Things go wrong in hospitals. Doctors make mistakes. People who need surgery and other procedures face real risks that can cause unfortunate outcomes, even if no mistakes get made.
No one disputes these facts. But when things do go wrong, the medical profession clamps down on information, making it virtually impossible for patients, or their families -- sometimes even other hospitals or medical boards -- to find out whether the outcome was unavoidable or the result of substandard care, say consumer advocates and trial lawyers.
The flaw lies in a complicated, often ineffective reporting system and laws that give hospitals the right to keep internal investigations confidential.
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Other actions that would improve patient safety include stricter criteria for reporting doctors to medical boards, stiffer consequences for failing to do so and more public disclosure of actions taken to discipline doctors, say patients' families and advocates.
In addition, some are calling for a ban on confidentiality agreements. South Carolina last year became the first state to outlaw gag orders in medical malpractice cases.
"One of the primary roles of a lawsuit is disclosure of information to have a deterrent effect that forces hospitals to clean up their acts and become safer," said Joanne Doroshow, executive director of the Center for Justice and Democracy, a New York-based consumer-rights group.
"The more that's put into darkness," she said, "the more liability there is for unsafe conditions."
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