MEDICAL ERRORS: Clinton Says Government Will Set Example
Saying the federal government will "lead by example" in reducing the number of deaths caused by medical error, President Clinton outlined a number of initiatives yesterday in response to last week's Institute of Medicine report that revealed 98,000 people die each year from medical mistakes, costing the nation up to $29 billion. Clinton said, "This is about far more than dollars or statistics. ... It's about the toll that such errors take on people's lives and on their faith in our health care system" (Gerlin, Philadelphia Inquirer, 12/8). Clinton detailed a four-pronged plan in his remarks yesterday, beginning with an executive memorandum that directs a health care quality task force to analyze the IOM study and report their recommendations to Vice President Al Gore within 60 days. He also instructed the government agencies administering health plans to take steps to reduce medical errors and required the 300-plus private health plans that participate in the Federal Employee Health Benefits Program to "institute quality improvement and patient safety initiatives." Clinton re-authorized the Agency for Health Care Quality and Research and provided the agency with $25 million on Monday to "improve health care quality and prevent medical errors," in an effort to maintain ongoing medical error research. Lastly, Clinton also directed budget and health care officials to include quality and patient safety initiatives in next year's budget. Commenting on the need for reform, Clinton said that "ensuring patient safety is not about fixing blame," but about "fixing problems in an increasingly complex system; about creating a culture of safety and an environment where medical errors are not tolerated" (White House release, 12/8). He added that once health care providers "know about a problem, [they're] under a moral obligation to deal with it" (Gearan, AP/Ft. Lauderdale Sun-Sentinel, 12/8). In conjunction with Clinton's remarks, Dick Davidson, president of the American Hospital Association, announced that AHA will work with the Institute for Safe Medication Practices "to provide hospitals with the latest information about reducing medication errors." The not-for-profit institute has been sending biweekly alerts to 5,800 hospitals about medication errors. Davidson added, "We can and we must do better" (Philadelphia Inquirer, 12/8).
On the evening news yesterday, the nation's health care providers and experts sounded off on how insurance providers can take an active role in helping to reduce errors. Allina Health System CEO Gordon Sprenger said that his organization is involving patients in the process more, utilizing the "sign-your-site" method that allows patients to mark where a certain procedure is to take place. Dr. Allan Korn of Blue Cross Blue Shield of Illinois said about insurers' role in the process, "Make no mistake. [Insurance companies] have the data to help improve the care that everyone in the system receives." And Janet Corrigan of the IOM added that insurance companies can "use their leverage in considering patient safety when they make decisions about who they contract with" (ABC, "World News Tonight," 12/7). Karen Ignagni, president and CEO of the American Association of Health Plans, said, "America's health plans endorse the Institute of Medicine's call for dramatic and systematic action to reduce the frequency of errors and the nature of mistakes throughout the entire health care system. The [IOM] has said that a systems-based approach is needed to address these problems and that is how managed care works. Managed care -- with measurement, accountability, data and research at its core -- provides a critical link in this effort" (AAHP release, 12/7).
The Media's Take
- A New York Times editorial marvels at the "remarkably rapid turnabout" in which Clinton and the federal government has responded to the IOM report. But the editorial argues that the "frightening statistics" were known "long before last week" and no one has figured out how to make things better. The editorial concludes, "Even adopting the institute's recommendations in full will not completely solve this chicken- and-egg problem. But the proposals should produce better information and at the same time protect patients" (12/8).
- J. Thomas Rosenthal, director of the University of California-Los Angeles Medical Group and chief medical officer of UCLA Healthcare, issues a word of caution in the Los Angeles Times: while it might be easy to place blame on individual doctors, the "overall decentralized and fragmented delivery system itself contributes to unsafe conditions." He argues that "creating an effective culture of accountability in a more integrated American health system will eliminate most medical mistakes." Further, he asserts that without a "greater culture of accountability," health care providers "will have a hard time improving quality." Rosenthal also makes an argument for physicians groups, saying that if they are "forced from the scene, a critical component capable of systematically improving safety will be lost." Rosenthal concludes that failure to include physicians groups "will make the task of hospitals and other organizations to successfully take on the challenge of the Institute of Medicine all but impossible and invite a self-defeating 'find the bad apple' regulatory approach to safety and quality" (12/8).
- A New York Daily News editorial praises Clinton's "swift action," maintaining, "If Americans are to continue to have faith in a health care system whose golden rule has always been 'first, do no harm,' Clinton's quick reaction to the report is just what the doctor ordered. For when it comes to prevention, there's no such thing as an overdose" (12/7).
- "Fatal errors should not be concealed, but the emphasis should be on correcting badly designed hospital systems rather than blaming individuals," an editorial in the Memphis Commercial Appeal argues. The editorial praises several Tennessee-area hospitals that have taken steps to reduce errors, including improvements in medication distribution, but insists that "more needs to be done." This should include addressing the problems of exhausted residents and doctors' often illegible handwriting, the editorial maintains. The editorial concludes that "mistakes that don't get corrected are likely to recur. If greater information about medical errors can be shared in a way that prevents mistakes and saves lives, everyone benefits" (12/8).