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or potential wrongdoers who might otherwise be tempted to ignore public obligations. Stevenson agrees with O'Brien's points, saying class actions allow for the hearing of cases that might not have been heard in the past. "We're now getting cases that historically were not pursued due to the costs of going to court." But the number of cases against health-care providers is isolated when compared to those against pharmaceu- tical companies or medical device man- ufacturers. "The main thing is access to justice for people who were previously disenfranchised," says Stevenson. An article in the May 26, 2009, Canadian Medical Association Journal stated disclosure of timely informa- tion to patients faces institutional barriers when it comes to address- ing errors involving multiple patients. "Transparency needs to trump con- cerns about increasing legal liability," it said. Authors doctors Roger Chafe, Wendy Levinson, and Terrence Sullivan wrote errors can be mitigated through six steps: • Identifying the error in a timely fashion. They advise this step is typi- cally taken due to concerns raised by medical staff or patients about the qual- ity of care given to a group of patients. • Conducting a review of an appro- priate sample of records or procedures to determine the extent of the error. • In cases where a full review is needed, identifying a project and estab- lishing the review's scope and resources needed. • Identifying affected patients and including their records in the review. • Reviewing clinical records. When an error in laboratory or diagnostic testing has occurred, a review should determine whether the resulting diag- nostic report affected the clinician's decisions, the appropriateness of care provided, and its outcomes. • Informing patients and other stakeholders such as affected hospital personnel, external authorities, insur- ers, family physicians, other health-care institutions, and the public. They sug- gest affected patients need to be fol- lowed up individually by the physician. "Institutional accreditation bodies are well-positioned to play a key role by requiring that organizations adopt such policies," the paper concluded. This is something Bussey and Boone agree on. "They can't walk away from it," says Boone. "They have an obliga- tion to the people who are suing them cies and developing disclosure pro- tocols. That's the approach of British Columbia's Interior Health Authority, says risk management corporate direc- tor Patty Glaim, who says such policies and procedures for critical incidents are needed "to make sure we are doing the right thing in terms of disclosure, to make sure . . . they don't hap- pen again, and make sure the patient has all the information to make sure they know what is going to happen to them." The IHA, like many other health authorities, has policies on inci- dent management and disclosure on Oftentimes people are getting health care from the people they're suing. The more emotionally invested people are in a class action, the more diffi cult they are to resolve. DANIEL BOONE, Stewart McKelvey but also to the general community." Boone adds that such cases often take on a political component, as the case information is available to the public. Stevenson says another interesting twist is the Internet, which has changed the face of medicine and the law. With patients now able to search situations online, they have another tool to pur- sue their own best interests. That said, many class actions are driven either by activist patients or activist lawyers. Either way, the attention of those in the medical industry is going to be gained and problems ultimately examined. The CMAJ says professional asso- ciations, government agencies, and accreditation bodies can assist health- care organizations in adopting poli- adverse events. The Canadian Medical Protective Association suggests those policies be in place for medical prac- titioners as well as management and leadership teams. In order to mitigate in adverse events, the CMPA suggests develop- ing policies and procedures to support quality improvement. This, it says, should include reporting of adverse events and close calls, and ensuring these are understood by health-care providers and followed by manage- ment and leadership teams. It also sug- gests implementing policies and pro- cedures separating systems-oriented quality-improvement reviews in sup- port of patient safety from account- ability reviews focusing on the actions INHOUSE APRIL 2010 • 33