Read how the AMA pursues medical liability laws on the state level to reshape the current medical liability system to better serve both physicians and patients.

The authors discuss trends in the medical malpractice liability insurance market, consider the impacts COVID-19 has had, and suggest using a CRP approach during the pandemic to lessen the consequences of a hardening insurance market.

The Apology and Disclosure Grand Rounds NWH incorporates a video simulated error and a presentation about “When Things Go Wrong”. The presentation discusses disclosure coaching & peer support, the emotional impact of errors on clinicians, and principles for transparent & compassionate disclosure and apology.

39 states have apology laws, with over a third applying to healthcare or other contexts. After over a decade of experience with apology laws, the authors explore whether apology laws reduce malpractice liability risk and why, and whether there is a reason to have them.

Background
Many health care organizations want to improve their responses to patients who suffer medical injuries. Their ability to understand how well they meet patients’ needs is limited by the lack of suitable instruments for assessing injured patients’ experiences.
Methods
This study aimed to generate items for a patient experience questionnaire that medical facilities can use to assess how well resolution met patients’ needs. The Medical Injury Reconciliation Experiences Survey (MIRES) was based on findings from previous studies of New Zealand and American patients’ experiences of non-litigation resolution of medical injuries. The researchers performed a content analysis of 24 transcripts from a stratified random sample of 92 interviews from the prior studies. Themes were extracted to develop a draft questionnaire, which was revised following feedback from experts. Cognitive debriefing interviews were conducted with 24 New Zealand and American injured patients.
Results
There were 40 items in the following domains: perceptions of communications with health care providers after the injury (15 items), perceptions of remedial gestures (11 items), indicia of the patient’s overall satisfaction with the reconciliation process (4 items), the nature and impacts of the injury (5 items), and patients’ characteristics (5 items). Participants’ feedback about the questionnaire was predominantly positive. Their suggestions led to 37 revisions.
Conclusion
The MIRES was comprehensible and acceptable to this group of post-injury patients. While further testing is desirable, the MIRES offers promise as a practicable approach that health care organizations can use to assess how well their reconciliation processes met patients’ needs.

Medical errors are associated with significant emotional, financial, physical and sociobehavioural impacts including reduced trust and willingness to seek healthcare. These impacts can last for years. The study sought to understand whether greater open communication is associated with reduced emotional impacts and decreased avoidance of doctors/facilities involved in the error.

Background: The emotional impact of medical errors on patients may be long-lasting. Factors associated with prolonged emotional impacts are poorly understood.

Methods: The authors conducted a subanalysis of a 2017 survey (response rate 36.8% [2,536/6,891]) of US adults to assess emotional impact of medical error. Patients reporting a medical error were included if the error occurred ≥ 1 year prior. Duration of emotional impact was categorized into no/short-term impact (impact lasting < 1 month), prolonged impact (> 1 month), and especially prolonged impact (> 1 year). Based on their reported experience with communication about the error, patients’ experience was categorized as consistent with national disclosure guidelines, contrary to guidelines, mixed, or neither. Multinomial regression was used to examine associations between patient factors, event characteristics, and organizational communication with prolonged emotional impact (> 1 month, > 1 year).

Results: Of all survey respondents, 17.8% (451/2,536) reported an error occurring ≥ 1 year prior. Of these, 51.2% (231/451) reported prolonged/especially prolonged emotional impact (30.8% prolonged, 20.4% especially prolonged). Factors associated with prolonged emotional impact included female gender (adjusted odds ratio 2.1 [95% confidence interval 1.5–2.9]); low socioeconomic status (SES; 1.7 [1.1–2.7]); physical impact (7.3 [4.3–12.3]); no organizational disclosure and no patient/family error reporting (1.5 [1.03–2.3]); communication contrary to guidelines (4.0 [2.1–7.5]); and mixed communication (2.2 [1.3–3.7]). The same factors were significantly associated with especially prolonged emotional impact (female, 1.7 [1.2–2.5]; low SES, 2.2 [1.3–3.6]; physical impact, 6.8 [3.8–12.5]; no disclosure/reporting, 1.9 [1.2–3.2]; communication contrary to guidelines, 4.6 [2.2–9.4]; mixed communication, 2.1 [1.1–3.9]).

Conclusion: Prolonged emotional impact affected more than half of Americans self-reporting a medical error. Organizational failure to communicate according to disclosure guidelines after patient-perceived errors may exacerbate harm, particularly for patients at risk of health care disparities.

Webinar Date: January 21, 2021

Wesley R. Butler discusses the role of confidentiality and privilege within the context of Communication and Resolution Programs.

Presenter: Wesley R. Butler is an attorney at Barnett Benvenuti & Butler PLLC in Lexington Kentucky who focuses on advising health care providers on regulatory matters that implicate safety, quality, and reimbursement.

Objectives: 

• Outline the elements of typical confidentiality and privilege interests in patient safety and quality analyses, and explore the public policies that support such interests
• Outline the fundamental components of common CRP processes in health care, and explore the public policies and ethical considerations that support CRPs for responding to patient harm events
• Analyze the interplay between CRPs and confidentiality and privilege interests to identify complementary and divergent points
• Conclude with practical suggestions to illustrate that health care providers can fully implement CRP processes while respecting the boundaries of confidentiality and privilege and,  ultimately, gain the benefits that both perspectives offer

Webinar Date: April 26, 2022

Moderator

• Caitlin Harrington. MD, JD

Speaker Panel

• Jeffrey N. Catalano, JD
• Jeff Goldenberg, MD
• Naomi Kirtner
• Jo Shapiro, MD, FACS

Webinar Date: February, 2021

Overview: COVID-19 has fundamentally altered our care processes and standards.  Care is being delayed, visits are happening by telemedicine, there are changes in how staff are deployed and interact with patients, and everyone is exhausted and emotionally depleted. These all make potential for patient harm events higher.  COVID-19 is also adding stress to already tightening medical professional liability insurance market. While it may be tempting to abandon ship when it comes to implementing CRP during COVID-19 times, CRPs are more important now than ever.  Fundamental principles of the CRP model-supporting patients, families, and clinicians after harm with open communication, empathy, learning, and accountability – are critical elements of how we respond to COVID-related harm events.  This webinar examines two cases of COVID-associated adverse events to help lead a discussion on the challenging aspects in implementing CRPs during this time.

Presenters: Michelle Mello, JD, PhD, and Thomas H. Gallagher, MD

Commentary by: Jeffrey Catalano, JD, Marcia Rhodes, Jonathan Steward, JD, MS, RN-BC, CEN, CPHRM

Learning Objectives: 

• Examine potential communication and legal issues associated with COVID-related harm events
• Describe how CRPs can be used as a strategy to address these COVID-related adverse events
• Learn about CRP resources to help address COVID-related challenges

Webinar Date: June 24, 2021

Presenters:

Objectives:

Webinar Date: September 23, 2021

Presenters: 

• Alan Lembitz, MD, MMM, Chief Medical Officer, COPIC
• Eric Wei, MD, MBA Senior Vice President and Chief Quality Officer, NYC Health + Hospitals
• Laurie C. Drill-Mellum, MD, MPH, Chief Medical Officer, Constellation

Learning Objectives:

• Understand the importance of physician involvement in the CRP process and how it helps both physicians and patients
• Examine the benefits of CRPs to physicians
• Explore the barriers to CRP implementation from a provider’s perspective
• Learn why psychological safety a critical component of provider support

Webinar Date: May 20, 2021

Moderator:

• Barbara Pelletreau, RN, MPH, Senior Vice President, Patient Safety, CommonSpirit Health

Speaker Panel:

• Claire Hagan, MJ, CPHRM Director of Risk Management Programs, Providence St. Joseph Health
• Brittnie Hayes, JD, Claims Manager, COPIC
• Linda Ubaldi, RN, CANDOR Training Specialist and Former Quality and Patient Safety Officer, CommonSpirit Health

Learning Objectives:

• Learn practical advice from “claims professionals” on how to transition a CRP case to claims
• Describe several of the key components for an ideal partnership and transition to claims from the perspectives of health systems, insurers, and patients and families
• Understand the needs of patients and families, and how and when to appropriately engage them, in this transition to “claims process”

Webinar Date: June 17, 2021

Presenters: Jonathan D. Stewart, JD, MS, RN-BC, CPHRM

Jonathan is a Senior Director of Risk Management and Patient Safety at BETA Healthcare Group, where he serves as a consultant to hospitals, health care facilities and medical groups. His current professional focus includes helping health care organizations operationalize communication and resolution programs, particularly the investigation and analysis of patient harm events.

Objectives:

• Identify conflicting notions of success and failure regarding CRPs
• Discuss the relationship between incomplete CRP implementation and irregular application of CRPs
• Describe lessons learned from unsuccessful applications of CRPs to individual events

Webinar Date: March 17, 2022

Moderator

• Caitlin Harrington. MD, JD

Speakers

• Dr. Jeff Goldenberg and Naomi Kirtner, co-founders of Talia’s Voice

Webinar Date: November 17, 2022

Presenters: Lauge Sokol-Hessner, MD, CPPS

Lauge Sokol-Hessner, MD, CPPS is a hospitalist, Clinical Associate Professor of Medicine at the University of Washington, QI Mentor at the UW Medicine Center for Scholarship in Patient Care Quality and Safety, speaker and consultant for the Institute for Healthcare Improvement, and a guest speaker for the Harvard Medical School Masters in Healthcare Quality and Safety (HMS MHQS). He has experience in operational quality & safety, developing leaders in quality & safety, teaching communication skills, coaching health care organizations to implement highly-reliable CRP programs, and he champions patient and family engagement, ethics, humanism, equity, and respect in health care. He completed medical school and residency at the University of Pennsylvania.

Webinar Date: October 21,2021

Moderator

• Carole Hemmelgarn, MS, MS

Speaker Panel

• Jack and Teresa Gentry
• Naomi Kirtner and Jeff Goldenberg, MD

Learning Objectives

• Understand what elements are important for patients and families to hear after medical harm
• Compare and contrast patient experiences with and without a Communication and Resolution Program (CRP) following harm
• Explain the importance of a highly reliable CRP for patients and families

Webinar Date: October 12, 2022

Presenter: WilliamM.  Sage, MD, JD

William M. Sage, MD, JD, an authority on health law and policy, is a tenured professor in Texas A&M’s medical and law schools, a professor by courtesy in the Bush School of Government and Public Service at Texas A&M, and a vice president in the university’s Health Science Center.   From 2006-2022, he held professorships in law and medicine at the University of Texas at Austin, where he also served as vice provost for health affairs.  He was previously a tenured professor at Columbia Law School, and has been a visiting professor at Yale, Harvard and NYU.  Prof. Sage is a member of the National Academy of Medicine, where he serves on the Board on Health Care Services and recently served on the Committee on the Future of Nursing 2020-2030.  Prof. Sage is a member of the Healthcare System and Value Research (HSVR) study section for the Agency for Healthcare Research and Quality (AHRQ), an elected Fellow of the Hastings Center on bioethics, and a longtime editorial board member of the journal Health Affairs.  He has written over 200 articles and has authored or edited four books, including the Oxford Handbook of U.S. Health Law (2016).  He holds an undergraduate degree from Harvard College, medical and law degrees from Stanford University, and an honorary doctorate from Universite Paris Descartes.

Webinar Date: July 15, 2021

Presenters: 

• Jo Shapiro, MD, FACS, Associate professor of Otolaryngology-Head and Neck Surgery at Harvard Medical School; Principle Faculty for the Center for Medical Simulation in Boston; Consultant for the Massachusetts General Hospital Department of Anesthesia, Pain and Critical Care
• Allan Frankel, MD, Chief Executive Officer, Safe & Reliable Healthcare

Learning Objectives:

• Identify conflicting notions of success and failure regarding CRPs
• Discuss the relationship between incomplete CRP implementation and irregular application of CRPs
• Describe lessons learned from unsuccessful applications of CRPs to individual events

Webinar Date: July 21, 2022

Presenters: Kyle Sweet, JD

Kyle Sweet is an Oklahoma-based defense lawyer represents healthcare providers in catastrophic injury cases around the United States. Kyle teaches in medical schools, dental schools and teaches seminars regularly to healthcare providers on how to avoid litigation by improving quality of care through more effective communication. Kyle is proud to serve on the CAI and looks forward to helping make Communication Resolution Programs the industry standard.

Webinar Date: December 17, 2020

Presenter: Julianne Morath, RN, MS, CPPS, Founding member of the Lucian Leape Institute of the National Patient Safety Foundation

Objectives:

1.  Define the term precondition and its relevance to Transparency

2. Identify at least two reasons to embrace transparency

3. Identify at least three levels of transparency

4. Demonstrate an understanding of why being transparent is so difficult

Webinar Date: April 15, 2021

Presenters:

• Suz Schrandt, JD,  Senior Patient Engagement Advisor, Society to Improve Diagnosis in Medicine; Founder, CEO, & Chief Patient Advocate at ExPPect
• Eric J. Thomas, MD, MPH Associate Dean for Healthcare Quality, McGovern Medical School, University of Texas Health Science Center at Houston; Board President, Collaborative for Accountability and Improvement

Objectives:

• Understand the individual and system factors that can cause diagnostic errors
• Explore the benefits of a CRP response following a diagnostic error
• Examine the consequences of a poor response to a diagnostic error
• Understand the importance of engaging, listening, and learning from patients and families following diagnostic errors

WEBINAR DATE: May 1, 2020

The COVID-19 pandemic is posing a host of potential medicolegal risks for healthcare providers, institutions, and liability insurers. How should one respond to the patient with behavioral challenges who refuses to comply with social distancing? How do COVID requirements affect consent and surrogate decision-making? What new legal issues are arising with rapid expanding telehealth programs or deploying providers to new care environments such as nursing homes? In what situations should healthcare providers or organizations be provided with immunity for potential adverse events associated with COVID-19 care?

PRESENTERS:

Moderator
Thomas H. Gallagher, University of Washington
Panelists
Marcia Rhodes, University of Washington
Leilani Schweitzer, Stanford Health
Michael Severyn, ProAssurance
Kyle Sweet, Sweet Law Firm

OBJECTIVES:

1. Identify current medicolegal issues associated with COVID-19
2. Consider how medicolegal issues associated with COVID-19 may evolve in the future
3. Discuss possible ways to address these issues

Webinar Date: September 17, 2020

Dr. Gordon Schiff talks about diagnostic error and how efforts to reduce diagnostic error align with the principles of communication and resolution programs.

Presenter: Dr. Gordon Schiff (Brigham and Women’s Center for Patient Safety Research and Practice, Harvard Medical School)

Objectives: 

1. Describe the frequency/epidemiology of diagnostic errors based on published studies and surveys.
2. Define diagnosis errors, and using a Venn diagram model differentiate diagnostic process errors, misdiagnosis, and adverse outcomes.
3. List 3 approaches to minimizing and preventing diagnostic errors.
4. Explain ways that missed/under diagnosis and overdiagnosis are related rather than just opposites
5. Describe overlapping and synergistic domains between the diagnostic error/improvement movement andCommunication and Resolution Program (CRP) efforts.

Large Scale Implementation of Communication and Resolution Programs

Presented by: Heather Gocke, M.S., RNC-OB, CPHRM, C-EFM

Webinar Date: January 29, 2020

Ms. Gocke introduces a comprehensive program and a holistic approach in reducing harm in healthcare through large scale implementation of CRP. In her presentation, she highlights the importance of disclosure and engagement, and she shares real-life challenges and secrets to success.

Learning Objectives:

1. Outline the method used to engage member sites in culture transformation
2. Learn  how culture measurement, survey data debriefs, and cognitive interviewing techniques are used to inform this body of work
3. Introduce the five domains and components of BETA HEART

Mitigating the Toll of Medical Errors on Clinicians by Jo Shapiro, MD, FACS

Webinar Date: October 31, 2019

As a clinician, being involved in adverse events can have devastating emotional consequences. How we react to these events – as individuals, colleagues and organizations – has a major effect on our organizational culture of psychological safety, provider wellbeing, disclosure and reporting, and patient safety.  Dr. Shapiro’s presentation will detail these effects and address the unique role that frontline physicians can play in supporting one another after adverse events. She will describe the peer support program developed at Brigham and Women’s Hospital and adopted by dozens of healthcare organizations. She will describe the building blocks of a creating and sustaining a peer support program, including providing the participants with the rationale to bring to leadership in advocating for peer support program resources.

Learning Objectives:

1. Identify the emotional impact of adverse events on clinicians
2. Recognize the impact this has on a culture of psychological safety, provider wellbeing, disclosure and reporting, and patient safety.
3. Provide a rationale to leadership for developing a peer support program
4. Delineate the foundational aspects of a peer support program

Webinar presented by Dr. Tom Gallagher on Thursday, June 6, 2019

Large-scale adverse events, situations in which a breakdown in care has affected multiple (sometimes thousands) of patients, pose significant challenges for institutions related to responding in ways that inform potentially affected patients without unduly alarming them and managing the follow-up. This webinar will highlight lessons learned from the field around responding effectively to adverse events, as well as key unanswered questions.

Learning objectives:

1. Describe the diversity of large-scale adverse events, and how responding to these events differs from managing adverse events that affect individual patients
2. List the key elements of an effective response to a large-scale adverse events and the tools that are currently available to assist with this process
3. Critique an actual large-scale adverse event patient notification letter and press release, and articulate opportunities for improvement in these documents.

The Communication and Optimal Resolution (CANDOR) process is a patient-centered approach used by health care institutions and practitioners to respond in a timely, thorough, and just way when unexpected patient harm events occur. It focuses on early disclosure of adverse events and a proactive method to achieving an amicable resolution for the patient/family and health care providers.

The video demonstrates an example of the care team’s disclosure meeting conversation with the affected family.

Discerning complicated approach of ethics and professionalism in medicine can be difficult. It’s similarly challenging when clinicians have to navigate through clinical or relational situation and develop an understanding of ethical, legal and more issues.

The Case Files consist of carefully crafted cases designed to stimulate proper approach and decision-making process. Case 18 focuses on transparent and compassionate disclosure and apology, and recognizing emotional challenged clinicians may face after an adverse event.

Colorado Candor Act: ARTICLE 51 Communication and Resolution After an Adverse Health Care Incident (2019)