Do medical malpractice caps reduce medical mistakes?

A reader responds to the recent WSJ story on the effects of non-economic caps:

I have become a pediatric patient safety advocate, not by my own choosing. I have received several emails from grieving parents over the past few months asking me for advice. They can’t get answers why their child died – because of the archaic and accepted disclosure policies most hospitals insist upon – nor an attorney to take their case. What am I to tell them?

I have worked in healthcare and have seen both sides of this issue. I do know that all physicians would want their child treated with every possible test – no matter what the cost. I think if you step back and look at what you would want as a parent, you would all agree with us. Order tests because it could save the child, not because it would save yourself. An MRI, EKG, labs or CT scan may have saved [my child’s] life and there is no price tag there. The issue should be on improving safety – not caps – because no parent files a lawsuit against a physician when their child dies for money.

Let me first say that I support non-economic caps and have pointed to many articles detailing its positive effect on the malpractice crisis. However, I also acknowledge that the medical field clearly has work to do in how we communicate medical errors. This study from JAMA highlights a disconnect between patients and physicians when responding to medical errors:

Both patients and physicians had unmet needs following errors. Patients wanted disclosure of all harmful errors and sought information about what happened, why the error happened, how the error’s consequences will be mitigated, and how recurrences will be prevented. Physicians agreed that harmful errors should be disclosed but “choose their words carefully” when telling patients about errors. Although physicians disclosed the adverse event, they often avoided stating that an error occurred, why the error happened, or how recurrences would be prevented. Patients also desired emotional support from physicians following errors, including an apology. However, physicians worried that an apology might create legal liability. Physicians were also upset when errors happen but were unsure where to seek emotional support.

Small studies have noted that full disclosure of medical errors reduces the risk of punitive actions:

Virtually all patients (98%) desired some acknowledgment of even minor errors. . . For both moderate and severe mistakes, patients were significantly more likely to consider litigation if the physician did not disclose the error.

Mistakes happen in medicine. Lawsuits are bourne out of the public’s expectation and demand for perfection. As advocation for non-economic caps continue, this reader’s letter reminds us that we should continue to be vigilant in maintaining open communication with patients – especially after medical error.

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