R. Austin Wallace, MD
Chairman, President and CEO
WV Mutual Insurance Company

C.A.R.E. - Communicate and Respond Effectively

The C.A.R.E. program was introduced during the fourth quarter of 2006. Participation in C.A.R.E. requires attendance at a specific skills development workshop. After attendance at this workshop, you are eligible to participate in the C.A.R.E. program. Attendance at the workshop and participation in the program may provide you with a 5% premium credit. These credits are applied at your next renewal and apply for three years.

The intent of the C.A.R.E. program is to foster open communication between physician and patient, resolve concerns, and assist families through difficult times. As physicians, we know that medicine includes both the art of communication, as well as medical science. Not every patient responds to our care the way that we – or they – hope. Sometimes, there are outcomes which are disappointing regardless of whether or not known risks or errors are involved. When patients experience outcomes which they do not anticipate, they want to understand why and have the problem fixed.

Trained staff at the Mutual will be available to you if you encounter a situation where a patient or family is significantly concerned as a result of an unanticipated outcome resulting from care you have provided. The Mutual can guide how to most effectively respond to patient frustrations. In appropriate cases, after telephone consultation, the Mutual may suggest that you invite the patient, or family, to contact the Mutual directly. Support can be made available to help them address unanticipated expenses.

C.A.R.E. Program Objectives

The objectives of the C.A.R.E. program are to:

  1. Provide communication tools and support for you in situations where care of the patient involved an unanticipated outcome; and
  2. Help you respond to patient needs and concerns effectively; and
  3. Reduce patient, or family, frustration or anger through removing communication barriers; and
  4. Provide support for patients and families as appropriate; and
  5. Thereby preserve the physician-patient relationship and create an optimal atmosphere for supporting the patient’s clinical and emotional care.

The C.A.R.E. program is enabled by the Open Communications legislation passed on April 9, 2005. The relevant part of the legislation is as follows:

"No statement, affirmation, gesture or conduct of a healthcare provider who provided healthcare services to a patient, expressing apology, sympathy, commiseration, condolence, compassion or a general sense of benevolence to the patient, a relative of the patient or a representative of the patient and which relate to the discomfort, pain, suffering, injury or death of the patient shall be admissible as evidence of an admission of liability or as evidence of an admission against interest in any civil action brought under the provisions of article seven, chapter fifty-five of this code or in any arbitration, mediation or other alternative dispute resolution proceeding related to such civil action." (Article 7. Actions For Injuries. Section §55-7-11a. Settlement, release or statement within twenty days after personal injury; disavowal; certain expressions of sympathy inadmissible as evidence. For the full text of the Open Communications legislation, please click here and go to §55-7-11a.)

Selected Disclosure Resources

"When Things Go Wrong: Responding to Adverse Events. A Consensus Statement of the Harvard Hospitals." - Burlington, Massachusetts: Massachusetts Coalition for the Prevention of Medical Errors; March 2006.

This consensus paper of the Harvard-affiliated hospitals proposes a full disclosure when adverse events or medical errors occur, including an apology to the patient. The paper represents the collaborative effort of a group of clinicians, risk managers, and patients participating from several Harvard teaching hospitals and the Risk Management Foundation.

“What to Do with the Unanticipated Outcome: Does Apologizing Make a Difference How Does Early Resolution Impact Settlement Outcome?” - Thomas H. Gallagher, M.D., Richert Quinn, M.D. Medical Liability and Health Care Law Seminar (DRI – March 2006, Phoenix, Arizona)