MEDICAL ERRORS: White House Rejects Mandatory Reporting

      Federal health officials announced they have rejected a plan by the National Academy of Sciences for a new federal law requiring hospitals to report all medical mistakes, the New York Times reports. Dr. John Eisenberg, who is reviewing the proposals for the Clinton administration, stated that the White House is "generally enthusiastic about the framework" of the academy's report, but said mandatory reporting could possibly aggravate the problem. Instead, Eisenberg and other government health officials maintain that mandatory reporting could have "unintended consequences," and argued that a well-designed voluntary system would be more effective. Dr. James Bagian, director of the National Center for Patient Safety at the Department of Veterans Affairs, said, "There needs to be some level of national reporting, so we can learn from our mistakes, but to allow disclosure of hospital names and practitioners' names would be counterproductive." Regardless of the administration's response to the report, Congress is moving ahead with plans to require some form of medical error reporting. Sen. Joseph Lieberman (D-Conn.) said that the report "pushed an alarm button" and hopes to pass legislation that will reduce errors in Medicare, Medicaid, and other government health plans. "We've got to make it mandatory, but we should also protect confidentially so hospitals don't have to fear a lawsuit every time they report a preventable error," Lieberman said. But Bagian maintained, "If you're not careful here, legislation could have a chilling effect on people's willingness and ability to report errors." The issue came to light when the Institute of Medicine reported in November that medical errors cause 44,000 to 98,000 deaths each year (Pear, 1/24).

Employers and Insurers Step Up
      Not waiting for White House and Congressional efforts, some the nation's largest employers and insurers are placing pressure on the health care industry to reduce medical errors. Concerned that the issue harms their workforce and pushes up the cost of providing health care, employers and insurers are discussing ways "to improve accountability and reduce errors," the Philadelphia Inquirer reports. Bruce Bradley, director of managed care plans for General Motors Corp., said, "Until recently safety [from medical errors] was not a high priority." Insurers are also concerned about the issue. This month, Aetna U.S. Healthcare, announced it would offer $1 million from its grant program to fund research on a medical error reduction plan. "There is a sense of renewed commitment and expanded commitment to patient safety," said John Kelly, an Aetna spokesperson (Gerlin, 1/23).

Laws Might Not Work
     Although lawmakers and companies alike are hoping to resolve the issue with a mix of mandatory and voluntary rules, even when laws are implemented, they do not always work. Of Philadelphia's 35 largest hospitals, which were mandated to report errors in 1998, only one reported a medical mistake since the law took effect -- prompting critics to argue that mandatory reporting is counterintuitive. Arthur Levin, director of the Center for Medical Consumers in New York City, said, "The low number raises questions. Is this simply a feel-good mandate where the department or the legislature thinks its taking care of the problem?" The 35 hospitals at issue care for more than 350,000 patients a year, which according to statistics, should account for 10,500 to 14,000 medical errors a year (Gerlin, Philadelphia Inquirer, 1/23).