Victim Compensation Without Litigation - the Lexington Experience. *Former chief of staff, VA Medical Center, Lexington KY Steve Kraman, MD* Professor, Pulmonary and Critical Care Medicine and Vice Chairman, Department of Internal Medicine University Of Kentucky Kentucky Clinic J-515 Lexington, KY 40536 [email_address]
Because of the generally held belief that to do otherwise would threaten the existence of the hospital.
Because of the belief that being honest with patients will provide them the ammunition to use in a lawsuit.
All the evidence in the medical malpractice literature contradicts the above beliefs.
What Happens if a Hospital Ignores These Fears?
From 1987 to the present, the management of the Lexington KY VA Medical Center practiced a policy of full disclosure including proactive disclosure when patients didn’t even suspect that anything had gone wrong.
We negotiated more than 170 settlements with patients
We went to trial only three times
Lost one case on the merits
Lost one case where we had acknowledged responsibility but could not reach settlement
Won one case
Our largest single payment from 1987 to 2003 (my retirement from the VA) was $341,000 in a wrongful death case.
Our average settlement was $16,000.
National VA Malpractice Payments (2000)* The mean malpractice judgment $413,000. The mean settlement pre-trial $ 98,000 The mean settlement at trial $ 248,165 Mean time from incident to trial date ~ 48 months. Recovery Frequency 31%. Lexington mean payment (2000) $36,000 *From office of VA General Counsel
What Happens When the Hospital Has Done no Wrong?
Never cut off communication.
Maintain professional relationship with patient.
Try to correct erroneous impressions of wrongdoing.
Cooperate with patient’s attorney.
Decline (politely and with explanation) any settlement .
Standard RI.1.2.2 (Effective July 1, 2001) “ Patients and, when appropriate, their families are informed about the outcomes of care, including unanticipated outcomes.”
American Society for Healthcare Risk Management (ASHRM)
Perspectives on Disclosure of Unanticipated Outcome Information (April, 2001).
“ ASHRM believes that patients are entitled to information about the outcomes of diagnostic tests, medical treatment, and surgical intervention. This perspective is the same whether the results are expected or unanticipated outcomes.”
National Patient Safety Foundation Talking to Patients About Health Care Injury: Statement of Principle When a health care injury occurs, the patient and the family or representative are entitled to a prompt explanation of how the injury occurred and its short- and long-term effects. When an error contributed to the injury, the patient and the family or representative should receive a truthful and compassionate explanation about the error and the remedies available to the patient. They should be informed that the factors involved in the injury will be investigated so that steps can be taken to reduce the likelihood of similar injury to other patients…. ------------------approved by the National Patient Safety Foundation Board of Directors on November 14, 2000.
"A long habit of not thinking a thing wrong gives it a superficial appearance of being right." Thomas Paine (1737–1809)