Candor Law Framework

Preliminary Process

Unexpected adverse patient outcome

  • Provider (unless patient is angry and requests alternative) meets with patient/family and discloses known information
  • Provider will follow-up with patient when more information available
  • Patient given contact info for PST member who will also follow-up with patient.

Patient Safety Team (PST)

Can include:

  • Patient safety representative
  • Chief medical officer
  • Peer support

PST member contacts patient/family

  • What is your understanding of what happened?
  • Did the doctor/provider answer your questions?
  • What questions do you still have?

Patient Safety Team

Internal meeting to discuss:

  • Incident with facts known
  • Patient/family current understanding
  • Provider perspective
  • Whether other providers are involved
  • If another provider/facility involved, is a joint approach appropriate
  • Provider meets with patient/family and may include PST member
  • Briefly discuss Candor process and provide Candor Informational Brochure/FAQs

At appropriate time (but within statutory notice period) follow up with patient/family with Candor forms to review:

  • Notice for Candor Open Discussions with relevant statutes
  • Patient Consent to Participate in Candor Open Discussions

Candor Process

  • If patient agrees and completes the consent, other parties may be involved who must acknowledge in writing the legal protections for the communications
  • HIPAA release for relevant medical records
  • Other parties that may be involved include family members and other patient supporters, legal counsel, liability insurance adjusters, PST members, other health care providers, and a Candor facilitator

Patient Safety Team

PST member maintains contact with patient/family throughout this process.

  • Ongoing investigation and record review
  • Review of systems issues
  • Discussions with other treating providers or their representatives as indicated
  • Expert review(s) as needed

Candor Meeting

  • A Candor meeting is scheduled with the patient/family and the treating providers at the completion of the investigation into the clinical care
  • A facilitator assists to allow each provider to speak regarding his or her own care and to allow patients and families to speak and to have their questions answered
  • Other parties may be present but this is primarily a discussion between the patient and the clinical team
  • Patients should learn about any changes made to prevent a similar occurrence and be encouraged to provide their insight into this process

Patient Safety Team

Soon after the Candor Meeting, the PST in concert with any other treating providers or facilities involved in the incident and their legal and liability insurer representatives should determine whether an offer of compensation is warranted and how this should be apportioned, as applicable

  • If there will be no offer of compensation, this must be orally communicated to the patient
  • If compensation is warranted the offer should be extended in writing
  • If a patient is not represented by legal counsel, they must be advised of their right to seek legal counsel regarding the offer:

Notice of Right to Seek Legal Counsel and Requirements to Repay Expenses Paid by Third Parties

  • A patient may be required, as a condition of an offer of compensation to execute all documents and obtain any necessary court approval
  • Alternatives to compensation or acts in addition to compensation should be considered
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