New York's health commissioner is fighting mad over hospitals' low compliance with the state's mandatory adverse events-reporting system and will seek stiffer penalties for those that fail to report in the future.
The situation in New York raises questions about the effectiveness of any federal mandatory medical error reporting system. Last year, President Clinton called for mandatory reporting after the release of the Institute of Medicine's 1999 finding that an estimated 98,000 Americans die annually as a result of medical errors in hospitals. To date, no federal legislation regarding mandatory reporting of medical errors has been passed. Most provider groups oppose mandatory reporting and instead support a voluntary system of collecting information on adverse events.
Fifteen states require some sort of medical error reporting from hospitals. A report released earlier this month by the Portland, Maine-based National Academy for State Health Policy found that hospitals are believed to underreport errors in the eight states with mandatory reporting that it studied.
The New York Patient Occurrence and Tracking System, released last week and based on 1999 data, found significant underreporting, particularly by hospitals in the New York metropolitan area. Commissioner Antonia Novello, M.D., has a multipronged strategy for pushing hospitals to improve. For example, state inspectors will audit patient charts during hospital inspections to catch hospitals that have failed to report adverse events.
"The commissioner is very upset that hospitals have not been following the law," said John Signor, a health department spokesman. "We believe that many hospitals are ignoring it or intentionally not reporting incidents."
New York hospitals have been required to report "occurrences," defined as an unintended adverse and undesirable development in a patient's condition, since 1985. In 1999, hospitals in the New York City region reported only 377 occurrences per 100,000 discharges. The top reporting region, Finger Lakes, N.Y., reported 1,101 occurrences per 100,000 discharges. The average for the state's seven regions was 625 occurrences per 100,000.
"We believe the variation should not be that large," Signor said.
Five hospitals did not report any occurrences for the year, and Signor said it is "hard to believe" no incidents happened.
Signor said Novello has vowed to use the public forum to chastise hospitals that fail to report high-profile adverse events.
The commissioner is working with Gov. George Pataki to push for state legislation that will increase fines for failure to report. Currently, hospitals pay $2,000 every time they are caught not reporting an occurrence. Novello wants to raise that to $6,000 for the first failure, $25,000 for the second and $50,000 for the third.
Although the Healthcare Association of New York State has encouraged its members to comply with the reporting law, association officials said they recognize why some hospitals fail to provide the level of data sought by the state. "There might be some feeling among hospitals that (the data) lacks an important use for them, and we need to find a way to make it more useful," said association spokeswoman Monica Mahaffey.
The cost of reporting occurrences to the state also may be an issue for some hospitals, Mahaffey said.