Medical Negligence Conversations In Ireland

Earlier this year, I traveled to Ireland.  It was a joyful visit for me, both because my maternal grandparents were born there and because I had an opportunity to spend time with so many professionals in Cork who work in healthcare.   Patricia Mallon, founder of the Cork Resolution Center in Cork, invited me to do a training for attorneys in collaborative law in medical negligence cases.   I asked Patricia if we could invite other stakeholders, including physicians, other healthcare practitioners, risk managers, hospital administrators, medical and law school professors, mediators and others.  My thought was that the more stakeholder professionals we could involve in a workshop and dialogue, the more we could build community and create a network of professionals working toward collaborative, non-adversarial practices in situations involved medical negligence.  We gathered about thirty-five professionals from the various stakeholder groups feet forth above.

On the first day of the workshop, Margaret Murphy shared with us the compelling story of her son, Kevin, who, tragically, died at the age of 21 due to several medical errors.   Her story was so powerful.   Her devastation at the senseless death of her beloved son brought her to patient safety work, which has does, literally, around the world.   After her powerful story, I spoke to the group about the use of collaborative law, a process used traditionally in family law, both in the U.S. and in Ireland.   The group of about 35 worked through a hypothetical medical error case, a powerful opportunity for all members of the group to get to know each other and consider how they all might work together to bring a collaborative, non-adversarial process, quickly, after medical error situations.

Day 2, we met together in the morning for a dialogue at which we discussed how to build upon our conversations of the prior day, how to expand the network of professionals from that conversation, and  what next steps should the group take to continue to move the process forward.   Patricia and I agreed to write an article about the workshop and dialogue and publish it in a medical journal to keep the process moving and growing.

How wonderful to be there with all those Irish faces!

Stay tuned.

medical negligence in Ireland

I'm working with an attorney, Patricia Mallon, in Cork, Ireland on a training (April 17, 2012) and dialogue (April 18, 2012) in health care. For the training, we will bring together attorneys, physicians, law and medical school professors, legislators, administrative agency staff, hospital risk management, patients, families, government officials, and others to learn the collaborative law/collaborative practices framework in medical error and other healthcare situations. The dialogue will provide a forum in which stakeholders in healthcare in Ireland come together in dialogue, recognize their shared commitment to the community, promote exploration of common ground, share their multiple points of view, speak their experiences, listen to each other, learn and think together, make a contribution, and create safe, healthy healthcare for all; reframe the conversation in the direction of collaboration, determination of common goals, and relaxation of our grip on certainty; support conversations that have not previously taken place; and encourage participants to continue the conversations with co-workers, their communities, and other interested individuals.

This is very exciting since there is, at times, some resistance from some of the stakeholders to bringing together these varied professionals and practitioners to discuss non-adversarial, healing practices in situations both before and after medical error. That resistance may arise, in part, out of mistrust and misunderstanding, which can be addressed through the dialogue process. The way forward begins with listening to each other and discovering new ways of being and working together.

I Have a Dream: ABA/AMA Joint Task Force

I'm finishing my book, which will tentatively be called "Healing at the Intersection of Law and Medicine." Continued thinking and writing about this intersection brings me to our commonalities.

The common threads between physicians and attorneys are many: human well-being, healing, justice, a moral contract with society, and commitment to our communities. This suggests a common vision. Taking that common vision and expanding it into our respective roles after adverse event/medical error situations will be a giant step forward. Think of the possibilities for human well-being and healing, not just for our patients and clients, but for ourselves and our communities. Why not a joint resolution of the ABA/AMA that we have agreed to come together to make a contribution to improved health care? A joint task force? A common vision statement? A cooperation clause?

I suggest a task force, composed of a small, representative, skillful group of members of the ABA and AMA, to hold dialogues about medical error/adverse medical event situations and our responses to them, our goals for improved practices, our values, and our experiences of collaboration. The dialogues will also consider how, when appropriate, we can shift our language and our cultures to improve both our legal and medical practices.

What better contribution could we make to healthcare and to our communities?

For those who share my dream, want to talk more about it, and/or have ideas and suggestions, please let me know. I am taking an appreciative inquiry approach, so would like to talk about what is right with these or similar ideas and improve on them.

Forgiveness

As I finish my book, entitled Healing at the Intersection of Law and Medicine, and prepare for my workshop in Ireland, I've been thinking about forgiveness in medical error situations. I've been talking on line extensively with two friends who have been through the heartbreak of losing their children to medical error. One, Margaret Murphy, lives in Ireland and lost her 21 year old son, Kevin, to a series of medical errors. She now works with the World Health Organization, the Irish Medical Council, and the hospital at which her son died on patient safety. She told me in one of her emails, "My take on forgiveness is that I can help healthcare forgive itself by raising awareness and using Kevin's patient journey as a learning tool."

Another friend who has forgiven caregivers after losing a child to medical error is Chris Jerry of Cleveland. He gave up his successful career in medical imagining to establish the Emily Jerry Foundation to do what he can to prevent others from injury or death due to medical error. He publicly forgave the pharmacist held responsible for the prescription error that caused the death of Emily. Now, he and the pharmacist, Eric Cropp, speak publicly about forgiveness and patient safety before pharmacy groups, medical schools, and community groups. Chris told me that he knew instinctively from the time of Emily's death that systems errors caused her death, not the conduct of one person. Still, the process that followed Emily's death was out of his control, both a hearing at which Eric lost his pharmacist's license and a criminal proceeding that sent Eric to jail. He and Eric are delivering the message that healthcare needs to look at systems, not individuals, when errors occur. Chris and Eric are delivering the message with great compassion to our health caregivers, attorneys and communities.

I want to thank Margaret, Chris and Eric publicly for the work they are doing in bringing compassion and forgiveness to all of us.

The Shadows of Life

I've just been reading about Don Berwick's comments at the IHI Forum. According to Dr. Berwick, one of his five principles to guide change in health care is: put the poor and disadvantaged first, "those in the beginning, the end, and the shadows of life."

I'm grateful for the phrase, "shadows of life." I've been writing for many years, in terms of injured patients and/or their families, about those on the "economic margins", if only temporarily. What I refer to are the youth, the elderly and those without substantial current and future earnings, often women who stay at home to raise families. I'm concerned for them--the youth, the elderly, the women, the unemployed--because they often have difficulty, when the need arises, finding attorneys in medical error situations in which their concerns and questions have not been addressed at all or satisfactorily. In a state like California with non-economic damage caps, set at $250,000 in 1975 and never raised, it is difficult, if not impossible, for those in the "shadows of life" (i.e. our youth, our elderly, our community members without a substantial income history) to find attorneys. My oldest and dearest friend lost her son, a college student, to medical error several years ago. Because he was a college student, there was no lost income at the time of his death and into the future. Attorneys typically take these cases on contingency fee. With the damage caps in California and many other states, it is difficult for attorneys to make up the costs of preparing medical malpractice cases, retaining experts, taking depositions, and trying cases.

Another of the many reasons the litigation process is not always the best choice in situations in which medical error is alleged. Rather than federal law setting damage caps, promoted during the Bush Administration, perhaps we should rethink what occurs before a medical malpractice case is filed: informed patient choice, disclosure, communication and exchange between patient and physician, empowerment of patients, and more. All these processes strengthen the patient-physician relationship before any concerns about adverse events arise, such that trust is established and the likelihood of litigation is significantly lessened.

medical-legal partnerships

I'm been so excited about the ideas of medical-legal partnerships (MLP) ever since I first heard of the concept several years ago. From a selfish (at least professionally) perspective, I am thrilled and hopeful to hear of ANY situation in which attorneys and physicians/health caregivers work together to help others.

As IHI said on its website re IHI's program on MLPs, "Let’s face it. If someone mentions the words “medical” and “legal” in the same sentence, the next thing we imagine we’ll hear about is a lawsuit." Instead, MLPs are team approaches to problem-solving on behalf of patients; the MLP concept is often referred to as "preventive law", which it clearly is.

In the past, physicians might treat the same indigent children-patients repeatedly for illnesses/diseases such bronchitis, pneumonia or asthma without realizing the cause could be treated as well. The cause might be peeling lead paint, no heat, mold, rodents, or dampness. Lawyers could treat the cause: they could make a phone call to the landlord, building owner, or the electric company and, hopefully, solve the problem. Many other issues that appear in the context of people's health are solvable in the legal system.

IHI noted that, instead of a lawsuit, we could: "Picture this instead: empowered, proactive social workers, collaborating with health care providers, lawyers, and legal experts, to ensure that the health of indigent patients isn’t undermined by unsafe housing, lack of food, or lack of access to benefits an entitlements."

I, along with so many others, try to bring attorneys and physicians into the same room to talk about working together, to set aside our assumptions and judgements and look at our common goals. Although my focus has been on non adversarial responses to medical error/adverse medical event situations, medical-legal partnerships are equally worthy, helpful, hopeful, and healing for the professionals, the patients, and our communities. These attorney-physician exchanges, this teamwork, is shifting the culture away from "there must be a lawsuit coming" to "there must be a common goal coming"!!

Webinar on collaborative law

I just held my first "test" webinar, bringing together: physician, nurse, psychologist, attorneys/mediators, patient safety advocate, family members, law school professors, and organizational development/systems thinkers. Such a great conversation, bringing so many perspectives into the conversation. Wonderful, hopeful group, discussing medical error, attorneys' roles, mediators' roles, patient advocates' roles, family members' experiences of medical error, systems thinkers' ideas about medical error, informed patient choice issues, and language in law and medicine.

I hope to continue to expand the conversation to include others involved in prevention of and response to medical error situations. So much work to be done!