Feb. 22, 2000 (Washington) -- Calling it "the most significant effort our nation has ever made to reduce medical errors," President Clinton announced a broad plan enlisting state governments and federal agencies to stamp out what has become an epidemic of preventable medical errors. Clinton said he hopes to reduce medical errors by 50% in five years.
However, the organizations representing the largest groups of doctors and hospitals in the country weren't in the room. They're concerned the plan might subject them to more lawsuits because it would require doctors to confess their mistakes.
"[T]he proposal for mandatory reporting will not improve patient safety and may, in fact, have the perverse result of driving errors underground," said Nancy Dickey, MD, the American Medical Association's immediate past president, in a statement.
If fully implemented, the president's plan would require the 6,000 hospitals getting payments from Medicare to establish error reduction plans, including new ways to stop prescription mistakes. Within a year, the FDA must come up with approaches to reduce errors caused by confusion between drugs with similar names or appearances. The White House hopes to increase the FDA's error-reporting budget for next year to a total of $33 million.
During the next three years, mandatory and voluntary error reporting programs would be established in the 50 states with the goal of helping providers learn from their mistakes and making sure they're held accountable for their errors. However, to encourage physicians to come forward, that information would not be made available for malpractice lawsuits, a change Congress would have to enact to the current system.
The issue of preventable medical errors was forcefully brought to the nation's attention last November in a report from the Institute of Medicine (IOM). The prominent advisory group noted that as many as 98,000 Americans die every year because of medical mistakes. In December, President Clinton announced that a task force would look at the situation and come up with recommendations. At that time, American Hospital Association's Dick Davidson was at Clinton's side, but not on this day.
Instead, Davidson said in a statement the plan "has some good ideas, raises many unanswered questions, and requires additional work to become a prescription for patient safety." It's estimated medical errors cost the nation $29 billion annually and that as many as 4% of patients fall victim to such a blunder. The IOM report says medication errors alone claim 7,000 lives a year.
"We ... want to replace what some call a culture of silence with a culture of safety, an environment that encourages others to talk about errors," said the president in his remarks. With that Clinton asked for Congress to fund $20 million on error reduction including a new Center for Quality Improvement in Patient Safety, which would do research and develop a national prevention approach. Many of his recommendations mirror the IOM report.
Still, it's clear much of the responsibility will fall on the states. "One of the advantages of our counting on the states to use their ingenuity to develop these programs is that we'll have an opportunity to look at how each state implements the program, evaluate them, and see which ones work best," John Eisenberg, MD, director of the Agency for Health Research and Quality, tells WebMD.
Eisenberg, one of the architects of the error reduction effort, says states may use their own medical boards or regulatory agencies to assemble the data. Just before the president's announcement, Eisenberg was on Capitol Hill trying to sell the plan to a hearing of two key committees that will have to give their OK before the plan could be implemented.
"If health care quality were a disease, and it were listed as the fifth or eighth leading cause of death, then people would not hesitate for a moment to call for a major research agenda," Eisenberg told the panel.
The bipartisan appeal of the reform is illustrated by the fact that Sen. Jim Jeffords, R-Vt., chairman of the Health, Education, Labor, and Pensions committee, was present at the president's rollout along with Sen. Tom Harkin, D-Iowa. He and Sen. Arlen Specter, R-Pa., have introduced a medical error bill that would, among other things, establish demonstration projects across the country on ways to diminish medical mistakes.
Currently, 23 states have some sort of error reporting system. Once nationalized, the information would be made public, but without specifically naming doctors or patients. "A wrong leg is removed, or a mother dies in childbirth. These aren't secrets. These aren't things that people hide. ... The issue of confidentiality applies at a much lower level, when we make more ordinary mistakes, and people are loath to talk about them," Lucian Leape, MD, adjunct professor at the Harvard School of Public Health, tells WebMD.
President Clinton is hoping to get his medical errors program enacted alongside the patient bill of rights. The net result, he says, would be a reduction in deaths and lawsuits.