In Maryland, after a 57-year-old mother of three’s thyroid treatment went wrong, leaving her

brain-damaged and comatose, officials from Good Samaritan Hospital approached her family twice to apologize and offer compensation.  When the family refused, according to court records, the hospital suggested the family get a lawyer.  They handed the family the business card of a Baltimore, MD attorney.

Several medical systems, including MedStar Health, LifeBridge Health and the University of Maryland Medical System, in Maryland, which collectively run about two dozen hospitals, have lists of lawyers who will accept patient cases for lower fees.  They recommend these attorneys with the expectation that claims will be settled promptly.

Participating attorneys and hospital officials say the referral system is for the good injured patients and their families, because it avoids the lengthy litigation when an attorney can accept the case at a reduced fee.  Maryland requires mediation before litigation.  Apology and compensation usually avoid lawsuits completely.  Malpractice litigation is expensive and time-consuming for the patient and the medical providers.

Some criticize the system as creating a conflict of interest.   Lawyers on the lists may defer to the hospitals and persuade the patient to take a deal rather than waiting for the best settlement or preparing a case for trial.  In MD, the Lawyers Rules of Professional Conduct leave it up to attorneys to determine if they have a conflict of interest in representing clients.

Medical malpractice lawsuits usually take three to five years to go through the courts, according to a multi-year study published in 2005.  Health care providers are suspicious of patient claims, and do not like high jury awards. Patients feel used by doctors who won't admit liability.  Only 2% to 3% of patients injured by negligence file claims, with just about half of the claimants recovering money, according to an article published last year in the New England Journal of Medicine.

On the campaign trail, GOP presidential candidate Rick Santorum advocates limiting payments to victims in medical malpractice lawsuits.  He blames high awards for driving up health-care costs. Over the course of 20 years in politics, he repeatedly favored capping malpractice awards.

However, Santorum testified in support of his wife when she filed a medical malpractice suit in 1999 that sought $500,000.  This was twice the cap in his 1994 legislative proposal. His wife, Karen Santorum, alleged a Fairfax chiropractor left her with a permanent back injury that might result in a lifetime of pain medication and restricted mobility.

Santorum, a former Pennsylvania senator, wants to be the Republican presidential nomination.

Santorum told reporters in Iowa that he backed award limits but his wife did not sue for “pain and suffering, which is the area he wants to cap.

His wife’s lawsuit did not seek a figure for pain and suffering, but Santorum testified in the case about the emotional and physical toll on his wife and how that justified a high monetary award, transcripts indicate. The judge in the case clarified the majority of the $350,000 the jury awarded the family was for unspecific losses and pain and suffering, an amount the judge concluded as “excessive.”

His wife’s lawsuit arose when in 1996 Karen Santorum gave birth prematurely to a fourth child, a son who died the same day. Suffering lower-back pain after the delivery, his wife sought out a chiropractor.  The chiropractor performed a spinal manipulation, which he and other experts testified was a standard, suggested therapy for her symptoms. Karen Santorum said the treatment caused a herniated disk in her spine, which was surgically removed.

The couple was unsuccessful in trying to seal the case.

Sentara Healthcare, a nonprofit health system that includes 10 acute care hospitals and covers 2 million residents in Virginia and North Carolina, launched a system-wide testing and implementation project that increased hand hygiene compliance from about 77 percent to 95 percent. The health system changed its culture to get hospital staff and physicians to comply.

When hand hygiene is not practiced, infection increases.  Bloodstream infections, urinary catheter-associated infections and ventilator-associated pneumonia are avoidable when patient safety advocates push for health workers to wash their hands. 

Hospital workers who don't participate in hand hygiene contribute to infections and poor patient outcomes and even deaths.  People forget to wash their hands because they try to work as fast as possible.  People think hand hygiene may not be necessary and if they do not do it others will unlikely find out.  They want to save time.

Hand hygiene Sentara involves not just washing the hands with soap and water, but also wipes, sanitizer foams, and other methods to improve frequency and compliance.  

Quantros, Inc., a provider of software and services to advance healthcare quality and safety performance, provides research on how implementing healthcare technology can improve patient safety, control infections, and comply with laws.  Kaiser Permanente, with an already large electronic medical record system, announced in January 2012 that 9 million Kaiser Permanente patients can access their medical information anywhere in the world on mobile devices through a mobile-optimized website.

Kaiser Permanente released an app for users of mobile devices, including the iPhone and Android.  Kaiser Permanente is a leader in the healthcare industry when it comes to providing online access to information for patients. In 2011, over 68 million lab test results were made available online to Kaiser Permanente patients.

Kaiser Permanente patients have 24/7 access to lab results, diagnostic information, personal health record, email access to doctors, and prescription refills. Those caring for an elderly with a chronic condition can now check lab results, refill prescriptions and communicate with the doctor's office on behalf of the patient.

"Providing our patients with clear and convenient access to their health information is a step forward in connectivity and improving the health care experience for patients, no matter where they are," said the executive director of The Permanente Federation.

The executive vice president and chief information officer said "Mobile solutions can have a positive impact on health. Health care, itself, will be much more convenient for many people. The mobile-friendly site and app are also a springboard for new innovations that will inspire members to be aware of their health and take steps to improve it."

Kaiser Permanente is known for leading health information technology. The Kaiser Permanente electronic health record enables all of Kaiser Permanente's nearly 16,000 physicians to electronically access the medical records of all 8.9 million Kaiser Permanente members nationwide. Kaiser Permanente also has an electronic medical library to support its caregivers. 

Are the odds of experiencing medical error the same as being in a plane crash? A report by the U.S. Department of Health & Human Services (HHS) recently concluded just one in seven medical errors involving Medicare patients ever get reported, and even when errors are reported, healthcare practices rarely change to avoid the same errors in the future.

Ron Shinkman of Fierce Health Finance summarized some steps hospitals could take in reducing medical errors:

1. Set legal liabilities for failing to report an error:  Failure to report an error makes it more likely the error may happen again.

2. Make RFID mandatory:  A radio frequency identification (RFID) system makes errors less likely.

3. Offer medical error insurance:  Patients should have health insurance co-payments and deductibles covered when medical errors happen.

4. Require transparent complaint reporting:  Patients and their families should have a federally mandated and monitored system for complaints about healthcare services to shed light on medical errors that might otherwise not be reported, and to improve the performance of healthcare providers.

5. Ban electronic devices for personal use:  The New York Times reported about surgeons and other medical staff responding to emails and texts while making rounds and during surgeries. Banning the use of all electronic devices for personal use while on hospital property will decrease distractions leading to medical errors.

6. Employ the unions:  The unions representing nurses and other hospital workers do not promote patient safety enough because they want to preserve jobs and benefits. Make pay raises based on error reduction and improved outcomes.

Serious medical mistakes at Minnesota hospitals and ambulatory surgical centers increased to 316 in 2011 from 305 in 2010, according to an annual report released in January 2012 by the Minnesota Department of Health (MDH).

Despite an uptick in medical mistakes, patient harm from adverse events in Minnesota declined from 107 in 2010 to 89 in 2011, the lowest in four years.

The key barriers to patient safety included pressure ulcers and wrong procedures.  These patient safety issues caused the overall increase in medical mistakes. According to Minnesota Hospital Association President and CEO, miscommunication between clinics and hospitals when scheduling surgeries can lead to medical mistakes.  Minnesota hospitals reported 141 cases of pressure ulcers, up 19% from 2010. Wrong procedures increased 63% to 26 events.

According to MDH Director of Health Policy Division, to prevent medical mistakes: "To truly change practice, providers need to adopt solutions involving modifications in workflow or workspaces, staff roles, technology, team dynamics and organizational culture. But to do this successfully, leadership needs to be fully engaged." Some hospitals are conducting safety checklists before each surgery, as well as regularly repositioning and monitoring patients to prevent pressure ulcers, noted the news article.  Hospital checklists have assisted medical providers reduce infection rates, cut costs, and decrease the risk of death for surgical patients. 

Tort reform in Texas has resulted in the decrease of lawsuits, but patient complaints to the state medical board and board investigations of physicians have increased, according to Internal Medicine News.

Members of the University of Texas Health Science Center at San Antonio, TX analyzed publicly available data from the Texas Medical Board and compared the 7-year period before tort reform (1996-2002) and the 6 years after the law was enacted (2004-2010).

"It appears that tort reform in Texas has done what it was intended to do," increased the activity of the Texas Medical Board, and decreased the activity of the medical liability tort system, according to the chairman of the surgery department at the University of Oklahoma, Oklahoma City, in discussing the report.

Before tort reform, approximately 125 complaints per 1,000 physicians were made to the medical board. After reform, the number increased by 13% to about 140 complaints per 1,000 physicians.  The rate of investigations increased from 38 per 1,000 physician to 52 per 1,000 physician before and after reform, with 5% of doctors the subject of a medical board inquiry. Before reform, 0.5 per 1,000 physicians were ordered to revoke or to voluntarily surrender their licenses; after reform, the amount increased to 0.8 per 1,000 physicians. 

Increases in investigations and disciplinary actions were driven by the legislature.  Lawmakers mandated greater oversight by the medical board, leading to an increase in enforcement.  According to the news article, placing malpractice in the medical board decreased costs, with the medical board process being transparent and allowing more input from doctors.

In 2011, Louisiana made the American Tort Reform Foundation (ATRF)'s annual Judicial Hellhole list, according to LegalNewsline.com.  ATRF is a District of Columbia nonprofit corporation, founded in 1997. According to the ATRF website, the main purpose of ATRF is to bring fairness, efficiency, and predictability to the civil justice system by educating the public, media, and policymakers about the need for a balanced civil justice system, how the American civil justice system operates, the role of tort law in the civil justice system, and the impact of tort law on private, public and business communities.

Judicial Hellholes are jurisdictions which ATRF claims are not just in civil litigation and court practices. According to ATRF, there are actions in Louisiana courts worth monitoring.  For instance, there was "an appellate court's decision to uphold a $15 million verdict for the family of a man who blew up his home while in the process of stealing natural gas from a local utility."

According to the news article:  "The perception of a state's legal climate affects how companies do business, and where they decide to invest and create new, well-paying jobs."

Also according to the news article:  "This jarring reputation as a potential Judicial Hellhole should concern every policymaker and citizen in Louisiana hoping to see more jobs and a stronger economy for our state."

Proposed legislation being discussed in the Massachusetts House includes reforms aimed at decreasing the use of "defensive medicine" and reducing costly lawsuits by encouraging reconciliation between doctors and patients. Patrick has also proposed making apologies inadmissible in evidence, and establishing a 180-day cooling-off period before a patient can file suit.

On the top of the Missouri Chamber of Commerce and Industry's lobbying agenda in the 2012 legislative session are changes to workers' compensation law, tort reform, and employment law reforms, according to the Southeast Missourian.

The Missouri Chamber consists of 3,000 members.  It is a large business organization in the state with four paid lobbyists who persuade legislators to create a business-friendly climate in Missouri.  In the upcoming legislative session, the chamber will focus on bills to resolve workplace injury disputes outside of court, and to make it harder for workers to file employment discrimination suits.

The members will push workers' compensation reforms that prohibit employees from suing co-workers over on-the-job injuries, and specify that occupational diseases should not be covered by the state's workers' compensation system.

Besides employment issues, executives added that tort reform is necessary due to threats of frivolous lawsuits putting small business owner out of business, according to KOMU.com.