Award for the Advancement of Patient Safety

by David B. Troxel, M.D., Medical Director, Board of Governors

Patient safety is, and always has been, the ultimate goal of the practice of medicine, and The Doctors Company is committed to providing its member physicians with the best information and management tools available to prevent patient injury, whether it is caused by medical errors or by system failures in our health care environment. In support of this commitment, Dr. Richard Anderson, chairman and CEO of The Doctors Company, and Dr. Donald Palmisano, a member of our Board of Governors, serve on the Board of Governors of the National Patient Safety Foundation.

In 2005, Dr. Palmisano received this award for his advocacy of the Patient Safety and Quality Improvement Act of 2005 during his tenure as president of the American Medical Association (AMA). This law establishes a confidential reporting structure in which physicians, hospitals, and other health care professionals and entities can voluntarily report information on errors to patient safety organizations for review by experts to improve the system for all with the goal of preventing future errors. In addition to his legislative activities, Dr. Palmisano was recognized for his participation in the National Patient Safety Foun-dation as a founding member of its Board of Directors.

Dr. Palmisano is a New Orleans general and vascular surgeon in private practice since 1970. He is clinical professor of surgery and clinical professor of medical jurisprudence at Tulane, as well as adjunct professor in the Department of Health Systems Management of the Tulane School of Public Health and Tropical Medicine. Dr. Palmisano was president of the Louisiana State Medical Society in 1984 and 1985, and, from 1999 to 2003, he was a member of the board of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). He was president of the AMA for the 2003–04 term and was recently elected to the Board of Governors of Tulane University Health Sciences Center.

The Doctors Company Names Troyen Brennan, M.D., and Lucian Leape, M.D., as 2006 Recipients of the Award for the Advancement of Patient Safety

The Doctors Company is honoring Dr. Brennan for his leadership in the national patient safety movement. He has made an important contribution to the nation’s health care by drawing attention to system problems as a common cause of patient injury. His unique understanding of both the medical care delivery and legal systems, coupled with his interests in health policy and medical ethics, has contributed to making the improvement of patient safety a national goal.

Dr. Brennan’s nuanced insights into how medical practice, medical ethics, and the law interrelate in the epidemiology of medical error have laid the foundation for the patient safety movement and have made a major contribution to enhancing patient safety in the American health care system.

Through 2005, Dr. Brennan was professor of medicine at Harvard Medical School and professor of law and public health at the Harvard School of Public Health. He has written 240 peer-reviewed articles and four books on a range of subjects, including medical ethics, health care law and policy, medical injury, and medical malpractice. He was also president of the Brigham and Women’s Physician Organization, where, under his leadership, one of the first comprehensive computer order entry systems was established—and linked to a quality management system. He has served on the Board of Directors of the American Board of Internal Medicine and chaired the ABIM/American College of Physicians Medical Professionalism Project. This culminated in publication of Medical Professionalism in the New Millennium: A Physician Charter, which established quality improvement and patient safety as responsibilities for every physician.

The Doctors Company is honoring Dr. Leape for his important leadership contributions to the national patient safety movement. He was an early advocate of the systems approach to preventing medical error, and his 1994 paper Error in Medicine drew national attention to this problem. His research has focused on the identification and correction of system failures that often contribute to the adverse medical events leading to patient injury. Dr. Leape has shifted the national focus from blaming individual caregivers to the importance of redesigning the health systems by which medical care is delivered.

Dr. Leape is an adjunct professor of health policy in the Department of Health Policy and Management at the Harvard School of Public Health. He has written over 100 peer-reviewed articles identifying where system failures occur within our health system, proposing solutions to improving clinical systems and processes, exploring ways for providers to report and openly discuss medical errors to prevent their recurrence, and identifying common ground for health care professionals, hospitals, patients, payers, and regulators to work together to improve patient safety.

Prior to joining the Harvard faculty in 1988, Dr. Leape was professor of surgery and chief of pediatric surgery at Tufts University School of Medicine. He was one of the founding members of the National Patient Safety Foundation and now serves as a distinguished advisor. He was a member of the Institute of Medicine’s Quality of Care in America Committee, which published To Err Is Human and Crossing the Quality Chasm—reports that drew national attention to the magnitude of patient injury resulting from medical error and the need to redesign our systems in order to improve patient safety. He is an advocate of institutional programs that promote the open disclosure of adverse medical events to patients and their families.

Participation in Adverse Event Disclosure Programs

It is AMA policy that following an unanticipated outcome, the physician is ethically required to inform the patient of all the facts necessary to ensure an understanding of what has occurred. Furthermore, the JCAHO requires health care organizations to disclose sentinel events, investigate their root causes, and take action to prevent their recurrence. The ethical rationale for disclosure is that the patient and his or her family have the right to know what happened—simply put, it’s “the right thing to do.” In addition, if no one explains what happened to a patient injured by an adverse event, he or she may assume that a mistake is being concealed. This leads to anger, which drives many malpractice claims. Disclosure takes the edge off of anger and helps maintain the physician-patient relationship.

The Doctors Company supports the AMA and JCAHO policies. We encourage our insured physicians who practice in organizations with structured adverse event disclosure programs (also known as “I’m Sorry” programs) to participate. A structured program means there are written program protocols, knowledgeable risk managers, a patient safety-oriented medical staff organization, training programs in patient disclosure and communication, and supportive institutional leadership.

Coping with the Stress of a Malpractice Claim

To assist our insured physicians in dealing with the stress and uncertainties associated with a malpractice claim, the following support program has been implemented:

When you report an incident or a claim to your Regional Claims Office, the claims specialist will refer you to The Doctors Company’s Web site (www.thedoctors.com). Once there, go to Patient Safety/Risk Management, then to General Risk References, and then to Litigation & Claims; or you can use the following URL to go directly to our litigation and claims section: www.thedoctors.com/litigation.

1. You will see these three selections:
Notification of an Incident or a Claim
Print and read this explanation of why it is important to notify your Regional Claims Office as early as possible after an incident occurs or a claim has been made against you. It explains what to report, how to report, and what to do and not do to assure defensibility.

Coping with Depositions and Trials
Print and read this excellent resource. It explains what to expect, from the initial request for records through the process of discovery to how to recognize and
manage stress.

Coping with Litigation Stress
The Physician Litigation Stress Resource Center provides useful information for managing the stress of a malpractice claim. Print and read “Coping with a Medical Malpractice Suit,” an article by Sara Charles, M.D.  Her book, Adverse Events, Stress, and Litigation: A Physician’s Guide, is also recommended—especially Chapter 8, “Coping with
the Stress Associated with Litigation.”

2. While our claims specialists are experienced in supporting you during the management of claims, feel free to call me to discuss the litigation process or what to expect, and to ask any questions that the claims specialist may have been unable to fully answer.

Medical Director David Troxel, M.D., can be contacted at (800) 352-0269 or at dtroxel@thedoctors.com.