Books and Essays by Doctor Frank Boehm

(May 27, 2006)

      In 1999, the prestigious Institute of Medicine published a report entitled To Err is Human, which claimed that up to 98,000 deaths occur each year in United States hospitals due to errors made by health care providers. This astonishing report pressured the health care industry to make changes that would correct the problem of errors made in the care of hospitalized patients. Now, seven years later we learn that the number of deaths that occur each year in American hospitals have actually increased, perhaps even doubled! It appears we are back to business as usual. What is going on here?

      It is not that the health care industry has not tried to correct the problem of medical errors; rather it has not been focused on the real issues causing medical errors. This assessment comes from two distinguished experts on the subject of medical errors writing recently in two prestigious medical journals.

      In The New England Journal of Medicine, George J. Annas writes that he believes the law should recognize patient safety as an inherent right. He believes it is the responsibility and duty of all hospitals to make sure that this right is protected and hospital responsibility can become a major motivator for developing systems in hospitals to reduce medical errors. This, Annas states, is contrary to the popular premise that it is lack of tort reform to reduce liability that is the real barrier to putting into place hospital safety programs. Annas goes on to say that "Hospitals that do not take specific actions to improve safety should be viewed as negligent and be subject to malpractice lawsuits when a violation of the right to safety results in injury".

      Annas also believes that all hospitals in America should put into place a system of reporting all errors, as well as what he calls near misses for quality control, which is to "make sure patients are told when their injuries were caused by errors". He does not believe that universal reporting and being open and honest with patients will drive up malpractice claims since no study has yet shown that reporting medical errors has increased medical malpractice rates.

      Vanderbilt is one of the few hospitals in this country that has made a patient's right of safety a top priority. We are working with system management groups in an attempt to change the culture of doing business with our patients. Initiating a computerized mechanism to place medical orders in a patient's chart (which has resulted in a significant reduction in medication errors), and hiring consultants from the highly effective safety conscious airline industry to work among doctors and nurses to put into place processes that lead to reductions in communication and system errors, are two examples of how Vanderbilt has taken seriously the right of a patient to safety.

      Annas's bottom line is that with a national adoption of a patient's right to safety, hospitals will be more likely to take measures to meet a goal of safety since failure to do so would result in increased liability to the hospital.

      Dr. Louis Weinstein, writing in The American Journal of Obstetrics and Gynecology, also addresses the issue of preventing medical errors. He claims that, "The emphasis of most physicians and medical professional societies has been on seeking tort reform with the imposition of non-economic damage caps and contingency fee limits". He believes the medical community needs to spend more effort on preventing errors than attempting to reduce liability for medical errors. He has a point.

      Medical errors that lead to patient harm are most often system errors and, therefore, with determination and a will to change, amenable to repair. Weinstein believes that tort reform does not address medical errors that are preventable and also believes we should remove the privilege of non-disclosure of peer review systems in hospitals so as to regain public trust.

      Without an open dialogue with our patients, as well as implementation of many other processes to effect patient safety, we are doing nothing to put into place a system that will result in a reduction of hospital errors (while increasing lack of trust in the medical profession). The recommendations by these two experts on the subject may be controversial but at least they are addressing the untenable situation of an increasing rather than decreasing number of medical errors that lead to patient death. We need to pay more attention to what they say.