Friday, June 28, 2002 | 4:41 a.m.
WEEKEND EDITION: June 30, 2002
There are 19 states that require hospitals and clinics to report medical errors to a central repository, but Nevada is not one of them.
Lawyers would like to make Nevada the 20th state to mandate that such data be collected. They would also like the information released to the public, including such details as the physician or medical facility that caused the errors, to make consumers better informed about medical providers.
But physicians say such reporting should be done confidentially and only for improving patient safety. They say that to make public certain details, such as who is responsible for errors, would invite more medical malpractice lawsuits. That, they say, would make Nevada's medical malpractice insurance crisis even worse.
The debate over the reporting of medical errors is one that has been played out all over the country. In at least five states -- Florida, Kansas, Massachusetts, New York and Pennsylvania -- lawmakers instituted mandatory reporting of medical errors along with tort reform to try to stabilize insurance rates.
Jill Rosenthal, project manager for the National Academy for State Health Policy in Portland, Maine, said some states view the mandatory reporting of medical errors as a trade-off physicians should make to gain tort reform that is opposed by attorneys.
"Medical providers are pressing state legislators to pass some kind of tort reform, and the legislators are saying, 'We'll give you relief on malpractice as long as you give us information on patient care,' " Rosenthal said.
The most definitive study of medical errors, published in 1999 by the National Academy of Sciences' Institute of Medicine, estimated that between 44,000 and 98,000 deaths occur each year in the United States because of mistakes by physicians and other health care providers. That would make medical errors the eighth-leading cause of death in the country, ahead of motor vehicle accidents, breast cancer and AIDS.
The most common problem areas identified by the report involved:
Many recommendations in the study were adopted by the Clinton administration in 2000, including appropriating $50 million to establish a national center for patient safety and quality.
Congress declined to pass other recommendations, including one that would have required the government to help states such as Nevada set up error reporting systems, according to Janet Corrigan, the study's director, said.
But Nevada began taking its own initiative last year when the Legislature established a subcommittee to develop recommendations on a medical error reporting system.
The recommendations were forwarded to the Legislative Committee on Health Care and are scheduled for consideration when it meets July 30 in Las Vegas.
The subcommittee recommended that Nevada's Department of Human Resources establish an Internet-based registry where medical facilities could voluntarily report errors. The subcommittee -- chaired by Dr. John Yacenda, chief executive of Health Care Strategies Inc., a nonprofit Reno consulting firm -- also recommended forming a group composed of health care professionals and state agencies to identify medical practices that can reduce errors.
Another recommendation is for the state to establish a surveillance system to monitor the causes behind "adverse" medical events, such as patient deaths.
But while Yacenda said he did not believe mandatory reporting was necessary, Assemblywoman Ellen Koivisto, D-Las Vegas, strongly disagreed. Koivisto, vice chairwoman of the health care committee, was the lawmaker who recommended forming the subcommittee.
"I just don't feel that their recommendations will do anything," Koivisto said. "Things have to be reported on a mandatory basis or else there's no purpose.
"The whole idea of the reporting system is that errors can be tracked and systems can be fixed."
Whether the reporting system should be mandatory or voluntary is only one aspect of the debate. Another -- and one that pits lawyers against doctors -- is the amount of reporting that should be available to the public.
Lawyers such as Bill Bradley of Reno, former Nevada Trial Lawyers Assocation president, comes down on the side of full public disclosure.
"It's a way to identify trends and then hold hearings to solve them," Bradley said. "It also allows consumers, who have been left in the dark, to make an intelligent choice about health care.
"If a pharmacy had 75 medical errors, I believe I should be entitled to know that."
Las Vegas malpractice attorney Gerald Gillock said "you should have access to the date and type of error that occurred and the name of the physician who caused it and the outcome in terms of the injury to the patient."
But Dr. Raj Chanderraj, Clark County Medical Society president, said he could support a medical error reporting system as long as specific information about the individuals or facilities remained confidential.
"Physicians would support it as long as it's educational and not punitive," Chanderraj said. "We want to make sure it's an educational tool for patient safety and health. If it was punitive, it would not serve its purpose. Nobody will report if it will hurt them.
"If it's going to be punitive, it could be a bonanza for attorneys."
Nevada physicians fear that attorneys would file more malpractice lawsuits if they have more information about the individuals or facilities linked to medical errors. And more lawsuits, they say, would lead to yet higher malpractice insurance rates.
Gillock said he did not believe full disclosure would lead to more lawsuits.
"You only have lawsuits in about 5 percent of the cases where medical errors occurred," Gillock said.
Fellow Las Vegas attorney Dean Hardy, another former trial lawyers association president, agreed.
"There are ethical rules in place that prevent me from going out and seeking specific patients," Hardy said. "You can advertise, but you can't solicit specific patients. That's not what lawyers do. It causes me great concern that lawyers are looked upon as though we're the creators of the problems."
There is already a certain degree of medical error reporting by Nevada hospitals, but much of it is either fragmented or hard to access for anyone who doesn't know where to look.
For instance, the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, Ill., which accredits most Nevada hospitals, collects a certain amount of voluntary information on medical errors from those facilities.
"Because they're voluntary, they get very few reports," Rosenthal said. "Mandatory reporting is intended to be a good way to ensure that there is accountability and methods to correct the errors."
Commission spokeswoman Charlene Hill said that in cases where a patient dies or suffers a "permanent loss of function" unrelated to the diagnosis, hospitals are required within 45 days to submit plans to prevent more such occurrences. Failure to submit plans can result in loss of accreditation.
Between January 1995 and last month, the commission was notified of 1,541 such cases nationwide, including 10 from Nevada, Hill said.
The problem with mandatory reporting is that it doesn't work if there is no system in place to analyze and correct the errors, according to Larry Matheis, Nevada State Medical Association executive director.
Matheis said he is not certain whether the recommendations made by Yacenda's subcommittee would accomplish that task.
"What you want are reports of failures in the system that may lead to improvements in patient safety," he said. "It should not be just to encourage lawsuits, but to find things that happen routinely in facilities. It should be confidential and should not be specific about the patient or doctor.
"One problem is when prescription drugs pass through different hands. Or you could have a surgeon who doesn't know what's on the patient's chart. The information on the chart may be incorrect or the patient is prepared for surgery incorrectly.
"But if there's no system in place for using this information, and it's clear that the information would only be used for litigation, that should not be the purpose of the reports," he said.
Dr. Ikram Khan, a Las Vegas surgeon who is the liaison between Gov. Kenny Guinn and a physicians' task force seeking to resolve the malpractice insurance crisis, said hospitals already have sound internal controls for identifying and correcting errors.
"As far as I'm concerned it's a very complex issue," Khan said. "What I may believe is an error you may not believe is an error. It's a complex issue because it's a multidimensional problem that involves the physicians, the hospital, the nurses, the clerks and the lab.
"One has to carefully analyze the situation before one points fingers.
"We need to do what's in the best interests of the patients. Hospitals already have a system of checks and balances at every level to watch for errors," he said. "Are we trying to do overkill here?"
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