title: Transparent and open discussion of errors does not increase malpractice risk in trauma patients.
abstract: OBJECTIVE
  We set out to determine if there is an increased medical malpractice lawsuit rate when trauma patient cases are presented at an open, multidisciplinary morbidity and mortality conference (M&M).
  
  
  BACKGROUND
  Patient safety proponents emphasize the importance of transparency with respect to medical errors. In contrast, the tort system focuses on blame and punishment, which encourages secrecy. Our question: Can the goals of the patient safety movement be met without placing care providers and healthcare institutions at unacceptably high malpractice risk?
  
  
  METHODS
  The trauma registry, a risk management database, along with the written minutes of the trauma morbidity and mortality conference (M&M) were used to determine the number and incidence of malpractice suits filed following full discussion at an open M&M conference at an academic level I trauma center.
  
  
  RESULTS
  A total of 20,749 trauma patients were admitted. A total of 412 patients were discussed at M&M conference and a total of seven lawsuits were filed. Six of the patients were not discussed at M&M prior to the lawsuit being filed. One patient was discussed at M&M prior to the lawsuit being filed. The incidence of lawsuit was calculated in three groups: all trauma patients, all trauma patients with complications, and all patients presented at trauma M&M conference. The ratio of lawsuits filed to patients admitted and incidence in the three groups is as follows: All Patients, 7 lawsuits/20,479 patients (4.25 lawsuits/100,000 patients/year); M&M Presentation, 1 lawsuit/421 patients (29.6 lawsuits/100,000 patients/year); All Trauma Complications, 7 lawsuits/6,225 patients (14 lawsuits/100,000 patients/year). Patients with a complication were more likely to sue (P < 0.01); otherwise, there were no statistical differences between groups.
  
  
  CONCLUSIONS
  A transparent discussion of errors, complications, and deaths does not appear to lead to an increased risk of lawsuit.
authors.affiliation: Department of Surgery, University of Texas Health Science Center at San Antonio, University Hospital, 78229, USA. stewartr@uthscsa.edu
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Stewart
authors.forename: Michael G
authors.initials: MG
authors.lastname: Corneille
authors.forename: Joe
authors.initials: J
authors.lastname: Johnston
authors.forename: Kathy
authors.initials: K
authors.lastname: Geoghegan
authors.forename: John G
authors.initials: JG
authors.lastname: Myers
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Dent
authors.forename: Marilyn
authors.initials: M
authors.lastname: McFarland
authors.forename: Joshua
authors.initials: J
authors.lastname: Alley
authors.forename: Basil A
authors.initials: BA
authors.lastname: Pruitt
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Cohn
mesh_terms: D006801:Humans; D008318:Malpractice / Q000706:statistics & numerical data*; D019300:Medical Errors / Q000331:legislation & jurisprudence*; D012307:Risk Factors; D014342:Truth Disclosure; D014481:United States; D014947:Wounds and Injuries / Q000628:therapy*