Leilani Schweitzer

Leilani Schweitzer

Last month, the American College of Physicians released a position paper, “Medical Liability Reform: Innovation Solutions for a New Health Care System”


The paper presents 9 recommendations for mitigating the challenges brought to health care by litigation. Wisely, the College of Physicians state, “Improving patient safety and preventing errors must be at the fore of the medical liability reform discussion.”


The paper provides an assessment of the costs of liability on the US healthcare system. For example, according to leading researchers, the annual cost of the medical liability system is about $55.6 billion in 2008 dollars, or 2.4% of total health care spending. The Congressional Budget Office estimated that in 2009, providers would incur $35 billion in direct medical liability costs, including premiums, settlements, awards and administrative costs not included in insurance.


Communication and Resolution Programs

Along with recommendations about payment caps, standards for expert witnesses, oversight of liability insurers, and the merits of mediation courts, the paper endorses the pilot-testing of Communication and Resolution Programs. Also known as Early Disclosure and Apology programs, Communication and Resolution Programs aim to avoid legal expenses, learn from unintended medical outcomes, bring healing to patients and improvements to patient safety.


The Risk Authority of the Stanford University Medical Network created its own Communication and Resolution Program in 2007, known as PEARL (Process of Early Assessment, Resolution and Learning). PEARL was designed  as a result of a growing national discussion about preventable medical errors, the rising costs of litigating and resolving medical malpractice claims, and grew from a desire to seek alternative methods to identify and resolve valid claims commensurate with the beneficent mission of Stanford Medicine.


Success of the PEARL Program

Early reports are that the PEARL program has been very successful. In the first 3.5 years after the implementation of PEARL, the frequency of claims dropped by 36%, yielding a savings of $3.2 million per fiscal year. Early indications show that the program has been well received by patients – which is the subject of current study.


Communication and Resolution Programs are supported because they have the potential to generate significant cost savings for both physicians and hospitals. These programs are also beneficial to patients and their families. By creating a culture of accountability and shared responsibility, Communication and Resolution Programs get patients the help they need when they need it, not only after enduring protracted legal battles that are both financially and emotionally costly for all parties.


The success of Communication and Resolution Programs is dependent on transparency, communication and trust, often requiring full apologies and extensive reviews to understand and explain exactly what happened in patient’s medical care.


Achieving the Full Potential of Communication and Resolution Programs

Shifting from a culture of ‘deny and defend’ to one of openness and transparency is not easy. Achieving the full potential of Communication and Resolution Programs is largely dependent on an intentional change of posture by an institution towards their patients who have experienced a medical error. Success also requires preparation and planning before a concerning event happens— in the middle of the night, with a distraught family waiting for answers, is not the time to think about the complexities of Communication and Resolution Programs.


Patients and their families, as well as, their care teams deserve the dignity and healing Communication and Resolution Programs can provide. And as the College of Physicians point out, there is not only an ethical mandate for Communication and Resolution Programs, but also a financial one.


By Leilani Schweitzer

Leilani serves as a Patient Liaison for Stanford University Hospital and Clinics and Stanford Children’s Health – Lucile Packard Children’s Hospital’s Risk Management. Leilani did not choose a career in health care, it chose her. Nearly nine years ago her son died after a series of medical mistakes. Leilani uses her own experience with medical errors to navigate between the often insular, legal and administrative sides of medical error; and the emotional side of the patient and family experience. Her work at Stanford gives her a unique view of the importance and complex realities of transparency, disclosure and apology.