Hospital's apology ends contentious litigation

For three weeks, lawyers representing Kent Hospital in Rhode Island were in Kent County Superior Court in Warwick, RI, battling with the attorneys representing the family of actor James Woods. The malpractice case alleged that the hospital was negligent in the 2006 death of Woods' brother Michael, and the presence of the celebrity in court every day brought television cameras and plenty of bad media exposure for the hospital.

And then on a Tuesday afternoon, Woods stood just outside the courthouse doors with his arm around hospital president Sandra Coletta and announced that he was withdrawing the suit. In a dramatic turnaround from the seemingly angry, resentful Woods who had been seen in the courtroom for weeks, Woods now smiled and even defended Coletta when reporters peppered her with questions.

What brought the sudden change of heart? Coletta had apologized to Woods and his family on behalf of the hospital.

Coletta tells Healthcare Risk Management that as the litigation moved forward in court, she was compelled one evening to call Woods and talk to him directly. She made the call not as an orchestrated strategy, she says, but simply because it felt like the right thing to do.

"As I was going through the case, there were a few times when I wanted to talk to James directly, but of course plaintiffs and defendants don't normally talk face to face, so that was the response when I suggested it," she says. "But he was still very angry. The anger and the pain was very clear in court, and I didn't know how we could get through this without talking to him."

Coletta arranged a meeting with Woods, which the attorneys thought was highly unusual and ill-advised. She planned to discuss her idea for starting a foundation in memory of his brother.

"I walked in, and I literally had not given any thought to saying, 'I'm sorry,' but it was just the right thing to do," she says. "I walked in and said I was sorry, apologized for his loss, and acknowledged the fact that we didn't do the right thing. We had a physician place an order, and we did not carry it out."

The effect on Woods was immediate, she says. It wasn't until that point that Coletta realized that no one at Kent had ever apologized and expressed remorse for the loss of his brother. She did not go into the meeting thinking she was going to make the bold statement that had been lacking; she just said what seemed appropriate, and it turned out to be what the Woods family had been waiting to hear all along.

Apologizing and communicating clearly with patients and family is nothing new at Kent, and Coletta would have expected that the family heard a sincere apology much sooner after the incident. But somehow that crucial conversation never happened.

"This is also an example of what happens when you don't say you're sorry. We were late. This didn't happen until the middle of the trial," Coletta says. "Had it happened earlier, I don't know if we would have even gotten to trial."

Lisa Greenlund, CHSP, ARM, director of risk management and safety at Kent Hospital, says she also was surprised that the family waited so long for an apology.

"This case evolved very quickly, and many things weren't discovered until the trial took place. We learned some things in the discovery process and didn't really understand what had occurred until the trial took place," she says.

Court records indicate that Michael Woods was 49 years old when he went to the Kent Hospital emergency department on July 26, 2006, complaining of a sore throat and vomiting. An electrocardiogram showed he had an abnormal heartbeat, and a doctor testified during the trial that she had ordered him placed on a heart monitor. Coletta acknowledges that the nursing staff never carried out that order. After returning from the X-ray department, his gurney was parked by a wall near a nurses' station in the ED. He suffered a fatal heart attack there.

Coletta says the case was not defensible from the start, and her goal was to find a settlement that would satisfy the Woods family. After the apology, the hospital and the Woods family agreed as part of the settlement to establish the Michael J. Woods Institute to help improve safety at the hospital. Kent will spend $1.25 million over the next five years to develop policies and procedures to promote patient safety and improve communication regarding patient care. The initiatives will begin in the emergency department. The institute will be run by a board that includes a Woods family member, and the hospital will hire a patient safety officer to coordinate the efforts.

Greenlund says the hospital has always had an informal policy of apologizing when appropriate, but following the Woods case, Kent is formalizing the effort. Staff and physicians are undergoing education about the importance of apologizing.

The risk manager also points out another lesson from trial: The presence of a celebrity greatly intensifies the media exposure and the stress on all the health care providers testifying and otherwise involved.

"Once they put the cameras in the court room, the whole dynamics of the trial changed. It was not your everyday trial," she says. "This was very traumatic for the staff. Had we anticipated those cameras in the courtroom, we would have provided emotional support before they even stepped through those doors. That was one of the biggest lessons for us."

Simple, honest apology best

John Banja, PhD, professor of rehabilitation medicine and clinical ethicist in the Center for Ethics at Emory University in Atlanta, is an expert on the effects of apology in health care, and he says the Kent Hospital is a good example of how powerful it can be. Coletta's apology probably had so much impact because Woods felt it was sincere, he says.

"When you apologize, you are essentially admitting that you were at fault, that you were in reasonable control of the situation and you made a mistake," Banja says. "What you did somehow harmed or injured this other person, and you're saying this should not have happened, I should not have done this. This can have a tremendous effect emotionally on the other person."

Apologizing can be extremely difficult for some people, because it requires a certain level of humility, Banja says. Admitting to an error, plainly and without excuses, can be challenging for some personality types, he says. Those people are the most likely to use weasel words and try to issue nonapologies such as, "I'm sorry if I offended anyone," or "If my words were misinterpreted, I'm sorry," Banja says.

"The best apologies are straightforward and honest, saying that you did something you should not have done," he says. "Trying to have it both ways, trying to apologize without losing face, can just have the opposite effect and turn people away."

Coletta also cautions against too much formalization of the process. It should come naturally and without hesitation, she says.

"Too much buffer has been put up around everyone in the health care system. There are classes on disclosure and apology, the right wording to use, but to me, if you have to so carefully craft the wording of how to say you're sorry, there's something wrong in the system," Coletta says. "My apology probably would have flunked the class on how to apologize and keep it from being used against you. I said an order was written and we didn't do it. The family just wants to hear the unvarnished truth and that you actually care."

An apology should not be strategy or clever maneuvering, Coletta says. It should be sincere and offered without qualifiers.

"We can say we made a mistake," Coletta says. "They don't expect us to be gods, but they get very irritated when we act like we are."

Sources

For more information on apologizing after adverse events, contact:

• John Banja, PhD, Assistant Director for Health Sciences and Clinical Ethics, Emory University, Atlanta. Telephone: (404) 712-4804. E-mail: jbanja@emory.edu.

• Sandra Coletta, President, Kent Hospital, Warwick, RI. E-mail: scoletta@kentri.org.

• Lisa Greenlund, CHSP, ARM, Director of Risk Management and Safety, Kent Hospital, Warwick, RI. Telephone: (401) 737-7010, ext. 1530. E-mail: lgreenlund@kentri.org.