Apology Laws & Medical Decisions Essay

As young children we are taught the golden rule – to treat others
how we would like to be treated.1 When that does not happen we are
told to apologize.2
It is irrelevant whether our wrongful acts or words
were done accidentally or purposefully.3 What matters is that we
recognize and acknowledge the aggrieved individual’s feelings,
express our sympathy, and sincerely apologize. These life lessons we
learned in kindergarten are equally important for us to carry with us
as adults. Unlike what we may want to believe, adults are not very
different from young children in this respect. We like to think that, as
adults, we are better communicators than children.Apology Laws & Medical Decisions Essay

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The truth is,
adults can conjure up just as many excuses not to apologize – no one
is around to tell them to apologize. Adults simply have their
conscience, which is influenced by what is put into that conscience,
to nudge them in the right direction. Long gone are the days when we
were yelled at by our parents for giving a backhanded apology to our
sibling – which was sometimes worse than giving no apology at all.
However, we still like to pass blame, make excuses, and avoid any
sense of vulnerability when a mistake occurs. It can seem easier to
hide behind a veil of justifications, excuses, and fears.
This veil we hide behind to avoid apologizing is also used by
physicians in the medical environment. Although physicians may feel
the need to apologize after an adverse medical event, physicians’ gut
instincts to apologize are often hampered by the fear that their
statements will be used against them in court.
4 This fear is further

Healthcare costs are a growing popular concern in the United States. Many reports
identify the rising number of medical malpractice lawsuits, the corresponding increase in
medical malpractice insurance premiums, and the widespread practice of defensive medicine as
the main factors that contribute to the rising cost of health care.1
In response, national and state
legislatures have proposed and enacted legislation to put into place a number of reforms,
including jury award caps, insurance premium price caps, state medical malpractice funds,
greater information disclosure, and of particular relevance to the current paper, apology
exemptions. In 1986, Massachusetts became the first state to adopt some form of an apology law,
which was designed to protect doctors from statements they might make to their patients
regarding complications the patient suffered under their care. More recently, these apology laws
specifically declare that a statement of apology made by a medical practitioner to a patient is
inadmissible as evidence of liability in court. In September 2005, then-Senators Clinton and
Obama cosponsored the National MEDiC Act, which would have implemented such exemptions
at a national level. As of January 2009, 36 states have implemented various forms of apology
laws.
State apology laws are premised on two stylized facts. The first fact is that doctors would
like to apologize to their patients for medical mistakes, but are stymied by their fear of inviting a

1
For more discussion and overview on medical malpractice see Sloan and Chepke’s (2008) book Medical
Malpractice.
1
lawsuit. Research shows that doctors are typically told to avoid admissions of fault and
apologies because of the risk of lawsuits (Lamb et al., 2003; Novack et al., 1989; Pinkus, 2000).Apology Laws & Medical Decisions Essay
The second fact is that a main motivation patients give when asked why they chose to sue their
doctors is anger, and that this anger would have been assuaged by an apology (Hickson et al.,
1992; May & Stengel, 1990; Vincent & Young, 1994). These two facts lead to a vicious cycle
that breaks down patient-doctor communication and thereby increases litigation costs. By
making apologies inadmissible as evidence in malpractice lawsuits, it is hoped that doctors
would communicate with patients more effectively, thus reducing patient confusion and anger in
the case of adverse complications and thereby reducing the cost of medical malpractice (Cohen,
2003).
To date, this paper is the first economic study to investigate the impact of the state-level
apology legislation on settlements and malpractice payments.2
In legal studies, apologies have
been found to have an important impact on the outcome of many legal cases. Unsolicited
apologies can have an impact on conviction rates as well as sentence and judgment sizes (Rehm
& Beatty, 1996). Some studies which give subjects hypothetical situations report that apologies
may reduce the subjects’ likelihood to litigate (Mazor et al. 2004; Robbenholt, 2003; Wu, 1999;
Wu et al., 2009). There are a few studies in the medical/legal literature that are similar to our
current research. These studies examined the apology programs in individual hospitals in
Pennsylvania (Liebman & Hyman, 2004, 2005) and Tennessee (Kraman & Hamm, 1999) and
found that programs that encourage effective apologies and disclosure of mistakes can
dramatically reduce malpractice payments. Most notably, the University of Michigan Health
Service reported that their per case payments decreased by 47% and the settlement time dropped

2 There is an extensive literature investigating the impact of tort reform on the speed of settlements and the amount
of malpractice payments (Browne & Puelz 1999; Danzon 1984, 1986; Durrance, 2009; Yoon 2001), but to our
knowledge, apology laws have always been ignored in past studies.
2
from 20 months to 6 months since the introduction of their 2001 apology and disclosure program
(Boothman, 2009). While the findings associated with hospital-level apology programs are
promising, one is uncertain of the generalizability of these results. The reason why the hospitals
in these studies decided to pioneer such programs could be endogenous, or there could be other
concurrent reforms at the hospital level, as such programs are often implemented by a
charismatic and reforming administrator. Therefore, the true effect of apologies on medical
malpractice litigation could be overestimated and the external validity of these studies is in
question.Apology Laws & Medical Decisions Essay
Our study examines the impact of state-level apology legislation. We use data from the
National Practitioner’s Data Bank (NPDB) Public Access File (2009), which includes the
universe of all medical malpractice payments made by or on behalf of a healthcare provider since
1991. Our analysis is conducted at two levels. The first is a difference-in-differences analysis
using the time variation from the staggered implementation of state-level apology laws to
investigate the impact on the total number of settlements and payments within a state-year. We
further explore the change of case composition by the severity of injury. The second is a duration
analysis on the impact of apology laws on time to resolution (i.e., how long it takes for a
malpractice suit to be resolved), which is conducted at the individual level. We further
investigate the impact of apology laws on settlement payments and how the size of this impact
depends on the severity of the patient’s medical injury. Similar to the concern raised earlier
about the hospital-level apology policy, one may be concerned that the passing of apology laws
at the state level could also be endogenous, which would result in a biased estimate. To address
these concerns we perform various robustness checks and the results remain consistent.
3
The analysis suggests that the apology laws could increase the number of closed
settlements by about 10–15% in the short run (3–5 years). One can attribute the increased
number of settlements to several reasons. Most notably, the increase can be due to an overall
increase in the number of claims or it could be due to faster settlement times. Consistent with
our theory, we find evidence that suggests that the overall increase in closed cases is due to faster
settlement times, while in the long run, the total number of lawsuits being brought forth is
declining. For example, on the subset of cases involving insignificant injuries—those cases
which are most likely to be resolved in the 3 to 5 years of available data—we see a 16–18%
reduction in total cases. When we investigate the impact of apology laws on the duration of cases
by the severity of medical outcomes, the hazard analysis results suggest that conditional on the
cases resolving before 2009, the cases with most severe outcomes settle sooner in states that have
the apology laws relative to states that do not. As for the dollar amount of the settlements, again
conditional on the cases resolving before 2009, apology laws reduce the settlement amount of the
most severe cases by $58,000–73,000 per case and the settlement amount of the “somewhat”
severe cases by $7,000–14,000 per case. In sum, we find that apology laws, at least in the short
run, induce faster settlements and lower payments for those malpractice cases brought by
patients who sustained the most severe medical injuries. Also, while we do not observe the
composition of cases that have yet to settle, the evidence suggests that these effects should
persist.
The remainder of the paper proceeds as follows: in Section 2, we provide background on
apology laws. In Section 3 we provide a model. Section 4 describes out dataset. In Section 5, we
discuss our empirical specification and present our findings. Section 6 concludes.Apology Laws & Medical Decisions Essay
4
2. Background of Apology Law
As of January 2009, apology laws had been enacted in 36 states, all of which were
enacted between 1999 and 2008 (except for Massachusetts, whose law dates to 1986). Table 1
lists all of the state legal codes pertaining to medical apologies.3
Table 2 shows that the timing of
other medical malpractice tort reform is generally not correlated with the passage of apology
legislation. Unlike other tort reforms, which have predominantly been a Republican issue
(Durrance, 2009), apology laws are not disproportionately supported by any particular political
party.4 While there is no hard data to substantiate the following claim, it is anecdotally accepted
that apology laws have been passed due to activist pressure rather than systemic changes in the
litigation environment, which means that apology laws are unlikely to be correlated with other
changes that affect litigation (e.g., tort reform).
5
[Insert Table 1 About Here]
[Insert Table 2 About Here]
State apology laws are very similar to one another as they tend to be copied from similar
templates. Connecticut’s apology law is a typical example. The Connecticut law states that:
In any civil action brought by an alleged victim of an unanticipated outcome of
medical care, or in any arbitration proceeding related to such civil action, any and
all statements, affirmations, gestures or conduct expressing apology, fault,
sympathy, commiseration, condolence, compassion or a general sense of
benevolence that are made by a health care provider or an employee of a health
care provider to the alleged victim, a relative of the alleged victim or a
representative of the alleged victim and that relate to the discomfort, pain,

3 California, Massachusetts, Florida, Tennessee, Texas, and Washington have general apology statutes that apply
across all industries while the other 30 States have specific laws that only protect the statements of apology made by
health care providers. The states can be first divided into two types depending on the applicability of these laws:
general versus health practitioners only. We perform an F-test checking whether we can group the general versus
health-care only laws together, the F-test fails to reject the null hypotheses that these two types of apology laws have
the same impact. Therefore, for the remainder of the paper, we are not going to differentiate between general and
health-care only apology laws.
4
In regressions not reported in the current paper, we find that political composition in the state Senate and state
House has no significant explanatory power on the passage of apology laws.Apology Laws & Medical Decisions Essay
5
See for example the efforts of the Sorry Works Coalition (Wojcieszac, Saxton, and Finkelstein, 2007).
5
suffering, injury or death of the alleged victim as a result of the unanticipated
outcome of medical care shall be inadmissible as evidence of an admission of
liability or as evidence of an admission against interest. (emphasis added)
Depending on the state, there is a slight variation in the types of statements that are protected by
these statutes. Protected statements typically include a combination of apology, fault, sympathy,
commiseration, condolence, compassion, and admissions of mistakes, errors, and liability. In the
legal literature, some studies divide apology laws into one of two categories: 1) full apology laws
that protect against all types of apologies including those that contain statements of fault,
mistakes, errors, and liability versus 2) partial apology laws that only protect against statements
of sympathy, commiseration, condolence, and compassion.
6 An F-test fails to reject the null
hypotheses that full and partial apology laws have the same impact. Therefore in our analysis, we
will not differentiate between full and partial apology laws.
3. Theory
To illustrate the mechanisms that we are analyzing, consider first the simplest possible
model of how doctors decide to apologize and how patients decide to litigate and settle. Previous
models of apologies (Ho, 2009) and litigation (Daughety & Reinganum, 1994, 2000; Farber &
White, 1994; Spier, 2005) have focused on asymmetric private information, but these
assumptions introduce considerable complications to the analysis that we will return to at the end
of this section.
Consider a situation in which there are two players: a patient/plaintiff (P) and a
doctor/defendant (D) who play a game of healthcare provision, apology, and litigation with the
following timeline:

6 The divisions between full and partial apology laws are arguably poorly defined. A paper by McDonnell and
Guenther (2008) reports eight states as having full apology laws, whereas an article by Morse (2009) reports only
five states as having full apology laws.
6
The patient’s health outcome, ℎ(, ),
7
depends on the doctor’s effort, , which can be
thought of as whether the doctor adhered to the standard of care, = ), but also depends on the
patient’s circumstances, which are represented by a noise term, ~(), and are unobserved by
the doctor when deciding effort. We will assume for now that the doctor always adheres to the
standard of care ( = ), but later we will consider the possibility that the doctor’s efforts may
depend on the incentives created by the threat of malpractice payments. The doctor then decides
whether to apologize ( = 1) or not apologize ( = 0).8
The cost of an apology for the doctor is that the apology can be used as evidence against
him/her in court. If litigation occurs, since the court cannot observe the doctor’s effort, we
assume that the expected judgment, ℎ, ,
9
is exogenously decreasing with better health
outcomes and exogenously increasing with the doctor’s apology (Sloan & Hsieh, 1990) since the
apology can be used as evidence (Rehm & Beatty, 1996). We consider the implications of
endogenizing the judgment size in Section 3.Apology Laws & Medical Decisions Essay
The benefit of an apology to the doctor is that it increases the psychic cost of litigation.
Numerous case studies suggest that anger is a main motivator for litigation that can overcome the
patient’s aversion to litigate (Hickson et al., 1992; May & Stengal, 1990; Vincent et al., 1994).

Physicians typically recall, with stunning clarity, the moment a patient’s treatment went wrong. Following an adverse event, physicians often are tormented by competing desires to apologize and instincts to forge ahead without acknowledgement. A patient’s decision to file a malpractice action may be triggered by the physician’s response to a problem − or lack thereof.Apology Laws & Medical Decisions Essay

The Washington Post highlighted contrasting tales of medical errors in which two patients suffered devastating consequences during surgery. Frustrated by a “white wall of silence” preventing her health care providers from articulating more than “’things didn’t go well,’” the first patient desperately committed to finding truth at all costs. In stark contrast, following his surgeon’s immediate explanation and apology for an error that rendered the second patient quadriplegic, the patient engaged in productive discussions with risk managers. The patient’s needs were met and his attorneys negotiated a confidential settlement without litigation.

Benefits of Apologies
Apologies may decrease feelings of frustration and anger that drive some plaintiffs to file lawsuits. A study published in the Journal of Patient Safety and Risk Management found that hospital staff and doctors willing to discuss, apologize for and resolve adverse medical events through a “collaborative communication resolution program” experienced a significant decrease in the filing of legal claims, defense costs, liability costs and time required to close cases. In 65% of the reported adverse events, no medical errors occurred. Events with medical errors were resolved by apology alone in 43% of the cases. Similar programs have cut the number of malpractice lawsuits and yielded dramatic litigation cost savings. In November 2017, consistent with studies demonstrating that resolution programs provide “an effective way to learn from medical errors and near misses, enhance patient safety, and improve the liability system,” the American Medical Association expressed support for this pre-litigation option.Apology Laws & Medical Decisions Essay

The practice of defensive medicine may create a perception of indifference as patients grapple with the impact of adverse outcomes. The “‘deny and defend’ model” has raised concerns due to expense, lack of transparency and error perpetuation. Modern programs aim to avoid litigation through prompt error disclosure, apology and compensation. Benefits of disclosure may include increased transparency, medical cultures supportive of clinicians facing adverse events, and enhanced patient safety due to discussions driven by acknowledgement and examination of errors.

“Apology statutes,” enacted in the majority of states, evidence legislative efforts to reduce medical liability, malpractice actions and related litigation expenses. Many states have changed laws “to exclude expressions of sympathy, condolences or apologies from being used against medical professionals in court.” Courts have addressed the admissibility of physicians’ statements, pursuant to “I’m Sorry” statutes, through the interpretation of statutory language or a focus on distinctions between “apologies” and “admissions of fault or liability.” See Stewart v. Vivian, 151 Ohio St. 3d 574 (2017); DeBussy v. Graybeal, 2016 Del. Super. LEXIS 616; Honey v. Bayhealth Med. Ctr., Inc., 2015 Del. Super. LEXIS 28; Strout v. Cent. Me. Med. Ctr., 2014 ME 77; and Lawrence v. Mountain Star Healthcare, 2014 UT App. 40.Apology Laws & Medical Decisions Essay

Advice of Counsel
While physicians may reduce malpractice litigation through improved patient communication, health care providers should seek advice from counsel as to best practices regarding discussions of adverse outcomes before such situations arise. Alternatively, a physician may apologize for the patient’s disappointment with an outcome and commit to investigating in an effort to share and address the patient’s concerns. Of course, any such commitment must be fulfilled to avoid exacerbating the problem and creating further resentment and dissatisfaction.

Studies of communication and resolution programs suggest that the risk of malpractice litigation and related costs may be mitigated by a health care provider’s apology to the patient or the patient’s representative(s) following a medical error or an adverse outcome. Such communications, however, should take into account jurisdictional variations with respect to the existence, language and scope of apology laws.

Medical treatments often pose a probability that the patient will suffer adverse health effects. The
probability of these adverse effects depend on the level of care exercised by the physician, which is not
observable by the patient. Adverse outcomes can lead to medical malpractice claims. However,
apologies by physicians can potentially provide a signal to the patient of the level of care, and
consequently will affect the rate of litigation and medical malpractice costs. This paper presents a model
of apologies and medical malpractice litigation and estimates the effect of state level laws regarding
medical malpractice and apologies.
In response to trends in malpractice lawsuits and malpractice insurance premiums, national and
state legislatures have proposed and enacted legislation to put into place a number of reforms, including
jury award caps, insurance premium price caps, state medical malpractice funds, greater information
disclosure, and of particular relevance to the current paper, apology exemptions. In 1986, Massachusetts
became the first state to adopt some form of an apology law, which was designed to protect doctors from
statements they might make to their patients regarding complications the patient suffered under their care.
More recently, these apology laws specifically declare that a statement of apology made by a medical
practitioner to a patient is inadmissible as evidence of liability. In September of 2005, then-Senators
Clinton and Obama cosponsored the National MEDiC Act, which would have implemented such
exemptions on a national level. As of January 2009, 36 states had implemented various forms of apology
laws.Apology Laws & Medical Decisions Essay
State apology laws are premised on two stylized facts. The first fact is that doctors would like to
apologize to their patients for medical mistakes, but are stymied by their fear of inviting a lawsuit.
Research shows that doctors are typically told to avoid admissions of fault and apologies because of the
4
risk of lawsuits (Lamb et al., 2003). The second fact is that a main motivation patients give when asked
why they chose to sue their doctors is anger; an anger that might have been assuaged by an apology
(Vincent, Phillips & Young , 1994). These two facts lead to a vicious cycle that breaks down patientdoctor communication and thereby increases litigation costs. By making apologies inadmissible as
evidence in malpractice lawsuits, it is hoped that doctors would communicate with patients more
effectively, thus reducing patient confusion and anger in the case of adverse complications and thereby
diminish the cost of medical malpractice by eventually reducing malpractice insurance losses and
premiums.

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Our study examines the impact of state-level apology legislation. Although we do not observe
actual apologies, the maintained assumption of this paper is that by reducing the consequences of
apologies, doctors would apologize more frequently. The purpose of apologies is to maintain the doctorpatient relationships. Our model presumes that patients care about their doctors’ intentions, but the
relationship between a patient’s health outcomes and a doctor’s intentions is fundamentally uncertain.
Patients are more inclined to sue a doctor with poor intention, (i.e., doctors who put in effort below the
standard of care). An apology is a signal that the bad outcome arose from bad luck rather than a lack of
effort.1
More apologies would therefore reduce litigation and speed up settlements. However, the law
could have perverse consequences. By reducing the cost of the apology, the laws could make apologies
less effective and therefore lawsuits may become more likely. Another unintended consequence may be
that patients may be induced to litigate more frequently if more apologies make patients better informed
about the extent and the cause of their injuries.
To disentangle these effects we use data from the National Practitioner’s Data Bank (NPDB) Apology Laws & Medical Decisions Essay
Public Access File (2009), which includes all medical malpractice payments made by or on behalf of a

1
A more extensive model of apologies based on signaling and asymmetric information can be found in Ho (2011).
In order to keep the focus on the litigation and maintain simplicity in the current article, we abstract away from
signaling by saying that an apology increases the psychic cost of suing a doctor, implicitly assuming the patients’
beliefs change.
5
healthcare provider since 1991. Given that the NPDB data set only consists of claims with positive
payouts, it does not contain information on open claims nor closed claims without payments. Therefore,
the dependent variable in most analysis would be the number of closed claims with positive payouts in a
state-year.
Our analysis is conducted on two levels. The first level is a difference-in-differences analysis
using the time variation from the staggered implementation of state-level apology laws to investigate the
impact on the malpractice closed claims frequency and malpractice compensation payout within a stateyear. We further explore the change of claim composition by the severity of injury. The second level of
analysis is a duration analysis on the impact of apology laws on time to resolution (i.e., how long it takes
for a malpractice suit to be resolved), which is conducted at the individual level. We further investigate
the impact of apology laws on claim payment and how the size of this impact depends on the severity of
medical injury.
The results from difference-in-difference would be biased if the passage of apology laws were
endogenous to malpractice trends within a given state, but our results remain consistent to various
robustness checks. The analysis finds that the apology laws increase the number of closed claims,Apology Laws & Medical Decisions Essay
particularly among cases involving the most severe medical injuries. One can attribute the increased
number of closed claims to several causes. Most notably, the increase can be due to faster resolution time
or an overall increase in the number of claims filed. Consistent with our theory, we find evidence that
suggests that the overall increase in closed cases is due to faster settlement times, while in the long run,
the total number of malpractice claims being brought forth is declining. For example, on the subset of
cases involving insignificant injuries—those cases which are most likely to be resolved in the 3 to 5 years
of available data—we see a 16–18% reduction in the number of closed claims. When we investigate the
impact of apology laws on the duration of cases by the severity of medical outcomes, the hazard analysis
results suggest that conditional on the cases resolved before 2009, the cases with most severe injuries
settle 19-20% faster in states that have the apology laws relative to states that do not. As for the claim
compensation payouts, again conditional on the cases resolved before 2009, apology laws reduce the
6
claim payouts of the most severe cases by $58,000–73,000 per case and the claim payouts of the
“somewhat” severe cases by $7,000–14,000 per case. In sum, we find that apology laws induce faster
resolution and lower payments for those malpractice cases brought by patients who sustained the most
severe medical injuries.2
The remainder of the paper proceeds as follows: Section 1 provides background information on
apology laws, in Section 2 we provide a model, section 3 describes out dataset, in Section 4 we discuss
our empirical specification and present our findings, and Section 5 concludes.
1 Background of Apology Law
As of January 2009, apology laws had been enacted in 36 states, all of which were enacted
between 1999 and 2008 (except for Massachusetts, whose law dates back to 1986).3

2
We would expect these reductions to lead to similar reductions in malpractice insurance premiums. Data on
medical malpractice insurance premiums was obtained from the Medical Liability Monitor Rate Surveys from 1995
to 2005. To make prices comparable, the data cover a typical contract based on coverage for a $1 million per
incident and $3 million per year cap. The impact of the apology laws on medical malpractice premiums for three
specialties—internal medicine, ob/gyn, and surgery—was also assessed, but these results turned up almost entirely
insignificant.Apology Laws & Medical Decisions Essay
This disconnect could be because medical malpractice insurance premiums are highly regulated and thus slow to
respond. While total medical malpractice payments were trending downward after 2001, total insurance premiums
continued to trend upward. Also, there appeared to be a great deal of inertia in insurance premiums, which often did
not change from year to year. Or it could simply be that our data lack the power to identify the differences.
3
The apology laws were initially identified using a search in lexis-nexis of state legal code using the words apology
and malpractice. Our list was confirmed from the website of the Sorry Works Coalition, an advocacy group
promoting apologies by physicians.
7
state legal codes pertaining to medical apologies.4
Unlike other tort reforms, which have predominantly
been a Republican issue (Durrance, 2009), apology laws are not disproportionately supported by any
particular political party.5
While there is no hard data to substantiate the following claim, it is anecdotally
accepted that apology laws have been passed due to activist pressure rather than systemic changes in the
litigation environment, which means that apology laws are unlikely to be correlated with other changes
that affect litigation (e.g., tort reform).6
Crucially, since studies such as Born and Viscusi (2005) and
Baker, Born and Viscusi (2009) find significant effects of tort reforms—and non-economic damage
awards in particular—affect malpractice payments, we find that apology laws are not significantly
correlated with other tort reforms, specifically noneconomic caps, punitive caps, laws on full information
disclosure, joint and several liabilities, and collateral source rules.
[Insert Table 1 About Here]
In a survey of hospital risk managers, Lamb et al. (2003) find that while 92% of managers
respond to mistakes with an explanation, and 87% would initiate an investigation, only 68% would
include an apology, and 33% accept responsibility. State apology laws have been enacted in order to Apology Laws & Medical Decisions Essay

4
California, Massachusetts, Florida, Tennessee, Texas, and Washington have general apology statutes that apply
across all industries while the other 30 States have specific laws that only protect the statements of apology made by
health care providers. The states can be first divided into two types depending on the applicability of these laws:
general versus health practitioners only. We use the specification in Table 3 but we create two dummies for the
general laws versus healthcare-only laws. We then perform an F-test checking whether we can group the general
versus healthcare-only laws together, the F-test fails to reject the null hypotheses that these two types of apology
laws have the same impact on claim frequencies and claim severity. Therefore, for the remainder of the paper, we
are not going to differentiate between general and healthcare-only apology laws.
5
In regressions not reported in the current paper, we find that political composition in the State Senate and State
House has no significant explanatory power on the passage of apology laws.
6
See, for example, the efforts of the Sorry Works Coalition.
8
increase these frequencies. State apology laws are very similar to one another as they tend to be copied
from similar templates. Connecticut’s apology law is a typical example. The Connecticut law states that:
In any civil action brought by an alleged victim of an unanticipated outcome of medical
care, or in any arbitration proceeding related to such civil action, any and all statements,
affirmations, gestures or conduct expressing apology, fault, sympathy, commiseration,
condolence, compassion or a general sense of benevolence that are made by a health
care provider or an employee of a health care provider to the alleged victim, a relative of
the alleged victim or a representative of the alleged victim and that relate to the
discomfort, pain, suffering, injury or death of the alleged victim as a result of the
unanticipated outcome of medical care shall be inadmissible as evidence of an admission
of liability or as evidence of an admission against interest. (emphasis added)
Depending on the state, there is a slight variation in the types of statements that are protected by these
statutes. Protected statements typically include a combination of apology, fault, sympathy,
commiseration, condolence, compassion, and admissions of mistakes, errors, and liability. In the legal
literature, some studies divide apology laws into one of two categories: 1) full apology laws that protect
against all types of apologies including those that contain stateme Apology Laws & Medical Decisions Essay

Apologies made by physicians for adverse medical events have been identified as a mitigating factor in whether patients decide to litigate. However, doctors are socialized to avoid apologies because apologies admit guilt and invite lawsuits. An “Apology Law,” which specifies that a physician’s apology is inadmissible in court, is written to encourage patient-physician communication. Building on a simple model, we examine whether apology laws at the state-level have an impact on malpractice lawsuits and settlements. Using a difference-in-differences estimation, we find that state-level apology laws could expedite the settlement process and increase the number of settlements by 15% within 3 to 5 years of adopting the laws. Using individual level data, we also find that apology laws have the greatest reduction in average payment size and the settlement time on cases with more severe patient outcomes. Ben Ho’s research links economic methods with insights from sociology and psychology to analyze social institutions. His research today is focused on how behavioral economics can inform the policy debate on climate change, and how social factors like identity and social networks influence our consumption decisions. His has also worked on an analysis of how apologies maintain relationships, and the role apologies play in medical malpractice lawsuits. He is a faculty fellow with the Cornell Institute for Social Sciences Project on Judgment and Decision Making, and an affiliate with Cornell’s Center for a Sustainable Future. Ho was the lead economist for energy and transportation at the White House Council of Economic Advisers. He received his PhD in economics from Stanford Graduate School of Business, and holds master’s degrees in education and political science from Stanford and electrical engineering/computer science from MIT, as well as bachelor’s degrees from MIT.Apology Laws & Medical Decisions Essay