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"There is no reason the patient should have to pay the economic consequences for our mistakes," said Dr. Lucian L. Leape, an authority on patient safety at Harvard, which recently adopted disclosure principles at its hospitals. "But we're pushing uphill on this. Most doctors don't really believe that if they're open and honest with patients they won't be sued."

Handling mistakes

At the University of Illinois, doctors, nurses and medical students now undergo extensive training in how to respond when things go wrong. An anonymous tip line has helped drive a 30 percent increase in staff reporting of irregularities.

Quality improvement committees openly examine cases that once would have vanished into sealed courthouse files. Errors become teaching opportunities rather than badges of shame.

"I think this is the key to patient safety in the country," McDonald said. "If you do this with a transparent point of view, you're more likely to figure out what's wrong and put processes in place to improve it."

For instance, he said, a sponge left inside an obstetrical patient led the hospital to start X-raying patients during and after surgery. Eight objects have been found, one of them an electrode that dislodged from a baby's scalp during a Caesarean section in 2006.

The mother, Maria Del Rosario Valdez, said she was not happy that a second operation was required to retrieve the wire but recognized the error had been accidental. She rejected her sister's advice to call a lawyer, saying she did not want the bother and that her injuries were not that severe.

Valdez said she was gratified that the hospital quickly acknowledged its mistake, corrected it without charge and later improved procedures for keeping track of electrodes. "They took the time to explain it and to tell me they were sorry," she said. "I felt good that they were taking care of what they had done."

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