Massachusetts Physicians Group Offers Update on Medical Liability Reform

A Massachusetts physicians and hospitals association this week provided an update on the state’s implementation of the Communication, Apology, and Resolution (CARe) program.

The Massachusetts Alliance for Communication and Resolution following Medical Injury (MACRMI) is an organization formed in 2012. It was formed as the result of a research initiative that began three years ago and is led by Beth Israel Deaconess Medical Center and the Massachusetts Medical Society, the statewide professional association of physicians.

MACRMI’s participants and supporters also include Baystate Health, Massachusetts Hospital Association, Massachusetts Coalition for the Prevention of Medical Errors, Medically Induced Trauma Support Services, as well as health insurers, provider organizations, and patient advocacy groups. The group is dedicated to the prompt resolution of medical liability arising from injuries to patients.

Mass. Gov. Deval Patrick last year signed into law a healthcare cost control bill. Photo Credit: Eric Haynes/Mass. Governor’s Office

MACRMI stated that the purpose of the research initiative, which was funded by a grant from the Federal Agency for Health Care Research and Quality as part of the President’s Patient Safety and Medical Liability Program in 2010, was to develop a roadmap to transform the medical liability system in Massachusetts.

The group said that effort resulted in 2012 with the adoption of medical liability provisions as part of the payment reform legislation signed into law by Massachusetts Gov. Deval Patrick in 2012.

Among the provisions are a six-month, pre-litigation resolution period, sharing of all pertinent medical records, appropriate apology protections for providers, and full disclosure to patients.

MACRMI Implementing Medical Liability Reform

MACRMI stated it has now begun to implement the roadmap to reform in Massachusetts, through a Communication, Apology, and Resolution (CARe) program (also known as disclosure, apology and offer, or DA&O). The pilot programs are now underway in six hospitals.

The group also announced this week the launch of its website,, for Massachusetts patients and providers.

MACRMI stated that its new website serves as the group’s primary communications tool, describing aspects of the CARe program — including its leadership, participants, and supporters.

The website offers resources for patients, clinicians, and institutions interested in starting their own CARe programs and contains descriptions on the process of resolving complaints, a glossary of terms, lists of frequently asked questions, a discussion forum, and shared learning to accelerate patient safety efforts.

Dr. Kenneth Sands, senior vice president for health care quality at Beth Israel Deaconess Medical Center and one of the principal developers of the initiative, expressed confidence and enthusiasm about the new approach. “After nearly three years of research, study, discussions and negotiations,” Dr. Sands said, “we are excited to begin the CARe program and implement these reforms in Massachusetts.”

“The pilots in the hospitals are critical steps in our reform efforts,” Dr. Sands said. “We firmly believe CARe will lead to a demonstrably better way to resolve medical liability cases. It will protect the rights of patients who have been harmed by avoidable events, reduce litigation, and cut health care costs. It will also enhance efforts to improve patient safety – one of the medical profession’s most important priorities.”

Dr. Alan Woodward, past president of the Massachusetts Medical Society, current chair of its Committee on Professional Liability, and co-developer of the initiative, said “CARe represents a fundamental transformation of the medical liability process, from one characterized by an adversarial culture of secrecy, denial, blame, and fear to one of honest communication, transparency, supportive assistance, and fairness. It is simply the right thing to do for patients, providers, and our healthcare system as a whole.”

In Western Massachusetts, where three of Baystate Health’s hospitals are participating, the CARe program is being overseen by Dr. Evan Benjamin, senior vice president for healthcare quality at Baystate Medical Center in Springfield.

Dr. Benjamin said liability reform is long overdue and that and the CARe program provides a framework for fairness, faster resolution, and transparency. “It should also lead to a new focus by providers on the all-important subject of patient safety. We are excited to be part of this new effort,” Dr. Benjamin said.

The three physicians said they are encouraged by the strong interest and commitment from stakeholders and hope the potential for CARe will be fully realized, as it offers many advantages over the current system.

MACRMI: Support of Attorneys, Legislators Key to Reforms

The physicians especially cited the support of attorneys and legislators in making the reforms possible.

MACRMI stated that an unprecedented agreement on legislative language last year among the Massachusetts Medical Society, Massachusetts Bar Association, and Massachusetts Academy of Trial Lawyers led to approval of the reforms by the legislature and Gov. Patrick and their subsequent inclusion into the payment reform bill.

According to MACRMI, passage of the law made Massachusetts the first in the nation to have comprehensive legislation that will enable the conduct of such a program in different practice environments with different insurance arrangements.

6 Hospitals Participating With Pilot Programs

The six hospitals now participating in the pilot initiative include three from the BIDMC health system (Beth Israel Deaconess Medical Center in Boston, Beth Israel Deaconess Hospital-Needham, and Beth Israel Deaconess Hospital-Milton); and three from Baystate Health system in Springfield (Baystate Medical Center in Springfield, Baystate Franklin Medical Center in Greenfield, and Baystate Mary Lane Hospital in Ware).

Five Goals of CARe

MACRMI stated that there are five goals for the CARe initiative:
(1) Improve communication and transparency about adverse outcomes;
(2) Support patients and families to help achieve a fair, timely and healing resolution to medical harm;
(3) Support clinicians in disclosing unexpected outcomes to patients;
(4) Improve patient safety by learning from errors and near misses and preventing future harm; and
(5) Provide an alternative to lawsuits and their unnecessary costs by meeting the financial needs of injured patients and their families quickly in the aftermath of an injury, without resorting to litigation.