The Profession of Law: Columbia Law School\u27s Use of Experiential Learning Techniques to Teach Professional Responsibility

Columbia Law School\u27s ethics course, The Profession of Law ( POL ), is an interactive, experiential exploration of lawyer ethics. The course, required for all third-year students, is taught on an intensive basis during the first week of the fall semester. It begins on Monday morning, the first day of the semester, and runs through mid-afternoon on the following Friday. The course has five goals: to introduce students to the rules that govern professional conduct; to help them develop an analytic framework for making ethical decisions in those broad areas where the rules do not give clear answers; to provoke them to think about what it means to be an ethical practitioner; to help them explore the relationship between their personal morality and professional ethics; and to give them the opportunity to practice ethical decisionmaking

Introduction to the Symposium Issue on Alternative Dispute Resolution Strategies in End-of-Life Decisions

At about 8:30 p.m. on a spring evening approximately twenty-five years ago when I was living in Newton, Massachusetts, our telephone rang. It was the emergency judge on duty that week asking me to go to a nearby suburban hospital to represent a sixty-eight-year-old woman whom I\u27ll call Mrs. P. She had been hospitalized for heart failure and was refusing treatment, saying that she wanted to die with dignity. Mrs. P and her husband had traveled to Boston from her home, a small town in New York about five hours away, to meet their newest grandchild. When I arrived at the hospital, the judge, her clerk, my client\u27s husband, her ten-day-postpartum daughter, and the hospital attorney had already gathered. I was introduced to them and given a bit of background. I learned that the patient had been treated for congestive heart failure for some period of time before her trip to Boston and that she had also received treatment for psychiatric problems. Soon after her arrival in Boston, she took a turn for the worse and went to the hospital. It turned out she had forgotten to bring her heart medication with her, but did not tell anyone until she became weak and disoriented. Earlier in the day her vital signs had begun to worsen. She was refusing intramuscle injections of medication that had a high likelihood of saving her life and having her up and about in a short time. In addition, the nurses reported that she had been a difficult and demanding patient. According to the physicians, without treatment she was likely to die within the next twenty-four to forty-eight hours

Mediating Medical Malpractice Lawsuits: The Need for Plaintiff and Physician Participation

At this moment in history, tort reform and new approaches to resolving medical malpractice claims are part of the national debate about how to improve health care. Federal funding is available for pilot projects to test new approaches to medical malpractice litigation. There is increased pressure from health care regulators to disclose adverse events and communicate better with patients and their families. These all present opportunities to increase the use of mediation, particularly to address medical malpractice lawsuits and to improve patient safety. For the past seven years, we have been studying ways in which mediation and mediation skills can resolve health care disputes in a way that enhances patient safety and quality of care. We have discovered that conventional ways of thinking, unjustified fear, and institutional and professional culture are all barriers to realizing the full benefit of mediation. Hospital leaders and lawyers need to rethink conventional ways of responding when a patient is harmed by medical care. In particular, attention should be given to ways to bring not only lawyers but also patients, family members, and especially physicians to the mediation table. As the use of mediation in health care increases mediators have a special opportunity, and therefore a responsibility, to educate participants about the full range of benefits available through mediation and to encourage participants to think about how what they earn during mediation can contribute to patient safety

What Happens When Mediation is Institutionalized?: To the Parties, Practitioners, and Host Institutions

The Alternative Dispute Resolution Section of the Association of American Law Schools presented a program, at the 1994 AALS Conference, on the institutionalization of mediation – through courtconnected programs and otherwise. The topic is an important one, because this phenomenon has become increasingly common in recent years. Moreover, the topic seemed especially appropriate for the 1994 program, since Florida – the host state for the conference – was one of the first states to adopt a comprehensive statute providing for court-ordered mediation (at the trial judge\u27s option) in civil disputes of all kinds. The move toward institutionalizing mediation has raised many questions, and this program was designed to highlight those questions, and provoke this discussion about them. The panel for the program was composed of mediation scholars, teachers and practitioners, from eight diverse jurisdictions around the country, with expertise on many different aspects of the institutionalization issue. The program was organized by Professor Baruch Bush (Program Chair), together with Professor Carol Liebman (Section Chair) and Dean James Alfini (Panel Moderator). This article presents an edited transcript of the panelists\u27 comments

The Profession of Law: Columbia Law School\u27s Use of Experiential Learning Techniques to Teach Professional Responsibility

Columbia Law School\u27s ethics course, The Profession of Law ( POL ), is an interactive, experiential exploration of lawyer ethics. The course, required for all third-year students, is taught on an intensive basis during the first week of the fall semester. It begins on Monday morning, the first day of the semester, and runs through mid-afternoon on the following Friday. The course has five goals: to introduce students to the rules that govern professional conduct; to help them develop an analytic framework for making ethical decisions in those broad areas where the rules do not give clear answers; to provoke them to think about what it means to be an ethical practitioner; to help them explore the relationship between their personal morality and professional ethics; and to give them the opportunity to practice ethical decisionmaking

Medical Malpractice Mediation: Benefits Gained, Opportunities Lost

In the past decade, the United States healthcare system has begun to use mediation to facilitate communication between patients and physicians after an adverse medical event, to ease tensions among members of care-giving teams, to resolve medical malpractice claims, and to help family members and medical professionals make awesome and wrenching decisions at the end of life. Implementation of the Patient Protection and Affordable Care Act of 2010 will produce new controversies and increase the need for mediation. Patients, families, physicians, nurses, other healthcare professionals, and administrators will require help managing the disagreements that arise as they adapt to the altered healthcare system. The Department of Health and Human Services understands this. The Agency for Healthcare Research and Quality recently announced seven grants as part of the Patient Safety and Medical Liability Initiative. Four grants, totaling $10 million, went to programs focusing on the interactions among patient safety goals, the litigation system, and physician-patient communication. Intelligent use of mediation and mediation skills can help us achieve a safer and more efficient healthcare system. But for mediation\u27s potential benefits to be obtained, government officials and healthcare professionals must decide how conflict should be handled and what the role of lawyers should be when difficult physician-patient communications are required. The potential benefits from mediation are significant: improved patient safety; teamwork; relationship repair; and financial savings for physicians, hospitals, and patients. But achieving those benefits requires understanding of what recent scholarship has reported about successful and unsuccessful uses of mediation in the world of healthcare and sophisticated training of healthcare professionals, so that they can make informed decisions about when to use mediation and how to participate effectively in mediation. This article will review two recent studies evaluating the use of interest-based mediation to resolve medical malpractice claims. The first studied cases brought against the New York City Health and Hospitals Corporation (the HHC study); the second, Mediating Suits against Hospitals (the MeSH study), studied cases brought against private New York City hospitals. The article will then consider how non-participation of physicians in mediations diminishes opportunities to achieve noneconomic goals that plaintiffs desire

Introduction to the Symposium Issue on Alternative Dispute Resolution Strategies in End-of-Life Decisions

At about 8:30 p.m. on a spring evening approximately twenty-five years ago when I was living in Newton, Massachusetts, our telephone rang. It was the emergency judge on duty that week asking me to go to a nearby suburban hospital to represent a sixty-eight-year-old woman whom I\u27ll call Mrs. P. She had been hospitalized for heart failure and was refusing treatment, saying that she wanted to die with dignity. Mrs. P and her husband had traveled to Boston from her home, a small town in New York about five hours away, to meet their newest grandchild. When I arrived at the hospital, the judge, her clerk, my client\u27s husband, her ten-day-postpartum daughter, and the hospital attorney had already gathered. I was introduced to them and given a bit of background. I learned that the patient had been treated for congestive heart failure for some period of time before her trip to Boston and that she had also received treatment for psychiatric problems. Soon after her arrival in Boston, she took a turn for the worse and went to the hospital. It turned out she had forgotten to bring her heart medication with her, but did not tell anyone until she became weak and disoriented. Earlier in the day her vital signs had begun to worsen. She was refusing intramuscle injections of medication that had a high likelihood of saving her life and having her up and about in a short time. In addition, the nurses reported that she had been a difficult and demanding patient. According to the physicians, without treatment she was likely to die within the next twenty-four to forty-eight hours

Medical Error Disclosure, Mediation Skills, and Malpractice Litigation: A Demonstration Project in Pennsylvania

In the past decade, the cost of medical malpractice insurance has skyrocketed in Pennsylvania. Physicians in high-risk specialties are reported to have moved out of the state, closed their practices, or retired, particularly in eastern Pennsylvania. Liability insurance companies have pulled out of the state. At the same time, serious medical errors continue to occur. Doctors and hospital officials, afraid of lawsuits and loss of insurance coverage, often stonewall patients and relatives, offering only barebones explanations of serious medical errors. Research shows this situation creates a vicious circle in which frustration, anger, and a search for information often motivate patients or their families to file medical malpractice suits. Against this backdrop, the Project on Medical Liability in Pennsylvania, an independent initiative financed by The Pew Charitable Trusts, developed the Demonstration Mediation and ADR Project in 2002 to explore the value of mediation and open, frank communication about medical errors as a means to avoid bitter and protracted lawsuits. The demonstration project, designed and conducted by faculty of the Columbia Law School in New York, involved three hospitals in eastern Pennsylvania and was based on an extensive review of existing research. Shortly after the demonstration project began, its potential findings gained significance because Pennsylvania enacted Section 308 of the Medical Care Availability and Reduction of Error Act. This law, the first of its kind in the United States, requires hospitals to give written notice to patients or their family after a “serious event.” In effect, the state now obligates health care providers to explain the circumstances and repercussions of serious health complications caused by inpatient medical errors

Disclosure and Fair Resolution of Adverse Events

The health care system in the United States is in turmoil. Patients are being harmed by too many, often fatal, mistakes. At the same time, physicians and hospitals are trying to cope with a costly medical malpractice crisis. These two crises create a vicious cycle. When something goes wrong in patient care, physicians and hospitals withhold apologies and offer as little information as possible for fear that anything they say may be used against them should patients or family members sue. Family members, in many cases, sue not only to receive compensation for injuries, but also in search of answers and explanations and because no one has said, “I\u27m sorry.” Each new suit reinforces providers\u27 fears and inhibits the sort of conversation and exchange of information with patients and colleagues that might restore trust and prevent errors being repeated, thereby decreasing lawsuits. This chapter explores ideas developed as part of the Pew Demonstration Mediation and ADR Project (“ADR Project”) to help break the cycle. Between 2002 and 2004, the ADR Project conducted a participant observer study that examined how mediation and conflict resolution skills might be helpful in disclosing adverse medical events and, when appropriate, reaching fair resolution of resulting claims for compensation. We focused on how those skills could be used to repair ruptured relationships between patients and physicians, to turn conversations about what went wrong into opportunities for learning about ways to improve patient safety, to include patients and their families in discussions about safety, and, when appropriate, to provide patients fair and timely compensation for their injuries