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Old 12-25-2009, 03:49 PM
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Default When & Why You Should Apologize to Patients

As many of us can attest, it’s hard to say you’re sorry. The process is vastly more complicated for healthcare professionals, including
NPs, who make life-and-death decisions in a world where multimilliondollar lawsuits are common. Despite the obvious risks of admitting guilt, the movement toward full disclosure—and finding a way to enable clinicians to empathize with patients and apologize for unfortunate outcomes—is gaining momentum. Apologizing for clinical errors even has been shown to reduce medical malpractice lawsuits.

The Institute of Medicine released To Err is Human, a report showing that between 44,000 and 98,000 deaths result from medical mistakes each year in the United States. The report forced the medical community to redouble its efforts to promote patient safety and reduce errors. It also launched a movement to dismantle what has historically been a deny-and-defend culture. “The movement owes much of its momentum to at least three sources,” said Sylvia Brown, JD, RN, vice president of risk management for Premier Insurance Management Services: the ethics of healthcare providers, studies supporting the effectiveness of disclosure in reducing exposure to massive court awards, and pressure from regulatory agencies. At least 29 states have implemented apology legislation. Under most of these laws, a provider’s apologetic expression of sympathy (“I’m sorry you had to go through this”) cannot be used against him or her in court. In a handful of states, the apology is inadmissible in court even when it includes an admission of fault (“I’m sorry I gave you the wrong medicine”). In 1987, the Veterans Affairs Medical Center in Lexington, KY, implemented a full-disclosure/apology program. Any patient harmed by a medical error is immediately informed of what happened and is offered an apology by facility officials. If the risk management team determines that the hospital or a staff member is at fault, the VA offers a fair settlement. Within 10 years, the hospital slashed annual claims payments from some $1.5 million to about $180,000.

Fundamental guidelines

Apologizing can deepen your relationship with the patient and family, safeguard the patient by acknowledging and addressing errors, and actually reduce the likelihood of a lawsuit. The key lies in knowing how to be ethical and honest while steering clear of legal risk.

Experts agree that clinicians must be familiar with and work within their organization’s approach to disclosure. Those who find themselves in
situations with unanticipated outcomes should immediately file honest, objective incident reports and contact the facility’s risk manager.


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Old 12-25-2009, 03:56 PM
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Two types of "apology" legislation have been introduced in statehouses nationwide. One version excludes from evidence mere expressions of sympathy after accidents; the other, more extreme type excludes both such expressions and apologies that admit fault.

The second form creates a loophole that can eliminate important facts as evidence. A statement such as "I'm sorry about the accident, I hope you are OK" should not be admissible. But the statement "I'm sorry I hit you, I had too much to drink before I got in the car" or "I'm sorry, I was talking on my cell phone and wasn't paying attention
Apology legislation that excludes admissions of fault has other problems. It could induce insincere apologies from unremorseful wrongdoers.

* anger injured parties who, without the wrongdoer's fault-admitting apology, could not prove the defendant's liability in court.

* undermine the legal system when parties who admitted their guilt when apologizing are not found liable.

To date, 18 states have enacted apology legislation:
Arizona (2005)
California (2000)
Colorado (2003)
Florida (2001)
Georgia (2005)
Maryland (2005)
Massachusetts (1986)
Missouri (2005)
Montana (2005)
North Carolina (2004)
Ohio (2004)
Oklahoma (2004)
South Dakota (2005)
Texas (1999)
Virginia (2005)
Washington (2002)
West Virginia (2005)
Wyoming (2004)

A related legislative proposal called "Sorry Works" has surfaced in Illinois and Tennessee. Backers believe that if doctors apologize for their errors, liability costs for the doctors and hospitals will decrease. The Illinois bill creates a pilot program for two hospitals, giving doctors there 72 hours after committing an error to apologize. The proposal specifies that if medical malpractice Improper, unskilled, or negligent treatment of a patient by a physician, dentist, nurse, pharmacist, or other health care professional. costs increase, the state will pay the difference; if they drop, the state pays nothing. The Tennessee bill goes a step further and places a $250,000 cap on noneconomic damages for doctors and hospitals that institute the program.

The Federal Rules of Evidence The Federal Rules of Evidence generally govern civil and criminal proceedings in the courts of the United States and proceedings before U.S. Bankruptcy judges and U.S. magistrates, to the extent and with the exceptions stated in the rules. Promulgated by the U.S. and most state codes of evidence treat an apology that admits fault as an admission of guilt admission of guilt n. a statement by someone accused of a crime that he/she committed the offense. If the admission is made outside court to a police officer it may be introduced as evidence if the defendant was given the proper warnings as to his/her rights . Before states enact legislation contrary to this well-established rule, they should consider the ramifications.

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