Executive Summary

A hospital in Washington settled a malpractice lawsuit with an unusual stipulation. In addition to a monetary payout, the hospital agreed to include the plaintiff in future efforts to improve patient safety.

  • Failure to diagnosis led to permanent paralysis.
  • The plaintiff will be involved with the ongoing investigation of the medical errors during his care.
  • The Hospital Is Reviewing Its Original Root Cause Analysis For Opportunities To Learn More.

The malpractice case brought against Overlake Hospital Medical Center in Bellevue, WA, by August de los Reyes involved a tragic outcome but, in other ways, seemed familiar until the parties reached an unusual settlement. In addition to paying $20 million, the hospital agreed to involve de los Reyes in ongoing safety improvement efforts in a way that goes beyond the patient safety councils found at some facilities.

De los Reyes, a former design head for Microsoft’s Xbox and now with Pinterest, broke his back and nearly severed his spinal cord in 2013 after a series of missteps at Overlake. The errors left de los Reyes paralyzed from the chest down at age 42, and the injury is thought to be permanent. (See the story enclosed in this issue for more information on the sequence of medical errors.)

De los Reyes says his professional interests and experience led him to see his injury as an opportunity for improving the healthcare process. “When we develop software, mistakes often happen, and we look at how the mistakes came about,” he says. “I’ve been fortunate to work in organizations that have the best talent and resources, so when you have a situation where talent and resources aren’t the issue, there is something else that allowed the problem to happen. Overlake is a modern hospital with the latest and greatest technology, and the doctors I met with were very capable, yet something happened that caused this situation to occur.”

Once the injury occurred, his natural reaction was to analyze the problem the same way he would with a computer issue and learn from shortcomings, de los Reyes says. His primary motivation was to prevent the same injury from happening to anyone else, he says.

“I didn’t have animosity toward the hospital or the doctors, and I assumed that everyone involved would want to keep this from happening again,” he says. “I opened that up as a channel of discussion in the settlement talks. Naively, I didn’t know that this was breaking new ground. To me, it just seemed like common sense.”

Direct Involvement

The settlement agreement with de los Reyes specifies that the hospital will work collaboratively with de los Reyes to understand what happened to him and to use that information for improving healthcare at the hospital, says David Knoepfler, MD, FACP, FHM, chief medical officer at Overlake. Exactly how the parties would collaborate was left open in the agreement, but Knoepfler says they agreed that de los Reyes would be involved in a significant way to learn more about his case and to design safety improvements.

The hospital has invited de los Reyes to its patient advisory council, but he moved to a different city after the injury and cannot regularly participate. His agreement with the hospital calls for him to work directly with hospital leaders and outside experts.

This type of collaboration requires a plaintiff and attorney who are oriented to improving the process rather than focusing on only one error, Knoepfler says. “August is a gentleman who is very forward-thinking, very systems- and design-oriented,” he says. “As much as this was a catastrophic event, August clearly wants to turn this into something positive. We came to this through August being very practical minded and wanting to make sure his experience could be used to positively impact the hospital and its systems.”

The settlement with de los Reyes meshes well with the hospital’s recent efforts to embrace transparency and patient safety, Knoepfler says. At the first meeting with de los Reyes, his attorney, Knoepfler, and other hospital leaders, the group mapped out the goals for the collaboration. The first and primary goal for de los Reyes was to learn exactly what led to his injury, beyond the medical reports and information available to him and his attorney. “He wanted to understand the nature of the event at a very deep level,” Knoepfler says. “We both had the goal of doing everything we could to effect positive changes at the hospital. August also wants to assemble leaders in the field of systems design and use his case to review existing designs and how to enact change.”

Meeting With Leaders

Knoepfler also agreed to de los Reyes’ suggestion that his attorney Robert Gellatly, JD, with the Luvera Law Firm in Seattle, meet with several department leaders at the hospital to review the case from a medico-legal perspective. The leaders came from all departments involved in de los Reyes’ care, including the ED, radiology department, and the hospitalist program.

“That meeting is not about learning how to practice defensive medicine but to learn what is crucial in terms of documentation and communication, anything that can be improved to provide better care,” Knoepfler says. “That effort to improve and provide the best care is primary, not just trying to avoid having a lawyer send you a letter.”

Gellatly says this case is not the first time his firm has sought such cooperation in a malpractice settlement, and many plaintiffs are eager for such a resolution. When de los Reyes expressed his interest, Gellatly proposed the agreement as a term of the settlement, and he specified that hospital leaders at the highest level would cooperate with de los Reyes. The settlement requires that leaders, including Knoepfler and the hospital’s chief executive officer, meet with de los Reyes to openly discuss ways the hospital’s systems could be improved.

The settlement was achieved with the hospital, the independent emergency medicine group that treated de los Reyes in the ED, and the radiology group responsible for his testing. The $20 million was all of the insurance available to those defendants, Gellatly says.

“They agreed, at our insistence, that there would be no confidentiality at all,” Gellatly says. “We let them know of that early in the process, because often the hospital’s attorneys will try to add a confidentiality requirement late in the settlement progress, and many lawyers go along with that. We don’t because we don’t think it serves the public interest.”

Seeking the Whole Story

Overlake leaders are reviewing their original root cause analysis (RCA) and seeking ways to expand or improve it, with the goal of having a detailed and thorough explanation of the adverse event at their next meeting with de los Reyes.

“My sense is that he’s not sure he’s gotten the whole truth because the legal process sometimes leads to obfuscation or not always a complete and comprehensive story,” Knoepfler says. “We’re revisiting the RCA to make sure we’re giving August the most complete story that we can.”

Once the sequence of events for de los Reyes’ case is thoroughly understood, the next step will be using that information to address communication issues in healthcare, as well as any other potential improvements. Knoepfler encourages hospital leaders to pursue this type of arrangement when appropriate and to work cooperatively with an injured patient even after a lawsuit is filed. Overlake has worked with other patients after adverse events in similar ways, and he has invited them to speak to quality committees and make other contributions.

“Work with the patients and, in our experience, if you can help the patient feel like they’re part of something bigger, that they’re changing the quality and safety of healthcare, it goes a long way,” Knoepfler says. “Everyone wants to contribute and make a difference.”


  • Robert Gellatly, JD, Luvera Law Firm, Seattle. Telephone: (206) 467-6090.
  • David Knoepfler, MD, FACP, FHM, Chief Medical Officer, Overlake Medical Center, Bellevue, WA. Telephone: (425) 688-5000.