How does CARe help patients?
Giving the patient as much information as possible, in a timely manner, helps patients and families to feel more in control and supported, and to heal from the experience and move beyond it. In cases where the hospital or health care organization’s patient safety team determines that the injury could not have been prevented, patients will not be offered compensation, but will still receive a full explanation of what happened. It is the goal of the program to be honest and transparent with patients about their care.
Do all Massachusetts hospitals and health care providers use CARe?
CARe is a very new program that has only been tried in a few states across the nation, so one of the reasons not all medical institutions use CARe is because they are just learning about it now. Some institutions are hesitant to try CARe because they believe it may open them up to more lawsuits, although more and more evidence suggests the opposite. Patients want and deserve to hear the honest truth, an approach supported by CARe. It is our hope that in a few years, many more Massachusetts institutions will be using the CARe approach. The main purpose of MACRMI and this website is to help share information about the CARe approach.
Has CARe been used successfully in other states?
Yes. This approach is more effective in supporting patients and families after an injury, and in identifying cases from which the institution can learn and improve, even if patients may not be fully aware of cases where errors occurred. Since 2001, successful implementation of a CARe model at the University of Michigan has led to decreased patient injuries and claims. This is a result of increased reporting of errors, improvements in the processes at the institution, more prompt investigation and discovery of the cause of the error, and decreased costs for all. Another similar program, PEARL, is in place at Stanford University Medical Institutions in California. We hope that in Massachusetts we will also see such positive results.
What is an “adverse event?”
I believe I was harmed as a result of medical treatment. What should I do?
First, determine whether the hospital or health care facility you were harmed at is part of the CARe project, or has made a commitment to a similar approach. If so, contact the patient relations department at that institution as soon as possible.
Beth Israel Deaconess Medical Center - Patient Relations - (617) 632-0364
Baystate Health Systems- Patient Relations - (413) 794-5456
If you do not see the hospital or health care facility listed in our registry, follow this link to the Assertive Patient site to find a list of Massachusetts facilities and the specific department to contact there.
It is also a good idea to contact an organization that can help you through such a difficult situation, and help guide you through the next steps. We recommend Medically Induced Trauma Support Services (MITSS), which is designed to help patients harmed as a result of medical treatment. You will also find helpful information at the Assertive Patient web site.
Different facilities are at different stages of adopting the CARe approach. This is a gradual process, and your (and your family’s) involvement can be of tremendous help to future patients.
Click here for an in-depth article on Baystate Health’s journey to create this type of program and involve patients and families.
Will I get to speak directly to my doctor?
CARe prioritizes linking patients with their doctors and health care team in an open and honest conversation after an adverse event. Some doctors want to be able to have a conversation with you right away about an adverse event, and will be willing to talk immediately. But some may need more time before they feel comfortable speaking with you. There can be a number of reasons for this, and it does not mean that they are avoiding you. Each person reacts to difficult situations in different ways.
What are my rights as a patient in this process?
You have the right to a full disclosure of a medical error, which includes the results of an investigation into what caused the error. As a patient, you also have the right to opt out of the CARe process at any time. And you have the right to involve a lawyer.
Should I hire a lawyer? What if I can’t afford one?
Depending on the health care facility at which you were treated, a lawyer may or may not be required. If a having a lawyer is optional, you will not be treated any differently whether you have one or not. However, we strongly suggest that all patients going through the CARe process be represented by a lawyer, especially if there is discussion of financial payment. It is important that the patient feels comfortable with any monetary offer that they accept, and a lawyer can help with that.
Attorneys can play an important role in advising you during this process. In particular, they can assist you in evaluating an offer of compensation from the health care provider or insurer to make sure it is sufficient, can help you make an educated decision about whether to accept a particular offer, and can inform you of various legal issues, requirements, and options.
Most attorneys do not charge a fee for an initial meeting with you to discuss the services they can offer and how they are paid for their services.
Who keeps the system fair? Who decides if the harm was avoidable or not, and who determines the amount of financial compensation?
The determination of whether or not harm was avoidable takes place in a process involving several groups. First, the hospital or health care organization’s internal patient safety team will go through the case, reviewing medical records and policies, and interviewing people involved in the event. With this information, the team will then decide whether the harm was avoidable. Then that decision will be referred to the health care group's insurer, who will also review the care, the research done by the patient safety team and most times have other expert doctors from different hospitals review everything to get more opinions. After this, the insurer will take into account all the research that was done, and make a decision regarding whether the harm was avoidable, and, if it was, the amount of the offer of compensation.
Also, in order to ensure that the patient feels comfortable with the amount offered and the explanation, and to feel confident about his or her own decision, the patient is welcome to bring an attorney to any discussions with the insurer about the offers or decisions regarding whether the harm was avoidable. Health care organizations implementing CARe want to work with patients and help them, and patients having their own representatives at the table helps make that possible.
What happens if the harm was not "avoidable?"
Medicine is not perfect, so even when a doctor, nurse, or hospital does everything right, or makes the best decisions they can, sometimes complications or problems occur that harm the patient. That is what is meant by harm that is not avoidable. Even when the harm was not avoidable, the patient will still receive an explanation of everything that happened and what the harm means for their care in the future. The health care workers will be there to answer any questions the patient may have about their situation.
Do I need to sign away my right to sue if I participate in the CARe process?
No, you do not need to sign away the right to sue in order to participate in the process. If, however, you accept an offer at the end of the process, you must sign away that right as you will have received compensation for the injury. You can participate in all discussions and meetings, including those that involve your attorney, and still retain your right to sue.
My family and I are angry and upset. Who can we speak to for support?
We recommend MITSS, which is designed to help patients (and their families) harmed as a result of medical treatment. Your health care center likely also has a patient relations team that would welcome your feedback and would like to support you in this process.
What role can I play in the investigation and learning process?
It is our hope that patients will want to participate in the institutional learning process after an adverse event occurs. By turning to you for information, your health care team can learn more than they can from just their point of view, so we encourage you to share whatever you are comfortable with about the event. We also hope that once the investigation is finished, patients may be willing to help health care centers devise ways to prevent a similar event from happening again.
How can my family help?
Your family can help you by being a part of the team working toward resolution of your situation. Family members are welcome and encouraged to participate in meetings, and to be involved in efforts to prevent similar situations for patients in the future. It is helpful for everyone if there is one main spokesperson among the family, i.e. one person who takes the lead to communicate the family’s point of view.
How will I be notified of results?
Representatives from the hospital, which may or may not include your doctor, will have a discussion with you (and your family if you choose) about the results of the investigation, and answer any questions you have.
How will I know if the medical institution has taken steps to avoid similar errors in the future?
If it was determined that the medical error in your situation was avoidable, the hospital representatives will tell you their plans to prevent the error from happening again. They will also listen to any suggestions you may have about how it can be prevented.
I am going in for medical treatment soon. How can I help make sure that nothing goes wrong?
It is important to remember that harm from medical error is rare and unlikely to happen to you as a patient. Whenever you are a patient it is always a good idea to make sure to ask questions when you don’t understand something, or want to know more, and to write down instructions that the doctors or nurses give you, and anything you’d like to remember. Don’t be afraid to speak up or have a family member do so if something doesn’t seem right to you; it is always worth it to double check if you are feeling uneasy. The Assertive Patient web site has a useful section on how to speak up as a patient.
You can also find tips for protecting yourself from medical error here at the Agency for Health Care Research and Quality site, and ten things you can do to be safe patient here at the Center for Disease Control and Prevention.