Abstaining From the Truth

Taking aim: Leonard Morgenbesser. photo: John Whipple

Waiting for the First Volley

An Albany Common Council resolution to create a gun-violence task force nears its one-year birthday, and remains unfulfilledClippings of carjackings and armed robberies, stories about shootings and home invasions—this is the stuff of Leonard Morgenbesser’s collection. And unlike most collectors, he looks forward to the day when his subject matter gets too scarce and he can find a new hobby.

“As far as I can tell, it’s a problem that doesn’t seem to go away,” said Morgenbesser, who has kept an ongoing record of gun-related crimes reported by the local media for nearly three years. According to Morgenbesser’s most recent tally, there have been 186 gun-related crimes reported by the media in the city of Albany since Sept. 19, 2002, with one incident occurring nearly every four days.

“And the media accounts—they might just be an underestimate of what’s going on,” said Morgenbesser. “People say that crime’s way down, that it’s not a problem. But when there’s someone with a gun to their head every four days, that seems like a problem to me.”

And 72 of those crimes have occurred since Albany’s Common Council unanimously passed a resolution earlier this year [“The Task at Hand,” Newsfront, Jan. 15] that, according to Morgenbesser, could lead to a decline in subject matter for his ad-hoc study.

The resolution, sponsored by Councilman Dominick Calsolaro (Ward 1), calls upon the mayor to create a gun-violence task force for the city, composed of various law-enforcement agencies, community groups and business organizations. Since its passage, there has been little word from Mayor Jerry Jennings about actually forming such an entity. Calls to the mayor’s office about the resolution were not returned.

“All we could do was pass the resolution,” explained Calsolaro, “because the council can’t set up a task force or appoint outside members to it.”

According to Calsolaro, such a task force would be utilized in cooperation with local law enforcement as a sort of education and outreach program to supplement law-enforcement efforts. Calsolaro cited the city’s recent “Don’t Buy for the Other Guy” campaign, which targeted illegal gun purchases, as the sort of program a gun-violence task force might play a role in developing. A task force would also gather, organize and analyze information about gun violence in Albany and cities with similar problems.

“Maybe once a month or four or five times a year they could meet with police,” said Calsolaro, who described the task force as being more of a proactive—rather than reactive—approach to curbing gun violence. “It’s like going after a disease. You need to know what you’re fighting before you can really fight it.”

Local law-enforcement agencies have been cautious about putting their support behind the task-force proposal, however. After the initial resolution passed, members of the Albany Police Department expressed concerns that such a task force would simply duplicate efforts already underway by city and state law-enforcement agencies.

“We’ll work within any legislation that passes,” said Detective James Miller, spokesman for the Albany Police Department, “but it would be crazy to duplicate things, because you won’t be using your resources in an effective manner.”

Miller cited Operation Impact, a joint city and state program targeting high-crime neighborhoods, as one program that targets essentially the same issues as the proposed task force. According to Miller, approximately 60 guns have been seized in the last four months, and the number of shots fired in the city—along with the number of people shot—is decreasing over time.

While Morgenbesser acknowledged the efforts of local law-enforcement agencies, he insisted that communication between law-enforcement personnel and the community—rather than simply between law-enforcement personnel and other law-enforcement personnel—may hold the answer to stopping gun crime before it happens.

“I would be the first on the front line saying that this is not just [Albany Police] Chief Turley’s problem,” said Morgenbesser. “But we can’t just fight this as a criminal justice and police issue—it’s a public-health issue, too.”

However, Morgenbesser added that the recent election of Albany County District Attorney David Soares might signal that a community-minded approach to law enforcement is gaining acceptance.

“When does [gun violence] become a problem?” he asked. “When it starts happening once every two days?”

—Rick Marshall

rmarshall@metroland.net

Seeking answers and apologies: David Baker. photo: John Whipple

Two Little Words

Local man seeking answers in his wife’s death wishes a policy called “Sorry Works” would come to Samaritan Hospital

Here is what David Baker understands about how his wife, Lisa Zenzen Baker, 42, died last year: She was admitted to Samaritan Hospital in Troy on Nov. 6, 2003, after a bout of nausea and vomiting, probably brought on by complications of her insulin-dependent diabetes. After four days, she was stabilized and expected to be sent home the next day. That night her blood sugar dropped to 55 mg/100mL (any measure below 60 mg/100mL is considered hypoglycemic) at 9 PM. She was given sugars but no complex carbs, which Baker believes is opposed to the hospital’s own protocol. Between 10 PM, when her glucose levels were last checked, and 2 AM, her blood sugar level plummeted to just 2 mg/100mL. She went into a coma, stopped breathing, and three weeks later, she died.

Here’s what David Baker doesn’t know: why or how this happened. Since his wife died, he hasn’t had any contact with any of the doctors involved in her care, despite many attempts on his part. “They didn’t give any explanation,” he said. He tried writing letters, and asking the Department of Health for an investigation. The DOH’s report, performed by the nonprofit health-care assessment company IPRO, said “the standard of care was met,” but again provided little to no details or explanation. DOH and Samaritan Hospital weren’t available for comment.

Baker is turning to a lawsuit, not because he feels he needs money, but “just to get answers. They won’t tell anybody anything until we put them under oath.” He’s been trying to get answers for a year, and says the absence of answers are prolonging his grief over the loss of his wife. “Here it’s been a year, and [I] haven’t even gotten to the point where [I] can start to move on, can’t even start the healing,” he said.

Baker’s experience is not unusual, said Doug Wojcieszak, a spokesman for the Illinois patients’ advocacy group Victims and Families. Wojcieszak, who lost a brother to a medical error, said that the members of his group have had similar stories to tell: “Doors slammed in our faces, records disappeared. Only after an attorney got involved did records surface, and only after money exchanged hands did they come to my parents and say ‘Gee, we’re sorry.’ ”

It’s not that doctors and nurses don’t want to take responsibility, said Wojcieszak and others. It’s that their defense attorneys and their malpractice insurance companies’ attorneys often dictate the policy, telling hospitals and doctors never to admit any wrongdoing or release any information that could be used against them in a lawsuit.

With medical errors claiming more lives per year than car accidents, according to To Err is Human, a report published in 1999 by the National Academy of the Sciences, and debate over rising malpractice premiums and tort reform getting national attention, the topic of medical liability is a hot one for everyone involved. (Depending on which study you look at, medical error causes anywhere from 48,000 to 96,000 deaths a year in this country.) But amid the debates, a new idea has been quietly taking hold that promises best-of-both-world results.

It started in 1987 at the Lexington, Ky., Veterans Affairs Medical Center. The hospital had recently faced some big financial losses due to lawsuits, and the newly installed chief of staff, Steve Kraman, had started a policy of internal investigations after every death or adverse outcome. “We stumbled into a case of a woman who died, and a few weeks after she died we found that there had been a medical error that had been directly responsible for the patient’s death, and the family had no idea,” recalled Kraman. “We decided the only proper ethical thing to do was disclosure.” They called the family in, advised them to bring a lawyer, explained all the details, apologized, explained how they would prevent such mistakes in the future, and said they felt they owed the family some compensation, which the lawyers would negotiate.

“That worked so well, we decided it was going to be our model,” said Kraman, who made every step of what they’d done in that case into a formal policy. It also was the policy to meet with families in cases where the hospital didn’t find an error. In those cases, the hospital staff opened up all the records and took as much time as they needed to explain what happened and why.

The results, said Kraman, were dramatic. The number of lawsuits plummeted.
“Ninety-nine times out of 100, [the apology] takes the anger out of it,” said Wojcieszak. “The biggest thing we get thrown in our face is a knee-jerk emotional reaction, ‘If you tell doctors to say they’re sorry, those lawyers will sue their butts off.’ [People] have a fundamental misunderstanding of how this works. Lawyers don’t file suits against doctors unless a family is mad enough to pick up the phone and call them.”

At the VA hospital, total liability costs also dropped, between fewer lawsuits and more frequent but much smaller settlements. Though the U.S. Attorney’s office, which had to approve settlements over a certain size, initially told them they were crazy, they allowed the experiment and quickly became supporters, said Kraman. The hospital developed a reputation for honesty among the local plaintiffs’ bar, who wouldn’t take a case if the hospital said it was going to fight it, because they knew the hospital didn’t cover up errors. And the hospital was better able to reduce errors, said Kraman, because of the open atmosphere that allowed people to disclose and talk about mistakes and work toward fixing them.

In 1999, Kraman wrote an article for the Annals of Internal Medicine called “Risk Management: Extreme Honesty May Be the Best Policy,” and a few other hospitals began to pick up the approach. The University of Michigan says its liability costs have dropped from $3 million per year to $1 million after implementing the approach. Disclosure and apology have also been quietly incorporated into the Joint Commission on the Accreditation of Healthcare Organizations’ standards.

Even some insurance companies have gotten on board. Copic, a nonprofit insurance company in Colorado, started a pilot program recently called the 3Rs: Recognize, Respond, and Resolve. Doctors in the program get training in communicating with patients, and whenever there’s an unexpected result they sit down with patient and family and “express concern, sorrow, and fault,” explained Copic’s George Dikeou. In about half the cases, Copic also provides a small amount of financial help—capped at $30,000. And they don’t require a release to get the money, so patients retain their right to sue. As of June, 592 cases had gone through the program. Only two were not fully resolved through the program; of those, one was resolved in the claims department without lawyers, and one was dropped. “If patients and their families are satisfied that they’ve been dealt with honestly and truthfully, they view the incident as a human mistake or human error. If they find out or think that’s something being concealed they think it’s malpractice,” said Dikeou. A 2003 state law that allows doctors to admit fault without that being held against them in court really helps, Dikeou noted. Copic is likely to expand the program to all its doctors.

And in Illinois, Wojcieszak’s group is pushing a pilot program dubbed Sorry Works, which is based on the VA’s approach. The pilot program will allow two hospitals to try the program “risk-free” (i.e. the state will pick up any increases in liability costs) for two years. (It’s a trickier thing to institute at a private hospital where an insurer has to be involved.) The program has passed the state Senate and is expected to pass the House as well.

Sorry Works has garnered praise from people of very different political temperaments, and those usually on opposing sides of the medical lawsuit issue. “For the Republican, pro-tort-reform crowd, it lowers lawsuits, lowers liability exposure, gives more control over exposure,” said Wojcieszak. “For Democrats and plaintiffs’ bars . . . more victims get justice, and no one’s constitutional rights are monkeyed with. They still have the right to sue, just most of the time it won’t happen.”

For Wojcieszak, who used to work for tort-reform advocacy groups before he lost his brother a year ago, supporting a program that is a true middle ground feels “like spring has arrived.” He’s helping to form a Sorry Works coalition that will include doctors, insurance companies, lawyers, and patient advocates, to take the concept national.

In the Capital Region, two major hospitals, Albany Medical Center and St. Peter’s Hospital, both say they follow the basic tenets of Sorry Works, though compensation offers are not quite as automatic. Both hospitals are self-insured, which allows them some flexibility, but spokesmen for the hospitals said it’s first a matter of ethics.

“Our approach is an ethical and moral one, rather than a financial one,” said Dr. John Morley, medical director of AMC’s hospital. “It’s our belief that patients have a right to know what’s going on with their cases. Doing what’s right, yet one more time, is a good financial decision as well.”

AMC does a “root cause analysis” of every adverse outcome, and also has a nationally known, aggressive program to track and learn from errors that don’t get to the level of patient harm, such as wrong prescriptions that are caught by the pharmacy, noted Tim Lesar, AMC’s director of pharmacy. Having an open, honest approach is essential to learning environment, said Lesar, but it requires a conscious decision beforehand of how to respond, because when errors occur, the human reaction is first one of defensiveness.

Those involved feel like honesty as a policy is spreading. “A few years ago we could say we don’t like slamming the doors on victims, but if we didn’t we’d go broke,” said Kraman. But, he said, with increasing numbers of hospitals lowering costs by saying “I’m sorry,” “we can’t say that anymore.”

—Miriam Axel-Lute

maxel-lute@metroland.net

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