Congressional committees last week approved legislation on two major issues facing the healthcare industry: patient safety and medical liability reform. Though the patient-safety bill enjoys broad bipartisan support, both measures could face an uphill battle as Congress races to finish its business before the October recess and midterm elections.
Last week the House Ways and Means Committee approved legislation to reduce medical errors as the Energy and Commerce Committee moved to cap the damages plaintiffs can win in medical malpractice cases.
The patient-safety bill would create a new national system to track medical errors, but its prospects for ultimate passage could be delayed by some lawmakers eager to ensure that the measure would not interfere with state laws that already govern error reporting.
Under the bill, hospitals would voluntarily send data on medical errors to patient-safety organizations, which then would aggregate the information for the broader provider community. The law would prevent hospitals from disciplining employees for reporting errors, and it would prohibit patient-safety organizations from taking regulatory or enforcement actions against a provider in connection with an error report.
A new Center for Quality Improvement and Patient Safety, operating under the Agency for Healthcare Research and Quality, would certify and coordinate activities of the patient-safety organizations.
Sponsored by Rep. Nancy Johnson (R-Conn.), the House bill "creates a culture of safety that can continuously improve the quality of our healthcare delivery system," Johnson said before the committee approved her bill by a vote of 33-4. A Ways and Means staffer said she expected the Energy and Commerce Committee to take up the bill as early as this week. The bill also could go directly to the full House.
On the other side of the Capitol, Sen. Edward Kennedy (D-Mass.) plans to introduce similar legislation this week that would address state law conflicts in the House bill and in another patient-safety bill introduced in the Senate this summer, an aide said.
The Senate proposal floated this summer-sponsored by Sens. John Breaux (D-La.), Bill Frist (R-Tenn.), Judd Gregg (R-N.H.) and James Jeffords (I-Vt.)-also involves voluntary reporting and prohibits punitive action against those who have committed or reported errors.
Kennedy is concerned, according to an aide, that the Senate bill could pre-empt stricter state laws. The House bill, Johnson and others emphasized last week, does not supersede state laws with more sweeping mandates. The House bill is "a constructive first step and we're looking forward to moving something through the Senate," said Jim Manley, a spokesman for Kennedy.
Rep. Pete Stark (D-Calif.), in a hearing on Johnson's patient-safety bill earlier this month, expressed concern that it doesn't compel hospitals to report errors or act on known patient-safety problems. Others view that as a good thing, arguing that if caregivers worry about liability they won't want to disclose errors.
"The voluntary aspect of the Johnson bill is the critical ingredient to making the whole process work," said Chip Kahn, president of the Federation of American Hospitals. "The notion that Stark and others have that somehow you can mandate people to report and make them potentially liable is a nonstarter in terms of leading to real quality improvement."
Rep. Jim McDermott, M.D. (D-Wash.), one of four Democrats to vote against the Johnson bill, supported most of its provisions but believes errors defined as sentinel by the Joint Commission on Accreditation of Healthcare Organizations should be subject to mandatory reporting, an aide in his office said.
The federation and other groups were uncertain about the safety bill's immediate prospects as Congress works through a short legislative session that could include a resolution to authorize invading Iraq. Some staffers on Capitol Hill, meanwhile, said that with Johnson's backing, the bill has a solid chance of getting to President Bush's desk.
Separately, the House approved legislation last week that proponents said would address skyrocketing medical malpractice premiums. The House Energy and Commerce Committee voted 21-13 in favor of a bill that would limit noneconomic damages in malpractice cases to $250,000. In addition, the bill would limit how much of the total damages plaintiffs' attorneys could collect.
Sponsored by Reps. Christopher Cox (R-Calif.) and Jim Greenwood (R-Pa.), the bill mimics California's Medical Injury Compensation Reform Act of 1975, which has saved the state more than $1 billion annually in liability premiums, according to the American Medical Association. A national malpractice bill is one of the AMA's top legislative priorities.
As amended by the Energy and Commerce Committee last week, the bill includes a provision stipulating that plaintiffs would have only three years from the date of injury to file a lawsuit.
A committee staffer said the bill is expected to reach the House floor this week, but some viewed its prospects for ultimate passage as dim, given the Senate's unsuccessful attempts to pass similar measures in the past.