March 29: Hospitals learn to say sorry

Brock Nelson remembers the final time he stonewalled a family about a hospital error.

Almost ten years ago, a teenage boy had died after doctors misdiagnosed his cancer. The boy's grief-stricken parents asked to meet with Nelson, then CEO of Children's Hospitals and Clinics of Minnesota.

"I was advised 'don't volunteer information, and don't admit or say that we made a mistake,'" he recalled. After the emotional meeting, he walked out shaking, turned to his lawyer and "vowed we're never going to do that again." Weeks later, he met with the parents again, apologized, and "shared everything we knew."

That was, by all accounts, the start of a sea change in Minnesota hospitals, which have been quietly challenging the code of silence surrounding medical mistakes.

Few go as far as the Park Nicollet Health System, which publicly admitted March 17 that the wrong kidney had been removed from a cancer patient at Methodist Hospital in St. Louis Park.

But many of Minnesota's largest hospitals are embracing the idea of fessing up to their mistakes, at least to patients and families, and trying to make amends.

That includes Regions Hospital in St. Paul, where Nelson is now CEO.

"As a whole state, I think the culture has shifted," said Dr. Phil Kibort, vice president and chief medical officer at Children's Hospitals. "In the last five, six years, we've been telling the truth."

Nationally, hospitals that admit mistakes "are definitely a minority," said Douglas Wojcieszak (pronounced wo-Chez-ik), who lost a brother to medical errors at a Cincinnati hospital.

Three years ago, Wojcieszak founded the Sorry Works Coalition (sorryworks.net) in Glen Carbon, Ill., to promote the idea that hospitals have a financial incentive to apologize and admit errors: They're less likely to get sued.

"For years they've covered this up," he said. "It's been a horrible strategy. ... It's the reason we have so many lawsuits."

Privately, he said, many hospital officials will admit as much. "They know why patients sue. Because no one will level with them."

'Don't say a word'

It's no secret that, for decades, doctors were warned to keep their mouths shut when something went wrong.

When Dr. Gary Brandeland lost a patient to an anesthesia error in 1986, he remembers, the hospital's medical director told him: "Don't say a word to anyone, not even your wife."

That was, he says, "the most unhealthy advice I have ever received."

Now an emergency-room doctor in St. Peter, Minn., he still bears the scars of that experience, which he shared in a moving essay in the journal Medical Economics in 2006.

His patient, Joy, a "beautiful, healthy 21-year-old," was about to give birth by C-section when the anesthesia was connected improperly, he wrote. By the time it was over, Joy was brain-dead and her baby was brain-damaged. Although he didn't make the mistake, he was the only one willing to meet with the family. "I apologized right away," he recalled last week. But the hospital, in Wisconsin, closed ranks.

"I just felt like I was thrown to the lions," he said, especially when the story made the evening news. "I assumed I would get sued. I thought the only dignity I have left now is to support the family." In fact, when the woman's relatives filed suit, they specifically instructed their lawyer not to go after him.

"I think they felt abandoned by everybody else," Brandeland said.

'They're rightly angry'

In 1999, Minnesota's two children's hospitals started disclosing errors to patients and families as a matter of policy. Even if it's a near miss, hospital officials meet with the family, apologize and explain what happened, Kibort said.

"Every time I do it, it just kills me," he said. "They're rightly angry. They put their trust in you to take care of their child, and they get upset."

At the same time, he said, the staff will talk about what they learned from the mistake, and what they plan to do about it.

"Parents all say the same thing: 'I just don't want this to happen to another child,'" he said.

Sometimes, it costs money. Several weeks ago, Kibort said, a baby received the wrong dose of a medication and suffered seizures, which resulted in a longer stay at the hospital. As a result, Children's covered all the extra medical costs, and offered to pay the parents' lost wages and expenses while they stayed at the hospital, he said.

It's hard to say if it's made a difference in legal costs, he said, because Children's has always had a low incidence of malpractice cases.

But the numbers have been more dramatic elsewhere. At the University of Michigan Health System, lawsuits dropped in half after it started admitting mistakes, saving nearly $2 million a year in legal costs, according to the Sorry Works Coalition.

The Luther Midelfort hospital and clinic in Eau Claire, Wis., also saw a drop in lawsuits after it started disclosing errors about eight years ago, said Dr. Terrance Borman, the medical director. "There was certainly, initially, some concern on the part of physicians: 'Gee, are you going to get me sued?' " Borman said. "I think the truth is just the opposite." Now the Mayo Clinic, which owns Luther Midelfort, is drafting a similar policy.

That is becoming common practice throughout the state, according to the Minnesota Hospital Association. "We take the position that the hospital has an obligation to share this information," said Bruce Rueben, the group's president.

Yet there's still a long way to go, says Wojcieszak, of the Sorry Works Coalition. "Three years ago, disclosure was a four-letter word," he said. When his brother was misdiagnosed and died of a heart attack in 1998, his parents felt a lawsuit was the only way to get answers. "We never got an apology," he said. "If someone had said sorry, and just dealt with them fairly, it would have made all the difference."

Maura Lerner • 612-673-7384