Dec. 13, 1999 (Washington) -- A mandatory national reporting system for serious medical errors is crucial, Sen. Arlen Specter (R, Pa.) said at a hearing Monday, backing a recent recommendation from a national panel of experts.
Although the American Medical Association (AMA) and American Hospital Association (AHA) raised red flags at the idea, individuals who were victimized by medical mistakes supported the move.
Specter's hearing had unusual timing -- Congress is in recess until January -- but the issue of medical errors has swept into the center of national news. Specter is chair of the Senate appropriations panel for federal health care agencies.
Earlier this month, the respected Institute of Medicine released a report that attributed as many as 98,000 deaths each year -- and at least $8.8 billion in health care costs -- to preventable medical mistakes. The institute urged that reports be required after errors that cause serious injury or death.
"There's going to have to be mandatory reporting," Specter tells WebMD, although he acknowledges that the nature and extent of reporting are a key question. "We're in very deep water on this," he said, noting that many health professionals believe that reporting requirements may chill their willingness to provide high-risk care.
Mary Wakefield, PhD, testifying for the institute, said that mandatory reports would be "extremely important" to ensure accountability among doctors, other providers, and institutions. She said that requirements should have confidentiality safeguards for those reporting.
Specter said he was interested in legislating on medical errors next year. His panel has powers in this regard; the institute called for a new federal center to set and track patient safety goals. Sens. James Jeffords (R, Ver.) and Edward Kennedy (D, Mass.) are also planning to unveil legislation through a separate committee.
It was a tough hearing for the health industry, as three patients told emotional stories of botched procedures that left them bitter at the system. "The foxes are allowed to guard the henhouse," complained Ray McEachern. His wife has a paralyzed left arm and leg and is on permanent medication after a resident performed an flawed angiogram that resulted in tubes becoming tangled inside her body.
McEachern's wife had anger for her attending physician, with whom she settled in a malpractice action. "He let a resident do the procedure without my approval," she said. "The resident didn't know what he was doing."
Debra Malone told the panel a tragic story of her father, a 64-year old doctor who died after an error-filled night in an intensive care unit. The ICU, she said, was staffed only with an intern and float nurse who was unfamiliar with the unit. "The attending physician was at home sleeping."
And Diana Artemis described an orthopedic surgeon's "incompetent after-care" from a total hip replacement, resulting in multiple corrective operations. "It is time the medical industry opens its books," she said.
But AMA immediate past president Nancy Dickey, MD, asked, "Is the surgeon responsible for a fall after surgery?" Dickey testified against the creation of a mandatory error-reporting system. That effort, she claimed, would backfire and establish an environment hostile to "trust and open communication." The AMA backs voluntary error reporting, she said, although it believes those who step forward must have a full guarantee against liability.
The AHA also had qualms about reporting requirements. Moreover, Jefferson Health System chief medical officer Stanton Smullens, MD, testified for the association that a patient could take more initiative in screening for the best care. For example, a patient could ask a doctor whether he's been sued and request that a resident not treat them. But Specter rejoined that only an "extraordinary patient" would ask those questions.
In contrast to the doctors and hospitals, the American Nurses Association said it backed a mandatory error-reporting system.
Meanwhile, health experts testified that ensuring health professionals won't be sued is central to battling system weaknesses that result in errors. "The best physicians and the best institutions make mistakes," said John Eisenberg, MD, administrator of the Agency for Healthcare Research and Quality. "We must change the culture of secrecy," he said, and avoid a reaction to errors he characterized as "name them, blame them, and chain them."
Martin Merry, PhD, a health management professor at the University of New Hampshire, agreed: "The root cause [of medical errors] is not incompetent doctors," he said, arguing that the institute's report was "long" on regulation. He recommended that health care build its delivery system "around our patients rather than our doctors and hospitals."