OR "Black Boxes" Coming, But Stupid Secrecy Persists...

Several years ago, I was speaking in Oklahoma and a veteran defense attorney came up after one of my talks and shared the following, "Doctors and insurance companies did the STUPIDEST thing in the world when they banned dads from videotaping in the delivery room, because most of the time those video clips proved the innocence of my physician client!  If, however, the video showed my client screwed up we settled those cases quickly and fairly.  Either way, the videos help me do my job!"

Since that time, there has been talk and even some legislative attempts at requiring video recording devices or "black boxes" (akin to airplanes) in operating rooms, without a lot of traction.  However, this week, The Wall Street Journal reported that so-called surgical black boxes are being tried out in several US hospitals and early feedback is positive.  Not surprisingly, the recordings help surgeons, nurses, and administrators make safety and efficiency improvements in the OR.  However, also not surprising, worries about litigation have crept into the picture with some of the same stupid musings we've endured through the years.  Consider these quotes from the WSJ article:

1) "Because the OR Black Box platform is set up to anonymize all data, it is extremely unlikely that data from the system could be used in cases of medical malpractice."

2) "...the data is deindentified and....makes it impossible for plaintiff attorneys to access any of the data.  He also notes that there are federal protections for the confidentiality of data from hospital quality-improvement initiatives." 
 
3) "The system's algorithms 'blur faces and cartoonify bodies' so that medical personnel and patients can't be identified." 

I can just imagine a plaintiff attorney dissecting one of the black box videos in front of a jury:  "Ladies and gentlemen of the jury, maybe you can help me pick out Dr. Smith, the surgeon, on this video clip?  Is he Mickey Mouse, Donald Duck, Goofy, or Dumbo?  I pick Dumbo...what do you think?" 

By blurring faces and even making cartoon characters of doctors and nurses, what kind of message does that send to juries?  Answer: This is a massive coverup because they are concealing their faces.  Which begs the next question: What else is the hospital hiding?   Horrible, horrible optics.  How can any intelligent person be so stupid and tone deaf?  And, no, as a non-lawyer, I cannot imagine these videos being protected under some sort of "hospital quality improvement initiative," as suggested in one of the quotes above.  If raw video footage can be withheld from litigation, then why can't the medical record itself be withheld?  It can't.  Interestingly, none of the three quotes above from the article were attributed to lawyers (two were from docs, one from a chief technology officer of a black box manufacturer).  Shame on the WSJ reporter for not seeking an intelligent quote from an experienced medical malpractice litigator.

Recording the OR and other areas of healthcare organizations represents a massive cultural shift with enormous benefits for safety, efficiency, and litigation -- but to get the benefits healthcare organizations have to be invested in disclosure and apology.  Organizations that practice disclosure and apology would be morally joined at the hip with the Oklahoma attorney I quoted at the beginning of this column.  The truth in the form of video footage is your best friend, either because it proves innocence (the docs and nurses did their job) or the video clearly shows mistakes and provides a road map to reconciliation and healing for all parties.  

Yes to OR surgical boxes.  No to goofy, non-sensical risk aversion practices being attempted with this technology.

Sincerely,

- Doug

Doug Wojcieszak, MA, MS
Founder and President
Sorry Works!
618-559-8168 (direct dial) 
doug@sorryworks.net