Need For A Malpractice National Registry

According to the National Practitioner Data Bank, Medical Malpractice Payment Reports and Adverse Action Reports, the United States had 599,945 medical malpractice claims that had plaintiff payouts spread out among 364,893 health care practitioners from 2004 through 2014. In the state of Pennsylvania alone, the number of medical malpractice claims tallied up to 25,283 plaintiffs, entailing 15,479 health care providers, during the same timeframe. According to some reports, approximately 44,000 to 98,000 people die in hospitals every year due to medical errors. Yet, the Journal of Patient Safety states that the numbers are likely higher, ranging from 210,000 to 440,000 patients. Without a doubt, health care in the nation isn’t as safe as it should be. Some even feel it’s a nationwide health care crisis.

Common Medical Errors

Surgical ErrorsMany medical errors occur in the diagnostic, treatment and preventative phases of medical care. There may be the use of outdated tests, error in the drug dose or the failure to provide prophylactic treatment. Even though there are many errors in drug dosing, there are many medical facilities which don’t implement the use of better systems, such as automated medication order entry systems. For inpatient incidents, surgical errors like wrong-site surgery account for approximately 34 percent of medical malpractice claims. For outpatient incidents, faulty diagnosis accounts for about 46 percent of all medical malpractice claims, according to the Journal of the American Medical Association. More commonly, medical errors are caused by faulty processes, systems and conditions that lead health care professionals to make mistakes. For example, when a patients sees multiple doctors for a health condition, there often isn’t a central database in place where one physician can access all of the patient’s medical information to better put in place proper protocol for treatment. All around, the health care system is fragmented and is at odds with itself.

What Is Being Done to Shape the Health Care System for Better Patient Safety

To help fix the fractured health care system, the Institute of Medicine (IOM) created the “To Err is Human: Building a Safer Health Care System” report with a four-tiered approach. Noting that the health care industry is a decade behind other high-risk industries for basic safety, the IOM recommended that Congress create a Center for Patient Safety to set national safety goals, define prototype safety systems, evaluate tools for analyzing medical errors and educating consumers about patient safety. The report also recommended implementation of mandatory reporting systems in which all state governments would be required to collect information that resulted in adverse medical events causing serious harm or death, the reporting of all adverse medical events to be required of all hospitals and health care organizations. The IOM also encouraged Congress to create legislation for the use of voluntary reporting systems which ensure confidentiality. This would help protect the reporter from being subpoenaed in a medical malpractice case.

It has been more than a decade since the IOM called for a national registry to track medical errors to bring greater accountability for health care providers. Yet, to date, only 10 states require hospitals to disclose unintended outcomes and medical errors to patients. The call for a national registry to track medical harm hasn’t come to fruition. In addition, a recent national survey revealed that physicians often refuse to report a serious medical error to anyone in authority. Cardiologists are the highest non-reporting specialists when it comes to medical errors. Clear evidence of medical errors does not make its way into patient medical records. ProPublica gathered stories from 1,000+ people from all 50 states inquiring about how the facility handled the situation when a loved one was injured during medical care. Only 1 in 5 respondents indicated that the medical facility or health care provider admitted and disclosed that harm had occurred. And disclosure came in half of those cases only when a complaint was made or a lawsuit was filed.

What’s Being Done to Ramp Up Patient Safety

States wanting to ramp up patient safety should follow the lead of six states that have enacted legislation to support the creation of patient safety centers. New York, Pennsylvania, Florida, Maryland, Oregon and Massachusetts have either endorsed or passed legislation for patient safety centers to create a safety culture. These six states have openly acknowledged the serious issue of patient safety and have commitments to improve patient safety. Five out of the six states have patient safety centers with mandatory reporting systems for serious adverse medical events. Several of those patient safety centers have access to medical data to assist with analysis. Three of those states also implement a voluntary reporting system for less serious medical errors, designed to enhance the already in-place mandatory reporting systems. Although the patient safety centers vary in procedure, most have activities that include educating health care providers and patients about steps to take to reduce occurrences of adverse medical events, developed systems for collection and analysis of adverse medical events, serve as a clearinghouse for best practices, promote collaboration between private and public sectors and coordinating state agency initiatives. The state of Pennsylvania even has a statute that allows for a discount in medical malpractice liability insurance premiums for health care providers that can demonstrate a decrease in serious medical adverse events after following the patient safety center’s recommendations. New York has an award program to recognize patient safety leaders in health care facilities. The effort for establishing state patient safety centers grew out of the 1999 IOM report that documented 98,000 U.S. deaths each year due to medical errors.

Medication ErrorsIn 2002, the FDA proposed a new rule requiring bar codes on certain biological product and drug labels. Health care professionals now use bar code scanning equipment to ensure the right dosage is administered, and the right patient receives the medication. Since VA hospitals have used bar codes nationwide, there was an 86 percent medication error reduction over a nine-year period.

Needed Initiatives to Improve Patient Safety

It’s important to note that most adverse medical events are systemic and not due to individual health practitioner fault. In addition to state patient safety centers, hospitals and other health care facilities need to implement initiatives to improve patient safety. Heath care facilities need to engage patients and families as partners in safety practices. This can be accomplished by defining and developing safety procedures at the delivery level and sharing that information with patients and families. Those health care professionals who make rounds should be encouraged to ask questions that probe patient safety. Opportunities for patient and family involvement in patient safety committees, coalitions and advisory groups should be available. Educational tools, learning aids and feedback forms should also be available to patients and families. When patients and their families are educated about patient safety, have the right tools, and better understand why they need to participate, their involvement can prevent medical errors and enhance safety.

Health care facilities should be using the latest in technology when it comes to medication. Computerized physician order entry (CPOE) has been shown to be effective in reducing medication errors. It eliminates the misinterpretation of abbreviations, decimal points and handwriting. While the number of facilities using CPOE is rising, the others need to jump onboard with the digital world. In 2002, the Pittsburgh Hospital unveiled its CPOE system and replaced prescription pads. Their system provides all kinds of information about potential drug complications, and won’t even let the order go through if a child’s weight isn’t in the system. It’s a complex medical system; medication errors can easily be made due to drug name confusion, labeling and lack of employee knowledge. In most cases, medication errors can’t be blamed on one person.

While new regulations, patient safety centers, new technology, patient education and increased communication between patient and health care provider all work together to improve patient safety, having a medical malpractice national registry in place could help reduce medical malpractice. Armed with this information, patients could make a more informed decision when it comes to choosing their health care provider. With the high incidence of medical errors, there is definitely a strong need for a medical malpractice national registry.