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While most risk managers would just as soon stay out of a courtroom, Jeannie Sedwick sees the opportunity as another weapon in her loss control arsenal.

Not that she welcomes the experience, but when Wake Medical Center faces a lawsuit by a patient, family member or hospital visitor, Ms. Sedwick is there to glean as much information as she can to help prevent similar claims that could lead to litigation.

And, she's on hand so employees called to testify don't feel abandoned by their employer.

As director of risk management, "I'm the representative who goes with the attorneys," Ms. Sedwick pointed out.

"I am there to make sure our witnesses get there when we need them, to prepare our employees for testifying in court and to give them moral support. They need a familiar face in the courtroom. And the jury needs to see a person who represents the hospital as opposed to just having an entity represented at a table," she explained.

Making the most of the litigation, whether a case is won or lost, means using the experience to prevent similar claims from occurring.

Therefore, after a trial, in a "very non-threatening way," staffers who testified are asked to participate in a presentation to their department or another area to share the experience, Ms. Sedwick explained.

It's an opportunity for other workers to learn from the perspective of a fellow employee what it's like to testify and what the employee believes he or she could have done differently, she said.

Ms. Sedwick will make a presentation if an employee is uncomfortable about participating. "We can do it from a risk management aspect. We think it's important to come back and to share that information and to learn from it."

She pointed out that "during any trial or preparation for trial or even just coming to an agreement through mediation, you identify where your strengths are in a case and you identify where your weaknesses are," Ms. Sedwick said.

"And it's important after that process is complete" that management and employees are aware of those strengths and weaknesses, she added.

Ms. Sedwick's strategy in heading off malpractice claims also involves an early warning system that can tip a plaintiffs attorney's hand.

If an attorney requests a copy of a patient's medical records or X-rays, that request is also forwarded to the risk management department.

"We have a hot list," Ms. Sedwick said. "We know the attorneys who typically do medical malpractice."

When a request is received, if there is no incident report or problem documented as part of the patient's treatment, Ms. Sedwick's department reviews the patient file to try to determine why an attorney would be interested in the case.

Other departments also tip Ms. Sedwick when a problem could be brewing.

Patient complaints and requests for records are forwarded to her office from the hospital's business office and physicians notify the risk management department of patient problems or lawsuits they are facing.

Physicians call and "tell us if they had a family that's real upset or concerned or whether they feel like a nursing error has occurred," Ms. Sedwick said, "or if they have issues they feel like risk management can come up and help them with. I've had physicians call me and say, 'Look, go talk with this family, we had an accident in surgery and I need to know the best approach to take. I need to talk with my insurance company, too, but I thought the hospital needed to know what I'm about to tell them. "

Ms. Sedwick also works to keep defense costs down by monitoring those costs and helping determine which services are actually worth the money.

When defense attorneys submit bills to the hospital's insurance company, a copy also goes to Ms. Sedwick and the hospital's in-house attorney. "The hospital attorney has looked at things and negotiated changes in the bill," she said.

Reviewing the bills "makes you more aware of what the charges are and how you can more efficiently deal with your attorney," she said. "Do you really need to have a meeting or will a conference call work? Are you going to have attorneys who are out of town or in town? Are you paying their travel time? How many attorneys have to go to depositions in San Francisco from the East Coast?"

Watching the bills "makes us real sensitive to what legal expenses are and what we try to do is control it," Ms. Sedwick explained.

Because of the facility's sensitivity to loss control, there haven't been any huge damage awards. "Our loss experience is extremely good," Ms. Sedwick said, and liability claims have never pierced the hospital's excess layer.

"And really, it's the philosophy here," she explained. "If you create a safe environment and your employees are not afraid to tell you a mistake has been made, then you have the opportunity to go in to the family and the patient and say, 'What can we do to make this situation right? "

Ms. Sedwick pointed out that "when people feel like you're not trying to cover something up, that you're not trying to make it difficult for them, most of the time they're reasonable."