Richard Boothman had a leg up on most hospital risk managers when he came to the University of Michigan Health System in 2001. For more than 20 years he had represented doctors as a trial attorney, and he knew enough about malpractice juries not to be afraid to admit that a mistake had been made. “If we apologize to a patient for a medical error, we should mean it, and we should be ready to repeat that apology to a jury if the patient decides to sue,” says Boothman, chief risk officer for the hospital system.

In one case, a jury was told that a mistake by a University of Michigan phlebotomist had resulted in a patient receiving seven units of the wrong blood type, which gave him flulike symptoms for three days. “We told the jurors about the changes we had made to prevent a repeat of that mistake and asked that they evaluate the damages,” says Boothman. The patient had asked for $250,000 in compensation; the jury, perhaps swayed by the hospital’s openness as well as by the relatively minor harm to the patient, returned a verdict of zero.

Claims against the hospital have been steadily decreasing, and though Boothman can’t be sure why, he says the university system’s policy of open disclosure may intercept patients before they feel the need to file a suit. In August 2001, 262 medical malpractice claims were pending against the University of Michigan, compared with just 83 in August 2007.

In another incident, a University of Michigan pathologist interpreted a biopsy of a patient in her seventies as a recurrence of lung cancer, and the patient’s physician broke the news that she might have as little as six months to live. Two years later, the patient was still alive, and the hospital discovered the pathologist had erroneously read an inflammation of her lymph nodes as cancer cells. “We could have let her believe she was a medical miracle, but we decided to tell her the truth,” says Boothman. He stresses, however, that the decision to disclose was made only after other pathologists confirmed the error.

“If half of the pathologists we consulted had read the biopsy as a recurrence of cancer, I’m not sure we would have apologized,” Boothman says. Although the patient initially claimed her emotional distress was worth $250,000, she ultimately accepted the university’s offer of less than $100,000. And because the hospital instituted a system of randomly double-checking pathology results, she returned as a patient.