The quest for medical error transparency suffers setbacks

Two recent articles in American Medical News highlight the difficulties in moving toward a blameless culture in medicine.

First we have the results of an Agency for Healthcare Research and Quality survey of 600,000 staff from over 1100 hospitals. Half of them “believe their mistakes are held against them, and 54% said that when an adverse event is reported, ‘it feels like the person is being written up, not the problem.’" And two-thirds are concerned that records of errors are maintained in their personnel files. Despite lip service by medical thought leaders, the reported responses have not changed since the last AHRQ survey in 2007.

Much more alarming is the second amednews.com piece, which involves a family secretly recording a conversation with the chief medical officer [CMO] of an Ohio hospital.

Two days after knee surgery, a man died of cardiac arrest apparently secondary to an overlooked high serum potassium level. Before he died, the patient’s children met with the CMO, who had not personally been caring for the patient. Unaware that the conversation was being recorded, the CMO “made sympathetic and apologetic comments and admitted fault on the part of the hospital for Smith's condition, according to court records.”

The Ohio appellate court ruled that the secret recording was admissible and not protected by peer review privilege, as had been argued by the CMO’s lawyers. They had claimed that the CMO had learned of the error via the peer review process. Ohio law states that as long as one party consents, conversations can be recorded.

Thus we are left with pie-in-the-sky appeals for greater transparency and candor regarding medical errors [the so-called “Just Culture”] vs. a litigious society with stealth technical capabilites and a workplace atmosphere of fear and distrust.

Somehow I do not foresee a major change in the way doctors and hospital staffs approach this issue.

DSK and Duke Lacrosse

Unless you have just awakened from a prolonged coma, you must be aware of the sensational rape accusation against Dominique Strauss-Kahn, former head of the International Monetary Fund and one-time favorite to become the next president of France. Now it seems the case has “blown up” due to significant credibility issues with the alleged victim.

What do the Dominique Strauss-Kahn and the Duke lacrosse team cases have in common? A lot.

Both involved men of privilege and women without.

The men in both cases were deservedly depicted as loutish brutes. DSK had been accused of previously molesting unwilling women and the Duke lacrosse players were said to have been ill-behaved on many occasions before their alleged sexual assault of a stripper.

Both DSK and the lacrosse team were tried and convicted in the media within days of the stories breaking. In reference to DSK having to do a “perp walk,” New York’s Mayor Bloomberg, who should have known better, said, "I think it is humiliating, but if you don't want to do the perp walk, don't do the crime."

The media trials resulted in severe penalties for both parties. The lacrosse team, which was favored to win the NCAA title, saw its season terminated and coach fired. The reputations of three players in particular were tarnished, probably for life. DSK lost his job and likely any chance to run for office. I don’t even want to guess how much money was spent on legal fees.

[By the way, being a loutish brute and having consensual sex with women other than one’s spouse does not necessarily disqualify one from public office. (Ref. Bill Clinton)]

Both of these cases were the basis for numerous pontifications about the relationships of powerful men and defenseless women and how the cases would help bring about changes in attitudes and so on. Women’s rights lawyer CherylThomas wrote that DSK’s swift arrest was a “…victory for our legal system.” I wonder what she will say now? I wonder if we will see any soul searching on the part of the Maureen Dowds of the world? Will they retract their columns? Will they apologize to DSK? I doubt it. I don’t recall many apologies to the Duke lacrosse players.

One notable difference is that the prosecution in the DSK case shared exculpatory information with the defense and the media while the now-disbarred Duke prosecutor withheld same.

We look like a bunch of fools to the rest of the world. Here’s the great democracy, the USA, where everyone is presumed innocent until proven guilty, passing judgment well before all of the facts were known. I was in Australia when the DSK story broke. A few days later, a newspaper called The Australian printed one of the very few stories suggesting that both sides of the issue deserved to be heard.

To me, both cases have set back not only the cause of women greatly but also the cause of justice.