The Pennsylvania Patient Safety Authority welcomed the new Physician General as its Chair, after an absence of a Physician General in Pennsylvania for some years. Carrie DeLone, MD, will be taking over the reins of an organization that started as a haphazard adjunct to the medical community and has now grown into a full-time, high level engine to drive the patient safety movement.
For me, thinking about the Patient Safety Authority is a lot like dealing with my own children. I take great pride in seeing the accomplishments and growth of my kids over the years. I like thinking that I had something to do with their success.
When I was President of the Pennsylvania Trial Lawyers Association (now called the Pennsylvania Association for Justice) more than ten years ago, one of my strongest agenda items was to assure that Pennsylvania became the first state to have a patient safety authority. The venerable Institute of Medicine recommended a patient safety authority as early as 1999 to address the catastrophe of medical errors in this country. The airline analogy worked. More people die yearly in American hospitals as a result of preventable medical errors than two 747’s crashing each month with the loss of all lives aboard. No one could tolerate that.
In the late ’90s and early ’00s, the medical profession and their pharmaceutical allies were calling vociferously for restrictions on the right to sue for serious medical errors. I, along with a few others, stood steadfastly against any change unless the legislature also addressed the epidemic of preventable medical errors. My vision for a patient safety authority was enacted, and the Senate of Pennsylvania appointed me as one of the Authority’s first members.
Today, the Pennsylvania Patient Safety Authority is a state, national and world leader in patient safety. We have seen falls in hospitals and wrong site surgery drop dramatically in the last 10 years. The Pennsylvania Patient Safety Authority has not done it alone, but it has been a leader in addressing problems in American hospitals.
It is difficult to measure the success of the Pennsylvania Patient Safety Authority except to note that patient safety is now on the lips of all medical health care professionals. Hand washing, one of the simplest ways to prevent infections, is better than it used to be but constant reminders are still necessary. The change has been gradual but notable .
One of the most important contributions of the Pennsylvania Patient Safety Authority is in the world of literature. Articles, data and information about patient safety is now widely available. Patients wear color-coded wrist bands, socks, and other paraphernalia to make sure that they are not mistaken or confused with other patients. The number of claims in medical malpractice cases and the payout in medical liability claims has dropped through the floor. Part of the reason for this is not merely patient safety, but also artificial barriers and hurdles that have been erected to discourage legitimate medical liability claims.
There is still much work to be done. Many hospitals in Pennsylvania report little or no medical errors, which they are required to do under the law. There simply is not the will to punish those institutions which are not in compliance with the law. We have the carrot, as a result of the Patient Safety Authority, but not the stick.
The Patient Safety Authority has a marvelous strategic initiative to measure future progress, to standardize reporting of medical errors, and to bring patients into the equation.
When my opportunity came to speak at the Patient Safety Authority meeting in Harrisburg, welcoming the new Physician General, I made the following points, which seemed to be well received:
- Consumers. We need to empower consumers. Patient Safety will be driven by patients demanding better hospitals and more attentive doctors.
- Truth. We need to realize that patient safety requires transparency and truth. Doctors and hospitals are getting better about telling their patients what has really happened during their care, but much work needs to be done in this respect.
- Electronic Medical Records. Electronic medical records are a mess, sometimes are impossible to read, and are confusing. This is seen by the Institute of Medicine, the Patient Safety Authority and others as a must improve issue.
- Business Community. The business community must understand that patient safety saves money. As Marshall Webster, MD, the CEO of the Pittsburgh healthcare system once said to me, “It’s simply good business.”
- Ego. Reluctance to be forthright must be addressed. Ego of some of the medical profession still prevents honest communication with patients and addressing of personality or training issues which create patient safety problems.
- Medical Schools. Patient safety must be part of the training in medical schools.
- Uniformity. Reporting of incidents and serious events needs to be more uniform, and the law needs to be adhered to by hospitals and nursing homes on a more consistent basis.
- Specific Problems. What works best are addressing specific problems. For example, we have made great progress in reducing the number of “falls” in hospitals. We also have made much progress in the case of wrong site surgery. We must look at problems in hospital diagnosis, infections, and many other fields of medicine.
- Government. The relationship between the Patient Safety Authority and the Department of Health requires attention. The Patient Safety Authority may be the brains and the heart, but the Department of Health is the muscle. The two agencies must work more closely together and coordinate their activities.
The legal system must also be addressed. There are medical errors and people deserve to be compensated for preventable medical errors. The following must be addressed in the legal system:
- Peer Review. Peer review of doctors is currently secret and not subject to any requirements or review as to its legitimacy. Proposals for statewide peer review or criteria for proper peer review have been suggested unsuccessfully in the past.
- Oversight. There is poor oversight by the medical licensure board and the Department of Health generally.
- Department of Health. The Department of Health is slow, understaffed, underfunded, and does little or nothing for patients and consumers.
- Experts. Expert witnesses who testify in medical liability cases are generally too hard to find, too expensive, and they fear testifying because of retaliation from their colleagues. This must be addressed through legislation.
- Venue. One-hospital counties and towns are unfair places to litigate serious and legitimate medical liability claims. There must be a change of venue provision which has teeth in it for such situations.
- Judges. Judges should not be serving on boards of hospitals or be in cozy relationships with them.
- Discovery. Discovery limitations must be lifted. It is currently too difficult or too hard to get information about what goes on in hospitals, how they are run, and the peer review conducted or not conducted. It is time to take off the blinders, remove the ear coverings, and permit the free flow of information about what really goes on in the hospital setting. This will not only enable legitimate claims to be aired, but will also enhance patient safety.
- Whistleblowers. Better whistleblower protection is necessary. There are many fine and decent people working in the medical community who would speak truthfully if they did not fear retaliation and threats to their future.
- Secrecy. Culture of secrecy must be addressed. The mentality of “don’t talk, don’t know, don’t jeopardize your future as a professional” and “hate lawyers” is all too strong in the medical community.
- Courts. The court system is often too slow, too expensive, and too intimidating. The courts must be more open to caring, and permitting litigation of serious claims. We now have a certificate of merit procedure in Pennsylvania and most other states which enhances screening of cases.
- Information. The truth about medical liability claims must be understood. While there are over 300,000 reports of incidents and serious events to the Patient Safety Authority, less than 1,500 medical malpractice cases in Pennsylvania are brought each year.
- Premiums. The high medical malpractice premium crisis of the late ’90s or early ’00s was not caused by lawyers of the legal system but rather very low interest rates as was taught to us by Professors Hofflander and Nye. We now know that the interest rate cycle has more to do with insurance premiums than claims payout.
- Doctor Availability. Doctors are not leaving Pennsylvania or any other state. In fact, in Pennsylvania the ratio of patients to doctors has improved markedly since 1973. There are also many more physician extenders today. The problem is that physicians do not want to go to rural areas, but that has always been a problem. This has nothing to do with medical liability claims, but rather with the personal habits and preferences of people who practice medicine.
We certainly are not out of the woods on patient safety. There needs to be vast improvement in the patient safety mentality and a more approachable legal system as well. The concept of a non-punitive way of encouraging patient safety can and should exist side by side with a legal system that reimburses people who are genuinely injured as a result of preventable medical errors.
Rieders, Travis, Dohrmann, Mowrey, Humphrey & Waters
161 West Third Street
Williamsport, PA 17701
(570) 323-8711 (telephone)
(570) 323-4192 (facsimile)
Cliff Rieders, who practices law in Williamsport, is Past President of the Pennsylvania Trial Lawyers Association and a member of the Pennsylvania Patient Safety Authority. None of the opinions expressed necessarily represent the views of these organizations.