For eight years, Pennsylvania Sen. Pat Vance has pushed for a law that would let a doctor say "I'm sorry" without worrying those words will be used against her in court.
This week, Vance's proposal finally cleared the state Senate.
In years past, the -- historically somewhat more liberal -- state House has approved "doctor apology" legislation. Dr. Richard Schott, a cardiologist and president of the Pennsylvania Medical Society, said the state Senate has always been the stumbling block.
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"It's well understood that the trial lawyers have a lot of control over the legislative process in Pennsylvania, especially in the state Senate," Schott said.
"As physicians. we want to communicate with patients and with their families, and when there are bad outcomes," he said.
Fears of lawsuit abuse are a barrier that keeps doctors and other health workers from expressing their feelings, he said.
Striking a balance
Many said this year's "doctor apology" bill is a compromise.
"It allows doctors to make expressions of sympathy without fear that those expressions will be used as a weapon against them, yet the legislation still preserves the rights of individuals to pursue claims for substandard health care," said Sen. Gene Yaw, R-Lycoming.
Statements that suggest negligence can still be used in court but the bill separates those from apologies or words of condolence.
Just a fraction of investigated claims in Pennsylvania go to court because each case has to be reviewed by a knowledgeable outside expert who is familiar with the medical subspecialty, said trial lawyer Jim Ronca, a managing partner with the firm Anapol Schwartz.
"Every surgery, every medical treatment, every drug that is prescribed, has complications and risks that are known," he said.
Negligence, he said, is different.
"That's when a doctor fails to meet the accepted standard of care," Ronca said.
Apology may help prevent suit
Legislation author Vance, R-Cumberland, says mounting evidence shows that an apology -- and explanation -- can lower the chances that a medical mistake turns into a malpractice lawsuit.
"It's not the money. Patients want an apology, good communication and, most importantly, something to fix the system so that no one else suffers the same event," said David Nash, dean of the Jefferson School of Population Health at Thomas Jefferson University.
For a long time, hospital culture encouraged physicians to stay silent and not share feelings or remorse with patients or family members.
Nash says that culture is changing. As an example, he says, Jefferson hosts an annual Interclerkship Day that gives students a chance to talk about medical errors and patient safety.
"We spend a good part of the afternoon working on how to talk to patients when something untoward happens, how to apologize, how to provide information," he said.