TAMPA — After the chief of staff at James A. Haley VA Medical Center realized that a veteran had died after receiving poor care, he told the man's family that he was sorry.
Simple words, yet once doctors rarely spoke them, even after mistakes so horrific they cost lives.
Now, that appears to be changing. As part of the national patient safety movement, several groups are pushing hospitals and doctors to own up to mistakes by apologizing to patients.
"It's a massive cultural shift," said Doug Wojcieszak, founder of an Illinois-based group called the Sorry Works! Coalition. "For decades, the typical approach of hospitals and their insurance carriers was shut up, and literally break off communications with the family."
While doctors and hospitals still are often reluctant to admit wrongdoing, apologizing and going public occurs more often.
"We think it's important, if the family is comfortable, to be public about our mistakes, so others can learn," said Jane Schumaker, senior associate dean and CEO of the University of Florida faculty group practice.
Schumaker was among the officials from UF and Shands Hospital who apologized to Gainesville residents Horst and Luisa Ferrero last fall, after a massive medication overdose killed their 3-year-old boy.
"The loss of a child is the worst thing that can happen to anybody," Horst Ferrero said last week. "Trying to prove that your son died because of a medical mistake makes it even harder. The fact that they did recognize that it was their fault did have a positive impact on the way everything developed."
University and hospital officials held a news conference to apologize, explain what went wrong and discuss what steps they would take for patient safety. The parents received an $850,000 settlement and are now raising money to build a children's hospital in Gainesville. They count many Shands doctors among their supporters.
In the past few years, several Florida hospitals have taken similar steps:
• Last month, after Tarpon Springs resident Richard Stecher died at Haley of complications of a perforated bowel obstruction, the chief of staff apologized to Stecher's longtime companion, Mary Nicholl, and her son.
• In May, Tampa General Hospital announced that staff there had accidentally started to perform a cardiac catheterization on the wrong patient. Hospital officials disclosed the error and say a doctor apologized to the patient.
• Two years ago, after an overdose killed a pregnant woman at South Florida Baptist Hospital, hospital officials held a news conference, apologized to the family and admitted the mistake.
"It's happening more and more," said Jim Conway, senior vice president with the Institute for Healthcare Improvement, a leading patient-safety group. "It's the right thing to do. … There's a growing expectation over a patient's right to an apology."
In June, the Florida Patient Safety Corp. endorsed the Sorry Works! group program of disclosure and apology.
"Clearly, it doesn't make things all better, but I think it is a start," said Susan Moore, the group's CEO. "I think it raises the trust level between the survivors and the hospital."
Of course, hospitals don't always make public admissions or apologies. After two psychiatric patients killed themselves in the same week recently at Tampa General Hospital, the deaths became public from autopsy reports, not through the hospital. And when South Florida Baptist made its admission about the patient death two years ago, it was after the woman's family alerted the media.
Nor do hospital officials make apologies just to be nice. Advocates say that when doctors apologize, patients are less likely to file lawsuits, saving on hospitals' legal costs. The University of Michigan Health System cut its lawsuits by half and cut legal costs per case from $65,000 to $35,000 after instituting a policy of apologizing, Wojcieszak said.
Although apologies are optional, doctors and hospitals do face some requirements when they make mistakes. Florida hospitals must file incident reports with the state when a patient is harmed. Those reports become public if regulators determine a mistake was made.
And when apologies are offered, they had best not be empty gestures, advocates say.
"I tell hospitals you don't want to be like the old-time insurance companies, showing up on the widows' doorsteps, and saying, 'Sign here, sweetie,' " Wojcieszak said.
Hospitals should offer settlements to injured patients and tell them they may need a lawyer, he said. A key step is the explanation of how to keep the mistake from happening again.
For Nicholl, the apology by Haley's chief of staff didn't help, because she felt it was prompted by her complaints, rather than a genuine wish to address the mistakes.
"They weren't sincere at all," she said. "If they were, they wouldn't have waited three weeks."
VA officials wouldn't discuss the case, but they did provide a policy statement on medical mistakes. That policy requires telling patients about such mistakes and, in severe cases such as Stecher's, an apology.
Other families feel apologies can make a difference. Wojcieszak's parents didn't get one when his brother died after a hospital failed to properly treat his heart attack.
"I came to the realization that everybody was missing the boat," he said. "Everybody thinks patients and families are out for blood, out to sue. The truth is, they want somebody to level with them, and they want to make sure it doesn't happen again."
Lisa Greene can be reached at firstname.lastname@example.org or (813) 226-3322.