Globe: New approach to medical errors takes hold

Doctors generally don’t admit to or apologize for even the most obvious medical mistakes. For the most part, they’ve never been allowed to. Blame it on those nasty malpractice lawyers who will use it against the doc in court. Or blame it on the hospital lawyers, who need to protect the institution, even if it means not sharing the facts with patients.

So, the Globe reports on an idea that’s been kicking around for a while called DAO – Disclose, Apologize and Offer. Championed at the University of Michigan, the system encourages doctors to admit to and apologize for medical errors and offer settlements as a way to keep the cases out of court.

In most states, anything that sounds like an apology can be used against a doctor in potential malpractice lawsuit. A survey by Harvard researchers identified one barrier to the new approach as “physician discomfort with disclosure and apology.” Still  risk management lawyers at Harvard hospitals issued a consensus statement endorsing the concept six years ago. The Mass Medical Society has been  looking for ways to promote the approach beyond Harvard. A local non-profit that runs support groups for doctors and patients – Medically Induced Trauma Support Services  – is also involved in the effort. And, Gov. Deval Patrick’s pending costs containment bill includes a provision that would make apologies inadmissible in malpractice cases.

Hints that the idea is taking hold emerged in a Globe story last year story on a lawsuit over a fatal overdose of blood thinner contains this statement from Mass General.

A spokeswoman for Massachusetts General Hospital said in a statement yesterday that the hospital regrets the error, and “our hearts go out to Mrs. Oswald’s family.’’

“As soon as we understood what had happened, we apologized and explained the situation to Mrs. Oswald’s family,’’ said (spokeswoman Peggy) Slasman. “We undertook a thorough and extensive internal review of the case, and we communicated with family members throughout this process. As a result of this event, we have made some specific changes to our practices to reduce the chance of such an event from occurring again.’’

In the Globe story Linda Kenney of the  Medically Induced Trauma Support Services welcomes the change, but advises patients to have a lawyer on hand  “to make sure the patient is getting what they are entitled to.’’

“The medical malpractice insurers have tons of attorneys on retainer,’’ said Kenney, whose group belongs to the new Massachusetts coalition.

And malpractice lawyer Andrew Meyer has this to say.  “For the most part, malpractice insurers are looking for a discount from fair compensation’’ by making an early offer, Meyer said. But “if a patient’s rights are not limited in any way, I have no issue with an attempt at early resolution. Cases just drag on for years.’’

More here.

The Globe on alarm fatigue, HIT and a hit to the hospital association

From The Globe:

• Wide heart monitor use tied to missed alarms/ State reports detail 11 patient deaths linked to alarm fatigue in Massachusetts
• Steward Health Care chain quits Mass. hospital group: For-profit chain says it can better advocate for its unique interests
• Report suggests HIT, incubators as part of economic development plan.

Boston hospital CIO Halamka on his wife’s diagnosis: “We have cancer”

Beth Israel CIO John Halamka usually blogs about health information with posts like “The EHR/HIE Interoperability Workgroup,” and very occasionally, his life as a vegan or his plan to  retire to a small family farm to raise organic vegetables.

Today he reports the disturbing news of his wife’s breast cancer. They’ve decided to document her treatment in real time.

The headline “We have cancer.”

Last Thursday, my wife Kathy was diagnosed with poorly differentiated breast cancer. She is not facing this alone. We’re approaching this as a team, as if together we have cancer. She has been my best friend for 30 years. I will do whatever it takes to ensure we have another 30 years together.

She’s has agreed that I can chronicle the process, the diagnostic tests, the therapeutic decisions, the life events, and the emotions we experience with the hope it will help other patients and families on their cancer treatment journey.

Another reason to root for the BoSox: Help for returning soldiers

On Veteran’s Day, consider these numbers from a Rand Corporation study: More than 300,000 U.S. soldiers will return from Iraq with concussions and head injuries. That doesn’t account for civilians.

So check out the Red Sox “Home Base” program, launched after players visited injured vets. To promote research, Home Base works with The Center for Integration of Medicine and Innovative Technology. CIMIT, a cross-disciplinary, cross- town collaboration that includes researchers from Harvard, MIT and local hospitals. The group applies technology – from electronic records to medical devices –to health problems.

Traumatic Brain Injury (TBI) has long challenged caregivers, who have limited options for determining prognosis and providing treatment. Recent prevalence of severe, moderate and mild TBI from military combat has increased the visibility of these issues. TBI and spinal cord trauma are major causes of morbidity and mortality throughout the world. Associated bio-physical changes are difficult to directly measure. The pathophysiology of TBI occurs in stages over prolonged periods of time. Better methods for characterization can aid in tailoring interventions to achieve better outcomes. CIMIT encourages novel approaches to treatment through functional and metabolic imaging and electromagnetic stimuli to localize treatment sites, measure progress, and identify the stages of recovery. CIMIT’s TBI & Neurotrauma Program seeks to explore novel techniques, including systemic and focal pharmacologic regimens, applied energy from lasers and ultrasound, and neuro-technological techniques, as methods to determine the stages at which they may be best applied. This program leverages the innovations of CIMIT Neurotechnology, Traumatic Stress Disorders, and Trauma & Casualty Care Programs, recognizing that many patients suffer from combinations of conditions that require clinicians to draw on a range of specialty resources. http://www.cimit.org/programs-traumatic-brain-injury.html

How is the Boston storm impacting area hospitals?

  We’ll update this as information comes in. Also see WBZ for school closings.

The Brigham and Women’s Hospital  main campus in Boston is open during today’s snow emergency. However, many of our satellite locations will have delayed openings. Please call your doctor’s office to confirm scheduling for today.

 We’ll update this as information comes in.

Dana-Farber Cancer Institute will be open for patient care on Monday, Dec. 27.

Patients who are not able to make their appointment are asked to call their doctor’s office to notify the staff that they are canceling their appointment, as well as make arrangements for rescheduling.

Patients with medical emergencies should call 911 or go to the nearest emergency room.

Children’s

Because of the Massachusetts State of Emergency, all clinics at Children’s–including Boston, Martha Eliot Health Center and all satellite locations–will cancel all non-urgent patient appointments for Monday, Dec. 27, 2010. If you have an appointment scheduled, you will be receiving an automated message about your cancellation. Please note that all surgeries will take place as scheduled.

If you aren’t sure whether or not to come to your appointment on December 27, or have any other questions, please feel free to call your doctor’s office and leave a message and someone will get back to you this morning to clarify.

Due to the weather emergency, Joslin Clinic will be closed on Monday, December 27.

Clinic appointment staff will be contacting patients affected by the closing to re-schedule appointments.

If you prefer to re-schedule your appointment without waiting to be contacted, please call: 

Adult Clinic: 617-309-2440
Pediatrics: 617-732-2603
Beetham Eye Institute: 617-309-2552

Mass Eye and Ear via Twitter: Our Operating Rooms are humming & patient floors are busy. We don’t let a little snow stop us

 Boston VA: Due to the snow storm the Framingham and QuincyCommunity Based Outpatient Clinics are not yet open. The Lowell and Worcester shuttles are not running at this time.

The main campuses of VA BHS are open and clinics are operational. 

 Shuttle service between West Roxbury, Jamaica Plain, Brockton and Causeway St.  clinics are running.

 Please take caution driving in for your appointment.  If you need to reschedule your appointment due to the weather/driving conditions please call your clinic as soon as possible.  IN THE EVENT YOU DO NOT HAVE THE DIRECT NUMBER FOR YOUR CLINIC,  please call the Patient Call Center at 800-865-3384 for assistance.

Boston hospitals: The rich get richer and the poor get sold

First, a note that this week’s roving roundup of health policy blogs, Health Wonk Review, is up on the Health Care Economist. For past posts, see the HWR home page.

In local news, The Globe reports on a massive, $1.5 (not a typo) billion  fundraising effort by MGH.  Known as the “Campaign for the Third Century of MGH Medicine,” about a third of the cash will go to putting up the building to the left. In addition to adding 19 operating rooms, it will expand the number of hospital beds  by almost 20 (not a typo)  percent, the Globe says.

We know where Bill Gates gets his cash. Let’s hope the rest isn’t Madoff money. (See the Brigham’s Shapiro Center and MIT’s Picower neuroscience program.)

Massachusetts General Hospital has raised $1 billion as part of a $1.5 billion fund-raising campaign — despite the tattered economy and turmoil in the hospital industry — putting it on track to set what is believed to be a New England record.

For the “poor get sold” piece, see the Globe and WBUR on the pending sale of the Caritas hospitals to a for-profit group.  Also see the paper of record and Commonhealth for stories — and in the latter case, a goofy video —  on the push for global payments.