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The Harvard Medical Practice study found that while 17 percent of claims appeared to involve negligent injury while only two percent of negligent injuries resulted in claims. Subsequent studies conducted in Colorado and Utah found similar results. Few injured patients receive compensation through the medical liability system, and those who do receive highly variable recompense, even for injuries that appear to be quite similar. It is estimated that at least $28 billion is spent each year on the inter-related combination of medical liability litigation and defensive medicine. The latter involves the excessive ordering of non-essential tests and treatments solely for risk management purposes. In a country in which escalating health care costs and diminishing health care access, these costs are increasingly indefensible, especially in the absence of evidence that such expenditures improve patient safety and health outcomes. The report suggests that 90 percent of medical errors are the result of failed systems and procedures that are poorly designed to accommodate the complexity of health care delivery. If properly designed, these systems and procedures could better prevent inevitable human errors from reaching patients. But understanding the root causes of errors requires their divulgence in the first place. In sharp contrast to the systems-based orientation of the patient safety movement, tort law targets individual physicians. For patients and family members, the physical and emotional devastation of medical error cannot be easily overcome. What they want most out of their ordeal is honest and open dialogue about what went wrong, and a “legacy” – having their experience serve as a lesson for prevention in the future. Seldom are such communications and assurances forthcoming. The axiom, “you learn from your mistakes” is too little honored in health care. Near-miss and error reporting is an essential component of safety programs across safety-conscious industries. Within health care, though, many physicians are often reluctant to engage in patient safety activities and be open about errors because they believe they are being asked to do so without adequate assurances of legal protection. The stifling specter of litigation results in the under-reporting of adverse events by physicians and avoidance of open communications with patients about error. On average, a medical liability case takes three to five years to come to closure. Closed claims provide valuable data for researchers to mine, but because of the lengthy elapse of time, opportunities for swift intervention to address unsafe practices are often lost. Cases that reach settlement in the intervening years are typically cloaked by “gag clauses” that require complainants’ silence, and squelch efforts to elucidate and ameliorate the factors that lead to injury. Creating cultures of safety within health care and improving quality and access -- indeed, making health care truly better -- requires that legal and medical institutions work together In order to frame the complex factors and issues that need to be addressed . Lack of disclosure and communication is the most prominent complaint of patients, and their families, who together have become victims of medical error or negligence. Years of expensive and wounding litigation often ensue when families are sometimes only seeking answers. Numerous proposals have been suggested for improving the medical liability system over the past several years. These proposals center on three broad approaches: 1) creation of alternative mechanisms for compensating injured patients, such as through early settlement offers; 2) resolving disputes through a so-called “no-fault” administrative system or through health courts; and 3) shifting liability from individuals to organizations. Though these approaches are distinct, they are not in conflict. One could imagine an injury resolution system that incorporates the characteristics of all three. Inherent in any alternative to the current tort system must be a high priority for disclosure - an acknowledgement of the error or injury, an apology, and assurances that steps will be taken to avoid such an error in the future. The Joint Commission’s accreditation standards require the disclosure of sentinel events and other unanticipated outcomes of care to patients, and to their family members when appropriate. A recent study confirms that many hospitals – half of those surveyed -are reluctant to comply with this standard for fear of medical liability suits. If disclosure is taken a step further to the offer of an apology, hospitals and physicians are even more likely to gravitate to traditional “defend and deny” behaviors. But there is increasing awareness that openness has the potential to heal, rather than harm, the physician-patient relationship. A growing number of hospitals, doctors and insurers are coming around to the idea that apologies may save money by reducing error-related payouts and the frequency of litigation Today, some prominent medical centers have adopted policies that urge doctors to disclose their mistakes and to apologize. Insurers, too, are increasingly urging apologies. This would be a beginning, but as gang members increasing imitate attorneys in putting their own economic and political welfare above that of the community, it would be just a beginning. . Health Care at the Crossroads: Strategies for Improving the Medical Liability System and Preventing Patient Injury can be obtained at HYPERLINK "http://www.jacho.org" www.jacho.org. (Jacho has not yet responded to a request to provide figures for Nevada.) -30- PAGE 2 PAGE 1 es:21-7-Bennett Columnџ@€ЊЊLџUЊЊ5Ѓ5CJ0ь "#$234ABCM‡ІЦUV5 7 O Q f h “ • Ћ ­ Х Ч й л   ' ) O Q HRЇЉЊњB"В"Ш"Щ"Ъ"д"ш"щ"ъ"ы"џ"##### #P&XPLXQNXQ@PfXQhXP@P:@QjXQ>@PX@ PZ@QlXQx@Q€XP, @Ql @QZQŠ@Pш@QОXPV@QТXP†@QЦXPА@QЪXP@QЮXP2@QвXPb@QжXP†@QкXPм@QоXP@QтXPf@QZPj:@QZQZQE@PКE@QPL@QцXQYQYQYQ*YQRYQTYQVYQXYQ€YQ‚YQžM@P†YQŠYP N@ GTimes New Roman5€Symbol3 Arial3Times9Palatino"ёˆаhисИFъИf >!ЅРДД€r0dУ##џџHealthcare at the Crossroads Johnny Gunn Johnny Gunnthcare at the Crossroads Johnny Gunn Johnny GunnЫDаЩъyљКЮŒ‚ЊKЉ http://www.jacho.orgрЩъyљКЮŒ‚ЊKЉ ,http://www.jacho.org/ўџ еЭеœ.“—+,љЎDеЭеœ.“—+,љЎT hpˆ˜  ЈАИР Ш ё'Nevada Observer>У#: Healthcare at the Crossroads Title (RZВ _PID_GUID _PID_HLINKS'AN{C91DAE00-5537-11DC-BD90-ACB753BEBD1B}AdEhttp://www.jacho.org/xўџ р…ŸђљOhЋ‘+'Гй0tˆИФифє  0 < HT\dl'Healthcare at the CrossroadsMieal Johnny GunnohnNormalG Johnny Gunn3hnMicrosoft Word 8.0r@H'­@€vщЧ@bс{PъЧ.addressed. - ьЅСc ,ПQ'jbjb№S№S \š1š1 #џџџџџџ]jjjjjjжєbbbb n$ЪU $Ьттттт"  , . . . . . . ,yєmŽZ ћj тт  Z , jjттž., , ,  jтjт, ~,Њ,jjjj , , , , jj, ’ ш?ћТЪ˜b" , Healthcare at the Crossroads By Bob Bennett Looking at the life from the bottom up, things appear quite different than from the top down. Those at, or near the bottom see the abuses by government, bureaucracy, corporations, organized religion, lobbyists, and of course, the legal profession as the main sources of discontent in America. Those near the top tend to see the failure of individuals to be obedient enough as the major problem of society. While the top can narrowly focus on bureaucratic abuses when it suits the corporate interest, rarely is change meaningful from the perspective of those on the lower rungs. The top portrays the courts and lawyers as defenders of liberty. Those at the bottom see it as a game the rich and powerful use it to avoid facing any meaningful accountability while perpetuating their abuses Only on rare occasions, when the abuses gradually creep up the ladder, enveloping even those near the upper strata, does the system begin to recognize that problems exist. It is a cause for celebration when a significant organization publishes a report stating problems exist with the process. Healthcare at the Crossroads- Strategies for Improving the Medical Liability System and preventing patient injury, a booklet put out by the Joint Commission on Accreditation of Healthcare Organizations is a refreshing look at how our legal system acts to prevent accountability in the healthcare industry. It states there is a fundamental dissonance between the medical liability system and the pa [4@ёџ4NormalCJOJPJQJmH <A@ђџЁ<Default Paragraph FontbўђbStyle1+ Ц& 0`Р№ P€Ар@B*CJOJPJQJnH Q#Xџџџџ џџ џџ џџ џџ( P Q#iQ'&XHB'Q'')*+Q'(џџ Johnny GunnpMacintosh HD:Users:administrator:Desktop:Nevada Observer:Vol. 4, No. 21, 09-01-07:News Pages:21-7-Bennett Columnџ@€--  Oи--5МQ#@@GTimes New Roman5€Symbol3 Arial3Times9Palatino"1ˆаhисИFйсИF>!ЅРДД€0У#џџHealthcare at the Crossroads Johnny Gunn Johnny Gunntient safety movement. The latter depends on the transparency of information on which to base improvement; the former drives such information underground. As a result, neither patients nor health care providers are well served by the current medical liability system. Setting caps on non-economic damages in medical liability cases has been the standard response, including in Nevada. Yet the effectiveness of the tort system itself in deterring negligence, compensating patients, and exacting corrective justice is being called into question. Extreme rewards are seen as reactions from juries, which can contain people who have been thwarted in their efforts to seek justice, whether from a closed medical profession, or from the numerous flaws in a justice system which favors power over integrity. As of March 31, 2007, the Joint Commission has received 4,234 reports of sentinel events. A total of 4,362 patients were affected by these events, with 3,115, or 71 percent, resulting in patient death. The 10 most frequently reported sentinel events are: Wrong-site surgery 552 Patient suicide 533 Operative/post-operative complication 504 Medication error 392 Delay in treatment 317 Patient fall 235 Patient death or injury in restraints 156 Assault, rape or homicide 156 Perinatal death/loss of function 129 Transfusion error 102 An unintended consequence of the tort system is that it inspires suppression of the very information necessary to build safer systems of health care delivery. 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