Wednesday, September 29, 2010

VA's Disclosure Policy Lauded in New England Journal of Medicine

VA's Disclosure Policy Lauded in New England Journal of Medicine

WASHINGTON (September 29, 2010)- The Department of Veterans Affairs (VA)
policy on disclosure of adverse medical events was praised as a
"valuable resource for all health care institutions" in an article in a
recent issue of the New England Journal of Medicine.

"At VA we strive every day to deliver superior health care," said Dr.
Robert Petzel, VA's Under Secretary for Health. "When mistakes occur, we
immediately acknowledge them and learn how we can do better in the

Adverse events, such as incomplete cleaning of medical instruments, may
affect significant numbers of patients over time. However, prompt
disclosure also presents an opportunity to quickly assess risk to
patients and to learn how to improve health care delivery and processes.

The article, entitled The Disclosure Dilemma, states that although many
health care organizations have adopted policies encouraging disclosure
of adverse events to individual patients, these policies seldom address
large scale adverse events. It adds, however, that VA's own disclosure
policy is "a notable exception."

The authors, including Denise Dudzinski, Ph.D., an associate professor
and Director of Graduate Studies at the Department of Bioethics &
Humanities at the University of Washington School of Medicine in
Seattle, go on to say that VA's policy outlines "a clear and systematic
process" for disclosure decisions regarding large scale adverse events
-a process that can include convening a multidisciplinary advisory board
with representation from diverse stakeholder groups and experts,
including ethicists. A co-author of the article is VA employee Mary
Beth Foglia, RN, Ph.D., of the National Center for Ethics in Health Care
and affiliate faculty at the Department of Bioethics and Humanities the
University of Washington.

The VA policy endorses transparency and expresses an obligation to
disclose adverse events that cause harm to patients. Its provisions can
include the convening of a multidisciplinary advisory board to review
large-scale adverse events, recommend whether to disclose and provide
guidance on the manner of disclosure.

The authors of the article conclude with the following observation,
which summarizes VA's philosophy on the matter: "Disclosure should be
the norm, even when the probability of harm is extremely low. Although
risks to the institution are associated with disclosure, they are
outweighed by the institution's obligation to be transparent and to
rectify unanticipated patient harm."

For additional information, contact the VA Office of Public Affairs
at 202-461-7600.

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