Professional liability insurance and medical error disclosure

Stuart McLennan; David Shaw; Agnes Leu; Bernice Elger

doi:10.4414/smw.2015.14164

Original article

Vol. 145 No. 2728 (2015)

Professional liability insurance and medical error disclosure

Stuart McLennan
David Shaw
Agnes Leu
Bernice Elger

DOI: https://doi.org/10.4414/smw.2015.14164
Cite this as:: Swiss Med Wkly. 2015;145:w14164
Published: 29.06.2015

Summary

QUESTION UNDER STUDY: To examine medicolegal stakeholders’ views about the impact of professional liability insurance in Switzerland on medical error disclosure.

METHODS: Purposive sample of 23 key medicolegal stakeholders in Switzerland from a range of fields between October 2012 and February 2013. Data were collected via individual, face-to-face interviews using a researcher-developed semi-structured interview guide. Interviews were transcribed and analysed using conventional content analysis.

RESULTS: Participants, particularly those with a legal or quality background, reported that concerns relating to professional liability insurance often inhibited communication with patients after a medical error. Healthcare providers were reported to be particularly concerned about losing their liability insurance cover for apologising to harmed patients. It was reported that the attempt to limit the exchange of information and communication could lead to a conflict with patient rights law. Participants reported that hospitals could, and in some case are, moving towards self-insurance approaches, which could increase flexibility regarding error communication

CONCLUSION: The reported current practice of at least some liability insurance companies in Switzerland of inhibiting communication with harmed patients after an error is concerning and requires further investigation. With a new ethic of transparency regarding medical errors now prevailing internationally, this approach is increasingly being perceived to be misguided. A move away from hospitals relying solely on liability insurance may allow greater transparency after errors. Legalisation preventing the loss of liability insurance coverage for apologising to harmed patients should also be considered.

References

Australian Commission on Safety and Quality in Health Care. Open Disclosure Standard review report. Sydney: Australian Commission on Safety and Quality in Health Care, 2012.
Canadian Medical Protective Association. Communicating with your patient about harm: Disclosure of adverse events. Ottawa: Canadian Medical Protective Association, 2008.
Massachusetts Coalition for the Prevention of Medical Errors. When things go wrong: Responding to adverse events. A consensus statement of the Harvard hospitals. Burlington: Massachusetts Coalition for the Prevention of Medical Errors, 2006.
National Patient Safety Agency. Being open: Saying sorry when things go wrong. London: National Patient Safety Agency, 2009.
Gallagher TH, Bell SK, Smith KM, Mello MM, McDonald TB. Disclosing Harmful Medical Errors to Patients: Tackling Three Tough Cases. Chest 2009;136:897–903.
Iedema R, Allen S, Sorensen R, Gallagher TH. What prevents incident disclosure, and what can be done to promote it? Jt Comm J Qual Patient Saf. 2011;37:409–17.
Gallagher TH, Lucus MH. Should we disclose harmful medical errors to patients? If so, how? J Clin Outcomes Manag. 2005;12:253–9.
Banja J. Medical Errors and Medical Narcissism. Boston: Jones and Bartlett Publishers, 2005.
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health C. 2007;19:349–57.
McLennan S, Elger B. Criminal Liability and Medical Errors in Switzerland: An Unjust System? Jusletter 2014, January 2014: 1–8.
Colledge F, Persson K, Elger B, Shaw D. Sample and data sharing barriers in biobanking: consent, committees, and compromises. Ann Diagn Pathol. 2014;18:78–81.
Shaw DM, Elger BS, Colledge F. What is a biobank? Differing definitions among biobank stakeholders. Clin Genet. 2014;85:223–7.
Colledge FM, Elger BS, Shaw DM. “Conferring authorship”: biobank stakeholders’ experiences with publication credit in collaborative research. PLoS One 2013; 8:e76686.
Leu A, Gächter T, Elger B. 365 Tage SwissDRG – Anreize, Instrumente, Wirkungen in: hill. Zeitschrift für Recht und Gesundheit 2013; 95. https://hill.swisslex.ch. German.
Leu A, Gächter T, Elger B. SwissDRG: Missbrauchsgefahr bei der Datenweitergabe an Krankenversicherer? Erwartungen und Entwicklungen. Jusletter 2014; March 2014. German.
Leu A, Gächter T, Elger B. Findet unter SwissDRG eine Minderversorgung besonders verletzlicher Patientengruppen statt? Pflegerecht – Pflegewissenschaft 2015;1:9–14. German.
Ritter C, Elger BS. Second-hand tobacco smoke in prison: tackling a public health matter through research. Public Health. 2013;127(2):119–24.
Wangmo T, Ruiz G, Sinclair J, Mangin P, Elger BS. The investigation of deaths in custody: a qualitative analysis of problems and prospects. J Forensic Leg Med. 2014;25:30–7.
Wangmo T, Handtke V, Elger BS. Disclosure of past crimes: an analysis of mental health professionals’ attitudes towards breaching confidentiality. Journal of Bioethical Inquiry 2014;11(3):347–58.
Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qualitative Health Res. 2005;15(9):1277–88.
Truog RD, Browning DM, Johnson JA, Gallagher TH, Leape LL. Talking with patients and families about medical error: A guide for education and practice. Baltimore: Johns Hopkins University Press, 2010.
Gallagher T, Waterman AD, Garbutt JM, Kapp JM, Chan DK, Dunagan WC, et al. US and Canadian physicians’ attitudes and experiences regarding disclosing errors to patients. Arch Intern Med. 2006;166:1605–11.
Kraman SS, Cranfi ll L, Hamm G, Woodard T. John M. Eisenberg Patient Safety Awards. Advocacy: the Lexington Veterans Affairs Medical Center. Jt Comm J Qual Improv. 2002;28:646–50.
Kachalia A, Kaufman SR, Boothman R, Anderson S, Welch K, Saint S, Rogers MA. Liability claims and costs before and after implementation of a medical error disclosure program. Ann Intern Med. 2010;153:213–21.
Studdert DM, Mello MM, Gawande AA, Brennan TA, Wang YC. Disclosure of medical injury to patients: an improbable risk management strategy. Health Aff (Millwood). 2007;26:215–26.
Gossweiler A. Spital-Haftpflicht: Kaum Leistungen – trotz hohen Prämien. Gesundheitstipp, May 2011:16–8.
American Medical Association. Apology Inadmissibility Laws: Summary of State Legislation. Advocacy Resource Center. American Medical Association, 2012.
Studdert DM, Richardson MW. Legal aspects of open disclosure: a review of Australian law. MJA. 2010;193:273–6.
Canadian Medical Protective Association. Apology legislation in Canada: What it means for physicians. Ottawa: Canadian Medical Protective Association, 2013. Available: https://oplfrpd5.cmpa-acpm.ca/-/apology-legislation-in-canada-what-it-means-for-physicians (accessed 2014 February 26).
British Columbia. Apology Act 2006. Section 2(1)(c)
Bailey TM, Robertson EC, Hegedus G. Erecting Legal Barriers: New Apology Laws in Canada and the Patient Safety Movement: Useful Legislation or a Misguided Approach? Health Law in Canada. 2007;28:33–8.
Thomeczek C, Hart D, Hochreutener MA, et al. Kommunikation: Schritt 1 zur Patientensicherheit – auch nach dem unerwünschten Ereignis. Chir Praxis. 2009;70:691–700. German.

How to Cite

1.

McLennan S, Shaw D, Leu A, Elger B. Professional liability insurance and medical error disclosure. Swiss Med Wkly [Internet]. 2015 Jun. 29 [cited 2024 Apr. 25];145(2728):w14164. Available from: https://smw.ch/index.php/smw/article/view/2045

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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[1] Australian Commission on Safety and Quality in Health Care. Open Disclosure Standard review report. Sydney: Australian Commission on Safety and Quality in Health Care, 2012.

[2] Canadian Medical Protective Association. Communicating with your patient about harm: Disclosure of adverse events. Ottawa: Canadian Medical Protective Association, 2008.

[3] Massachusetts Coalition for the Prevention of Medical Errors. When things go wrong: Responding to adverse events. A consensus statement of the Harvard hospitals. Burlington: Massachusetts Coalition for the Prevention of Medical Errors, 2006.

[4] National Patient Safety Agency. Being open: Saying sorry when things go wrong. London: National Patient Safety Agency, 2009.

[5] Gallagher TH, Bell SK, Smith KM, Mello MM, McDonald TB. Disclosing Harmful Medical Errors to Patients: Tackling Three Tough Cases. Chest 2009;136:897–903.

[6] Iedema R, Allen S, Sorensen R, Gallagher TH. What prevents incident disclosure, and what can be done to promote it? Jt Comm J Qual Patient Saf. 2011;37:409–17.

[7] Gallagher TH, Lucus MH. Should we disclose harmful medical errors to patients? If so, how? J Clin Outcomes Manag. 2005;12:253–9.

[8] Banja J. Medical Errors and Medical Narcissism. Boston: Jones and Bartlett Publishers, 2005.

[9] Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health C. 2007;19:349–57.

[10] McLennan S, Elger B. Criminal Liability and Medical Errors in Switzerland: An Unjust System? Jusletter 2014, January 2014: 1–8.

[11] Colledge F, Persson K, Elger B, Shaw D. Sample and data sharing barriers in biobanking: consent, committees, and compromises. Ann Diagn Pathol. 2014;18:78–81.

[12] Shaw DM, Elger BS, Colledge F. What is a biobank? Differing definitions among biobank stakeholders. Clin Genet. 2014;85:223–7.

[13] Colledge FM, Elger BS, Shaw DM. “Conferring authorship”: biobank stakeholders’ experiences with publication credit in collaborative research. PLoS One 2013; 8:e76686.

[14] Leu A, Gächter T, Elger B. 365 Tage SwissDRG – Anreize, Instrumente, Wirkungen in: hill. Zeitschrift für Recht und Gesundheit 2013; 95. https://hill.swisslex.ch. German.

[15] Leu A, Gächter T, Elger B. SwissDRG: Missbrauchsgefahr bei der Datenweitergabe an Krankenversicherer? Erwartungen und Entwicklungen. Jusletter 2014; March 2014. German.

[16] Leu A, Gächter T, Elger B. Findet unter SwissDRG eine Minderversorgung besonders verletzlicher Patientengruppen statt? Pflegerecht – Pflegewissenschaft 2015;1:9–14. German.

[17] Ritter C, Elger BS. Second-hand tobacco smoke in prison: tackling a public health matter through research. Public Health. 2013;127(2):119–24.

[18] Wangmo T, Ruiz G, Sinclair J, Mangin P, Elger BS. The investigation of deaths in custody: a qualitative analysis of problems and prospects. J Forensic Leg Med. 2014;25:30–7.

[19] Wangmo T, Handtke V, Elger BS. Disclosure of past crimes: an analysis of mental health professionals’ attitudes towards breaching confidentiality. Journal of Bioethical Inquiry 2014;11(3):347–58.

[20] Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qualitative Health Res. 2005;15(9):1277–88.

[21] Truog RD, Browning DM, Johnson JA, Gallagher TH, Leape LL. Talking with patients and families about medical error: A guide for education and practice. Baltimore: Johns Hopkins University Press, 2010.

[22] Gallagher T, Waterman AD, Garbutt JM, Kapp JM, Chan DK, Dunagan WC, et al. US and Canadian physicians’ attitudes and experiences regarding disclosing errors to patients. Arch Intern Med. 2006;166:1605–11.

[23] Kraman SS, Cranfi ll L, Hamm G, Woodard T. John M. Eisenberg Patient Safety Awards. Advocacy: the Lexington Veterans Affairs Medical Center. Jt Comm J Qual Improv. 2002;28:646–50.

[24] Kachalia A, Kaufman SR, Boothman R, Anderson S, Welch K, Saint S, Rogers MA. Liability claims and costs before and after implementation of a medical error disclosure program. Ann Intern Med. 2010;153:213–21.

[25] Studdert DM, Mello MM, Gawande AA, Brennan TA, Wang YC. Disclosure of medical injury to patients: an improbable risk management strategy. Health Aff (Millwood). 2007;26:215–26.

[26] Gossweiler A. Spital-Haftpflicht: Kaum Leistungen – trotz hohen Prämien. Gesundheitstipp, May 2011:16–8.

[27] American Medical Association. Apology Inadmissibility Laws: Summary of State Legislation. Advocacy Resource Center. American Medical Association, 2012.

[28] Studdert DM, Richardson MW. Legal aspects of open disclosure: a review of Australian law. MJA. 2010;193:273–6.

[29] Canadian Medical Protective Association. Apology legislation in Canada: What it means for physicians. Ottawa: Canadian Medical Protective Association, 2013. Available: https://oplfrpd5.cmpa-acpm.ca/-/apology-legislation-in-canada-what-it-means-for-physicians (accessed 2014 February 26).

[30] British Columbia. Apology Act 2006. Section 2(1)(c)

[31] Bailey TM, Robertson EC, Hegedus G. Erecting Legal Barriers: New Apology Laws in Canada and the Patient Safety Movement: Useful Legislation or a Misguided Approach? Health Law in Canada. 2007;28:33–8.

[32] Thomeczek C, Hart D, Hochreutener MA, et al. Kommunikation: Schritt 1 zur Patientensicherheit – auch nach dem unerwünschten Ereignis. Chir Praxis. 2009;70:691–700. German.