With the media becoming more aggressive in reporting medical errors, it seemed appropriate that the Joint Commission on Accreditation of Healthcare Organizations sponsor a panel discussion on the topic during its conference on patient safety in Chicago earlier this month.
A group of journalists on the panel naturally had a different take on what constitutes openness in reporting mistakes than did a group of providers, with the reporters favoring the "let it all hang out" approach. Both groups agreed patients should be informed of errors that affect them and that hospitals and physicians should stress how the error will lead to a change in practices to avoid future mistakes. But that's about as far as the consensus went.
Albert Wu, M.D., associate professor of health policy and management and medicine at Johns Hopkins University, Baltimore, who has studied medical errors, says a news leak about a deadly infection outbreak linked to bronchoscopes at Johns Hopkins Hospital earlier this year came just as the hospital was getting set to inform patients and hold a press conference. "The consequences of the leak were bad for just about all of the parties concerned. It raises the question of whose rights are being protected, the rights of patients or the public's right to know. These things aren't always immediately clear," Wu says.
Dan Prinster, vice president of business development and planning at St. Mary's Hospital and Medical Center, Grand Junction, Colo., says, "Reporting medical errors is a way to improve medical care, but it's important that it is done without blame. If it's done without blame, the provider learns from it and makes improvements. If it's done with blame, it becomes about the providers protecting themselves."
Karl Stark, a reporter with the Philadelphia Inquirer, says being upfront with reporters is the best way to keep them at bay. "The sense of being stonewalled by a hospital leads to reporting of medical errors," he says. "The mistake is bad, but the cover-up is worse."
But Donald Palmisano, M.D., chairman-elect of the American Medical Association and a lawyer, says the nation's "litigation problem" and a "blame and shame system" of covering medical errors prevent openness among physicians about mistakes and impede changes to prevent repeats of the errors.
"When someone cuts off the wrong limb, someone's going to be on the sharp end of the stick. Does this blame-the-(provider) approach enhance public safety? We don't believe it does."
And we thought the patient got the sharp end of that particular stick.
At this time of year, journalists often do stories about the needy, but this one is about a hospital that has become homeless, or at least has lost its moorings.
The Floating Hospital, a not-for-profit outpatient clinic that provides medical care to New York's indigent, has been docked for two weeks in Brooklyn, prevented from caring for patients or from returning to its old Manhattan landing.
The hospital, which long had been docked off the tip of Wall Street, already had been unceremoniously bumped last year to the South Street Seaport after the terrorist attacks on the nearby World Trade Center. The city recently moved it to an isolated Brooklyn pier to accommodate emergency ferry service in case of a transit strike. But with the city's transit strike averted, the seaport has forbidden the barge from returning and has asked the city to dock it elsewhere. Seaport officials say the hospital was inconsistent with the area's retail and commercial nature.
Hospital COO Ellie Tinto-Poitier says the seaport has threatened to sue the city if the hospital returned. Seaport officials did not confirm the threat but did say they wanted the hospital to stay away indefinitely. "We are, again, from pillar to post," Tinto-Poitier told the New York Times.
The hospital has been afloat since 1866 but more recently has had only about 3,800 indigent patients per year.
Young men, old problems
What else besides eternal frustration do the Boston Red Sox, who can't seem to win a World Series, have in common with the Medical Device Manufacturers Association, which complains that healthcare group purchasing organizations are unfairly preventing its members from hitting home runs with hospitals?
Answer: They both have 28-year-olds leading their organizations.
In certain circles, the Dec. 13 announcement that Mark Leahey, 28, director of federal affairs at the Washington-based trade group, was taking the helm as executive director of the MDMA was even more surprising than the Red Sox's November announcement that Theo Epstein was the forlorn ball team's new go-to general manager.
Leahey succeeds Larry Holden, who resigned "to pursue other business opportunities," according to a written statement. Early last week Leahey, a graduate of Georgetown University and the Georgetown Law Center, referred all questions regarding the sudden and unexpected change in leadership to Paul Touhey, the MDMA board chairman. But by the next day, Leahey reported that in light of the numerous inquiries received, the MDMA was going to stick with its written statement.
"Larry was instrumental in asserting the position of the research-focused, entrepreneurial medical device sector in the public policy debate," Touhey said in the statement. "We wish him well."
The long-running tensions between the small-device manufacturers and GPOs came to a head this past year when a Senate subcommittee and several federal agencies began investigating whether the GPOs hamper the market availability of innovative technologies, as the small-device manufacturers charge. That put Holden in the spotlight as the voice for the beleaguered companies.
"Larry Holden was a very capable lobbyist and helped the MDMA position itself very well in Washington," says Jody Hatcher, a spokesman for group purchasing giant Novation. "Unfortunately we disagreed with a lot of his tactics. It was wrong for him to criticize healthcare group purchasing when we should all really have the same goal, which is affordable, high-quality healthcare."