Associations representing Iowa’s legal and medical professions have found common ground with proposed legislation aimed at reducing medical error rates and their corresponding costs in Iowa. 

The measures, Senate Study Bill 1176 and House Study Bill 143, would provide greater opportunity for health care providers to acknowledge medical errors and offer compensation to patients while preserving the patient’s right to pursue a malpractice lawsuit, if necessary. From the doctors’ perspective, the most exciting aspect is that the model has proved effective in other states in reducing medical errors in the first place.

For the past year, the Iowa Medical Society and the Iowa Association for Justice have been working together on model legislation that would provide the framework for bringing the process, known as Communication and Optimal Resolution, or Candor, to Iowa. A form of the Candor process has been used for more than a decade by the University of Illinois Medical Center at Chicago. Using Candor, the medical center has significantly reduce its rate of medical errors and the legal and insurance costs associated with them, said Dr. Jeffrey Maire, a Des Moines surgeon and current president of the Iowa Medical Society’s board. 

“It allows (injured patients) to gain knowledge, and not be frustrated the next day wondering what’s going to happen to them,” Maire said. “And it allows the (health) systems to fix their problems, and that’s the best benefit in and of itself. The patients get knowledge, and if there are problems with the system, they can be fixed.”

Preventable medical errors are the third-leading cause of death in the United States, and deaths from medical malpractice have increased by two to four times in the past 15 years, according to an issue brief by the Iowa Association for Justice. A 2013 study by the Journal for Patient Safety estimates that between 210,000 and 440,000 Americans die annually from preventable medical errors. 

The number of medical malpractice lawsuits in Iowa has dropped by more than 50 percent in the past 12 years, according to the IAJ.

However, liability insurance premiums for medical professionals in Iowa are 58 percent higher than those in surrounding Midwestern states, according to the Iowa Medical Society. Additionally, Iowa medical malpractice cases take longer to reach resolution and cost significantly more – approximately $13,500 per case – than in neighboring states, the IMS said.  

Brian Galligan, a Des Moines attorney and president-elect of the Iowa Association for Justice, said many efforts aimed at reform in the past focused on taking away patients’ rights. 

“The past approach has been very little communication with the patient on the front end,” said Galligan, who led negotiatons for the IAJ with the Iowa Medical Society. “That resulted in an approach of deny and defend.” 

The bills, which have passed through committees in each chamber prior to the funnel deadline this week, establish statutory protocols by which a health care provider can engage in an “open discussion” with an injured patient. As part of that process, the provider may investigate the incident and disclose the results to the patient, as well as make a conditional offer of monetary compensation to the patient. All communications during the open discussion period would be privileged and confidential and would not be admissable in a court proceeding. However, the patient would retain the right to file a claim in court without prejudice if an offer is rejected. 

Since establishing is Candor program in 2004, the University of Illinois Medical Center at Chicago has implemented more than 200 system improvements as a result of that program and reduced the time it takes to reach settlements with patients by 80 percent, Maire said. The medical center has also had a 20 percent decrease in billings associated with defensive medicine, and in the past three years has experienced a $22 million reduction in medical liability premiums. 

Massachussetts became the first state to enact a Candor law in 2012, followed by Oregon in 2013. Maire said the concept will be new to many of the physician members of the IMS, and the association has not yet had any discussions with leaders of the major health systems in the state. 

“I think this is going to give them framework to be able to pursue it,” he said. “When they look at what is happening at the University of Illinois, where they have a department for Candor that’s actually supporting itself by being able to take away revenue that would be put toward legal issues and have it put towards patient care by a Candor system, that is very effective and very promising.”