When Donna Helen Crisp, a 59-year-old nursing professor, entered a North Carolina teaching hospital for a routine hysterectomy in 2007, she expected to come home the next day.
Instead, Crisp spent weeks in a coma and underwent five surgeries to correct a near-fatal cascade of medical errors that left her with permanent injuries. Desperate for an explanation, Crisp, who is also a lawyer, said she repeatedly encountered a white wall of silence: The hospital and her surgeon refused to say little more than "things didn't go well." Crisp spent years piecing together what happened. "I decided I was going to find out even if it takes the rest of my life," she said.
Jack Gentry said he "went into the hospital a patient and came out a victim." In 2013, the retired Baltimore police officer suffered a catastrophic spinal cord injury during disk replacement surgery at MedStar Union Memorial Hospital that left him a quadriplegic.
But unlike Crisp, Gentry and his wife, a nurse, were immediately told what had gone wrong by his surgeon, who apologized for the error. The hospital covered Gentry's rehabilitation and other major expenses and paid an undisclosed amount in compensation, all without litigation.
"When hospitals mess up, they need to do the right thing," Gentry said. "MedStar did."
For patients and their families killed or maimed by medical errors, Crisp's experience _ in which doctors clam up and hospitals deny wrongdoing and aggressively defend their care _ remains standard operating procedure in most institutions.
But spurred by concerns about the "deny and defend" model _ including its cost, lack of transparency and the perpetuation of errors _ programs to circumvent litigation by offering prompt disclosure, apology and compensation for mistakes as an alternative to malpractice suits are becoming more popular. Researchers at Johns Hopkins University in Baltimore recently estimated that medical mistakes kill 251,000 Americans annually, which would make them the third-leading cause of death. Traditionally, the only way for patients to find out what went wrong has been to sue.
A blueprint for the approach used in Gentry's case is being promoted by the federal Agency for Healthcare Research and Quality. Called CANDOR, an acronym for Communication and Optimal Resolution, the approach is modeled on a long-standing program pioneered at the University of Michigan. It was tested in 14 hospitals around the country, including MedStar's Washington Hospital Center and Georgetown University Hospital.
Although they differ, these programs _ which typically feature prompt investigation of errors whose findings are shared with the victims, as well as an apology and compensation for injuries _ are operating at the University of Illinois at Chicago, Stanford and eight hospitals and outpatient groups in Massachusetts. Despite fears that the new approach would encourage lawsuits, the opposite has proved true. In Michigan, the number of lawsuits was cut nearly in half, and the hospital system saved about $2 million in litigation costs in the first year after the new model was adopted in 2001.
"The whole point of this isn't to drop malpractice costs, it's to drive patient safety," said Richard Boothman, the University of Michigan Health System's executive director of clinical safety and chief risk officer, who launched the program after a career defending doctors and hospitals. "We need to hard-wire as quickly as possible the lessons of these cases."
In most hospitals, Boothman said, patient safety experts do not routinely talk to risk managers who handle malpractice claims. As a result, valuable information about preventing errors is lost.
