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WHEN ACCIDENTS HAPPEN:
Insult added to injury when patients are refused answers // Some bring their anguish to court //
A simple apology could have saved feelings and dollars.

The Hardest Word

BY Anita Slomski // Fall 2007
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Doug Wojcieszak, Sorry Works!

Peter Yang for Proto

It was left to Doug Wojcieszak, Jim's brother, to make something of the young man's preventable death. Doug founded Sorry Works!, an organization that encourages hospitals to tell patients and families when errors occur.

Suing a Cincinnati hospital for the death of their 39-year-old son, Jim, brought cold comfort to Ray and Arlene Wojcieszak. “My parents cried every day for months, as they were forced to relive Jim’s death over and over during the deposition and discovery process,” says Doug Wojcieszak, Jim’s brother. But their anger over the shocking mistakes made by Jim’s doctors was just as powerful as their grief. They couldn’t forget how the cardiovascular surgeon, “mad as a wet hen,” in Ray’s words, after Jim died during emergency open-heart surgery, told the family he would have performed bypass surgery on the son’s three blocked arteries had Jim’s doctors recognized that a series of heart attacks rather than a bacterial infection was ravaging their patient’s heart. The reason Jim’s condition was misdiagnosed, the family believes, is that the hospital mixed up Jim’s medical chart with that of Ray, his father, whose cardiac stress test, a few months earlier, had revealed a heart as healthy as a 35-year-old’s.

When the family demanded answers from the hospital on why Jim’s heart attacks had been overlooked, “the wall of silence descended,” says Doug Wojcieszak. “Even the surgeon who had been honest the day my brother died told my parents he was no longer allowed to speak to them about the event.”

Jim Wojcieszak died in 1998. The suit was settled in 2000 before trial for an undisclosed amount. Five years later, Doug Wojcieszak started an advocacy group, Sorry Works!, to convince hospitals to abandon their “deny and defend” approach to negligence. What injured patients want, says Wojcieszak, is full disclosure of a mistake, followed by a sincere apology, a promise to fix systems that may have contributed to the error and a timely offer of compensation. “Had the hospital done those four things, what would we have sued over? Nothing,” says Wojcieszak. “If you treat us with respect, we don’t want to own your hospital, your speedboat or your kids’ college fund. We just want what’s fair so we can move on with our lives.”

Yet few people in medicine would feel safe admitting that they were at fault for a poor outcome, and physicians and hospitals have their own list of grievances about the current system of adjudicating claims of medical malpractice. The prevailing view in medicine is that juries lack the technical knowledge required to decide whether the standard of care has been violated. Moreover, although 71% of claims are dropped or dismissed, physicians often must endure the agony of defending themselves against meritless claims while paying a median amount of $15,000 a year for malpractice insurance coverage.

In short, the current system isn’t working well for anyone. Doctors, often reluctant to accept high-risk cases, practice defensively, all too aware that even the appearance of a slipup could land them in court. Though there is no official tally, droves of physicians have left practice, particularly in states with high insurance premiums.

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The Psychology of Apology

Hard as it is to admit an error to the world, it can be even harder for a doctor to admit one to herself.

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1. “Medical Liability: Beyond Caps,” Health Affairs, July/August 2004. Excellent overview of the current medical malpractice crisis, including articles that explore ideas for an improved litigation process and offer a look at California’s long-standing tort reform.

2. “Disclosing Medical Errors to Patients: Attitudes and Practices of Physicians and Trainees,” by Lauris C. Kaldjian et al., Journal of General Internal Medicine, July 2007. A look at how often physicians say they admit to medical errors—and how infrequently they really do.

3. “The Sorry Works! Coalition: Making the Case for Full Disclosure,” by Doug Wojcieszak et al., Joint Commission Journal on Quality and Patient Safety, June 2006. Wojcieszak lays out the challenges hospitals face in compensating patients for mistakes—and cogently dismantles each argument for why such a protocol won’t work.

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