July 2002 • Volume 8 • Number 7 |
The Institute of Medicine blew the whistle on medical errors in 1999 in its report, To Err Is Human. Agencies, consumer groups and legislators began asking health care professionals to share information on medical mistakes, a first step to preventing similar errors.
Immediately, physicians began saying yes to fostering patient safety -- but no to revealing errors that might be used against them in court.
Federal protections would prevent
disclosure of information in civil, criminal or administrative |
Now, Sens. James Jeffords, I-Vt.; Bill Frist, R-Tenn.; John Breaux, D-La.; and Judd Gregg, R-N.H., have honed a patient safety bill that wins on two counts. It would encourage patient safety reporting systems and, at the same time, go far to protect physicians from prosecution based on the information they report.
The Academy has pledged its support for the new Senate bill -- S. 2590, the Patient Safety and Quality Improvement Act. The legislation supports collection of patient safety data, information that does not identify the patient or health professional.
"This legislation would create a system for reporting nonidentified patient safety information that focuses on preventing and correcting system failures and not on assigning individual or organizational blame," AAFP Board Chair Richard Roberts, M.D., J.D., of Madison, Wis., wrote to Jeffords and Frist.
A similar bill, the Patient Safety Improvement Act, H.R. 4889, has been introduced in the House of Representatives by Nancy Johnson, R-Conn. However, H.R. 4889 calls for the protections against disclosure of the patient safety data in court to be coordinated through Medicare, a proposal the Academy opposes. The Senate bill would have the Agency for Healthcare Research and Quality coordinate federal patient safety work, which the AAFP favors.
Nuts and bolts of new system
How would the new reporting system work? Both the Senate and House bills call for the following processes that the AAFP supports:
Information -- classified as privileged and confidential, data not identifying the patient or health professional -- would be voluntarily submitted to patient safety reporting systems.
Federal protections would prevent disclosure of the information in civil, criminal or administrative proceedings unless a judge found that the information met all three of the following criteria: It was material to a case; it was not available from any other source; and releasing the information would be in the public interest.
Patient safety organizations would set up a feedback loop so that those submitting information could learn from mistakes others reported.
"We need to encourage a learning culture to reach the greatest number of patients with improved safety measures," Roberts wrote.
Comments on House bill
In a letter to Johnson, Roberts advised, "The Academy is concerned that the (House) bill amends the Social Security Act and places these protections (against disclosure in court) under Medicare, instead of through AHRQ."
He explained, "Under the (House) bill, primary care physicians without Medicare billing numbers need to go through the Medicare physician billing application process solely for the purpose of obtaining a billing number in order to claim federal protections for reported data. This provision alone is likely to have a chilling effect on reported data."
Roberts added, "The Academy believes that existing error reporting systems have research connections to AHRQ and see this national center for primary care research as the most appropriate place to house patient safety efforts."
FP Report is published by the AAFP
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Copyright © 2002 by American Academy of Family Physicians.