The Silent Treatment

Because state law allows hospitals to keep their mistakes secret, James Williams may never know exactly how his wife went in for routine surgery and came out in a coma

At 3:41 p.m., Sharon Williams's heart stopped beating, and the staff began cardiopulmonary resuscitation. A breathing tube was placed in her throat at 3:44 p.m. Chest compressions were stopped at 3:58 p.m., when Williams's pulse and blood pressure returned. She remained unresponsive, and at 4:00 p.m. she was placed on a ventilator. Williams was comatose. Her breathing had slowed or stopped for 18 to 20 minutes. The report concludes that Williams's nurse was responsible for the neglect. (The nurse has appealed the finding, but a Department of Health spokesman says the appeal hearing has not yet been scheduled.)

Williams was immediately transferred from Fairview-Riverside to the larger intensive-care unit at the Fairview University campus. On May 5 she was discharged and transferred to Vencor Hospital for "long-term management." "The progress record indicated that [Williams] remains in a deep coma with a very grave prognosis for neurological recovery," the report states. There's no way of knowing whether she can hear or see anything.

To date, this report--a public document released by a state agency, not the hospital--is the only information James Williams has been given offering insight into the chain of events that left his wife in a coma. Williams felt he had little choice but to hire a lawyer and sue Fairview Health Services, the company that owns the hospital. Only through legal findings, it seems, can Williams hope to get Fairview to pay for Sharon's ongoing medical costs. And only in a courtroom is he likely to find out what happened during the 15 minutes that changed his life forever.

Most hospitals belong to the Joint Commission on Accreditation of Healthcare Organizations, a voluntary organization that periodically reviews quality of medical care. The commission mandates an investigation by an internal group made up of hospital staffers, called a peer review, when an incident in a member hospital results in a grave injury or death. This in-house review generally takes place shortly after the incident in question, when memories are fresh. In Minnesota, as in most states, laws ensure that the data gathered in these reviews stays confidential: It is not made available to the patient, or the patient's family. It is not included in the patient's medical chart. It cannot be introduced into a lawsuit.

The idea behind this is that confidentiality allows medical professionals to discuss candidly what went wrong without fear of retribution or liability. "People need to feel safe. If they fear repercussions to their actions or comments, they may not want to be as honest," Fairview's Van Bree explains. "Self-examination has to be done in a sense of getting things to be better for everyone. Peer review is the process that gets that to happen."

But William Tilton, the St. Paul medical malpractice attorney who is representing the Williams family, adamantly believes that the opposite is true: Only full disclosure of mistakes will bring about better health care. "Those laws were passed without a lot of debate and without a lot of thought," Tilton declares. "I don't think they were passed with any proof that medical care would improve. It's been decades that it's been assumed that secret investigations of doctors by themselves is the best way to improve medicine."

The question of medical errors has, in recent years, been the subject of broader study. In November 1999 a prominent medical-research institute released a report that bore startling news: Based on two recent studies investigating deaths due to hospital errors, researchers estimated that the number of Americans who die each year because of medical mistakes ranges between 44,000 and 98,000. Even the lower figure is far greater than more widely discussed killers, such as car accidents, breast cancer, and AIDS. The report, issued by the Institute of Medicine, a part of the National Academy of Sciences, went on to estimate that the costs of these preventable injuries--lost income, lost household production, disability, and healthcare--fall between $17 billion and $29 billion.

Part of the reason the public seems unaware of healthcare error rates, the report states, is that "patient safety is also hindered through the liability system and the threat of malpractice, which discourages the disclosure of errors.... Most errors and safety issues go undetected and unreported, both externally and within health care organizations."

Raising awareness about medical errors is the first step toward increasing public demand for improvements, the survey's authors conclude. "The goal of this report is to break this cycle of inaction. The status quo is not acceptable and cannot be tolerated any longer. Despite the cost pressures, liability constraints, resistance to change, and other seemingly insurmountable barriers, it is simply not acceptable for patients to be harmed by the same health care system that is supposed to offer healing and comfort."

But even if the records from Fairview's own peer review of Sharon Williams's case are confidential, Tilton argues, the notes made by state health department investigators--notes that Tilton believes include some of the peer review data--are not. On November 3 he asked Hennepin County District Judge John Sommerville to allow him to see the state's files. "This is the best evidence of what happened here," he argued. "The only person who doesn't know it is the Williams family. Why should this stuff be protected? We know more about a plane crash in Taiwan three days ago than the hospital has been willing to give up on what happened to Sharon Williams."

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