Dec. 7, 1999 (Washington) -- In an effort to make the American medical system less prone to dangerous or deadly error, President Clinton announced a series of measures Tuesday that is aimed at encouraging a culture of openness and accountability among health providers.
"Too many families have been the victims of medical errors that are avoidable, mistakes that are preventable, tragedies, therefore, that are unacceptable. Everyone here agrees that our health care system does wonders, but first must do no harm," said Clinton, flanked by health care professionals and insurers at a White House event in the Rose Garden.
The president's comments come in the wake of a highly publicized report from the Institute of Medicine (IOM) last week documenting an epidemic of medical errors in the U.S. The IOM's blue-ribbon advisory committee concluded that up to 98,000 Americans die every year from medical mistakes, costing as much as $29 billion. "It's ... about creating a culture of safety and an environment where medical errors are not tolerated," said Clinton.
Among the steps announced by the White House to improve patient safety: an executive order requiring a federal task force to report back in 60 days on ways to reduce medical errors; a requirement that all 300 health plans serving the 9 million Americans covered by the Federal Employee Health Benefits Program develop patient safety initiatives; and, finally, a mandate that all federal agencies administering health plans -- like the Department of Health and Human Services and the Pentagon -- implement the latest error-reduction technologies.
All in all, some 94 million Americans would be affected by these efforts to reduce avoidable medical errors. The president singled out the American Hospital Association (AHA) for its campaign to eliminate prescription drug mishaps, which claim 7,000 lives annually. "As good as our systems are today for preventing and reducing medical errors of all kinds, the Institute of Medicine report makes it very, very clear: We can and must do better," said Richard Davidson, AHA president. The association is urging its members to develop a model program that will help prevent drug errors.
"Many of the recommendations that we're making to hospitals today really do not require a major commitment in terms of financial resources," said Michael Cohen, president of the Institute for Safe Medication, which is working with the AHA. Some suggested changes include things as simple as locking up or moving dangerous drugs. There are obvious financial incentives, as each drug error in a teaching hospital adds almost $5,000 to the bill, said Cohen.
The president also said he just signed $25 million authorization legislation for the Agency for Health Care Quality and Research, which will direct at least part of its efforts toward tracking down the causes of medical mistakes. However, in spite of the IOM findings, Clinton says it doesn't mean that Americans have a bad health care system, but rather one that needs to change along the lines of big corporations that are reducing industrial injuries, or how the aviation industry has dramatically improved its safety record.
"It's not a matter of weeding out a few people who are not performing. It's a matter of creating an environment in which it's hard to make a mistake -- and one in which it's easy to do the right thing," said William Richardson, who chaired the IOM panel that wrote the report on medical errors. Others in the field accept that 'kinder, gentler' approach.
"What you really try to do is build up the culture that you support the people when a near-miss happens ... but what we hope to do in our hospitals is really push this culture issue around a blameless system, and this isn't a finger-pointing issue," Gordon Sprenger tells WebMD. Sprenger, who heads the 1-million-member Allina Health System, says he is encouraged by the White House plan, but he says that tort reform must follow to keep the error problem from being driven underground.
The American Medical Association, which was not at the event, reacted cautiously to the president's plan. "We will certainly seek a seat on that task force. ... I think that we will carry the message that, in general, the AMA supports [these] efforts. This is our concern: How do we investigate errors or even potential errors without the risk of having to defend ourselves [from malpractice suits]?" says AMA immediate past president Nancy Dickey, MD.
However, openness about error necessarily means more lawsuits, says the president -- that is, if doctors are willing to admit error and help others learn from their mistakes. He pointed out that 22 states have mandatory error reporting laws, and that hasn't generated a marked increase in malpractice cases.
"Our recommendation that deaths from medical errors be reduced by 50% over the next five years is something that many professionals and associations and organizations think is, in fact, a reasonable target," said Richardson.
WebMD Washington correspondent Sean Martin contributed to this report.