of months later she noticed on a report from her time in the hospital that there had been an incidental finding of a mass on a CT scan relating to the gallbladder surgery. She was never notified of the mass and then through her own outreach found out that she had Stage 3 ovarian cancer. As a result of this delayed diagnosis and the fact that she should have been notified about the finding months earlier, she found an attorney and they sent the hospital a pre-litigation letter.
The hospital reached out to see if the patient could come in and meet with them so they could hear more from her. This meeting did occur and the patient and her husband both felt that they were listened to and heard. They also received an apology from the staff in attendance and the staff explained changes they made to protocols to prevent something similar happening to another patient. She continues to get treatment for the ovarian cancer at BI because she still trusts them and their care. Luckily, it was determined that the delay did not lead to a long-term impact on her care and she is currently cancer free. The hospital did offer compensation to her, and after discussing her options with her attorney she agreed to accept, thus avoiding a lengthy legal process.
This panel was an example of how the CARe process can work to bring the patient and the providers together as human beings to talk about what happened and apologize. The patient’s attorney, Jeff Catalano, was a leader in working with the medical society to pass legislation (within Chapter 224) to promote apology, disclosure and compensation and he has continued to educate other attorneys about CARe programs and the impact on patient safety and transparency.
This kind of program, as it spreads across more hospitals, will hopefully lead to more openness and discussions both among hospital staff and between staff and patients/families about errors and how to prevent their recurrence. As hospitals develop and implement the programs, it is vital that they engage patients and families in the process. Patient and Family Advisory Councils (PFACs) are ideal vehicles for bringing in the patient and family perspective to the development of the CARe program.
- Deb Wachenheim, HCFA's Patient/Family Organizer and Coalition Coordinator