Hands-on approach to patient grievances:
An interview with Charles R. Hatcher, Jr., MD, FACS

by
Karen Sandrick, Chicago, IL

After he stepped down as CEO of the clinic, Dr. Hatcher served as director of the Emory University Medical Center and vice-president of health affairs for the university. He retired from his active surgical practice as well as his administrative duties in July 1996. Dr. Hatcher now is an advisor to the president and board of trustees of the Robert W. Woodruff Health Sciences Center of Emory University.

Although Dr. Hatcher has not been associated with Clifton Casualty Co. since 1983, the insurer continues to adhere to his philosophy of providing personal attention to patients who harbor grievances. In the following interview, Dr. Hatcher explains how and why he believes such personal contact with patients can defuse potentially contentious situations.

Q. When you established Clifton Casualty Co., you decided to follow a different approach to handling patients' grievances. Why?

A. When you are covered by an insurance company, their lawyers dictate whether or not you settle and how you handle a potential claim. It's been my experience that lawyers don't mind a lawsuit. That's their business, that's what they do; so they tell you to take a hands-off position: ``Don't do anything. Don't say anything. If you try to make any settlement with the family, it will imply guilt on your part and result in an even worse settlement down the line.'' Insurance company lawyers ask you not to address a grievance from a patient but to let them handle it.

I feel there are a significant number of cases where people bring suit against a doctor or an institution simply because they don't have the financial resources to handle unexpected bills or prolonged disability. If a case didn't go according to the explanation they had been given beforehand, they assume--especially if they are prodded by lawyers--that something must have gone wrong, someone mistreated them, and they bring suit. But I think if you talk to them early on and offer some satisfactory assistance with their financial problems, that is all they want.

Q. Specifically, how did you handle individual grievances from patients?

A. I met personally with the patient involved—and usually with the family in attendance. If the patient had incurred unexpected expenses, such as a prolonged length of stay secondary to a complication, or if a complication or misadventure had delayed their return to work, I would quantify their financial losses with them and offer an immediate settlement.

Q. Some patients might feel threatened by such a process. How did you put patients at ease?

A. I would meet with the patient and the family and talk about how none of us expected this event to happen. I would acknowledge that these things occur, that I wanted to be certain they were not put at any great disadvantage as a result, and that I hoped we could assist them. If the patient was scheduled to go home on such-and-such a day according to the doctor's predictions but had to be reoperated on and stay an extra couple of days, I told him or her that we would cover the extra expenses. We would cancel any charges that occurred in excess of what the patient had been led to believe was the normal course. We would also compensate the patient for the time he or she missed work because he needed more time to convalesce. Then, I would tell him, ``This is not my personal money; it belongs to the partners of The Emory Clinic. But if you will just sign a release saying this arrangement is satisfactory to you, I will authorize a check to be cut for the appropriate amount of money. I can do that as CEO of the insurance company.''

Q. How well has this approach worked?

A. Most patients appreciated my intervention and felt the proposed settlement was more than fair. Only one family proceeded to litigation after such a discussion because they were steadfast in their feeling that a doctor should be brought to account for abandoning their father.

Q. What happened in that case?

A. A gastroenterologist removed a polyp apparently without adequately explaining the risk of bleeding. Bleeding occurred, the gastroenterologist was called, and he instructed the nurse that the bleeding was routine and of no particular consequence. He did not contact or visit the patient. The patient continued to bleed, the nurses continued to follow the gastroenterologist's lead and minimize the situation until the patient went into shock. The patient's wife then ran into the hallway, found another physician, and brought him into the room. The physician had the patient taken back to the operating room immediately and operated to save his life. The gastroenterologist did not arrive on the scene or visit the patient postoperatively. I could understand the position of the family. This physician subsequently resigned from Emory Clinic to enter private practice.

Q. Why do you think your approach has worked so well?

A. Patients sometimes just want to be heard, and nothing is more soothing than to be seen by the doctor in charge. They want to voice their complaint and want to be sure that someone in authority has heard them, that steps will be taken to prevent this from happening again, that we will try to make sure no other patient goes through the experience they have gone through. Patients need to know that we are appreciative of their calling this situation to our attention because the only way we can correct things is if they tell us.

Q. Is Clifton Casualty handling patients' grievances in 1997 the same way you did some 20 years ago?

A. When I was there, we probably had 250 doctors, but now there are almost 850 doctors; so it is not quite the hands-on approach that I experienced because the current CEO is too busy to handle every situation. The company has a risk management office headed by a person who has been properly trained, and she meets with anyone who makes an incident report or addresses some dissatisfaction to a doctor or nurse. She is empowered to make a cash settlement in any minor situation up to $10,000 on her own initiative. But if the situation is more complex and she feels a doctor should become involved, the associate director of the clinic works with her in personal discussions with the family.

Q. Many physician groups and clinics are plagued by frivolous malpractice lawsuits. How did you discourage these lawsuits?

A. I hired the best and most aggressive malpractice defense lawyers so plaintiff attorneys understood there was no easy money to be had. I also got the word out that Emory was known for being fair to patients and we were not going to be an easy target. We let trial attorneys know that if there was something that we felt had been malpractice, we would be glad to discuss that with the patient. But we would fight as hard and as long as we could against frivolous claims.

Q. Why did you take that stance? Many people would say it's far easier and cheaper for physicians to settle even frivolous claims.

A. Most insurance company lawyers will tell you to settle even if you want to defend yourself as a matter of principle because you have done nothing wrong. They say it will be cheaper for you to settle. But the doctor's reputation will be ripped a notch or two. I really don't like to settle a claim if a doctor feels it will damage his or her reputation and unfairly so.

Some lawyers will sue for $50,000 and say, ``We'll settle out of court for $25,000,'' figuring it would cost that much and more to defend the suit. But I think settling such cases out of court is a bad precedent. I would spend $100,000 to defend a $25,000 suit if I felt we had committed no error. And I believe we were absolutely in the right, because you more than get your money back by discouraging these lawsuits. You let the trial lawyers know there is no easy money out there, and they will not make you do anything you don't want to do.

This article on professional liability was generated through the efforts of the Committee on Professional Liability of the ACS Board of Regents. Members of the committee believe that this and other articles published in the Bulletin should stimulate thought and possible action on a wider spectrum of issues related to professional liability.

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Ms. Sandrick is a freelance medical writer in Chicago, IL.
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Bulletin of the American College of Surgeons
Vol.82, No.8, August 1997