Work in Progress: Patient Notification

A little known Oregon law requires hospitals to provide written notification of serious adverse events to all victims (or families of victims). The law is largely ignored; last year 40 such written notifications were recorded, though national studies of medical errors predict there likely were over 1,000 such events at Oregon hospitals.

The director of the Oregon Patient Safety Commission recently told me he thought the entire story of the current health care crisis could be told through the lens of patient notification. I'm not sure he's precisely correct, but I do believe he's close.

Patient notification brings into focus many of the conflicts that keep our health care system from operating efficiently. Does a doctor trust a patient enough to tell him or her the truth? Does a patient believe a doctor will do so? Usually, after a mistake, a physician will call his or her malpractice attorney before even talking to hospital officials, or before telling hospital officials at all.

Let's say a decision is made to tell the patient, or the patient's family. Rarely is this done in writing, despite the Oregon law. But if it is, who signs the written admission--the doctor or the hospital? At some point the patient's health insurer (assuming he or she has insurance) gets involved. Medicare, for instance, will no longer pay hospital bills that result from medical mistakes such as acquired infections made at the hospital.

A while back I received an anonymous tip on a hospital death that, after a year's worth of reporting, resulted in a change in the way the Oregon Department of Human Services oversees hospital psychiatric departments. That story forced state officials to publicly report how many forcible restraints and seclusions each hospital uses on psychiatric patients.

But a sidebar I wrote to that story concerned this issue of hospitals telling families after mistakes have been made. I interviewed Jim Conway, who was brought in as executive vice president at Dana-Farber Cancer Institute in 1995, shortly after Betsy Lehman, a Boston Globe columnist, died after being administered the wrong dose of chemotherapy.

The administrators at Dana Farber decided that, for better or worse, they would publicly disclose everything that had happened, and why. They believed other hospitals could learn from their example, not only in terms of preventing hospital mistakes, but also that confession helped heal the patient/hospital relationship. In addition, Conway told me, the public confession helped the Dana-Farber staff get past the event, which had traumatized many of them.

For my National Fellowship project, I am hoping to tell a narrative story based on one Oregon hospital incident, one medical error. I would tell it from different perspectives, interviewing physicians, nurses, administrators, the patient, the patient's family, the physician's malpractice insurer, the patient's health insurer, medical error experts, liability experts and probably many others I cannot conceive of yet.

I think this singular, human story could put into a new light for readers many of the conflicts that keep health care reform from happening.

I will start with the risk managers at Portland-area hospitals, trying to convince them to let me review a case where a mistake was made and confession made to the patient or family. They might not cooperate. Public records searches of state DHS hospital accreditation investigations might yield my case. Maybe somebody out there will have a better suggestion for finding the case.