Clinton releases medical error proposal

In response to the Heath Care Quality Task Force's analysis of the Institute of Medicine's report on medication errors, President Clinton issued a list of recommendations for reducing medical errors by 50% within five years.

"[T]he time has plainly come, as a result of the IOM study, to just take a step back and ask ourselves: How can we redesign the system to reduce medical error? Have we given all of our caregivers adequate training? Do they adequately coordinate with, and communicate with, one another? Do all settings have the right kinds of teams and systems in place to minimize mistakes?" asked the president during a February 22 press conference.

The president's recommendations include the following steps to reduce medical errors:

•Â Establishing a new Center for Quality Improvement in Patient Safety with a budget of $20 million to invest in research, develop national goals, issue an annual report on the state of patient safety and translate findings into better practices and policies.

•Â Ensuring that each of the 6,000 hospitals participating in Medicare has patient safety programs in place to prevent medical errors.

•Â Gradually phasing in a state-based system of reporting medical errors that will include mandatory reporting of preventable medical errors that cause death or serious injury and voluntary reporting of other medical mistakes and so called "near misses" or "close calls."

•Â Working with the National Quality Forum, a private-public group of healthcare experts, to develop a set of patient safety measurements that would lay the foundation for a uniform system of reporting errors.

•Â Developing new standards to help prevent medication errors.

"If we can do this and pass a strong, enforceable patient's bill of rights, we will have gone a long way toward ensuring quality healthcare for all Americans in the 21st century," Clinton said. "Just think about it. We can cut preventable medical errors in half in five years; reduce concerns about lawsuits and about medical mistakes; avoid needless injuries and deaths; save lives; and make the world's best healthcare system much better for all Americans."

The healthcare industry responds

The Chicago-based American Medical Association said it supported Clinton's goal, but cautioned against creating a "culture of blame" that would emerge by requiring the mandatory reporting of medical errors.

"The AMA is opposed to the expansion of mandatory reporting of medical errors," said Nancy W. Dickey, immediate past president of the AMA. "There is no evidence to show that mandatory reporting improves patient safety. Before we expand data collection activities we need to analyze existing state systems to determine the most effective uses of finite resources."

American Hospital Association president Dick Davidson said that, for the president's proposals to work, Doctors must be comfortable coming forward to report errors. "To have an effective reporting system that actually reduces errors, we need strong protections so doctors and nurses will come forward without fear of retribution," Davidson said. "The heart of the issue is finding ways to improve our systems – the checks and balances designed to help prevent future errors. Without these protections, we could drive error reporting underground and miss important opportunities to protect patients."

Chip Kahn of The Health Insurance Association of America, Washington, issued a statement saying the proposals were "on the right track," but that legal reform would be needed before mandatory reporting would be successful.

"Unfortunately, existing, lenient medical malpractice laws and the current litigious legal environment effectively hamper these type of efforts to improve health care quality," said Kahn. "As a result, proposals to improve reporting of medical errors and information sharing should not be offered in a vacuum. If we truly want to improve patient care by reducing medical errors, we must at the same time encourage efforts to detect and report errors by considering broader legal reforms that would eliminate lawsuit abuse." PR