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On Halloween night in 2000, Alice Perreault-Steubing and her husband, Matt, tried to convince emergency room workers something was wrong with their 8-month-old son.
Julius had suffered brain damage from mistakes made during his birth. His parents insisted there was a problem with a feeding tube connection put in his stomach earlier that day.
A surgeon was called in and discovered the connector had been misplaced. Immediate surgery saved Julius' life. A few weeks later, an unexpected letter arrived at their home.
"I think of Julius daily and wish him a speedy and complete recovery," wrote physician Dan Jackson, who first placed the connection. "I am very dismayed that he suffered from the tube replacement, sincerely intended to help not hurt him."
It wasn't a full apology, but the letter "just meant so much to me," Perreault-Steubing said. "I just remember thinking, why can't they all do that?"
Utah Sen. Dave Thomas says more might if SB41 passes - preventing physicians' apologies and explanations from being used as evidence in a courtroom. Thomas argues the ban could encourage physicians to communicate with their patients, lower their legal costs if they are sued, and give patients who file lawsuits a better idea of what to investigate.
Opponents say it could hurt already-injured people without increasing how often Utah patients learn about errors in their care.
Utah hospitals report inpatient "adverse events," ranging from cuts to deadly mistakes, to the state Department of Health - with nearly 103,000 tallied between 1999 and 2004. But physicians don't have to reveal these medical injuries to those patients.
Advocating apologies: It's different for patients at the University of Michigan Health System, who hear the facts, an apology and how future mistakes will be avoided when an error is made during their care. Its "open disclosure" policy - adopted without a law that protects apologies - has cut malpractice claims by half and defense litigation costs from $3 million to $1 million.
Neither LDS nor University Hospital in Salt Lake City has such a program. University Health Care does encourage "honest interaction with patients, whether there is fault or not," said medical director Neil Kochenour.
"Open disclosure is our practice," he said. "We have been doing it for a long time and don't feel we need to have a written policy."
Kochenour believes it would be "very unnatural" for doctors not to say they are sorry for an adverse outcome.
"There's no question that there's an extremely defensive and closed attitude and some doctors just clam up and don't talk about it," he said. "That attitude doesn't prevail here."
William Hamilton, medical director of LDS Hospital, said he believes more will apologize if the bill passes.
"I think you'll see more communication because there won't be a fear of expressing sympathy and having that used as proof of culpability," he said.
The Utah Hospital Association supports the bill. Dave Gessel, its vice president of government relations and legal affairs, acknowledges he hopes malpractice insurance premiums could go down if fewer people file lawsuits. But association members also believe it will help break down the wall of silence between patients and providers, he said.
The Utah Trial Lawyers Association opposes the bill, arguing juries should have all the facts. For Clark Newhall, who practiced emergency medicine for 20 years before becoming a plaintiffs' attorney, the bill rings hollow.
"While encouraging doctors to apologize is a laudable goal, it's not enough," he said. "Encouraging apologies without encouraging compensation for injuries, . . . it's simply one more instance of doctors whining at the Legislature to get their way without being responsible for the reason that they are having to apologize in the first place."
Lawyers and judges who advise the Utah Supreme Court on rules decided against recommending a ban on using apologies as evidence, said committee member and plaintiffs' attorney Ed Havas.
"The consensus was, why would we want to carve out exceptions to the rule for one profession when everyone else in the world has to play by the rules?" he said. "Which is, if you admit you made a mistake that admission can be used against you."
Should jurors know? Jackson considers his letter to the Steubing family private, Primary Children's Medical Center said. One reason Alice Perreault-Steubing so deeply appreciated receiving it: A lack of information from physicians has been her greatest frustration over the nearly six years Julius has been in her life.
"I would like doctors to be able to feel more comfortable about telling the real story, whatever that is," she said.
But she has mixed feelings about Thomas' bill, fearing it could keep vital information from a judge or jury.
During his birth, Julius' umbilical cord was pinched and he began to suffocate. Perreault-Steubing was being cared for by a resident - who was not trained to perform the Caesarean section surgery Julius needed - because her doctor wasn't at the hospital.
She learned a painful lesson: Hospitals generally are not required to have a physician who can perform a C-section immediately available. In her later lawsuit, she argued nurses delayed contacting her doctor and failed to notice a fetal heart monitor was warning of disaster.
She settled her lawsuit with the hospital on one condition - that she could speak out about what happened. Now she urges consumers to learn as much as they can about procedures or care they are undergoing. Becky Brailsford of Highland, who also has a son injured during birth, is angered by Thomas' bill. She warns Utahns that apologies are of limited help - they won't pay for a lifetime of medical care needed by an injured patient.
"There are some things that an apology doesn't restore," she said. "It doesn't even come close to what you have to live with."
To her, the focus should be on improving health care rather than apologizing for it.
Her physician didn't know she was carrying twins, she said, and there were problems when they arrived early. Even with insurance, her 12-year-old son's medical expenses top $30,000 a year. A former nurse forced to quit to care for her son, Brailsford said she thinks physicians will be slow to change and patients must be choosy.
"It will not open up any more communication with patients," she said of Thomas' bill. "If it wasn't there before, it will not be there after."