Proponents of medical malpractice legislation often decry any attempt to link their cause to better reporting of medical mistakes. Tort reform, they say, addresses frivolous lawsuits and greedy lawyers, while stricter accountability for medical errors only would force providers to practice defensive medicine and open them up even more to the ambulance chasers.
This is really interesting given that the U.S. House of Representatives overwhelmingly passed both types of legislation almost simultaneously and everybody knows that the harmless, voluntary error-reporting bill is political cover for severe limits on pain and suffering awards for harmed patients.
This page already has made the case against tort reform (Jan. 27, p. 18; July 15, 2002, p. 22), but the House bill on medical errors is a different story. Without significant amendment, it should be defeated in the Senate.
At first glance, it may seem odd to oppose a bill titled the Patient Safety and Quality Improvement Act. Aside from adding the words motherhood and apple pie to the title, it couldn't sound warmer or fuzzier. The real harm from this bill is that it would lead the public to believe that something meaningful is happening on medical errors. It isn't.
Under the bill, hospitals would voluntarily report medical mishaps to newly created patient-safety organizations, which then would pull together marketwide data to use in quality-improvement efforts. No specific information on a hospital would be made public and the bill would pre-empt state laws that might be more specific and have more teeth. So the net effect, if anything, would be to reduce the amount of information patients have about the quality of their local hospital.
Yes, the bill would allow hospital employees to report medical errors without fear of retribution. The problem is, the patient-safety organizations would be prohibited from taking regulatory or enforcement actions against a provider for screwing up, even if that provider hasn't reported the event to the Joint Commission on Accreditation of Healthcare Organizations or a government regulatory body.
The bill comes as evidence mounts that healthcare providers continue to bury their mistakes. Only 30% of patients harmed by a medical error were told of the problem by the provider at fault, according to a national survey published last year in the New England Journal of Medicine.
A more recent study, published in the March/April edition of Health Affairs, found that among 245 hospitals surveyed, only 54% reported that it was routine practice at their hospital to tell patients or their families when a patient had been harmed by care. Respondents also were much less likely to disclose preventable medical errors, even some that involved the death of a patient.
In July 2001, the JCAHO began to demand that hospitals report all unexpected outcomes of care. Now that it will begin surprise inspections beginning in 2006 (See related story, p. 8), maybe the commission can surprise everybody by finally playing the role it was intended to, which is to crack down on institutions that have done little to improve their quality of care.
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Please join us in congratulating Modern Healthcare reporter Julie Piotrowski for being awarded a Knight Public Health Journalism Fellowship at the Centers for Disease Control and Prevention. Piotrowski is one of only eight reporters worldwide selected for this prestigious honor. Piotrowski, who covers public health for the magazine, will participate in a three-month program at the CDC in Atlanta this summer to learn more about the nation's public health system. She will bring that valuable experience back to Modern Healthcare and, more importantly, to its readers as they grapple with pressing public health issues such as bioterrorism and severe acute respiratory syndrome.