1.2.2002 00:05
R.I. DOH in bed with
hospital lobby MISTAKES in our nation's hospitals
cause between 44,000 and 98,000 deaths each year. That horrifying statistic was
provided in 1999 by the National Academy of Science's Institute of Medicine.
Two years ago, I began discussions with the Rhode Island Department of
Health (DOH) in an effort to eliminate the miscues that injure or kill patients
in our hospitals. In response, the General Assembly issued a budgetary
appropriation and in a June 16, 2000, letter of intent ordered the DOH to study
the issue and propose remedial action. Unfortunately, the efforts of the
department have been less than stellar, contrary to the progress in other
states.
The DOH recently completed its study and reported its findings
to the General Assembly in November. The final report, frustratingly, contains
no action plan to reduce the number of medical errors occurring in our hospitals
and does not explore any of the innovative approaches to medical care undertaken
in other states.
The Institute of Medicine (IOM) study was both
overwhelming and grim. According to an extrapolation of numerous studies,
mistakes in hospitals are a leading cause of death in our country. In addition
to the thousands of deaths, between 500,000 and 1 million people are injured
each year from such mistakes. According to the report, a hospital patient's
chances of being injured as a result of a hospital error increases 6 percent
each day.
The reporting of these errors is a problem because of the
"cloak of secrecy" among hospital staff relating to mistakes. To illustrate the
extent of underreporting, only six errors were reported in Rhode Island
hospitals in 1999 after deducting kidnappings and hospital falls. According to
numerous authoritative studies documented in the study, the number should have
been in the thousands.
During the 2000 legislative session, I proposed
the creation of a Patient Safety Council. The bill (2000 H-7189) addressed both
the necessity of providing oversight of hospitals, which did not exist, as well
as the closing of a loophole in the current reporting law that has partly
enabled hospitals to drastically underreport mistakes and fail to make the
changes necessary to avoid repeating them.
The DOH countered with an
in-house "Hospital Survey Team" and the result became a $300,000 budget line
item called the Hospital Care Consultant Report. The June 16, 2000, letter of
intent provided to the DOH made it clear that hospitals were not reporting
mistakes under the existing statute. The DOH was instructed to provide oversight
of hospitals, analyze information from numerous sources, including the IOM, and
propose systemic changes to hospital care to prevent errors in the future.
Unfortunately, the hospital lobby has been less than enthusiastic about
addressing the crisis. Lobbyist Edward Quinlan has been the most vociferous
critic of the IOM study as well as hospital oversight in general. He has
dismissed the IOM report as nothing more than a dated report and analysis.
Unfortunately, it appears that Mr. Quinlan either has not read the 200-page
report or hopes that no one else has, since the IOM study is an analysis of many
scientific studies from the 1980s and 1990s.
Making matters worse, the
director of health, Dr. Patricia Nolan, made it clear that the hospital lobby,
especially Mr. Quinlan, would have an inside track regarding the contents of the
final report as well as policy relating to curing the hospital error reporting
law and curbing medical errors.
Mr. Quinlan's position appears to have
influenced the department's progress, or lack thereof. The final report issued
by the DOH last month was a disappointment because it failed to provide any
remedial action recommendations to the General Assembly. Nor did the report
explore any of the innovative approaches for the hospital system other states
have been pursuing since the IOM study. Many other states have turned proactive,
refusing to follow Rhode Island's static response.
New York, for
example, has tightened its rules in an effort to prevent a surgeon from
operating on the wrong side of a patient's body and limited the number of
consecutive hours doctors can work.
Massachusetts recently initiated a
program to computerize significant portions of the medication-delivery system.
In addition, its Department of Health received a $4.5 million grant from the
federal Agency for Healthcare Research and Quality to collect and use
information on medical errors in an effort to prevent them in the future.
The federal government has also recommended that states initiate a
confidential database on the Internet for health-care workers to report mistakes
in hospitals. The database will help state government regulators and medical
professionals spot trends in mistakes in an effort to avoid repeating them.
I have repeatedly made DOH officials aware of the above progress. But
two years after the IOM study, the department has yet to provide an analysis of
what systemic changes can be made to reduce errors. It has not provided any
reasons why it dismisses the aforementioned ideas for change from other
jurisdictions.
In sum, I seriously question whether the Department of
Health is capable of significant improvements to the hospital-care delivery
system by reducing errors. It is my opinion that the department is overly
concerned with the hospital lobby and is uncomfortable playing the role of
licensing agency and investigator/enforcer. As more than one health-care
official has said to me, the department is not sure if it is sound policy to be
both the Federal Aviation Administration (licensing) and National Transportation
Safety Board (investigative/enforcement). If the department is uncomfortable
with taking positions opposed to the hospital lobby, then it should not have
rebuffed the independent Patient Safety Council. The department cannot have it
both ways.
Rhode Island state Rep. H. Norman Knickle, who represents
District 37 in Warwick, is a member of the House Judiciary Committee.
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