Hospitals Draft Disclosure Policy

Over the past year, a group of 16 doctors, nurses, administrators, and patients at Harvard-affiliated hospitals in the Boston area have developed what could become a uniform policy for the process of disclosing and apologizing for medical mistakes that occur in all Harvard-affiliated hospitals.

The group, led by Adjunct Professor of Health Policy at the School of Public Health Lucian Leape, distributed its 50-page draft to the CEOs of around a dozen hospitals this past May. So far, they have received largely “positive feedback” from the hospitals, according to Tullis Professor of General Medicine and Primary Care at Harvard Medical School Thomas Delbanco, who is a member of the group.

The group is currently in the process of clarifying some of the language in the document, and hopes to produce a final copy by September, Delbanco said.

The policy encourages increased transparency between doctors and patients.

“When things go wrong and there’s a possibility of a malpractice suit, the basic policy has been for everyone to keep their mouth shut and let the lawyers take over. And a kind of wall of silence has built up between patients and their families and the doctors,” Delbanco said. “We’ve said that’s not the right thing to do, and that frank and open and human discussion should occur right away.”

The proposed policy would also have hospitals provide immediate follow-up support to patients, their families—and their doctors—in the event that a mistake occurred during treatment.

Leape’s group has not yet proposed who would pay for the increased support it recommends.

The group’s proposal has traditionally been resisted by some doctors and insurers, who fear that such openness could hurt them in court.

Harvard insures itself through the Controlled Risk Insurance Company, which is affiliated with the Risk Management Foundation.

The policy’s supporters said that its implementation may reduce malpractice fees by fostering increased trust between doctor and patient. However, no conclusive studies have been conducted.

“Patients aren’t stupid, and you know when something has gone wrong, usually, and while there are always patients that will sue because of perceived revenge or greed, mostly what people want is an acknowledgement that something is going on,” said Mary Dana Gershanoff, co-chair of the Adult Patient & Family Advisory Council at Dana-Farber Cancer Institute, who is representing patients for Leape’s group.

But Robert Hanscom, Director of Loss Prevention at the Risk Management Center, said the focus of the group has been aimed at improving the principles of health care, not reducing costs.

“The cost-benefit thing I don’t think has really come into this,” he said, “We’re saying do the right thing anyway. Communicating openly with these patients and their families is the right thing to do human to human.”

Gary Jernegan, co-chair of the Pediatric Patient & Family Advisory Council at Dana-Farber Cancer Institute and another patient representative for Leape’s initiative, became involved at Dana Farber when his daughter—now 11, then two and a half—was diagnosed with cancer.

“Cancer is as much a mental war as it is a physical war and this project is truly an emotional aspect of medicine,” Jernegan said. “For me to have the opportunity to see this level of expertise and what they’re trying to accomplish is comforting.”

Group members say this effort is part of a larger trend in which patients are more involved in their own treatment.

“It boils down to the very basic principle of a doctor-patient relationship. The relationship has to be strong and have good communication, and if something goes wrong you still need to have that,” Jernegan said.

“I think it’s starting to sweep across the country,” Hanscom said, “We’re not alone in trying to carve out that future.”

Leape could not be reached for comment.

—Staff writer Natalie I. Sherman can be reached at nsherman@fas.harvard.edu.