“Cooling Off Period”? Like Patients Who Have Been Harmed Should?

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I’m definitely with healthcare leaders that believe in apologies, transparency, and compassion following medical errors.  It is an integral part of healing, helps improve patient safety, and we owe it to our patients.  I also believe it demonstrates ownership which is crucial for relationship building, assertiveness, and collaboration.  (The stuff we’re always saying we should do!)

I just read this article about medial errors that took place at Tufts Medical Center  recently.  It is an interesting article telling two stories and a phenomenon known as “cognitive bias” also referred to as “ascertainment bias” which initially I was going to write about (I think we have to trust each other so that we can not trust each other…but I’ll save that for another day).

glacierBut, what was upsetting and surprising (the errors aren’t surprising anymore) was learning about a new law some states have that require patients and families to wait 6 months following the initiation of a claim involving a medical error aka for the family, a tragic loss.  It’s called  The “Cooling Off Period“!

Who does the cooling off period serve?  Do we think people will get over their loss? Become too tired to face a legal battle?  Fall under a bus?  Do providers get a chance to get their ducks in a row?

If this six month period was to allow for authentic communication and truth-seeking, which further delving suggests it might be, I don’t think I would have the strong reaction I do.  But a “Cooling off period”?  Sounds hurtful and patronizing and not the right direction to go in.

In one of the Tufts cases the pharmacy didn’t have the drug the surgeon requested and sent an alternative to the nurse, the nurse gave it to the surgeon and the surgeon gave it to the patient.  It killed her.  If it was my family member I would not want to be told to ‘cool off’. Meanwhile,  Tufts sent the family a letter denying they did anything wrong.

The most powerful testimony I’ve heard regarding this issue came during a webinar with Leilani Schwietzer. (CEU available through 11/13/2015)  She works in Risk Management now as a Patient Liaison for Stanford Health Care, but 9 years ago her 20 month old son, Gabriel died b/c of errors at two hospitals.  One offered full disclosure and genuine apologies.  The other, a wall of silence.  To this day, it is emotionally painful.  And there was NO lawsuit filed. Leilani so astutely shares in recalling the aftermath of her son’s death, “I don’t remember what the neurosurgeon said, but I do remember the tears in his eyes”.

The conclusion I draw about this law depends on how it is used and what it is called.  What do you think?  BTW here are some great resources on apologies and disclosure following medical errors.

Robinson, Z., Hughes, R., editor. (2008). Patient Safety and Quality: An Evidenced-Based Handbook for Nurses. Agency for Healthcare Research and Quality.http://www.ncbi.nlm.nih.gov/books/NBK2652

Harvard Hospitals Consensus Statement. (2006). When Things Go Wrong: Responding to Adverse Events: http://www.macoalition.org/documents/respondingToAdverseEvents.pdf

Kchalia A, et. al. (2010). Liability claims and costs before and after implementation of a medical error disclosure program. Annals of Internal Medicine. 153 (4): 213-231. Abstract: http://www.ncbi.nlm.nih.gov/pubmed/20713789

Galleger, T. H. et. al. (2003) Patients and Physician’s Attitudes Regarding the Disclosure of Medical Errors. Journal of the American Medical Association. 289 (8: 1001-1007. http://az-shrm.org/wp-content/uploads/2012/04/Disclosure_Patients__Physicians_Attitudes_Re_Disclosure_Med_Errors.pdf

Tuckett, A., (2003). Truth-Telling in Aged Care: A Qualitative Study (Thesis). School of Public Health, Faculty of Health, Queensland University of Technology. http://eprints.qut.edu.au/15862/1/Anthony_Tuckett_Thesis.pdf

Massachusetts Alliance for Communication & Resolution following Medical Injury. http://www.macrmi.info/#sthash.7FnJRTl7.dpbsAmerican Medical Association. AMA Code of Ethics, “Patient Information Section 8.12.” Accessed at: http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion812.page?

Lachman, V. (2007). Patient Safety the Ethical Imperative. Medsurg Nursing. Vol 16 (6). Accessed at: http://www.nursingworld.org/DocumentVault/Ethics_1/Patient-Safety-The-Ethical-Imperative.pdf

Committee on Patient Safety and Quality Improvement and Committee on Professional Liability, The American College of Obstetricians and Gynecologists. Disclosure and Discussion of Adverse Events. Committee Opinion; no. 520: 1-4. (2012). Accessed at: http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Patient-Safety-and-Quality-Improvement/Disclosure-and-Discussion-of-Adverse-Events

O’Connor, E., Coates, H. M., Yardley, L. E., Wu, A. W. (2010) Open Disclosure of Adverse Events – Transparency and Safety in Healthcare. International Journal of Quality Healthcare.   Vol 22 (5) pages 371-379. Accessed: http://www.medscape.com/viewarticle/733685_1



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What are your thoughts?