NavHosp Jax team goes 'Beyond the Headlines'

In her opening remarks, Bureau of Medicine and Surgery (BUMED) Chief of Staff Rear Adm. Christine Hunter discussed the questions several congressional committees wanted answered concerning lawsuits decided over the past year against Naval Hospital Jacksonville. These cases, which received considerable news coverage, were filed as much as a decade ago, but Congress and Navy medicine leadership felt they must be addressed.

Hunter said congressional staffers pursuing these issues were confident troops were being provided outstanding care in the field, but they wanted to know how the war was affecting the hospital's ability to provide safe care at home.

''Congress wanted reassurance that our quality programs were sufficient,'' she said.

BUMED conducted thorough case reviews stemming from the lawsuits and concluded the treatment and procedures were reasonable, medically indicated and that patients were well informed. Members of congressional subcommittees agreed. Nevertheless, the nagging question remained for Hunter, ''How are we getting to a bad outcome when people are making reasonable decisions?''

Conference keynote speaker and well-known trial lawyer William H. Ginsburg, Esq. shares insights gained from years of arguing medical litigation cases with Naval Hospital Jacksonville medical staff at the "Beyond the headlines" conference.

Media reports and some beneficiary comments seem to reflect a sense that military health care providers and civilian contractors who work in military treatment facilities are protected from the consequences of medical errors. But Navy Surgeon General Adm. Donald C. Arthur is holding military providers accountable and Hunter agreed.

''We have oversight all the way to the surgeon general,'' she said. ''We also have an external review system, because more eyes on these cases will give us greater insight.''

She revealed BUMED's plan to recruit a chief medical officer who will focus on in-depth analysis.

The BUMED review highlighted the need for better communication between the health care team and improved critical thinking skills. Other issues included sluggish response times, closer supervision of trainees, and redefining concepts of patient care to include the family when appropriate. Hunter urged the audience to focus on these themes while continuing to look for ways to improve the delivery of health care to their patients.

The keynote speaker was attorney William H. Ginsburg. A graduate of the University of Southern California School of Law, Ginsburg has successfully tried more than 350 civil jury trials and 10 criminal cases involving health care issues in both federal and state courts. He also served as an Army officer from 1968-1971.

Ginsburg said, ''It is extremely important to know what we don't know. It is okay to have doubt or admit what we don't know. That is the time you call in a colleague or consult with a specialist.''

For the good of the patient, he urged the audience to foster a work environment with open communication and without fear of retaliation. He warned providers to avoid distractions, to look past the obvious and to be creative. Ginsburg encouraged them to be aware of the potential for errors.

Health care Mediator Barbara Moidel, from the National Naval Medical Center, Bethesda, Md., also provided valuable information on disclosure to patients or their families when an unanticipated outcome occurs.

''We are seeing shifts in the culture about disclosing information following an unintended event. Unintended events are usually related to systems failure,'' she said.

Moidel's remarks illustrated how disclosure is a process, not a single event and information is provided as it becomes available.

''[During disclosure] people want three things. First they want information in real time. Second, they want an apology or acknowledgment for what happened. Lastly, they want to know whatever happened to them was not in vain and it will not happen to someone else.''

Moidel added, ''We are all part of the same team. Providers are just as devastated when something occurs. Patients know medical errors happen and when errors occur, they want information from the person with whom they have the relationship. Disclosure is the right thing to do regardless of the consequences to the hospital.''

Naval Hospital Jacksonville Commanding Officer Capt. Raquel Bono closed the conference by reminding her staff of the personal toll unintended errors take not only on the patient and their family but also on the medical team involved.

''Beyond the Headlines is a way to look at our vulnerabilities and mitigate them,'' said Bono. ''We have fertile ground for improvement, but we are not unique. It happens here and in the civilian world, but we have a unique opportunity to address it and make it better for our patients, our staff and our health care delivery system.''

Other topics discussed at the conference were medical documentation and coding, clinical practice guidelines and the Armed Forces Health Longitudinal Technology Application (AHLTA)æthe new electronic medical records system that puts patient information at physicians' fingertips to help eliminate incidents of missing records and test results.