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someone must have done something wrong. If the communication is seen as evasive, the already damaged relationship between the medical professionals and the family is likely to be further harmed and the risk of litigation and the cost of settlement will increase. More research is needed on the impact of disclosure and apology, but our advice is always to disclose when harm has occurred for several reasons. First, it is the proper thing to do. Patients have the right – legal and moral - to know what has happened to them and why. They need that information in order make informed decisions about further treatment. In addition, full disclosure invites the kind of conversation with the patient and family members that can reveal critical information for avoiding recurrent harm. Further, if the hospital and health care provider have enough information to know that they caused the adverse event or medical error, an apology is warranted from both a pragmatic and an ethical standpoint. If fault is clear, an apology of responsibility should be offered. The best course of action is a clear explanation about what happened that adjusts the mediators in non- content and pace of discussion to the ability of the malpractice cases, we patient or family to absorb what is being said and have observed the damaging effect of allows time and opportunity for questions. At the mediation, the chief of medicine was able to listen empathically to the widow and respond with a full apology, acknowledging the hospital’s complete responsibility for the misdiagnosis and explaining exactly what treatment had been administered. He became the embodiment of the hospital for the plaintiff, which gave her the opportunity to express her rage and sadness and then her gratitude for his apology, his patience, and his clarifications. The widow at one point wondered whether events might have taken a different course had she been able to persuade her husband to go the ER immediately after his fall. She was reassured that she had done all that she could have and that had he gone to the ER the night of the accident it would have been too early for the bleed to show up on tests. The presence and participation of the chief of medicine was healing for the widow, which probably could not have been accomplished by the hospital’s attorney or risk manager. His stature and his commitment of time to the mediation eloquently conveyed the hospital’s determination to accept responsibility and learn from its mistakes. Early in the negotiation, the chief of medicine indicated in private session that he was not satisfied with simply working out a monetary settlement. It was important to him to give meaning to the loss of life. He suggested that the hospital fund an annual lecture in memory of the deceased. The plaintiff seemed moved by the idea and ultimately decided that a lecture would be an excellent memorial and that it should be on emergency medicine. This mediation lasted five and a half hours. Attending were the plaintiff, her brother, her lawyer, defense counsel, the chief of medicine, the director of risk management, and two representatives from the hospital’s insurance company. The hospital representatives were willing to apologize, at the beginning of the mediation, although not necessarily to admit legal liability. The hospital representatives looked for ways to restore ruptured relationships and learn more about how systems had failed as they also worked out a fair monetary offer. Consider once again the case of Mr. B who died after the insertion of a subclavian central line collapsed a lung. During the mediation, Mrs. B expressed her grief and anger, asked questions about her husband’s care (specifically why a resident had been allowed to place the central line), and told representatives from the hospital how she had been treated during and after the event. The chief of medicine, speaking for the hospital, started his response to Mrs. B by apologizing for what she had been through. He explained the reason a central line was needed and factors that go into deciding where to place it. He also discussed medical training and supervision of residents. The patience and empathy exhibited by the chief of medicine set a tone which began to repair the broken trust. The hospital representatives were shocked to learn that,