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Comment & Response
April 2018

What Patients Expect and Deserve—Reply

Author Affiliations
  • 1University of New South Wales School of Law, Sydney, Australia
  • 2Stanford Law School, Stanford, California
  • 3Stanford University School of Medicine, Stanford, California
JAMA Intern Med. 2018;178(4):578-579. doi:10.1001/jamainternmed.2018.0135

In Reply Dr Gunn understandably objects that the clinical team evidently did not refer her sister’s case to the hospital’s communication-and-resolution program (CRP) when Dr Gunn raised concerns about her care following her death. Especially given the severe outcome, standard practice would be for health care clinicians to alert risk management so that the case could be evaluated under the CRP. It would be highly unusual for risk managers not to take action in a death case where a family member has complained, but we lack information about why CRP initiation took so long in this case. What is clear is that CRPs are reliant upon clinicians and families to report adverse events, and without timely reporting, they cannot function effectively. In a study of 2 Massachusetts hospital systems1 (that connected us with patients for our interviews but did not care for Dr Gunn’s sister), 71% of CRP events were reported by clinicians, 25% by patients or family members, 3% by attorneys, and 1% by another party. Even with perfect clinician reporting, some events will first come to light through patients’ complaints because clinicians are not aware of them. However, the proportion should be low.

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