April 2000 Bulletin

Caution on reporting urged

Legislated requirements should be nonpunitive, says AAOS

The AAOS is urging Congress to proceed with caution and careful planning before medical error reporting is required or encouraged of hospitals or other health care providers.

In a statement entered into the proceedings of three congressional hearings, and in a letter to all 535 members of Congress, AAOS supported efforts to eliminate medical errors. AAOS pointed out that it had initiated several programs such as the "Sign Your Site" to eliminate medical errors program.

The congressional hearings were in response to a report by the Institute of Medicine (IOM) that up to 98,000 Americans die each year from medical errors in hospitals. The IOM called for mandatory public disclosure of all medical mistakes that cause death or serious injury and voluntary reporting for other errors and "close calls."

"If new reporting requirements, whether mandatory or voluntary, are legislated," AAOS said, "then the approach should encourage open and candid discussions and disclosures through nonpunitive mechanisms for reporting that ensure patient and provider confidentiality and expand peer review protection.

"Even if the reporting is institution-based and not individual-based, or just voluntary and not mandatory, implications for the availability and use of such data may result in unintended consequences. Discovery rules and statutes governing access, entitlement and use of such information must be carefully scrutinized.

"Policies must require appropriate definition of the type and use of data necessary for a successful medical error reporting program, as well as the process for reporting. A successful effort will require careful planning of the many critical components of a reporting mechanism."

AAOS believes that physicians and other health care professionals are already held accountable through a well-established punitive-based judicial system, as well as licensing structures and ever-more complicated accrediting processes. "We believe all entities involved in making medical decisions should be equally accountable," AAOS said. "But additional systems with punitive undertones could defeat efforts to foster an open dialogue on medical error and patient safety.

John Eisenberg, MD, director of the Agency for Healthcare Research and Quality, which will lead the effort against medical errors, told a Senate committee hearing that no one knows if mandatory reporting works.

Sen. Arlen Specter (R-Pa.), chairman of the Senate Appropriations subcommittee that funds the Department of Health and Human Services, and Sen. Tom Harkin, (D-Iowa) the panel’s ranking Democrat, recognized the limited evidence on reporting medical errors in their bill which calls for 15 separate demonstration projects to test how to best gather information on medical errors.

President Clinton also responded to the IOM report by supporting most of its recommendations. Clinton proposed that all states require mandatory reporting of medical errors that cause serious injury or death. However, he recognized that mandatory reporting was a contentious issue and supported prohibiting the use of medical error data as discoverable information in any litigation. He encouraged voluntary reporting of other errors and "close calls" and urged that information to be made public would be grouped by institution without identifying patients.

President Clinton also ordered immediate mandatory reporting of medical errors at the 500 Defense Department hospitals. The Health Care Fi nancing Administration will require error-reduction plans this year in all 6,000 hospitals that participate in Medicare.

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