The Chairman of ProAssurance Corporation (NYSE: PRA), A. Derrill Crowe, M.D., will participate in the Sandler O’Neill Insurance Equity Conference at the Parker Meridien Hotel in New York on September 13, 2001. Dr. Crowe will be part of a panel that will review the current state of medical malpractice insurance.

The presentation will begin at 7:55 AM EDT and will be available by phone or webcast. The telephone number is (800) 559-9370; international participants may dial (847) 619-6368. The ID number for the call is 4565549.

ProAssurance Corporation is an insurance holding company formed by the merger of Medical Assurance, Inc. and Professionals Group, Inc., two of the leading specialty property/casualty insurance groups in America. ProAssurance is listed under the symbol “PRA” on the New York Stock Exchange.

ProAssurance boasts approximately $2 billion in assets, $495 million in annual gross written premiums, and licenses to write business in over 45 states. The Company is the nation’s fourth largest writer of medical professional liability insurance and one of the 100 largest writers of personal auto coverage. Through its wholly owned subsidiaries, Medical Assurance, Inc. and ProNational Insurance Company, it insures more than 30,000 physicians and other health care risks. ProAssurance also owns 84% of MEEMIC Holdings, Inc., (NASDAQ:MEMH) a provider of auto, homeowners, umbrella, and boat coverages, primarily for educational employees and their families, through MEEMIC Insurance Company.

Major rating agencies recognize the financial strength and stability of the Company’s operating subsidiaries. A. M. Best rates Medical Assurance, ProNational and MEEMIC Insurance Company “Excellent;” while Standard and Poor’s rates the claims paying ability of Medical Assurance and ProNational as “Strong.”

Medical Assurance and Professionals Group were leaders in the medical professional liability industry’s move toward consolidation. Measured either by frequency of acquisition or success of consolidation, each company compiled an impressive track record. Working together, the leadership of the combined companies will build on their successful experience by forming a professional liability group serving the evolving needs of the health care industry.

Choice Hotels International (NYSE:CHH) has entered into a partnership with Star HRG that enables Choice franchisees to provide low-cost medical and dental insurance coverage to their employees.

The agreement between Choice and Star provides limited benefit insurance programs that help with basic, everyday medical and dental expenses. Under Star’s Fundamental Care program, employees receive coverage for physician visits and accidents, prescription and vision discounts, accidental death benefits, and coverage for preventive and basic dental procedures. Some of the plans also include term life insurance.

The plans are available to all hotel employees for as little as $3.45 per week. Premiums are paid by participating employees through payroll deductions or through a stored-value Visa Payroll Card.

Premium collection for the insurance program is fully administered by Star. The combination of insurance benefits and a Visa Payroll Card is an industry first, allowing Choice franchisees to offer employee benefits without any of the typical administrative workload.

“Recruiting and maintaining quality employees is the number one challenge for our franchisees,” said Daniel Rothfeld, Choice’s senior vice president, partner services. “They are constantly looking for tools that give them a competitive edge in today’s tight labor market.

“By providing affordable insurance benefits to their employees, our franchisees have that edge,” Rothfeld said. “Star makes it easy for our franchisees to offer the program. It’s a turnkey solution to one of the most pressing issues in hotel operations - labor recruitment and retention.”

About Choice Hotels International

Choice Hotels International (NYSE:CHH) franchises more than 5,000 hotels, inns, all-suite hotels and resorts open and under development in 46 countries under the Comfort Inn, Comfort Suites, Quality, Clarion, Sleep Inn, Rodeway Inn, Econo Lodge, and MainStay Suites brands. More information is available at www.choicehotels.com. About

Star HRG

Star HRG, a division of The MEGA Life and Health Insurance Company, is a member company of UICI (NYSE:UCI) and is recognized as a national leader in providing Limited Benefit Medical Plans. Star HRG addresses the unique benefit needs of entry-level, part-time, and high-turnover employees by providing voluntary insurance programs, at a price employees can afford. Star HRG’s innovative insurance solutions help companies to reduce turnover, improve recruiting, and stabilize benefit expenses within the hourly paid workforce. More information is available at www.fundamentalcare.com.

Comfort Inn, Comfort Suites, Quality, Clarion, Sleep Inn, Econo Lodge, Rodeway Inn, and MainStay Suites are registered trademarks and service marks of Choice Hotels International.

International Medical Group(SM), Inc. (IMG(SM)) announces the formation of IMG Europe Ltd., a wholly owned subsidiary of IMG. This division will provide marketing services, administration support and emergency medical assistance to IMG’s European insured members from its offices in the United Kingdom.

“We are always looking for better ways to serve our agents and their clients,” said Joe Brougher, President of IMG. “This will enable us to expand and enhance the services we provide to those who are traveling or living throughout Europe.”

The new company will be headed by Ernest Jones. Jones spent many years in insurance before joining the travel insurance industry in 1979 as General Manager of a Jardine Glanvill Company. From 1986 through 1998, Ernie was Managing Director of Mercury International, having co-founded the company. His experience in the travel insurance field and especially the area of international assistance and claims is appreciated throughout the industry.

IMG Europe Ltd. may be contacted at VW2 Maritime House, Basin Road North, Hove, East Sussex, BN41 1WR, telephone: +44.127.338.4926, or fax: +44.127.338.4934.

International Medical Group, Inc. is a worldwide leader in designing, distributing and administering global healthcare benefits. IMG’s international reputation for excellence has been established by providing medical, life and disability insurance products to individuals, families and groups in more than 150 countries.

Since 1990 IMG has served over 500,000 clients worldwide including vacationers, business executives, missionary groups, entertainers, Fortune 500 companies, schools and universities, professional marine crew, expatriates and local and third country nationals. IMG is based in Indianapolis, Indiana. Its companies also include International Claim Managers(SM) which is responsible for overseeing precertification, large case management, and emergency medical evacuation coordination for IMG products. Each of IMG’s companies is committed to meeting the unique needs of its international clientele. For more information about IMG and its products, please call 800.628.4664 or 317.655.4500.

The Centris Group Inc. (NYSE:CGE), a provider of domestic and international insurance and reinsurance products and services, today announced that it has signed a definitive agreement to acquire Indianapolis-based VASA North America Inc. and its subsidiaries and Seaboard Life Insurance Company (USA), from Seaboard Life Insurance Company (Canada) and its parent, Seaboard North American Holdings Inc., a Canadian company that is owned by Eureko, B.V. of the Netherlands.

The majority of the acquired group’s business is medical stop-loss and group term life insurance for self-insured employers. The transaction is expected to close following receipt of regulatory approvals which Centris believes can be obtained within 60 to 90 days.

The group to be acquired includes VASA Brougher Inc., a medical stop-loss managing general underwriter, Seaboard Life Insurance Company (USA) which is licensed in 41 states and the District of Columbia, and VASA North Atlantic Insurance Company, a property/casualty insurer licensed in 36 states and the District of Columbia. Both insurance companies are rated “A-” (Excellent) by A.M. Best Company. The sale does not include Seaboard Life Insurance Company (USA)’s individual life and annuity business, which is being sold separately.

Acquisition solidifies Centris’ leadership

position in medical stop-loss business

“This acquisition not only strengthens our position in the medical stop-loss business, but also brings a widely licensed life insurance company into our group. This will allow us to leverage our capital more advantageously, and will provide synergistic opportunities for other companies in our group like INTERRA,” said David L.Cargile, Chairman and Chief Executive Officer of The Centris Group.

VASA Brougher is believed to be the fifth largest provider of medical stop-loss coverage in terms of annual premiums generated. Prior to this acquisition, Centris’ USBenefits subsidiary was already the leading provider of medical stop-loss coverage in the country. VASA Brougher’s operations will be integrated into Centris’ existing operations, giving Centris access to its distribution system which is particularly strong in the Midwest.

“This strategic acquisition is a move forward in terms of strengthening our leadership position in the medical stop-loss business,” said Cargile. Centris indicated its medical lines revenues are expected to grow by approximately 15% to 20% as a result of the acquisition. “We believe that by focusing on medical and other specialty lines, we can achieve the most efficient use of our capital base,” added Cargile.

Centris indicated that the purchase price for the group will approximate the statutory book value as of the closing date of the insurance companies being acquired. Centris also indicated that as part of the transaction the sellers have agreed to provide protection for adverse loss development on the acquired group’s existing business. Other terms of the transaction were not disclosed.

Company exploring best strategy for property/casualty lines

As previously announced, Centris recently retained Advest, an investment banking firm, to explore strategic alternatives for its property/casualty insurance lines, which generated $47.3 million in gross premiums written for the six month period ended June 30, 1998. Statutory policyholders’ surplus for Centris’ insurance companies at June 30, 1998, was $117.7 million. Among the alternatives being considered is a possible sale of Centris’ property/casualty operations.

About Centris

The Centris Group Inc. operates complementary businesses based on its expertise in the handling of specialized risk. It is a market leader in medical stop-loss coverages that produce revenues from both premiums and fees. Centris is also a provider of property/casualty reinsurance, excess and surplus lines insurance, special risk accident and health insurance products and reinsurance intermediary services. Other specialized risk operations include claim review, premium and claim auditing, prospective program review and runoff management.

Among the most highly rated companies in its markets, The Centris Group conducts business both nationally and internationally through USBenefits Insurance Services Inc., USF RE INSURANCE COMPANY, USF Insurance Company and INTERRA Inc. Centris’ insurance operations are rated “A” (Excellent) by A.M. Best Company and USF RE is assigned a claims paying ability rating of Aq (Good) by Standard & Poor’s.

Forward Looking Statements

Some of the statements included within this release which are not historical facts may be considered to be forward looking statements within the meaning of section 29A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of 1934, and therefore are subject to certain risks and uncertainties which could cause the actual results to differ materially from those suggested by such statements. Such risks and uncertainties include, but are not limited to the following: catastrophic losses in the company’s insurance lines or a material aggregation of such losses; changes in federal or state law affecting an employer’s ability to self-insure or other adverse regulatory changes; the adequacy of the company’s reinsurance program; general economic conditions in this country or abroad; adverse developments in the securities markets and their impact on the company’s investment portfolio; the effects of competitive market pressures within the medical lines or property/casualty marketplaces; the effect of changes required by generally accepted accounting practices or statutory accounting practices; and other risks which are described from time to time in the company’s filings with the Securities and Exchange Commission. The words “believes”, “anticipates”, ” expects” and similar expressions are intended to identify forward looking statements.

Global banks are out to break the chains that prevent them from offering more services in emerging markets. Their customers’ finance executives wish them well.

When Amkor Technology acquired three semiconductor assembly and test factories in Korea last year, the West Chester, Pennsylvania-based semiconductor supplier and tester used three global banks-Citibank, Societe Generale, and Deutsche Bank-to structure the $900 million deal. But because of Korea’s restrictions on foreign banks, Amkor still needed the services of a local bank to transfer securities of the seller, Anam Semiconductor Inc., in which Amkor agreed to increase its investment as part of the transaction. And, says Amkor

CFO Ken Joyce, the local bank’s fees for the service “were high per U.S. standards.”

The deal was a typical example of where U.S. companies turn for financial services as they cross more and more borders. While global banks are doing business throughout the world, they still face obstacles to competition with local banks. Last March, for instance, Malaysia released a 10-year plan to provide for the equal treatment of foreign banking competitors. But only after developing a strong set of domestic banks will the country allow nondiscriminatory treatment of foreign players already operating in the country. And only at that point will the country allow new foreigners in.

Granted, Malaysia is an extreme case. Other emerging-market countries have made great strides in opening their markets to foreign banks. But the remaining hurdles faced by outsiders are so high and widespread that more than a few U.S. companies maintain their own in-house banks to help finance their operations in certain markets.

Consider the results of a recent CFO magazine survey of top finance executives. It found that only 33 percent of those companies doing business abroad said that their major U.S. lenders provided services to them in all foreign countries, while 38 percent said some provided services and 29 percent said none did. And the reason given by those who answered “some” or “none” was that the hanks were not located in those countries.

That’s a situation most CFOs would clearly like to see change. By offering as full a range of products and services as possible–from cash management and custodial services to investment banking and insurance–in as many markets as possible, global banks can enjoy great economies of scope and scale, at least some of which they can be expected to pass along to their clients. Says Steven Meyer, treasurer of Baxter International, a medical products company based near Chicago, “To have to do everything with a local bank is inefficient.”

Some of the limits facing foreign banks involve specific legal restrictions (see table, page 92). Other, less direct means of inhibiting competition with local banks involve everything from red tape to poorly capitalized financial systems, unreliable legal systems, and lack of good accounting procedures.

To be sure, the extra cost such barriers impose on clients may not spell the difference between a deal’s failure and success. It obviously didn’t stop Amkor’s Korean deal. But with profits under pressure, anything that shaves costs is something CEOs welcome. Witness the recent decision by Gateway, the personal-computer maker, to close most of its foreign operations because earnings outside the United States were insufficient. “They are giving up growth opportunities,” notes Donald Young, an analyst for UBS Warburg.

Other companies in much the same boat are looking for ways to improve their global operations’ profitability, and those often involve consolidating their banking relationships. One major U.S. multinational, for example, has started a pilot program to see if it can reduce its use of local banks in Southeast Asia. Most of those relationships were developed when the company, which requested anonymity, operated on a country-by-country basis. But the company has since moved to a regional and then a global approach to doing business abroad, and it would prefer to deal with banks on that basis as well. Under the test program, the company has asked a global bank to see which of the company’s local banks could be replaced by Southeast Asian institutions that are part of the global bank’s network of correspondent banks. Ideally, the global bank could then rationalize the company’s use of local bank products and services within the region by eliminating duplication wherever feasible.

Mergers and acquisitions activity in the health insurance sector took a big jump with two recently announced multi-billion dollar deals. UnitedHealth Group announced its intent to buy Mid Atlantic Medical Services for almost $3 billion, while Anthem Inc. has agreed to purchase WellPoint Health Networks for $16.4 billion. These merger announcements are driving speculation of further consolidation within the insurance industry, and raising questions about competition in the sector.

According to a survey conducted at KPMG’s 14th annual Insurance Industry Conference, a majority of insurance companies expect the industry to see an increase in merger and acquisition activity. Of the companies surveyed, 59 percent said they expect to see an increase in merger and acquisition activity over the next year, while 11 percent said they expect it to decrease and 30 percent said they expect the M&A activity to remain at its current level.

Some industry experts claim that the movement of regional insurance carriers to merge into national companies is a tactic to combat the rising costs of medical care while struggling to keep premiums at reasonable levels and still see profits. “The insurance industry is still ripe for further consolidation,” said Scott Keller, president of DealAnalytics.com. “Given the fact that the major players are consolidating, it will put pressure on smaller regionals to get up to scale.”

Insurance companies grow by either gaining new members or through mergers and acquisitions. When the recent economic downturn caused an increase in unemployment, insurers lost members whose insurance was carried by their employers. Many employers are also fighting for lower rates. According to an employer survey conducted by the Kaiser Family Foundation, nearly two-thirds stated they had shopped for a new health plan or carrier in the last year. In response, growth minded companies have sought to expand through acquisitions.

The desire to remain competitive may be another factor contributing to M&A activity. Three years ago, insurance executives said that they saw international finance firms as their greatest competitive threat, but in this year’s KPMG survey they said that their major competitors were other major insurance carriers. Anthem’s proposed acquisition of WellPoint would create the nation’s largest health insurer. According to industry analysts, other large industry companies such as Aetna, CIGNA, and UnitedHealth Group could feel more competitive pressure as a result of the Anthem merger. The perception of banks as a competitive threat has also increased over the past few years, according to the KPMG survey.

Large-scale consolidation in the industry may have some positive benefits. Investments in improving quality of care, customer service, and general operating efficiency require capital outlays that only large corporations can afford. A recent Wall Street Journal article stated, “The Anthem and UnitedHealth deals represent the latest steps in a decade-long consolidation of health plans, doctors, and hospitals. Over time, the moves could lead to greater standardization and simplification of an enormously complex system.”

Not everyone agrees that such consolidation would be good for the nation’s health care system. According to American Medical Association president Dr. Donald J. Palmisano, the Anthem deal “will create a giant company on a scale not seen in an industry where competition has already been reduced.” Dr. Palmisano also said that the recently proposed industry deals “should raise concerns that the country is headed toward a health care system dominated by a few publicly traded companies that operate primarily in the interest of their shareholders.”

While the consolidation of top managed care companies might improve customer service over time, it isn’t likely to solve the national problem of rising health-insurance premiums because consolidating the large corporations reduces competition. “There’s a real worry that these big national networks will make it harder and harder for smaller, local insurers to operate,” said Joe Martingale, a senior consultant at Watson Wyatt Worldwide, an employee-benefits firm. The decrease in competition means it is more likely that health care costs will rise, since competition is one of the factors that keeps prices low.

Regardless of whether industry consolidation ultimately benefits our nation’s health care system, it seems likely that M&A activity in the industry will continue. Driven by competition and the need for capital to deal with the rising costs of medical care, companies in the health insurance sector will continue to see mergers as a useful business tool.

First, let me say happy Perioperative Nurse Week. AORN celebrates Perioperative Nurse Week from Nov 9 to 15, 2003. This year’s theme is “Perioperative Nurses: Providing Safe Patient Care … in the OR and Beyond.” Please take the time to say thank you to your peers in perioperative nursing. If someone does something special for you, do something special for someone else–and not for just this week. Pass the good will on, and you will be surprised at how it grows.

Secondly, I want to wish everyone a happy Thanksgiving. We all have much to be thankful for, not only in our practice, but in our personal lives as well. I often think about how others affect both my professional and personal life. What I want to talk with you about this month, however, is how others in the surgical arena, and their practice, affect us as perioperative nurses.

LIABILITY REFORM

One topic that keeps coming to mind regarding our surgeon colleagues is the escalating cost of medical practice insurance and the issue of medical liability reform. What I would like is for all of us to think about how this issue affects nursing, as well as the people to whom we provide care.

In a statement to the US House of Representatives on the oversight hearing on health care litigation reform, the American College of Surgeons (ASC) wrote,

The large premium increases and
declining number of liability insurance
carriers are forcing many surgeons
to make difficult decisions
about limiting the scope of their
practice, moving to other states, or
retiring early. (1)

There are particularly difficult situations in West Virginia, Pennsylvania, New Jersey, Mississippi, Nevada, and Florida. It is anticipated that other states without reforms are headed toward a similar crisis. Currently, 24 states have some type of medical liability reform.

According to an article in the Las Vegas Review Journal highlighting the impact of rising medical liability insurance rates in Nevada,

Five trauma surgeons
and 26 specialty surgeons
have resigned or
requested leave from the
University Medical
Center’s trauma center,
citing the risk of doing
business when rates of
medical malpractice
insurance are soaring. (2)

For example, the insurance premium for a colon and rectal surgeon in Nevada in the year 2001 was $35,000. At the end of 2001, it increased to $100,000.

Another example is cited in the Cleveland Plain Dealer.

A Cleveland obstetrician
buying a policy
from Medical Assurance Co in 2002
typically would have paid about
$100,000, or 38% more than what
the policy cost in 2001. This year,
that premium is about $119,000, a
one-year price increase of 19%. (3)

By my calculations, that is an increase of 57% in a two-year period.

The American Medical Association says the problem is so bad that

access to health care is
now seriously threatened
in states such as Florida,
Georgia, Mississippi,
Nevada, New Jersey, New
York, Ohio, Oregon,
Pennsylvania, Texas,
Washington, and West
Virginia. And, a crisis is
looming in more than 30
other states. (4)

On the other hand, plaintiffs’ attorneys do have a point. Patients sometimes are grievously damaged, with loss of life or limb.

An interesting study was conducted at the Albert Einstein College of Medicine, New York. Thirty-six malpractice cases involving cervical spine surgery were identified. Twenty of these cases were from California, and 16 were from New York. California has a cap of $250,000 on pain and suffering, and New York has no cap. Questions included who sued, who was sued, who won, who lost, and why.

Researchers concluded that all of the six plaintiff verdicts and four of the nine settlements appeared to be appropriate; however, researchers could determine “no fault” in five cases that the defendants had settled, and they concluded that the surgeons did not deserve to lose the suit. (5) What is even more interesting is that the author of the study found fault in five defense verdicts. These patients were newly quadriplegic patients and had sustained new postoperative root injuries. These patients deserved monetary awards but received no compensation whatsoever.

THE EFFECT ON PERIOPERATIVE NURSING

My question to all of you is how does this affect your perioperative nursing practice? Are facilities closing down part of their surgical suites because there are not enough procedures? Are nurses losing their positions because of low caseloads? Do patients have to go to different areas to receive the care that is needed? Are patients receiving safe, quality care from all of their providers?

I just learned of two very capable and highly regarded urologists who are leaving my community because of the high premium increases in their malpractice insurance. As of now, the facility has not been able to replace them; thus, the caseload volume has dropped at the surgery center, and staff members’ hours sometimes are reduced. I believe that many of you have similar stories.

Even as mediation has come to be a dominant force in settling such cases as rear-end SUV collision accident claims in Terrebonne Parish, Louisiana,1 mediation has become a major force in settling international business disputes.2 The principles and techniques involved in mediating the two kinds of disputes are very much the same, with a leavening of cross cultural complexity for the latter.3 The purpose of this paper is to show the fundamental similarity of international business mediation to domestic mediation, to discuss the overlay of additional problems that international mediation presents, and to discuss particular mediation tactics-including playing the “culture card”-that can be employed to overcome cultural problems in international business mediations.4

I. MEDIATION ACROSS THE BOARD

Unlikely as it may sound, the principles involved in mediating the international business dispute are the same as mediating the rear-end SUV collision in Terrebonne Parish. I say this because I happen to have a rather wide exposure to mediation and alternative dispute resolution, having mediated or attended as an observer or arbitrated cases ranging from indeed rear-end SUV collisions in Terrebonne Parish on up through business and securities problems, finally on up through employment and financial problems arising from major international transactions.

In all of these various types of cases, the advantages of mediation remain the same: avoiding the risks, expense, delay and the stress of litigation.5 These factors are discussed further below.

As a backdrop to the discussion it should be noted that recent data suggest that the settlement rate for litigated cases is exceedingly high, belying the public myth of a “litigation explosion.”6 It would appear to be much more accurate to say that there is a “settlement explosion.”

Mediation is right in the thick of this “settlement explosion.” The data indicate that the settlement rate for mediation approaches 80%.7 It might be argued that while 80% is a good settlement rate, it is not as high as the overall case settlement rate which is apparently as high as 92%.8 Thus it might be argued that mediation is not apparently effective.

However, such an argument could not be more in error. These settlement percentages make reference to different populations. Many of the cases that go to mediation are cases that the attorneys involved could not settle by themselves. Thus the mediation population is made up of disproportionately tough cases. In most of the cases that I encounter in my mediation practice, the attorneys have previously attempted to settle. From these perspectives, an 80% settlement rate is an outstanding result. As another anecdotal piece of evidence, I see many lawyers as repeat players in the mediation practice. Since they have had ample opportunity to observe the process, they must think the process has value or they would not keep coming back.

And what value does mediation bring to the table? As alluded to above, the value of mediation lies in its avoidance of the following hazards of litigation or arbitration: costs, risk of a poor result, delay, and stress.9 Perhaps the greatest over-arching principle is this: In mediation, the parties don’t ever get a result they have not agreed to. The parties are, to use an overworked phrase, “empowered.” Not only are the parties empowered as to result, they are empowered as to process.

I have had parties in private caucuses stand up, pace around and tell their lawyers to “shut up,” while they sounded off about the case. The lawyers sit there meek as a lamb, which can be a good thing. This never happens in a courtroom- it cannot. For many parties in a case, this is the only lawsuit they will ever experience. In a mediation, their memory of it will not only be the result-it will be that they had some say about what happened, that they called a shot, that their agreement was required.

These emotional, client-empowering arguments for mediation can easily be seen to be important to the parties in the case of the rear-end SUV collision in Terrebonne Parish.10 In the Terrebonne Parish case, the injured plaintiff, with his Cajun cadence, was being paid by Tri-West Insurance Company for lost future wages, for past and future medical bills, for back injuries and for pain and suffering.11 This was paid, after mediation, by the Tri-West adjuster flown in from Atlanta and her local outside counsel, as they took this one off their case management file, hitting a little below the number they were authorized, and moved on to the next case, coming out of Grand Isle. The parties were not too unhappy, and the black cloud that was this case has been wiped out of their lives and careers. They controlled it. In lawyer-speak, Tri-West didn’t take a big pop and the plaintiff didn’t get zeroed. Anything can happen when you put it to a jury. Even if the jury talks like you, that doesn’t mean they’ll give you home cooking.

The same considerations come into play when the case is at the other end of the business spectrum. Let us consider the example of a failed agreement by a French company to license a line of clothes in the U.S., which triggered a resignation by the CEO. The CEO wants to collect his severance package, which is disputed by a shareholders’ derivative suit. Notwithstanding that the parties and their attorneys are all experienced in business, there is the same concern about the loss of control and about matters going in directions unfathomed. This creates a desire to throw some fixed, predictable amount of money at the complex problem to make it go away. And the great thing about it is that you don’t have to do the law school thing-analyze doctrines, facts, consider motions, venues, and all the rest. You don’t have to write an exam. Just a check.

Time was when doctors were reluctant to admit–to themselves or anyone else–that they were capable of making significant medical errors.

Sure, there were sometimes “unexpected outcomes.” “Bad babies,” “noncompliant” patients or “idiopathic” symptoms might confound a dutiful physician’s best efforts. But mistakes on the part of caregivers were dismissed as rare and, if they should occur, shameful.

No longer.

Today, according to two landmark surveys conducted in January by the American College of Physician Executives, three out of four physician leaders concede they know a doctor in their community whom they would avoid because they think he or she is prone to medical mistakes.

Nearly 60 percent report there is a hospital in their community they’d spurn because they do not trust the competence of its personnel.

Current medical literature is full of admissions of the fallibility of physicians and health care institutions.

So how should doctors respond when they recognize they’ve done something wrong?

Four out of five of the physician survey respondents believe that the doctor and hospital owe the patient and family an apology.

Three out of five physician executives are convinced that a genuine expression of regret by caregivers who have erred would help reduce malpractice lawsuits.

The general public agrees. Three out of four patients in a companion survey say they’d be at least “somewhat” likely to take legal action if they or a family member were the victim of a medical error. But nine in 10 assert they’d be more likely to sue if the doctor or organization were trying to cover up the blunder.

Still, for all that, only about half of a group of 1,019 U.S. physician executives reported that their own organization is actively encouraging doctors and staff to volunteer an, “I’m sorry,” when a lapse has injured a patient.

“Throughout American health care, mistakes happen,” summarized a senior executive at a California hospital in response to the ACPE survey. “Nevertheless, covering up is a tradition of much longer standing than apologizing.”

Blame the lawyers

ACPE’s surveys of physician and patient opinion on medical mistakes and on how to deal with them reveals a growing consensus nationwide that honesty is the best policy when physicians and health care institutions err.

Members of the College were polled online between January 4 and January 10, 2006. More than 700 of those who responded hold managerial positions in hospitals or hospital systems, group practices, academic, government or military health care organizations. Ninety are chief executive officers.

Their responses were paired with those of a national sample of 1,008 adults over the age of 18 (representing past or future patients) surveyed by telephone January 4-8, 2006, by International Communications Research, of Media, Pa. Margin of error for the latter poll, according to ICR, is +/- 3.09 percent at the 95-percent confidence level.

In the past, openness about mistakes has not been the health care sector’s traditional tactic. Or at least it has not been the approach customarily recommended to doctors and hospitals by defense attorneys and insurers in an era of rampant malpractice litigation.

“Although I believe that apologies should be made,” commented a physician executive at an Ohio academic medical center in response to the survey, “our lawyers and risk management personnel are very much against it and block us from doing it.”

Concurred the medical director of an Ohio group practice: “The lawyers in our agency have gone so far as to instruct the doctors NOT to make condolence calls or letters. When I get called by a family that a patient has died, I am forbidden from calling them back or sending a letter. Damn lawyers screw everything up.”

Not surprisingly, that was a theme often sounded–in various forms–by the physicians polled. Burdened by hefty malpractice insurance premiums and a virtual certainty that at some point in their careers a dissatisfied patient will sue them, doctors focused much of their wrath on the lawyers who represent aggrieved plaintiffs.

“Trial lawyers are not about making things work better,” railed a physician in a Texas group practice. “They are about suing anyone who doesn’t get the perfect outcome.”

“Only medical tort reform, or a ‘worker’s comp’-like compensation system for adverse outcomes, will allow us to truly address medical errors in a transparent and collaborative, non-threatening, non-adversarial environment,” suggested an academic physician executive in Pennsylvania. “Discussing errors up front with patients [while] attorney ads [run] nearly full time on daytime TV encouraging patients to ‘get the money you deserve, even for the smallest error,’ will NEVER happen … [not] when you know that there are 40 or 50 attorneys willing to take money from your insurer (and not necessarily give it to the poor patient who suffered from the error)…. It is an unfortunate fundamental flaw in our system that we have tort law as the DRIVING force in our system … Darn shame.”

Background and Purpose. The Internet has made possible the free flow of ideas and information to an extent undreamed of just a decade ago. This project was developed to determine if the Internet could be readily used as a communication tool by two physical therapist education programs, located in two different countries, to bring together their students in a collaborative project examining each country’s physical therapist practice and health care system. Method/Model Description and Evaluation. Eighty-four students from the University of South Australia and the University of the Sciences in Philadelphia participated in this project. Work was performed within small collaborative groups, with each group consisting of at least one student from each university. Each group was assigned one of five patient-based scenarios in order to develop patient goals as well as interventions to reach these goals. All students were invited to complete a questionnaire regarding their perceptions of the similarities and differences between the health care systems of the two countries and to compose an essay on which system was “best” at meeting the needs of their patient. Using a purpose-designed feedback questionnaire, students were surveyed to determine the strengths and weaknesses of the collaborative project. Outcomes. A majority of the students indicated that collaborating with a student from another country on the same assignment was beneficial in terms of expanding knowledge, developing plans of care, and learning about another country’s health care system. Discussion and Conclusion. Collaborative educational projects via the Internet between two geographically distant universities are both feasible and beneficial. As this form of learning evolves, it is anticipated that the percentage of students who experience difficulty exchanging information with their international partners will decline as they become increasingly facile using the computer as a communication tool. This will hopefully lead to additional international educational collaborative uses of the computer, perhaps in areas such as peer review and research.