FAQs
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A CANDOR law would protect the CANDOR communications from being subsequently disclosed in a related legal or administrative proceeding. Such protection would encourage immediate candid communications by physicians and hospitals with patients when medical care results in unanticipated outcomes. It would create a culture of transparency and encourage the medical team to expeditiously accept responsibility for errors. The process would promote both internal and external policy and procedure changes to prevent the same errors with other future patients.
The current CANDOR bill being considered by the Georgia General Assembly is HB 807. It can be viewed here.
Georgia Representative Sharon Cooper, who chairs the House HHS Committee, recently held a subcommittee hearing on the Georgia CANDOR bill. It was a day-long hearing with CANDOR experts from around the country:
Florence LeCraw, MD (Georgia);
Leilani Schweitzer (Nevada);
Karen Lorenzen, Esquire (Iowa);
Barbara Pelletreau, RN, MPH (California);
Jean Martin, MD, JD (Colorado);
Tim McDonald, MD, JD (California/Illinois);
Lorens Helmchen, PhD (Washington, DC); and
Doug Wojcieszak (Illinois).
The hearing was recorded and can be viewed here.
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Yes. CANDOR is not a mandated process, and the patient could elect to proceed with traditional litigation if not satisfied with the CANDOR process.
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Yes. Patients are encouraged to have legal representation throughout the process. In addition, a family member or friend is allowed too.
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The CANDOR process would promote a change of culture. It would remove “blame and shame” that clinicians currently feel exists, so that when there is an injury or “near miss,” instead of silence or “deny and defend,” those involved in the incident become proactive. They would be able to have candid communications will all persons involved, including the patient/family,-- so that the events that led to the incident can be retraced. The knowledge gained in the investigation can then be used to design interventions to prevent the same scenario from happening to future patients. See Van der Schaaf’s diagram which identifies opportunities for averting adverse events.
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Yes. Most incidents result from human error or systems errors, not from willful indifference or incompetence. Physicians want to do the right thing and will be much more willing to take part in CANDOR knowing that CANDOR communications have protection and participation and compensation will not automatically affect their careers via a negative report to the National Practitioner Data Bank (NPDB).
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No. A CANDOR law would not remove oversight of physicians. A hospital would still be reviewing incidents through the standard peer review process. Additionally, patients always have the right to file a complaint with the Medical Board. Certain actions by a hospital against a physician’s privileges, and certain actions by the Medical Board against a physician’s license, would still get reported to the NPDB.
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Yes. The CANDOR process could be used by all persons who provide patient care. It is not limited to physician care or even hospital care.
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Yes. A request by the patient, or his counsel, for the provider(s) to consider CANDOR discussion could be made via two methods:
1) The request could be made orally
2) The request could be made by an innocuous letter merely indicating that the patient would like to have discussion regarding the medical care provided to him.
If any written request comes with an allegation or claim of medical malpractice or a demand for payment, the CANDOR process could not be used.
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As explained by Ken Broda-Bahm, PhD, complete and proper apologies contain four components:
“ 1) Responsibility - I did it
2) Remorse - And I feel bad about it
3) Repair - So I’ll fix it
4) Reform - And I won’t let it happen again"
The current Georgia law would seemingly protect a physician's communication (as long as others are not present) that expresses responsibility and remorse, but the law does not expressly protect communications of repair (including offers of compensation) or reform (discussions of fixing the system so that it does not happen to other future patients). The CANDOR process is not one conversation, as the current apology law contemplates; it is a process that includes multiple communications and disclosures as knowledge is garnered over a period of time. More than just an apology, CANDOR involves seeking input from the patient, the transparent development of policy and protocols to improve patient safety, and offers of compensation, as appropriate. Legislation specific to the CANDOR process would also help promote the process as being sanctioned by the General Assembly.
Additionally, recent published analysis of state apology laws has determined that despite their intended purpose of decreasing malpractice claims, they are actually associated with an increased risk of litigation when the apology is not paired with a process for resolution such as CANDOR.
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