Remedy for Medical Errors

When the Institute of Medicine reported in 1999 that easily preventable medical errors kill as many as 98,000 Americans each year, Congress promised to swiftly put into effect that advisory body’s key recommendation: to create a system for doctors, nurses and other medical professionals to confidentially report errors to regional patient safety organizations. These groups would compile, verify and pass the reports to a new national clearinghouse, which would use them to distill and disseminate lessons for health workers. Today, four years and who knows how many amputated limbs and other serious medical mistakes later, legislators have failed to act.

That could change Wednesday, when the Senate Health, Education, Labor and Pensions Committee considers two medical-error bills: draft legislation by Sen. Judd Gregg (R.-N.H.) the committee chairman, and HR 663, which the House passed in a 418-6 vote this year. Senators at the hearing should encourage Gregg to set aside his murky proposal and embrace the House’s clearer, if modest, alternative.

The flaw in Gregg’s bill is that it imposes secrecy when there should be sunshine and allows disclosure when it should guarantee privacy. It gives up critical information in key places: It fails to protect sources’ identities, for instance, meaning that a doctor could learn that a colleague had reported an error.

In other ways, Gregg’s bill is too clandestine. The House bill requires the Health and Human Services secretary to establish a national patient safety database and gives the secretary the authority to demand access to the regional patient safety groups’ data. The proposal by Gregg -- who before his last election received $115,071 in contributions from political action committees representing hospitals, doctors and other health-care interests -- would permit the database construction. But it would bar Washington from requiring regional groups to tell it about lapses in patient safety.

There’s little reason to think that without Washington’s prodding, doctors and hospitals will establish aggressive new systems to curb medical errors. This month, California inspectors reported that in analyzing botched surgeries at Queen of Angels-Hollywood Presbyterian Medical Center, they found “no documentation or other evidence to indicate that these cases were discussed, presented or subjected to scrutiny by any committee of the medical staff.”

HR 663 is imperfect. It won our tepid endorsement four months ago because rather than requiring health professionals to report medical errors, it merely urged them to do so via a voluntary system. Still, it substantially improves the present system by letting safety groups monitor errors while assuring medical professionals that reporting them won’t get them fired, ostracized or sued.