Hospitals band to reform med mal, cut litigation

Seven hospitals in Massachusetts have begun a major initiative to improve the medical liability system in the state. The new alliance has launched its effort with the release of a Roadmap to Reform, an alternative approach to medical liability intended to improve patient safety, increase transparency, reduce litigation, and cut costs to the health care system.

The alliance contains some of the most notable healthcare groups in Massachusetts, with major teaching hospitals, statewide provider organizations, and patient advocacy groups participating. Beth Israel Deaconess Medical Center (BIDMC), which along with the Massachusetts Medical Society (MMS) had a principal role in the research effort to create the roadmap document, is joined by Baystate Health in Springfield, the largest health care provider in western Massachusetts; Massachusetts Coalition for the Prevention of Medical Errors; Massachusetts Hospital Association; and Medically Induced Trauma Support Services (MITSS), a nonprofit whose mission is to support patients, families, and clinicians who have been affected by adverse medical events.

The Roadmap to Reform proposes a process of Disclosure, Apology, and Offer (DA&O), an alternative to the current tort system, which many health professionals say is inefficient, drives health costs higher, and is unduly burdensome to patients, physicians, and the health care system, says Alan Woodward, MD, chair of the MMS Committee on Professional Liability and a past president of the organization. The DA&O approach will be instituted, beginning this year, in seven hospitals in the state to test its feasibility in different practice environments with various insurance arrangements.

"The current approach to medical liability is onerous for both patients and physicians," Woodward says. "It discourages transparency, inhibits communication between caregivers and patients, burdens physicians with excessive premiums, leads to unwarranted lawsuits, and motivates physicians to practice defensive medicine. We can make the approach to medical liability much better for both patients and physicians and stop driving unnecessary costs with a new model that promotes honesty and transparency."

The seven hospitals participating in the initiative include three from the BIDMC health system (Beth Israel Deaconess Medical Center in Boston, Beth Israel Deaconess Hospital — Needham, and Beth Israel Deaconess Hospital — Milton); three from Baystate Health system in Springfield (Baystate Medical Center in Springfield, Baystate Franklin Medical Center in Greenfield, and Baystate Mary Lane Hospital in Ware); and Massachusetts General Hospital.

The seven hospitals specifically were chosen to allow demonstration in various hospital settings and within different malpractice insurance models, explains Kenneth Sands, MD, MPH, senior vice president for Health Care Quality at BIDMC. The different settings will make it possible to assess the impact on patient safety, malpractice claims, and overall liability costs, he says.

DA&O programs have been implemented in several settings outside of Massachusetts and have demonstrated success as an alternative to the current tort system, Sands says. Both physicians believe that patients and clinicians will regard the DA&O model as fairer, timelier, and more supportive than the traditional response to adverse events, which is adversarial, stifles the exchange of information, and thwarts efforts to improve patient safety. They also say the model will lead to faster resolution of cases and enhanced reporting of medical errors.

Woodward explains how the DA&O system works: Under the DA&O model, healthcare professionals and institutions and their insurers disclose to patient and families when unanticipated adverse outcomes occur; investigate and explain what happened; establish systems to improve patient safety and prevent the recurrence of such incidents; and, where appropriate, apologize and offer fair financial compensation without the patient resorting to legal action. Such a system will not deny patients the right to bring legal action, but it would make tort claims a last resort. Adverse events in which the provider or institution is deemed to have met the standard of care would be firmly defended.

"The DA&O model, which has been highly successful at the University of Michigan Health Care System for a decade, is gaining broad support across the nation and is regarded as a successful approach to medical liability reform and patient safety by such groups as The Joint Commission," Woodward says.


• Kenneth Sands, MD, MPH, Senior Vice President for Health Care Quality, Beth Israel Deaconess Medical Center, Boston. Telephone: (617) 667-1325.

• Alan Woodward, MD, Chair, Committee on Professional Liability, Massachusetts Medical Society, Waltham. Telephone: (781) 893-4610.