Kaiser CEO Injects Medical Safety Into Health-Care Debate

The head of Kaiser Permanente, denouncing the quality of American health care, said Wednesday that blunders by doctors and other health-care professionals put Americans unnecessarily at risk for illness and death.

Medical accidents and mistakes kill 400,000 people a year, and rank behind only heart disease and cancer as a leading cause of death, Dr. David Lawrence, Kaiser’s chief executive, said in a speech to the National Press Club here. Mistakes alone, he said, kill more people each year than tobacco, alcohol, firearms or automobiles.

In the first National Press Club appearance by a top Kaiser executive in 50 years, Lawrence chose to make a high-profile issue of medical safety. He compared medicine unfavorably to the airline industry, which reduced its rate of fatalities from flight by 80% between 1950 and 1990.

Lawrence spoke as the Senate debated legislation that would give patients more leverage in dealing with health maintenance organizations such as his.

He and individual doctors are on opposite sides of a debate that pits the managed-health-care industry and employer groups against health-care professionals and patients.

They are also on opposite sides of a cultural divide, with entrepreneurial doctors on one side and huge managed-care organizations on the other.

In his speech, Lawrence promoted the view that managed care, thanks to efficiencies of scale and to a greater capacity to gather information about patients and treatments, is better and safer care than that of traditional fee-for-service medicine. Doctors typically argue that individual practitioners, because they are intimately acquainted with their patients, are in the best position to help them.

The American Medical Assn. has been pushing hard for legislation to give doctors the last word in deciding which tests and treatments are “medical necessities.” HMOs and business groups representing employers say that would merely drive up spending as doctors sought to increase their incomes by ordering more tests and procedures.

Lawrence’s speech, as an invitation to consumers to demand safer care, seemed designed to split HMOs’ political opponents. Oakland-based Kaiser is California’s largest health maintenance organization, with 33% of the market.

Most patients “continue to believe in the myth of Marcus Welby, the unbridled benefits of technology and the assumption that competence and safety are spread evenly and consistently throughout the health-care system,” he told the gathering. “If passengers were asked to fly with a commercial airline organized like most health care, they wouldn’t get on the plane.”

Lawrence said he and some other health industry leaders have organized foundations and commissions aimed at “aggressively tackling the problem of patient safety.”

Critics inside the medical industry want improved reporting procedures for medical mistakes and gathering of information about “near-misses”--accidents that didn’t quite happen--just as airlines and air traffic controllers study near-collisions to learn how to avoid actual collisions.

When hospital workers place the wrong liquid in an intravenous bag but detect the mistake before any harm is done, they are reluctant to tell anyone for fear of losing their jobs, Lawrence said. A “legal safe harbor” for such workers would let them report the information and help hospitals take measures to minimize mistakes, he said.

Safety also can be improved, Lawrence said, when doctors work in groups, because they are able to look at one another’s work, share information on patients and keep up with new developments in medical procedures. He cited as successful group practices the Mayo Clinic, the Cleveland Clinic, Group Health Cooperative of Puget Sound in Washington state, Harvard’s Vanguard Medical Group and the Permanente medical groups that contract to care for Kaiser patients.

As one small sign of the benefits to be reaped, Lawrence said Kaiser’s technique of teaming up doctors, nurses, pharmacists and health educators has reduced hospital days and emergency room visits by 80% among asthmatic children.