Hospitals, Doctors Fear Fallout of Call for Error Reporting

Hospital and physician organizations voiced strong concerns Tuesday about President Clinton’s proposal for mandatory reporting of serious or deadly medical errors, saying it could lead to a proliferation of malpractice lawsuits and encourage “a culture of blame” in medicine.

Many hospitals and doctors fear that if they are forced to report medical errors and the information is disclosed to the public, it will become an open invitation to trial lawyers to bring lawsuits. And that in turn will cause doctors and nurses to be reluctant to report mistakes for fear of undermining the institutions they work for and their colleagues.

“Our concern is it would reinforce a culture of blaming and fear, which would totally contravene the purpose of ferreting out where medical errors are,” said Maureen Sullivan, legal counsel and vice president of the California Healthcare Assn.

But White House officials said the worry about lawsuits is an overreaction. “If you die or you have a serious adverse medical result because an error was made, you and your family are not going to be waiting for a report to come out to decide whether to file a lawsuit,” said Chris Jennings, the president’s senior health policy advisor.

Clinton formally urged hospitals on Tuesday to report serious or deadly mistakes in response to an Institute of Medicine report in November showing that from 44,000 to 98,000 Americans die annually as a result of medical mix-ups. The errors range from botched surgeries to misread prescriptions.

Clinton can require reporting at veterans hospitals and the 6,000 hospitals that participate in Medicare.

His action was applauded by some experts who see errors as a widespread, systemic problem in medicine.

“This may be the price we have to pay in order to establish a new culture of openness with patients and their families,” said Molly J. Coye, former health services director in California and a member of the committee that produced the Institute of Medicine report.

The report concluded that health care is a decade or more behind other high-risk fields--such as the airline industry--in its attention to basic safety. The report recommended a nationwide reporting system.

Clinton’s proposal is intended as a compromise between patient advocates, who want mandatory full disclosure of all mistakes, and the medical community.

Nearly 20 states have either mandatory or voluntary medical error reporting systems, but most do not work very well because they lack guarantees of confidentiality for the hospitals, said Rick Wade, senior vice president of the American Hospital Assn.

“Not all errors justify lawsuits, but once you put this information out there, you open the door for all the ambulance chasers to go out on fishing expeditions,” he said.

Tom Scully, president of the Federation of American Health Systems, said a more reasonable approach would be a program similar to one in Florida in which errors are tracked and aggregated anonymously. The data are then used by hospitals to improve treatment and to design medical guidelines.

The California Medical Assn. opposes any kind of mandatory reporting “because we believe it has a chilling effect on candor and on improving patient safety,” said Susan Penney, the organization’s legal counsel. But the organization would support a voluntary, confidential reporting system, she said.

The medical code of ethics instructs doctors to tell patients when a mistake has been made, but they are reluctant to do so if they think a lawsuit would result.

Administration officials say that neither the names of doctors nor patients would be reported. But physicians say they worry that in a small town hospital where everybody knows everybody, anonymity is largely fictional.

“I can tell you, as someone who has practiced in small hospitals of 100 to 200 beds for most of my life, if I was told about a medical error, I could tell you who the doctor is, who the patient was and who the nurses were that were involved,” said Dr. Nancy Dickey, immediate past president of the American Medical Assn. and a family physician who practices in College Station, Texas.