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The Story of MedStar's Disclosure and Apology Program

Over the years, we have shared disclosure success stories which either focused on individual cases or entire organizations that are embracing disclosure and apology. Perhaps, this might be our most powerful success story to date as we turn the focus to MedStar Health, which is a large hospital system based in Baltimore with 10 hospitals across the Maryland/Washington DC region.

MedStar is unique for many reasons...it is NOT an academic medical center or government facility. MedStar does have independent physicians with their own insurance policies through PIAA carriers. And MedStar is operating in a large urban environment with plenty of trial lawyers. Yet, despite these "obstacles," MedStar is doing very, very well with disclosure and apology. Indeed, if MedStar can successfully operate disclosure in a town like Baltimore, what is your excuse for not being able to do disclosure?

My primary contacts at MedStar have been Dr. David Mayer and Larry Smith, JD. Larry is a super guy and the head of risk management for MedStar -- he pioneered MedStar's approach to disclosure. Dave is also a terrific person, and many readers of this space will remember Dave's work on disclosure and apology at the University of Illinois Medical Center with Dr. Tim McDonald. Dave is now Vice President of Quality and Safety at MedStar.

The MedStar disclosure and apology program is called, "CANDOR," which is short for Communication and Open Resolution. MedStar's program was the blue print for the national CANDOR Tool Kit funded by AHRQ, and Dave, Larry, and other MedStar team members helped develop that tool kit.

To help develop this column, the MedStar team shared articles and stories with me, and I spoke at length with Dave Mayer. However, I can best describe MedStar's approach to disclosure and apology with two words: Jack Gentry.

Jack is a patient who recently suffered a crippling, life-changing medical error in a MedStar facility, and the leadership and clinical teams never ducked their responsibility -- financial, emotional, etc -- to Jack and his family.

I decided Jack's story best exemplifies MedStar's approach to disclosure because the big cases are what truly test and define your disclosure program. Too often we hear/read self-congratulatory tales such as, "95-year old woman with Stage 12 cancer, one foot in the grave, the other on a banana peel, and who regularly talks to dead relatives, is given a double-dose of aspirin...our highly ethical leadership team apologized immediately and the grandson thought we were terrific (cue the trumpets blaring in the background)."

Don't mean to be too harsh...all disclosure is good. However, show me your "highly ethical leadership team" in action when your staff's paperwork snafu led to a missed cancer diagnosis for a 42-year old professional person with three little kids at home. And the cancer is now terminal....let's see your ethics now. Do you have a program in place to address the financial and emotional needs of the patient and family, or will they have to beat out of you during a lengthy litigation process?

I don't have to ask these questions of MedStar. They live these principles ever day under the direction of Dave, Larry, and a team of people committed to doing the right thing, and Jack Gentry is a perfect example.

Jack was a newly retired Baltimore police officer, and he and his wife, Teresa, a nurse, were looking forward to a terrific retirement. However, Jack was experiencing shooting pains in his right arm and losing strength in his hand, so he sought surgery. The plan was to replace one disk, and fuse another with MedStar surgeon Dr. Justin Tortaloni. However, the replacement disc was inserted too far during the surgery and impacted Jack's spine, leaving him paralyzed from the neck down. The honesty started before the surgery was over, as Dr. Tortolani immediately disclosed to Teresa. Going forward, the MedStar leadership team literally ran to the Gentry family, and helped them through the entire process, including financial resolution. The attorneys for the hospital and Gentry family worked together in a collegial fashion to fairly address the financial needs of the family. Jack and Teresa are now vocal advocates for MedStar's disclosure and apology program, including working with Dr. Tortolani, Dave, Larry, and others. The Gentry's involvement includes a December 2016 panel discussion for MedStar which was videotaped and will be shared in our next e-newsletter -- yes, that's a teaser.

However, to wet your appetite here is a summary of Jack Gentry story from MedStar, and I want to draw your attention to the last two paragraphs which are a quote from Larry Smith:

"'The litigation environment was always there,' Larry L. Smith, MedStar's vice president for Risk Management, said. 'But we agreed that we would deal with that later. It took two years to settle, because we wanted to make sure we were accounting for Jack's full future needs. There was no need to rush.' When both parties decided it was time to work out the financial terms, they did so in a one-day mediation session, which was rare for its brevity.

'One thing we can feel good about at MedStar is, whenever we have the opportunity, our first response is to pull resources together to help the team and to help the patient and family,' Smith said. 'Our message to our staff is, 'Do the right thing.''"

If you would like further information on MedStar's disclosure and apology program, please contact Dr. David Mayer at:

David Mayer, MD
Vice President, Quality and Safety
MedStar Health
5565 Sterrett Place
3rd Floor
Columbia, MD 21044
410-772-6547 (P)
David.B.Mayer@medstar.net

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