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Checklist aims to ease burden of disclosing medical errors

Knowing how and when to disclose information about a medical error requires careful planning and coordination by doctors and health care team members, legal experts say.

A new checklist developed by the American Health Lawyers Assn. is designed to guide health professionals through that difficult process, while encouraging them to establish policies to address such events before they happen, said Elisabeth Belmont, corporate counsel for MaineHealth, a hospital system based in Portland. She helped draft the checklist.

The recommendations, released June 13, suggest health professionals consider specific questions before approaching patients and their families about adverse events. They include:

What expressions of empathy and apology can be extended to the patient or their family that are consistent with the protections afforded by state apology laws?

Have planned communications to the patient undergone prior review by managers or legal counsel?

How will the disclosure to patients affect those involved? Will they be involved during discussions with patients?

Failing to adequately address reporting of adverse events can be detrimental to health professionals who are part of such incidents, Belmont said.

“An inadequate or poorly executed disclosure of a [serious clinical adverse event] will serve to frustrate front-line practitioners, negatively affect the reputations of the provider organization and individual practitioners involved in the incident and encourage medical malpractice claims,” she said in an email.

The checklist reminds doctors and others to preserve records related to adverse events and to make sure clinicians are debriefed while details of the incident are still fresh. Health professionals may be required to produce documentation related to medical errors to state regulatory agencies as well as professional liability insurance carriers, Belmont said. If a medical liability claim is filed, records about the event also may be necessary, she said.

The checklist is among recent efforts aimed at more transparency about medical error disclosures. This year, seven Massachusetts hospitals launched Disclosure, Apology and Offer, a program modeled after a similar effort at the University of Michigan Health Care System. The programs target improving transparency and reducing medical liability lawsuits.

Data have shown that being open and honest after a medical mishap reduces medical liability lawsuits, said Peter Leibold, AHLA executive vice president and CEO.

“A lot of literature has been written to the fact that if you’re looking to resolve disputes efficiently, the desire to be transparent is a strong one, provided that it’s [weighed] against the rights of the providers,” he said. “You don’t want to be disclosing anything before you talk to the person involved about what happened.”

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