DDBA 8562 Week 10 Error Disclosure Position Paper Example

Acknowledge the Error in Full: A Position Paper Arguing That a Hospital Should Tell a Family Exactly What Went Wrong With an Opioid Infusion, Against an Insurer's Cooperation Clause and Counsel's Advice to Express Sympathy Without Admitting Fault

Student Name

Walden University

DDBA 8562: Seminar in Law and Ethics in Healthcare Management

Instructor Name

Month Day, Year

Acknowledge the Error in Full: A Position Paper Arguing That a Hospital Should Tell a Family Exactly What Went Wrong With an Opioid Infusion, Against an Insurer's Cooperation Clause and Counsel's Advice to Express Sympathy Without Admitting Fault

Position

A composite 280-bed hospital in Colorado gave a 71-year-old patient recovering from hip surgery a hydromorphone infusion programmed at ten times the ordered rate. She suffered respiratory arrest, was resuscitated and spent four days in intensive care before recovering. The pump log and the pharmacy order show the error. The family has asked what happened. This paper argues that the hospital should acknowledge the error in full: tell the family that the infusion was programmed incorrectly, that this caused the arrest and that the hospital is responsible, and apologize. The strongest objection, built in full below, is that doing so before the insurer consents may forfeit coverage and expose the hospital and its nurses to liability the facts may not support.

The Duty to the Patient

Professional codes call on clinicians and organizations to disclose errors honestly to patients, and accreditation standards require that patients be told about unanticipated outcomes of their care. Gallagher et al. (2003) surveyed patients and physicians and reported that patients expected to hear about any error that hurt them, including what occurred, why, how its consequences would be handled and what would stop it happening again, together with an apology, while physicians often favored choosing words carefully and avoiding explicit statements that an error occurred. The family here has asked directly, and the facts are documented.

The Duty to the Institution

The hospital's professional liability policy contains a cooperation clause: the insured may not admit liability or agree to a settlement without the insurer's consent, on pain of losing coverage for the claim. The composite state's apology statute makes expressions of sympathy, benevolence or condolence inadmissible as evidence of liability but does not protect statements admitting fault. Counsel has therefore advised the hospital to say it is sorry for what the family is going through, without saying that an error occurred or that the hospital caused the harm.

The Strongest Objection

The objection is not simply that disclosure invites lawsuits. It is this. At this stage, the hospital knows the pump was programmed at ten times the ordered rate, but it does not yet know why: whether the nurse misread the order, whether the pump's interface invited the error, whether pharmacy labeled the bag confusingly, or whether a combination of these occurred. A full acknowledgment that the hospital is responsible, made before the investigation finishes, may assign responsibility wrongly, including to a nurse who followed a flawed process. It may also breach the cooperation clause and leave the hospital uninsured for a claim that could exceed a million dollars, harming every future patient the hospital's finances support. On this view, a careful expression of sympathy now, with fuller disclosure after the investigation and with the insurer's consent, serves both duties better.

The Answer

The objection is right about causes and wrong about facts. The hospital should not speculate about why the error occurred before the investigation. But it knows what occurred: the infusion ran at ten times the ordered rate, and that caused the arrest. Withholding that fact while expressing sympathy treats the family as adversaries and is likely to be discovered. The position is therefore narrowed: acknowledge the error and its effect in full now, state that the causes are under investigation and will be shared, apologize, and commit to telling the family what the hospital learns.

The coverage risk must be managed, not ignored. The hospital should notify its insurer immediately and seek consent to disclose the facts; many insurers now support disclosure programs. Mello et al. (2014) studied six early adopters of communication-and-resolution programs and found that insurer engagement was among the conditions for success.

Reading the Michigan Evidence

Kachalia et al. (2010) examined claims and legal spending at the University of Michigan's health system in the years on either side of its move to disclose errors and offer compensation, and found fewer claims, fewer lawsuits, shorter time to resolution and lower costs after implementation. Because the study looked at one institution across two periods with no comparison site, anything else that changed in those years could account for part of the drop. It supports the claim that disclosure need not increase liability costs; it does not prove that disclosure reduces them everywhere. This paper's position does not depend on reduced costs. It rests on the duty to the patient, with the evidence showing that the institutional cost need not be the catastrophe the objection fears.

Conclusion

The hospital should tell the family exactly what happened and that it is responsible for the infusion error, apologize, and promise the findings of its investigation, after seeking the insurer's consent the same day. Sympathy without acknowledgment would satisfy counsel and fail the patient.

References

Gallagher, T. H., Waterman, A. D., Ebers, A. G., Fraser, V. J., & Levinson, W. (2003). Patients' and physicians' attitudes regarding the disclosure of medical errors. JAMA, 289(8), 1001-1007. https://doi.org/10.1001/jama.289.8.1001

Kachalia, A., Kaufman, S. R., Boothman, R., Anderson, S., Welch, K., Saint, S., & Rogers, M. A. M. (2010). Liability claims and costs before and after implementation of a medical error disclosure program. Annals of Internal Medicine, 153(4), 213-221. https://doi.org/10.7326/0003-4819-153-4-201008170-00002

Mello, M. M., Boothman, R. C., McDonald, T., Driver, J., Lembitz, A., Bouwmeester, D., Dunlap, B., & Gallagher, T. (2014). Communication-and-resolution programs: The challenges and lessons learned from six early adopters. Health Affairs, 33(1), 20-29. https://doi.org/10.1377/hlthaff.2013.0828