Georgia State Rep. Sharon Cooper lost her husband eight years ago and still feels the sting of outrage over the lack of communication from his health care providers. Now, she is sponsoring legislation intended to encourage providers to discuss candidly with patients any mistakes made in their care.
Cooper, a Republican from Marietta, now chairs the Georgia House Health & Human Services Committee. She hosted an all-day hearing Thursday to explore the Georgia CANDOR Act, a bill she introduced during the last week of the 2020 legislative session.
Doctors, lawyers and legislators discussed the implications of the bill, which would provide a process for hospital systems to initiate talks with patients and/or their families quickly after a problem, error or accident occurs.
Cooper said the topic is personal to her, because several incidents occurred in her late husband’s care that she considered to be adverse reactions.
“Nobody ever came and talked to me about [them], which I still have feelings about,” she said. “I still have feelings about the use of that hospital; I don’t go to the doctors there, because it’s still very raw with me.”
Cooper said she wished the hospital would have used the disclosure and support provided by CANDOR, which stands for Communication and Optimal Resolution.
According to the bill, a health care provider or facility may provide a patient with written notice that they want to enter into an open discussion with the patient within six months of learning of a problem. The notice must include copies of all the relevant laws regarding deadlines, confidentiality, and medical malpractice.
If the patient agrees to the discussion, the talks cannot be used in any subsequent malpractice lawsuit, since the goal is to avoid such a lawsuit. But the patient can engage an attorney for the process and have them present for all the talks.
The provider must investigate what happened and explain it to the patient, and explain what is being done to prevent it from happening again. The process could result in the provider and patient negotiating a compensation settlement and avoiding any future medical malpractice action.
Dr. Florence LeCraw, an Atlanta anesthesiologist and adjunct professor at Georgia State University, led a study which showed that hospital staff and physicians who are willing to explain, apologize for and resolve adverse medical events significantly reduce legal defense and liability costs. She said the CANDOR Act is intended to remedy the hospital system’s strategy of “deny, delay, defend.”
“When a physician has an adverse outcome, something bad happens to their patient, we call our attorneys to tell them that this happened,” she said. “And they tell us, ‘Don’t talk. Don’t talk to your colleagues; don’t talk to your friends. Don’t talk to the hospital, and definitely do not talk to the patient.’”
Dr. Tim B. McDonald, Chief Patient Safety and Risk Officer at RL Datix, a healthcare software company that focuses on patient safety programs, spoke on the potential impact of CANDOR on physician and nurse burnout, and said that, according to his data, 70 percent of all claims and lawsuits go away with no indemnity payment when information is shared with the patient. McDonald said it’s a matter of maintaining trust immediately following an incident, and avoiding a “wall of silence.”
“Every hour that goes by without effective communication following serious harm is another harm, and it feels intentional,” he said.
Under the proposed bill, patients could withdraw from protected discussions at any time to pursue a lawsuit, and could report egregious behavior to the hospital board even after a settlement.
CANDOR allows hospitals to offer compensation, but LeCraw said impacted patients often want different remedies that can’t be offered through litigation.
“A risk management person told me her hospital had a really bad error, resulting in the death of a baby,” LeCraw said. “It was horrible. And so when they had the meeting with them and went through the process, they came back and said, ‘We don’t want money. What we want you to do is build a memorial garden in the name of our baby so people can come, who are suffering as their loved ones are in the hospital, and pray or have quiet time together.’”
Karen Lorenzen, a medical malpractice lawyer, said CANDOR law also benefits physicians.
“I think the two things that I like most about it is that it has a way of providing an outlet for patients and their families that I have never seen in litigation,” she said.
Following the meeting, Rep. Katie Dempsey, a Republican committee member from Rome, said she became more enthusiastic about the bill with each and every speaker throughout the day.
“I think there are ways not only that we could and should do this, but we’ve got some of the infrastructure and experience to maybe, really build it out a little quicker than we might think,” she said.