Is honesty the best policy for hospitals? Should a hospital patient be told when an error causes injury?

The nation's hospitals generally answer "No" to these questions. But one hospital in Kentucky says, "Yes."

Recent newspaper articles provide a fascinating and alarming insight into the scope of medical errors in hospitals and what the hospitals do when they are discovered. Excerpts follow.

The Medical College of Pennsylvania Hospital (MCP) is known for providing advanced medical care.

It is also representative of modern American hospitals in another respect: In the past decade alone, records show, hundreds of MCP Hospital patients have been seriously injured, and at least 66 have died after medical mistakes.

The Philadelphia hospital's internal records cite 598 incidents reported by medical professionals to the hospital administration in the past decade. In some of those cases, patients or survivors were never told that the injuries were caused by medical errors.

Amazingly, none of the doctors involved in the incidents was subjected to disciplinary action.

For patients of all ages, serious injury and death caused by medical errors are well-known facts of life in the medical community. But they are rarely reported to the public.

MCP Hospital's records came to light only because of bankruptcy proceedings last year, when its new owner publicly filed a detailed account of the 598 incidents reported at the facility from January 1989 through June 1998.

Those numbers mirror what is happening across the country. Lucian Leape, a Harvard University professor who conducted the most comprehensive study of medical errors in the United States, has estimated that 1 million patients nationwide are injured by errors during hospital treatment each year and that 120,000 die as a result.

In their study, Leape and his colleagues examined patient records at hospitals throughout the state of New York. Their 1991 report found that one of every 200 patients admitted to a hospital died as a result of a hospital error. Researchers say that medical errors reported to hospital authorities represent roughly only 5 to 10 percent of the number of actual medical mistakes at a typical hospital.

Contained in the MCP records is a history of one hospital's experience, providing an unprecedented glimpse into the extent and nature of hospital mistakes.

The cases run the gamut from benign to fatal, and involve patients whose health status ranged from young and vital to old and infirm. They include:

• Four patients who died after they received too much medication, the wrong medication, or no medication.
• Surgical ``misadventures'' during which patients' organs were punctured or blood vessels were pierced.
• An epilepsy patient who died and another who was left paralyzed on one side after brain hemorrhages during surgery by inexperienced and inadequately supervised residents. In those two cases, four doctors at MCP later signed a letter to a hospital administrator saying mistakes by unsupervised surgical residents "resulted in the unfortunate death of one of our patients."
• Two middle-age patients who died after cardiac emergencies -- men who according to hospital records did not receive proper or timely treatment from emergency-room residents. One man sat in the emergency room with dangerously elevated blood pressure for more than seven hours before dying of a heart attack.
• An 18-year-old man who received the wrong type of blood in a transfusion after an automobile accident, and died after an apparent hemolytic reaction to the blood.
• Eight surgical patients who required second operations to retrieve sponges, cotton or metal instruments left inside their bodies.
• Inadequate intensive-care monitoring, which delayed response to a woman who had stopped breathing. She suffered permanent brain damage.

Lawyers for MCP, a 400-bed hospital, have consistently denied the hospital's liability in lawsuits arising from errors. The hospital's own records suggest that its experience is no different from that of most hospitals in America.

Was it the interns who made the mistakes?

The MCP doctors who treated patients included in the report had a wide range of expertise. Some were first-year doctors-in-training, or residents, working under the supervision of attending doctors. Others were veteran faculty who had graduated at the top of their medical-school classes and are regarded by their colleagues as among the most competent in their specialties.

Were the negligent doctors disciplined by the state regulators?

None of the 40 doctors involved in some of the most serious mistakes at MCP was ever subjected to disciplinary action by the state Bureau of Professional and Occupational Affairs, according to an agency official.

Did the injured file lawsuits seeking compensation?

Because most medical mistakes do not go beyond hospital walls, it is estimated that only 2 to 10 percent of all cases involving medical error result in lawsuits.

There were many instances at MCP in which hospital staff did not tell patients or their relatives about errors in medical care -- errors that staff viewed as serious enough to warrant informing hospital administrators.

A Kentucky hospital takes the high road when medical errors occur.

In one Kentucky hospital medical errors are not handled like nuclear secrets. The Veterans Affairs Medical Center in Lexington, Ky., treats medical errors differently from most hospitals.

The 400-bed hospital does not simply encourage its staff to tell patients and their families the truth about errors. It has a tough policy that requires giving the information as soon as possible by aggressively seeking out patients and families, even after discharge if necessary. Hospital employees actually persuade the occasional reluctant victim to accept financial compensation.

The VA hospital in Kentucky has learned that doing the right thing can also mean saving money. By going out of its way to be open and honest with patients and their families, the hospital has found that it is minimizing its legal exposure because families are not as angry when they learn of a medical error.

In 1986, the hospital lost two malpractice lawsuits at trial, costing it a total of $1.5 million in awards. For a government facility that primarily treats older patients, whose claims usually result in lower damages, that was an eye-opening sum.

Now, hospital officials begin assembling dossiers and taking testimony soon after incidents. As soon as they determine that a mistake has occurred, they notify the patient or family members. If they believe harm has been done, rather than evade the truth in an attempt to avoid liability, they advise the family to hire a lawyer and they seek to quickly resolve the problem with a fair settlement.

The hospital drills its policy into its staff, especially the residents who train there, seeking to create a culture in which mistakes are acknowledged and lead to changes that prevent recurrences. Some of the ethics seminars that it has held for employees have featured patients who were injured by treatment at the hospital, explaining how honesty reinforced rather than undermined their trust.

Sadly, Florida hospitals do not generally follow the approach of the Kentucky VA facility. They often treat discovered medical errors as secrets not to be shared with the patient. As a result, in Florida it is certainly wise to consult with a Board Certified Civil Trial Lawyer and if available a Doctor/ Lawyer  when malpractice is suspected.

You need every advantage on your side. At Ward & Caggiano, P. A. you get Orlando Medical Malpractice Lawyers dedicated to uncovering the medical mistakes and providing you with the justice you deserve. Contact us online or Call us at 407-244-1212 for you FREE NO OBLIGATION CONSULTATION.