Daily Rounds: Legal Challenges To Reform; Brokers Thrive; Baker’s Record; Cautionary Malpractice Tale

September 13, 2010, 3:51 am

≫ Next: Malpractice Lessons For Mass. From Michigan: Safer Doctors Mean Safer Patients

Healthcare lawsuit: States opposed to healthcare overhaul pin hopes on Florida court hearing – latimes.com Conservative legal challenge to federal reform comes to court this week. (Los Angeles Times)

Patient Money – Health Insurance Brokers Can Guide Individual Buyers – NYTimes.com Brokers are busier than ever as individuals explore their new options. (The New York Times)

A brash change-agent, Baker rose fast – The Boston Globe [Gubernatorial candidate Charlie] Baker “made a variety of radical moves in state government. Some would come back to haunt him, including his decision to approve the hospital merger that created Partners HealthCare, the powerful consortium some blame for helping push up health care costs.” (Boston Globe)

Yale Alumni Magazine: Light & Verity Surgeon told patient ‘We got it all’ when in fact she never had cancer and he knew it. $12 million and 15 years of legal proceedings later, she says she might not have sued if doctors had been honest and apologized. (yalealumnimagazine.com)

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Malpractice Lessons For Mass. From Michigan: Safer Doctors Mean Safer Patients

March 2, 2011, 7:15 am

≫ Next: NEJM: Malpractice Reform Heads In New Directions, Because It Has To

≪ Previous: Daily Rounds: Legal Challenges To Reform; Brokers Thrive; Baker’s Record; Cautionary Malpractice Tale

WBUR’s Morning Edition host Bob Oakes reports here:

BOSTON — One plank of Gov. Deval Patrick’s plan to bring down soaring health care costs in Massachusetts is to change the laws around medical malpractice.

Under proposed changes, doctors in Massachusetts would be able to apologize to patients — without the risk that their apology could be used against them later, in court. The state would also implement a six-month “cooling off period,” so that hospitals and patients could try to resolve problems without lawsuits.

Rick Boothman, the chief risk officer at the University of Michigan health system, uses some of the ideas that Patrick is proposing. If his hospital makes a mistake, they tell the family they’re at fault and apologize — without the condition that the family won’t sue.

Boothman told Bob on the air today that the Michigan approach has dramatically cut the number of malpractice claims, as well as the number of those claims that end up in court. And it has changed medical culture, too.

“In order to make patients safer, we have to make doctors safer,” he said. “This is the only profession I know where it’s inherently risky to begin with, and a mistake can ruin someone financially. That’s unfair.”

“We tell our staff that they must always feel free to express sympathy and empathy to a family,” apart from any apology, he said. And as for apologies, “We not only say ‘I’m sorry it happened,’ but ‘I’m sorry we did this.’”

“We have to find a way to keep physicians and nurses professionally accountable,” Boothman said, “but we have to make the system far less punitive.”

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NEJM: Malpractice Reform Heads In New Directions, Because It Has To

April 21, 2011, 9:13 am

≫ Next: Mass. Study: Electronic Health Records Bring 6-Fold Cut In Malpractice Claims

≪ Previous: Malpractice Lessons For Mass. From Michigan: Safer Doctors Mean Safer Patients

Gov. Patrick’s plan for the next wave of health reform includes changes in malpractice rules. To quote our own Bob Oakes:

Under proposed changes, doctors in Massachusetts would be able to apologize to patients — without the risk that their apology could be used against them later, in court. The state would also implement a six-month “cooling off period,” so that hospitals and patients could try to resolve problems without lawsuits.

An article just out in the New England Journal of Medicine offers some enlightening background on the current state of thinking on malpractice reform. Written by two Harvard experts, Allen Kachalia and Michelle M. Mello, it describes a pivotal moment that I’d sum up thusly: Most of what we’ve tried so far hasn’t worked very well. Let’s try some new things.

The authors write:

Medical liability reform is headed in a new direction, reflecting dissatisfaction with both the narrow focus of traditional approaches to liability cost control and the lack of effectiveness of most traditional reforms in achieving even that limited objective. The launching of the federal demonstration projects may reduce the impetus for federal statutory reform in the immediate future, but it may reap longer-term gains. By spurring both private innovation and nontraditional public-policy reforms, the new approaches to medical-injury response that are now being tested may bring us closer to a liability system that fosters, rather than obstructs, progress toward safe and high-quality health care.

And they note some clearly good news: research on the effectiveness of various malpractice reforms has expanded and improved in recent years.

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Mass. Study: Electronic Health Records Bring 6-Fold Cut In Malpractice Claims

June 27, 2012, 10:25 am

≫ Next: Sen. Warren Endorses Ballot Initiative On Patient-To-Nurse Ratios

≪ Previous: NEJM: Malpractice Reform Heads In New Directions, Because It Has To

There’s strong consensus that the American medical system must march decisively into the era of electronic health records and the shift is happening rapidly, particularly here in Massachusetts.

But understandably, some concerns remain that computer glitches could potentially cause errors. I don’t even like to imagine a doctor with my technological abilities — or lack thereof — getting used to a new prescription or diagnostic system. So here’s a bit of reassuring news from a paper just out online in the Archives of Internal Medicine:

“The rate of medical malpractice claims when electronic health records (EHRs) were used appeared to be about one-sixth the rate when EHRs were not used, according to a research letter that reported on a total of 51 unique closed malpractice claims and survey data from some Massachusetts physicians.”

From the paper, some interesting analysis on whether this really means better medicine is being practiced:

This study adds to the literature suggesting that EHRs have the potential to improve patient safety and supports the conclusions of our prior work, which showed a lower risk of paid claims among physicians using EHRs. By examining all closed claims, rather than only those for which a payment was made, our findings suggest that a reduction in errors is likely responsible for at least a component of this association, since the absolute rate of claims was lower post-EHR adoption.

Unmeasured factors may, in part, account for the apparent 6-fold reduction in malpractice claims attributed to EHRs. For example, physicians who were early adopters of EHRs may exhibit practice patterns that make them less likely to have malpractice claims, independent of EHR adoption; these early adopters contribute a disproportionate amount of time in our analyses, favoring an effect of EHRs on reducing malpractice claims. Furthermore, other interventions may have occurred concurrent with EHR implementation that could account for some of the observed reduction of malpractice claims attributed to EHRs.

While this study includes only a small number of post-EHR claims, it suggests that implementation of EHRs may reduce malpractice claims and, at the least, appears not to increase claims as providers adapt to using EHRs. The reduction in claims seen in this study among physicians who adopted EHRs lends support to the push for widespread implementation of health information technology.

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Sen. Warren Endorses Ballot Initiative On Patient-To-Nurse Ratios

September 25, 2018, 2:11 pm

≫ Next: The Patient: 'Last Time In The ICU, My Wife Died.' What Do You Say?

≪ Previous: Mass. Study: Electronic Health Records Bring 6-Fold Cut In Malpractice Claims

The measure is opposed by Massachusetts hospitals. Nurses unions are split on the initiative.

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The Patient: 'Last Time In The ICU, My Wife Died.' What Do You Say?

September 26, 2018, 9:42 am

≫ Next: Panel Asks AG Healey To Ensure Beth Israel-Lahey Merger Doesn't Hike Prices Or Hurt Care

≪ Previous: Sen. Warren Endorses Ballot Initiative On Patient-To-Nurse Ratios

A medical student describes a moment of struggling to respond to a patient's plaintive comment, and tries to learn for the future.

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Panel Asks AG Healey To Ensure Beth Israel-Lahey Merger Doesn't Hike Prices Or Hurt Care

September 27, 2018, 1:31 pm

≫ Next: Health Care Hacking On The Rise, Mass. General Study Finds

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The state's Health Policy Commission asks the attorney general to look into ways to make sure a proposed Beth Israel-Lahey Health merger would not send prices soaring or hurt health-care access for lower-income people.

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Health Care Hacking On The Rise, Mass. General Study Finds

September 28, 2018, 1:06 pm

≫ Next: Trump's 'Public Charge' Rule Could Mean Life-And-Death Decisions For Legal Immigrants

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The shift to electronic medical records means a single breach can affect many more patients.

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Trump's 'Public Charge' Rule Could Mean Life-And-Death Decisions For Legal Immigrants

September 28, 2018, 1:09 pm

≫ Next: Mass. Health Care Policy Advocate Dies At 69

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Three local doctors decry a Trump administration proposal that would penalize legal immigrants applying for green cards if they use public benefits.

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Mass. Health Care Policy Advocate Dies At 69

September 29, 2018, 8:37 am

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Timothy Gens was the executive vice president of the Massachusetts Health and Hospital Association for over two decades.

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Backers Of Nurse Staffing Proposal Object To Agency's Study

September 29, 2018, 9:46 am

≫ Next: When Patients Can't Be Cured: Mass. Med Schools Teaching More End-Of-Life Care

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A report from an independent state agency on the potential costs of a November ballot question on nurse staffing levels is generating controversy.

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When Patients Can't Be Cured: Mass. Med Schools Teaching More End-Of-Life Care

October 1, 2018, 1:46 pm

≫ Next: Nurses Ballot Initiative Could Cost Over $900 Million A Year, State Panel Estimates

≪ Previous: Backers Of Nurse Staffing Proposal Object To Agency's Study

All four Massachusetts medical schools are trying to get better at helping students grapple with palliative care.

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Nurses Ballot Initiative Could Cost Over $900 Million A Year, State Panel Estimates

October 3, 2018, 3:42 pm

≫ Next: Defining Blackout: Why Understanding Alcohol-Induced Amnesia Is Crucial Amid Kavanaugh Allegations

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Proponents of the ballot measure -- Question 1 -- called the Health Policy Commission's estimate a "guess."

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Defining Blackout: Why Understanding Alcohol-Induced Amnesia Is Crucial Amid Kavanaugh Allegations

October 3, 2018, 7:48 am

≫ Next: 70 Percent Of Mass. Residents Think Narcan Should Be Widely Available In Workplaces, Poll Finds

≪ Previous: Nurses Ballot Initiative Could Cost Over $900 Million A Year, State Panel Estimates

"I've seen the prevalence of blackouts ranging anywhere from 10 percent to up to 50 percent of young people who drink," says Dr. Richard Saitz. "It's fair to say it's not rare."

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70 Percent Of Mass. Residents Think Narcan Should Be Widely Available In Workplaces, Poll Finds

October 4, 2018, 1:39 pm

≫ Next: Untangling The Science On Bicycling And Sexual Function

≪ Previous: Defining Blackout: Why Understanding Alcohol-Induced Amnesia Is Crucial Amid Kavanaugh Allegations

Blue Cross Blue Shield of Massachusetts also announced an "opioid toolkit" service for its workplaces and for employer customers.

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Untangling The Science On Bicycling And Sexual Function

October 5, 2018, 12:32 pm

≫ Next: Beth Israel-Lahey Merger Passes Hurdle But With 'Unprecedented' Conditions

≪ Previous: 70 Percent Of Mass. Residents Think Narcan Should Be Widely Available In Workplaces, Poll Finds

Does cycling impact sexual function? The science is conflicted, but efforts are under way to reduce risk.

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Beth Israel-Lahey Merger Passes Hurdle But With 'Unprecedented' Conditions

October 10, 2018, 11:54 am

≫ Next: Baker Against Ballot Question To Boost Nursing Staffing

≪ Previous: Untangling The Science On Bicycling And Sexual Function

The state Public Health Council gave the merger a green light but included conditions aimed at keeping costs down and protecting health care access for lower-income patients.

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