Editorial: Patient safety is paramount

Thursday, Feb. 24, 2000 | 9:29 a.m.

There is agreement among hospitals, doctors, nurses, patients and policymakers that something needs to be done about the alarming rate of medical errors. After all, the National Academy of Science's Institute of Medicine reported in November that medical errors caused between 44,000 and 98,000 deaths a year -- more than those killed by highway accidents, breast cancer or AIDS. Coming to terms on steps to prevent a reoccurrence of these mistakes, though, is proving difficult.

The Institute of Medicine recommended that Congress establish a federal center for patient safety that would create national safety goals and track the progress in achieving them. Also, the institute believes that hospitals and other health care groups should report serious mistakes to state licensing boards so they can track problems and take disciplinary action if needed. But doctors and hospitals worry that if they're named specifically, they could be held liable for millions of dollars in damages if a patient subsequently brings a lawsuit against them.

On Tuesday President Clinton weighed in on this debate, offering his proposals. Clinton said all hospitals should take measures to reduce medical errors. And within three years, Clinton said, the states should establish mandatory reporting requirements for medical mistakes. The president tried to strike a balance between the competing concerns of confidentiality and full disclosure. For instance, Clinton said the states should require disclosure if a mistake results in death or serious injury. If, however, the error was less serious then only the hospital -- not the health care provider -- would be identified.

Doctors and other health care providers believe, though, that if public reporting could result in possible litigation, then there might be an incentive to withhold the reporting of errors, which won't help anyone. Still, as a Clinton administration official noted Tuesday, doctors and other health care providers already are bound by ethical guidelines -- if not regulation or law in some states -- to publicly report mistakes that harm patients. So it's not as if the administration is announcing a radical proposal. This is not about retribution; disclosure should prevent errors from happening in the first place, because openly acknowledging what went wrong allows health care professionals to learn from someone else's errors.

There is strong bipartisan support in Congress for requirements to publicly report errors, but the medical community isn't united. While the American Medical Association, which represents doctors, and the American Hospital Association both oppose public reporting, the American Nurses Association said it generally supports Clinton's efforts. Doctors and hospitals should try to work with the administration in the same way that nurses are doing. Otherwise a golden opportunity to dramatically improve patient care may be lost.