Bioethical mediation promotes healing of patients, family and staff

August 15, 2011

Good Samaritan's mediator is a minister and former judge

FSCC HEALTHCARE MINISTRY

What happens when hospital staffers disagree among themselves on the medical treatment of a patient?

Suppose family members believe the hospital made a mistake while caring for their loved one. What if a mistake was made?

All of these scenarios could be an appropriate opportunity for bioethical mediation, says Rev. Vickie Kumorowski, director of spiritual care at Good Samaritan Medical Center in South Zanesville, Ohio. Kumorowski has mediated a number of conflicts at Good Samaritan and believes wholeheartedly in the process, which was first developed in 1978 at Montefiore Medical Center in New York.

Kumorowski has solid credentials for her work in conflict resolution. In addition to taking university courses in mediation and health care dispute resolution, she is a former attorney who spent 20 years practicing law and then four years as a state trial judge in Kansas. While pursuing a judicial studies degree, she explored the ethical issues arising from the human genome project as her thesis. That led her to the study of more spiritual issues and eventually she became an ordained minister in the Disciples of Christ. 

Active listening
Bioethical mediation is described as a nonjudgmental, nonbinding, confidential process that respects the views of all parties involved and seeks to quickly resolve issues and conflicts within a hospital setting.

"We bring everyone in" when there's an unresolved medical issue, says Kumorowski. "I have found that if people feel heard, that's what makes all the difference in the world."

Employees at Good Samaritan know that they can call Kumorowski at any time. If a patient is critically ill or near death and there is an unresolved conflict, mediation may need to happen quickly and can be informal, says Kumorowski.

Nurses and doctors at Good Samaritan have received some training on when mediation is appropriate, but Kumorowski hopes to receive grant money to do more training, not only on the mediation process but also to teach other staffers to be mediators. The hospital's director of mission, Sr. Maureen Anne Shepard, OSF, also has taken a course in mediation and plans to serve as a backup mediator, says Kumorowski.

When called in to mediate, typically the first thing Kumorowski does is to review the treatment given to a patient and investigate the details of what happened by talking with staff. She is not there to make judgments, but rather to gather facts.

"I try to understand what the issues are," says Kumorowski. "It's really important to remain open-minded."

She also talks to family members and the patient, provided the patient is coherent and communicative, to get their side of the story in a patient-staff conflict. Then she brings together the doctors and nurses involved in caring for the patient and the family members. Sometimes the meeting is held in the patient's room. 

Clearing the air
"The first responsibility of a mediator is that everyone understands the medical facts," says Kumorowski. Family members are encouraged to ask questions, and everyone gets a chance to express their opinions. Kumorowski then seeks a resolution to whatever conflicts exist.

Kumorowski recalled the case of a patient who underwent heart surgery at a hospital where Kumorowski had worked previously. The surgery went well, and the patient recovered. But shortly after he went home he developed severe lung problems, unrelated to the surgery, and had to be readmitted to the hospital.

After the comatose patient had been on a ventilator for several days, the patient's wife asked that her husband be given "comfort care" rather than being kept on the ventilator. Her husband had made it clear to her beforehand that he didn't want to remain on life support, Kumorowski recalls. The pulmonary specialist also felt there was no hope of recovery for the patient, but the patient's cardiologist "wanted to do everything in his power to save him," says Kumorowski. "It was very hard for him to let go." So Kumorowski brought the patient's two sons, the cardiologist and the pulmonologist together. The wife elected to stay by her husband's bedside. Once the cardiologist heard the full extent of the patient's lung problems, he understood the wife's position and changed his stance on treatment.

"It was a very healing experience, to have that kind of understanding" among the parties involved, especially for the cardiologist, says Kumorowski. "I thought it took a lot of courage for him to say, 'I understand where (the wife) is coming from.'" 

Owning up to mistakes
Mediation also can be useful in cases in which a hospital has made a medical error. There is evidence that when a hospital admits error, apologizes to the family and takes steps to avoid that error in the future, that family is more likely to accept a settlement offer and less likely to go to trial on a medical malpractice claim.

"People need to hear that you're sorry," says Kumorowski. "Families want to know that their loved one's life made a difference, and that this won't happen to anyone else." Sometimes, there may not have been an error, and that needs to be explained, too, so that families understand when an adverse medical outcome wasn't anybody's fault, Kumorowski adds.

Being open about errors also helps a hospital to prevent them in the future, adds Kumorowski. 

De-escalating problems
Dr. Richard Tuck is a pediatrician at Good Samaritan who also chairs the ethics committee for Genesis HealthCare System in South Zanesville, a system that includes Good Samaritan. Tuck says one of the strengths of mediation is that it can quickly resolve medical conflicts that if left alone, can fester and become a crisis. Unresolved turmoil over a patient's care, especially cases in which a patient has died, affects not only patients' families but hospital staffers too.

"Often these things come up, and they need to be dealt with, literally immediately," says Tuck. "The emotional level is very high, not only for patients and families but for support staff and physicians as well."

The biggest challenge in mediating conflicts is making doctors and medical staff aware of the process and its potential for helping them, says Tuck. "Doctors tend to be individuals who would like to ignore" mediation. Then a conflict "reaches a point where it can't be ignored."

Tuck says Good Samaritan did a role play about mediation during the hospital's lunch hour that seemed to be very effective in reaching doctors, not only mentally but emotionally. The scenario involved staffers acting the parts of parents who rush to the hospital to face an emotionally horrifying situation in which their teenage son has been in a car accident and is brain dead. In the role play, they discover their son had signed an organ donation card, but the parents are divided on whether to honor their son's wish.

Tuck said Kumorowski then showed how a mediator can be helpful in resolving such conflicts, and she asked the staff audience for their ideas on how they would resolve such an emotional issue.

Kumorowski sees the hospital setting as a place where a dynamic web of relationships creates "a healing community."

"In the mediation process, the patient is a person, not just a liver problem," says Kumorowski. "We're dealing with issues that are so sensitive and so deep and so profound. That's what I've tried to advocate here, to use mediation as a tool to promote a better healing of patients and their families."

 

Copyright © 2011 by the Catholic Health Association of the United States
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