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When something medically goes wrong

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Each year in Massachusetts hospitals, hundreds of patients are injured because of serious medical errors and other safety problems. Some die as a result of these mishaps.

Earlier this month, the state Department of Public Health published its latest tally of serious reportable events: 753 in 2013. That’s a 70 percent jump over the prior year, when acute-care hospitals reported 444 incidents. While health officials attribute the rise to more complete reporting by hospitals — rather than to deteriorating conditions — it’s clear that safety problems are prevalent.

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Patients who are harmed and their families are entitled to information about the incident under state regulations. Some hospitals are going further by improving communication with all patients who experience something unexpected in the hospital, and by compensating those who are seriously injured before a lawsuit is filed.

Here is what to expect, and what to ask for, if you experience a medical error in a Massachusetts hospital.

What is a “serious reportable event?”

The health department has identified 29 types of specific incidents that can gravely harm patients, are usually preventable, and likely occur because of gaps in hospital policies and procedures.

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Not all safety problems are serious reportable events, but health officials usually scrutinize these incidents more closely. The list includes traditional medical errors, such as giving a patient the wrong medication, but also includes suicides and assaults, which hospitals often can prevent by having appropriate safeguards in place.

When an error is made, is there a time frame in which a patient or family members must be told?

Yes, hospitals must notify the patient or a relative, the health department, and the patient’s health insurer within seven days. Regulations allow hospitals to tell a patient verbally, or write a letter.

‘You might know there was a serious event but you might not have all the understanding yet about what might have happened.’

Dr. Kenneth Sands, chief quality officer at Beth Israel Deaconess Medical Center 
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Leaders at several hospitals said they usually do both. But these letters or conversations are often brief. “You might know there was a serious event but you might not have all the understanding yet about what might have happened,’’ said Dr. Kenneth Sands, chief quality officer at Beth Israel Deaconess Medical Center, which recorded 50 serious reportable events last year. “You make a commitment to have further conversations when you know more. You don’t want to speculate. Often these things evolve, and it’s very hard for people to let go of what was said if it was wrong.’’

For example, caregivers may know immediately that a patient had a bleeding complication because he was given too much anticoagulation medicine, but they might not have determined whether the nurse wrote the wrong dose, or a pharmacist dispensed it incorrectly.

The facility must provide a deeper analysis of the incident within 30 days, including how it occurred, whether it was preventable, and whether improvements are planned to head off future problems.

Dr. Madeleine Biondolillo, associate commissioner at the state health department, said that hospitals fail to notify patients of errors in about 6 percent of cases.

Are hospitals allowed to charge insurers and patients in these cases?

If the facility determines that the incident was preventable, it is not allowed to bill for necessary follow-up care — such as a second operation to remove a sponge left inside a patient during abdominal surgery.

Are hospitals giving patients the information they want, and are entitled to?

Disagreement exists about this.

“For the most part, hospitals do a very good job,” Biondolillo said. When they don’t, health officials require them to add more information to the reports that are given to patients. “You can tell whether a hospital did a systematic, thoughtful analysis or whether it was cursory and they were not taking responsibility,’’ she said.

But Benjamin Zimmermann, a malpractice attorney with the Boston law firm Sugarman & Sugarman, said some hospital reports given to patients contain “bare bones information’’ that is meant to comply with the regulations but does not always satisfy patients and families.

In one case in which a patient died of a medication error, the pharmacist dispensed the wrong dose but the hospital did not include information in its report about why that happened, he said. It also said someone wrote over the proper dose in the chart with the erroneous dose, but did not identify who altered the chart, or even who was interviewed as part of the investigation, Zimmermann said.

“Often times that’s the first thing the patient is looking for — a clear picture of what happened,’’ he said. “The information can vary by hospital and by who did the investigation. A family can certainly ask for more detail. Whether that’s provided, that’s going to depend on the decision makers at the institution.’’

It’s rare to see a report that identifies specific caregivers and exactly what they did wrong, Zimmermann said. That’s in part because of the state’s so-called peer review law, which allows hospitals to keep confidential certain aspects of internal investigations into mistakes.

What recourse do patients or families have if they suspect an error occurred but have not been told, or the hospital is not forthcoming?

Deb Wachenheim, health quality manager at Health Care for All, a Boston-based consumer advocacy group, suggests patients first go to the hospital’s patient advocate — every hospital should have one. If that person isn’t able to help get answers, then contact the Department of Public Health, or a lawyer, she said.

Do hospitals ever offer compensation for their mistakes — before the case ends up in court?

While it’s becoming more common, the practice is still rare.

This is partly because serious reportable events often do not result in significant injury, said Janet Barnes, head of risk management at Brigham and Women’s Hospital. Of the 71 serious reportable events identified by the hospital last year, most involving bedsores and falls, none have resulted in settlements so far, she said.

Most hospitals, including the Brigham, do not have specific funds set aside to compensate patients. So settlement discussions often do not start until a patient hires a lawyer who notifies the malpractice insurer of an intent to bring a claim.

State law now requires a six-month cooling off period after this notification before a lawsuit can be filed, to encourage settlements outside of court. A group of six hospitals, Beth Israel Deaconess Medical Center in Boston, Beth Israel Deaconess Hospital-Needham, Beth Israel Deaconess Hospital-Milton, Baystate Medical Center in Springfield, Baystate Franklin Medical Center in Greenfield, and Baystate Mary Lane Hospital in Ware, are participating in a pilot program to offer prompt apologies and financial settlements for preventable mistakes.

Sands said one goal is to have detailed conversations with patients about any type of unexpected problem — a post-surgery infection, for example — even if it does not qualify as a serious reportable event.

“If you don’t have [the conversations] the patient is left with the idea that ‘something happened to me and no one told me about it,’ ’’ he said. “ ‘They must be covering up, so I am going to go get a lawyer.’ ’’

Liz Kowalczyk can be reached at kowalczyk@globe.com.
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