As chief clinical risk officer at Premier Physician Services, Tom Syzek, MD, FACEP, was responsible for loss prevention and claims management. “We never had a single case in which a physician’s apology was used against us in court in Ohio, West Virginia, or South Carolina,” Syzek says.
Syzek was involved in resolving about 30 claims using disclosure, communication, apology, and offer. The group contracted with hospitals to provide ED care and was self-insured through a captive insurance company. When a patient or family contacted the hospital with a complaint, they were referred to Syzek by the hospital’s risk manager if the case involved one of the group’s employed EPs.
“In each of these cases, I was in direct contact with the patient, the parents of a minor, or the family representative,” Syzek recalls. Syzek also remained in contact with hospital risk managers and informed them of the eventual outcome and resolution of each case. This was the process:
- Syzek stayed in frequent contact with the patient or family, and met with them in person;
- A thorough investigation of the event included a review of all medical records and interviews with involved parties;
- A determination was made as to negligence and causation;
- When warranted, an apology was made to the patient or family, along with a plan for education and/or remediation of the responsible clinician;
- A financial offer was made, but the patient or family was encouraged to seek legal advice and representation before agreeing on the final settlement;
- Final resolution occurred through a legal agreement, including financial compensation when appropriate.
All cases were approached using a process of investigation, disclosure, and apology. “In addition, there were offers made and accepted, but only in those cases where I felt we or the physician had some degree of fault or liability,” Syzek says. If it was determined no error was made, there was no offer. Here are some of the cases involving ED care:
- A pregnant woman lost a fetus at viable gestational age due to the EP’s delayed recognition and treatment of pre-eclampsia. The case was resolved via communication, apology, and offer, conducted with the patient’s spouse;
- A 37-year-old man with a foot laceration sustained permanent injury due to inadequate evaluation and treatment by the EP. The case was resolved with direct communication, an apology, and offer to cover expenses related to missed work and subsequent medical care;
- An EP failed to diagnose a tendon laceration in a 70-year-old man’s hand wound, resulting in permanent injury. The case was resolved via direct communication, apology, and offer to the patient;
- An EP failed to detect and remove a retained foreign body in a 6-year-old’s foot laceration. The case was resolved with direct communication with the parents, apology, and offer;
- An elderly man with abdominal pain was misdiagnosed on three ED visits and was diagnosed with cholecystitis. The case was resolved via communication with patient, apology, and offer for compensation of missed work and additional medical care required;
- An EP initially failed to diagnose epidural hematoma on a CT scan of a 25-year-old man with blunt head injury. The radiologist over-read the CT scan the next day.
The hematoma was noted, the patient was notified, and the patient returned for subsequent appropriate care.
The case was resolved by direct communication with the patient and family, an apology, and a small financial offer.