Challenging Dogma - Fall 2007

...Using the social and behavioral sciences to improve the practice of public health.

Wednesday, March 19, 2008

Preventing Medical Errors: Piercing the Shroud of Secrecy Surrounding the Issue is the Key to Success

While most new parents enjoy a time of celebration and wonder following the birth of their children, actor Dennis Quaid and his wife suffered the scare of their lives. In November 2007, their newborn twins nearly died after receiving a massive overdose of heparin, a blood-thinning drug.

According to an ABC News article: "the hospital released a statement that confirmed that three of its patients had received 1,000 times the prescribed Heparin. Instead of 10 units per millimeter, the patients received 10,000 units. ... a pharmacy technician mistakenly stocked the 10 unit vials and 10,000 unit vials in the same drawer. Protocol at the hospital is to keep the different units separated. 'This was a preventable error, involving a failure to follow our standard policies and procedures,' the hospital said. 'Although it appears at this point that there was no harm to any patient, we take this situation very seriously.'"

Not all patients, however, are lucky enough to survive severe medical errors. According to the Institute of Medicine, between 44,000 and 98,000 patients in the United States die each year due to medical errors occurring in the hospital. There are at least 1.5 million annual injuries due to preventable medication errors alone.

Upon first thought, one might believe that a strong litigation initiative - punishing health care providers and holding them responsible for errors - might be the way to amerliorate this serious problem. However, upon closer inspection, I believe that quite the opposite is true.

Perhaps the critical problem that has been holding up progress in reducing medical errors is secrecy about the issue - lack of reporting and lack of communication - due specifically to the threat of litigation.

According to a Food and Drug Administration (FDA) report: "Neonatologist Margaret Donahue, M.D., says the fear of being sued suppresses discussions about medical errors. 'Even if a procedure is done with the best intention and skill, and it doesn't turn out the way it was supposed to, the doctor often still ends up having to pay the patient a huge settlement. It's that culture--the feeling they're going to lose no matter what they do--that keeps physicians closed among themselves.'"

"Historically, people have looked for someone to blame when medical accidents happen, according to FDA's Woodcock [Janet Woodcock, M.D. is the head of FDA's Center for Drug Evaluation and Research]. For victims and their relatives, she says, there may be some satisfaction in that. But from the perspective of fixing the problem, the secrecy that results keeps the medical community from learning what happened and how to correct the problem."

The key, therefore, to unveiling the cloak of secrecy that surrounds health care providers and institutions and which shields patients from the information they need and deserve is to somehow address the litigation threat that is responsible for the veil of secrecy in the first place.

Perhaps this threat is most problematic when it interferes with the direct communication of the occurrence of medical errors to the patient and the patient's family. Even an apology or expression of sympathy for the consequences of a medical error could be construed as an admission of guilt, and health care providers may avoid such communications solely out of fear of litigation.

Another critical component of any successful intervention to reduce medical errors is to treat the problem from a systems level and not merely from the perspective of individual mistakes. Most errors, even when blame can be attributed to individuals, stem from more fundamental causes, often involving systems, policies, or social and environmental conditions.

But the most important component of a successful strategy to deal with medical errors is to bring these errors out into the open. We cannot fix a problem if the problem is not reported. We cannot expect accountability if hospitals are not accountable.

A bill (S1277) currently before the Massachusetts legislature, entitled "An Act Promoting Healthcare Transparency and Consumer/Provider Partnerships," goes a long way toward providing a strategy based on the above principles. The bill would require hospital reporting of serious adverse, preventable medical errors and hospital-acquired infections, require that health care providers inform patients when these errors occur, and allow providers to apologize or express sympathy to patients regarding errors without fear that the apology would constitute an admission of guilt under the law.

The bill states: "In an action for malpractice, negligence, error, omission, mistake, or the unauthorized rendering of professional services against a provider of health care, statements or writings by such provider of health care expressing apology or sympathy relating to the pain, suffering or death of a person which is not the result of intentional misconduct by such provider of health care and made to such person or to the family of such person shall be inadmissible as evidence of an admission of liability."

This would go a long way towards unraveling the veil of secrecy that enshrouds the issue of medical errors. It would open up doors of communication between providers and patients.

Ultimately, it is the partnership between the patient and the provider which determines the success or failure of medical treatment. Senate Bill 1277 aims to create such a partnership.

The battle against medical errors is not going to be won or lost by physicians and health care providers alone. The key to victory is empowering consumers and providers to work together to overcome the 8th leading cause of death among Americans.

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