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The Full Disclosure / Early Offer Movement: What it Could Mean for You if You Ever Suffer a Medical Mistake

A concept called "full disclosure / early offer" is spreading through the health care field like a wildfire. In short, the movement encourages -- and in some states even grants legal rights to -- doctors and other health care personnel to apologize after they've made a medical mistake.

medical error

It's anger, not greed, that drives most patients to take legal action when a medical error occurs, according to the Sorry Works! Coalition.

Traditionally, doctors were discouraged, to put it lightly, from saying much of anything about a medical mishap for fear that it could be used against them in litigation.

Instead of "full disclosure / early offer," the preferred course of action was more like a policy of "defend and deny."

It was commonplace, meanwhile, for patients to receive only partial information or misinformation altogether regarding what occurred, for instance being told they had an allergic reaction to anesthetic when, in reality, too much had been given.

Medical errors in hospitals alone cause 44,000 to 98,000 deaths in the United States each year, according to the Institute of Medicine. This makes them the eighth leading cause of death in the country.

By allowing doctors to apologize for mistakes, and take any necessary remedial action right away, the theory is that it will cut back on the amount of medical practice lawsuits. Further, this practice also makes reporting medical errors much easier, since the mistake is already out in the open. Many medical errors currently go unreported, even though becoming aware of the mistakes that are occurring would likely help to prevent them from happening again in the future.

In fact, while most doctors say they do want to be honest, fewer than half will reveal serious errors they have made, according to an August 2006 study in the Archives of Internal Medicine.

Health care providers "willing to admit when they have made an error and quickly get on top of it ... cut down on the anger that leads to litigation ... Patients bring lawsuits when they can't get answers," says Doug Wojcieszak, founder of The Sorry Works! Coalition, an advocacy group aimed at publicizing and implementing the full disclosure / early offer concept.

Full Disclosure / Early Offer Spurs Positive Changes

More than 30 states have adopted laws that will protect a doctor's apology from being used in a trial. Further, hospitals across the United States are adding policies that actually require doctors and nurses to disclose medical errors and offer apologies to the patients and families affected. In many cases, financial settlements are also offered upfront.

The University of Michigan Health System is one such hospital that has begun using a policy that encourages full disclosure of medical errors and apologies to patients.

full disclosure policy

Upon adopting a full disclosure policy for medical errors, the University of Michigan Health System saw pre-suit claims and lawsuits decrease from 260 in July 2001 to fewer than 100 in January 2007.

Since they have implemented these changes, the number of pre-suit claims and lawsuits has decreased from 260 pending in July 2001 to fewer than 100 in January 2007. Further, the average amount spent on legal fees for each case has fallen more than 50 percent.

In all, litigation costs fell from an average of $65,000 per case to $35,000 per case, which resulted in a total average annual savings of $2 million to the hospital.

The average time it took to resolve claims and lawsuits also fell dramatically, from 20.7 months in 2001 to 9.5 months in 2005.

Similarly, the largest malpractice insurer in Colorado, COPIC, enrolled 1,800 physicians in a program that required them to express remorse to patients for medical care gone wrong, along with explain in detail what happened. Meanwhile, the insurer paid for the patients' related expenses.

As a result, malpractice claims against the 1,800 doctors dropped by 50 percent from 2000 to 2005, and the cost of settling the doctors' claims fell by 23 percent.

"Many doctors really want to be open and apologize to patients, but are led to believe it can end up in financial disaster, when the truth is quite the opposite," according to Michigan Health System's chief risk officer Richard Boothman in a Wall Street Journal article.

The MEDIC Bill: A National Policy for Apology

The full disclosure /early offer programs have been so successful that they're receiving national attention.

Sens. Barack Obama (D-Ill.) and Hillary Rodham Clinton (D-N.Y.) have proposed national legislation known as the National Medical Error Disclosure and Compensation Bill (the MEDIC bill) that would "provide federal grant support and technical assistance for doctors, hospitals, and health systems that disclose medical errors and problems with patient safety and offer fair compensation for injuries or harm."

They believe the MEDIC bill would:

  • Promote open communication between patients and providers

  • Reduce the rates of preventable medical errors

  • Ensure patient access to fair compensation for medical injury, negligence, or malpractice

  • Reduce the cost of medical liability insurance

What Does This Mean for Patients?

Experts agree that full disclosure is the best policy to help institutions learn from their mistakes. As a patient, this means that hospitals and doctors may eventually be able to bring down the number of medical-error-related deaths each year (which, remember, is now as high as 98,000).

The ultimate goal, optimistically, would be to provide a safer, more open and honest setting for health care in the United States.

"We like to educate people that disclosure is simple common sense," writes the Sorry Works! Coalition. "Reducing anger among patients and families and avoiding the appearance of cover-ups decreases the number of lawsuits, defense litigation expenses, and health care providers' settlement costs."

"When the emotions of patients and families are acknowledged and constructively addressed," they continue, "money becomes a secondary issue."

Recommended Reading

Items Left Inside People After Surgery: Just How Common is This Terrifying Ordeal

27 Never Events: They're Not Supposed to Happen, but They Often Do


The New England Journal of Medicine May 25, 2006, Volume 354:2205-2208

The Sorry Works! Coalition August 19, 2007

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