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Clinton acts to reduce medical mistakes

BMJ 2000; 320 doi: http://dx.doi.org/10.1136/bmj.320.7235.597 (Published 04 March 2000) Cite this as: BMJ 2000;320:597
  1. Fred Charatan
  1. Florida

    President Clinton has called for a nationwide system of reporting medical errors in the wake of last year's Institute of Medicine report, which found that between 44000 and 98000 Americans die each year from medical mistakes.

    More than 6000 hospitals will be required to introduce programmes to reduce medical errors—for example, in the prescribing and dispensing of drugs—as a condition of participating in Medicare, the federal health insurance programme for those aged over 65.

    Mr Clinton's plan will also require all 50 states to adopt error reporting systems, to be triggered whenever a hospital mistake results in serious injury or death. Currently, 18 states including New York, New Jersey, and Connecticut require hospitals to report certain kinds of mistakes and “adverse events.”

    Under Mr Clinton's plan, hospitals reporting errors would be publicly identified, but the names of doctors, nurses, and patients would remain confidential. Medical errors include the use of the wrong drugs, surgery on the wrong body part or the wrong patient, errors in blood transfusions, and improper insertion of catheters or feeding tubes.

    The president will ask Congress for $20m (£12.5m) to create a Center for Quality Improvement and Patient Safety as part of the Agency for Health Care and Quality in the Department of Health and Human Services. Mr Clinton's plan will require legislation.

    Despite its appeal to consumers, the proposal has come under strong criticism from medical experts. Dr Nancy Dickey, former president of the American Medical Association, said, “We are opposed to mandatory reporting. It may well drive underground the very information you need to improve safety. A number of states have mandatory reporting, and there's no evidence that they have greater safety or fewer errors.”

    Her remarks were echoed by Richard Davidson, president of the American Hospital Association, who said, “The idea that a mandatory reporting system is going to change behaviour is naive at best. You need to focus on making a cultural change in hospitals, to promote open discussion of errors, and that's not possible if some plaintiff's attorney is climbing on your back.”

    Dr Richard Gaintner, chief executive of Shands Health Care, which operates seven hospitals around Gainsville, Florida, said that he feared that the reporting of medical errors would feed the appetite of lawyers eager to sue hospitals for malpractice. “We take medical errors very seriously,” Dr Gaintner said in an interview, “but the incredible litigiousness in the healthcare field is of great concern to us. I have been in this business for 30 years and have sat on the boards of several insurance companies. I've seen too many examples of information that gets out and is used in ways that are not good for patients or patient care.”



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    “President Clinton plans public reporting of hospitals” medical errors

    (Credit: AFP PHOTO/STEPHEN JAFFE)