Resolution author unhappy with medical errors report

Wednesday, April 24, 2002 | 9:03 a.m.

CARSON CITY -- Assemblywoman Ellen Koivisto, D-Las Vegas, author of a resolution calling for a study of medical errors in Nevada hospitals, says she can't support the recommendations of a subcommittee that wants to create a statewide registry of the errors.

"I don't think John Yacenda (chairman of the subcommittee) had a real understanding of medical errors," Koivisto said.

She complained the plan would create a new state bureaucracy and that the registry would only gather dust.

After a five-month study, Yacenda's subcommittee suggested establishing an "anonymous, voluntary, password-protected, standardized incident reporting system and registry" on the Internet.

The system would track adverse events and "near misses" attributable to errors in dentistry, medicine, nursing and pharmacy. It would permit the public to view the voluntary reporting system.

The subcommittee recommended allocating more money for the state Bureau of Licensure and certification to conduct annual reviews of hospitals to look at patient safety issues.

Yacenda's report was presented Tuesday to the Legislative Committee on Health Care, which will decide later whether to go forward with the recommendations.

Koivisto, when she sponsored the study resolution in the 2001 Legislature, envisioned the hospitals submitting a confidential standard report. The data would go to departments at UNLV and UNR that analyze that type of data. The departments would try to detect trends and make recommendations to hospitals on how to avoid such problems in the future.

The information would be used to correct practices and not to punish hospitals, Koivisto said. And it would not be used in any malpractice lawsuits.

"We know things happen," Koivisto said. "But we don't have any way to track it to fix some of the issues in the system."

She also criticized another recommendation that called for certain information be supplied to a patient when he or she is admitted to a medical facility. That's already being done, said Koivisto, who is chairman of the Assembly Committee on Health and Human Services.

The Yacenda subcommittee encouraged the University and Community College system to make nursing programs a top priority during the next biennium. It also recommended a statewide surveillance system be created to monitor medical errors.

Koivisto said any reporting system should be confidential. The hospitals, she said, would not make the reports if they knew they would be made public.

Koivisto said each hospital has its own safety committee that reports errors. The purpose of having them file a standardized report would be "to find problems that can be fixed."

The resolution sponsored by Koivisto said at least 44,000 people die each year in hospitals nationwide from preventable medical errors. It said establishing a reporting system is "an effective way to improve the safety of patients in this state."

Koivisto said similar reporting systems are being used in other states. "It would be nice if Nevada is not dead last" in starting one of these system, she said.

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