Health Care

Military doctors, patients come together after medical errors

The Defense Department is expanding a program that helps ease some of the sadness, anger, confusion and frustration felt by patients and military doctors after a medical error or poor treatment experience.

Underway at eight military medical centers with plans to expand to more, the Healthcare Resolutions program provides a way for doctors, patients and family members to talk — and even apologize — after a medical mistake, unexpected death or breakdown in physician-patient communications.

Developed in 2001 at what is now Walter Reed National Military Medical Center in Bethesda, Maryland, the program facilitates discussions between doctors and patients or their family members, aiming to shed light on what went wrong and what's being done to ensure it doesn't happen again, said program developer Barbara Moidel.

"We have learned the value of transparency. We do not want to be defined or disabled by adverse medical events; we commit to learning from them by being transparent. We acknowledge, we apologize," Moidel said.

In a profession where insurers and attorneys have long discouraged apologies out of concern that they are potential fodder for lawsuits, the act is gaining steam in medical settings, providing assurance to patients that their experiences were taken seriously and helping doctors heal after they have caused harm or distress to patients, defense officials said.

Moidel, a career speech pathologist, developed the military program's blueprint after she received a wrong diagnosis in a civilian facility that nearly left her paralyzed.

"I had to fight to find out what happened," she said. "But the other thing that stuck out was the physician who misdiagnosed me felt worse than I did. I remember reaching out to comfort him."

With Healthcare Resolutions, patients and doctors can contact their military hospital's Healthcare Resolution specialist, who facilitates the release of information pertinent to their case and coordinates mediation sessions between physicians and patients or their family members.

The sessions let patients and doctors get answers from one another and help deal with problems head on, recognizing that "something happened," and something has been learned from it, according to Army Maj. Gen. Jeff Clark, Walter Reed-Bethesda commander.

"We as providers know we want to apologize; this program creates an environment that says it's OK," Clark said. "Patients want honesty and sometimes an apology ... and they want commitment, not only to them, but to the next patient, to make sure it doesn't happen again."

Moidel said the program was not created to prevent legal action against a military treatment facility but does provide an alternative resolution process.

Military family members are allowed to file medical malpractice suits against military treatment facilities, but active-duty troops are barred from doing so under the 1950 Supreme Court decision known as the Feres Doctrine.

The Healthcare Resolutions program does not remove a patient or family member's legal right to file a claim or grievance, and patients maintain the right to be represented by counsel.

According to the DoD instruction on the program, resolution specialists work with military treatment facility lawyers on cases that may have legal implications, but attorneys are not involved in mediation sessions and specialists are barred from dispensing any opinions or advice on legal action.

Healthcare Resolutions specialists also will disengage from the mediation process if a lawsuit is filed.

The program also is separate from patient safety, risk and quality control, which investigates medical errors and adverse events. Resolutions advisers do not make any determination regarding negligence or medical error.

The regional program is active at eight military treatment facilities: Walter Reed; Fort Belvoir Community Hospital, Virginia; Naval Medical Center, Portsmouth, Virginia; Naval Medical Center San Diego; Naval Hospital Camp Pendleton, California; U.S. Naval Hospital Okinawa, Japan; Naval Hospital Jacksonville, Florida; and David Grant Medical Center, Travis Air Force Base, California.

The Air Force has plans to expand the program to three more facilities, while the Army will hire specialists for five additional facilities in the coming year, Moidel said.

Each office is responsible for handling cases at military hospitals and clinics in their regions that do not have their own full-time facilitator.

Referrals to the program come from various sources, including hospital leadership and staff, patients, legal offices and customer service.

Healthcare Resolutions takes cases beyond the scope of customer service complaints, ranging from unanticipated consequences of treatment, delayed diagnosis and medical errors to unexpected deaths, patient dissatisfaction with care or poor patient-doctor interaction.

In 2014, the DoD's eight Healthcare Resolution specialists handled 1,400 cases.

"We are available 24/7, nights, weekends and holiday times. The holidays our case load bumps up tremendously," Moidel said.

The number of civilian hospital systems that have launched similar programs or encouraged doctors to apologize after making a mistake has grown in the past decade, with some, such as those at the University of Illinois and University of Michigan Health System, seeing their medical malpractice suits drop by half, according to The New York Times.

Clark said this new program is among several designed to promote transparency in the military health system and change the way doctors relate to their patients.

"The culture of 'deny and defend' is gone. It needs to be gone. But the culture of transparency has been slow to take hold. This is something the medical profession needs to do a better job of," Clark said.

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