Jan. 26, 2000 (Washington) -- Bills to better ensure patient safety in the health system are already in the works, as Congress returned to work for the year this week. Late last year, the respected Institute of Medicine reported that as many as 98,000 people die each year from preventable medical mistakes. The report sparked congressional interest, in calling both for a national center to support safer health systems and mandatory reporting of serious errors.
A bipartisan group of senators led by Sen. Joseph Lieberman, D-Conn., is drafting a bill that would increase error reporting requirements for health entities that contract with Medicare, Medicaid, Veterans Affairs, the Department of Defense, and federal employee health benefits programs.
At a joint session of the health appropriations and veterans affairs panels, Sen. Arlen Specter, R- Penn., announced Tuesday that he would introduce legislation that would establish a series of demonstration projects on medical errors. According to Specter, some of the projects would require error reporting to the federal government and would "mandate that the hospital physician who made the mistake ... report that to the patient."
Another medical errors hearing, held Wednesday by the Senate's Health, Education, Labor, and Pensions Committee, featured testimony from Olympic gold medal runner Gail Devers. Devers said her thyroid condition was misdiagnosed for several years, preventing her from training and leading to depression.
But national solutions are a tricky policy puzzle. Health experts pinpoint the "culture of blame" and fear of lawsuits as a serious hindrance in reaching more open discussions that can lead to better systems and procedures. But lawmakers are wrestling with the Institute of Medicine's recommendation for mandatory reports on serious errors.
Reporting might prompt health professionals to take more responsibility for errors when they occur. "There is a very big problem of accountability and public perception of accountability," Harvard School of Public Health policy professor Lucian Leape, MD, tells WebMD.
At the same time, the American Medical Association and American Hospital Association oppose required reports for fear of legal reprisal. And Judy Smetzer, director of risk management at the Institute for Safe Medical Practices, said that mandatory reporting systems focus on deaths and injuries rather than the circumstances leading to them.
Within the next 2 weeks, executives of various federal agencies, including the departments of Health and Human Services, Labor, and Defense, will deliver to President Clinton their recommendations on specific actions to prevent medical errors. White House officials are hesitant to embrace mandatory error reporting. Specter is critical of this stance. "If they leave it on a voluntary basis, they're not going to get the information," he says. "The administration is timid. I think we've got a very tough problem. We need to have a tough answer."
Some experts point to technology as a savior. Prescribing errors -- bad penmanship, failure to recognize possible drug-drug adverse interactions, dosage mistakes -- are a major problem in patient safety. But some hospital doctors may now enter prescriptions through computerized systems. And bar codes on the medication and a patient wristband can confirm that a medication being administered is indeed the correct drug.
As part of an ongoing series of safety initiatives, the Department of Veterans Affairs plans to add bar coding for all VA operating room medications by this June.
"We think that this should be standard for every hospital in the country," Leape tells WebMD. "Computer entry will take care of prescribing errors, and bar coding takes care of administration errors. Those two together would reduce medication errors by probably 90%," he says.
Meanwhile, the Business Roundtable, a group of large firms that employ about 10 million Americans, testified today that it is developing a voluntary certification program for its members' purchase of health insurance. Under the roundtable's plan, physicians in hospitals should use computers for entering prescriptions, patients should be referred for specific procedures to hospitals with high survival odds or volume for those services, and patients in intensive care units should be "actively" monitored by doctors with credentials in critical care medicine.
Doctors -- and the medical training system -- have come under fire in medical error victims' testimonies. Joe Donahey, who testified Tuesday, was left blinded by back surgery. He said that he had not been told that his surgeon had had three similar episodes in the previous 18 months. Moreover, he said that he was told only after the fact that a resident had performed the procedure. The surgeon, he said, had floated between two surgical suites.
Leape, recalling his 36-hour pediatric surgery residency days, added that health professionals should have shift limits.