Hospitals, doctors must come clean when patients are harmed

All of us enter a hospital with the expectations of receiving safe effective care and leaving in better shape than when we came in. For the vast majority this is the case. But for some, mistakes are made and sometimes death results.

There is currently a debate as to how often this occurs. At least three studies have found that preventable patient deaths in U.S. hospitals approximate 200,000 a year. They occur so often that some researchers now estimate that they are the third-leading cause of death in the United States.

Not everyone agrees. Some point to flawed data and come up with estimates which show much better results.

However, the data tend to err on underestimating by not capturing all events and not even measuring deaths due to diagnostic errors. And some have even used data from Great Britain’s National Health Service to argue that the care in the United States is relatively safe, but this makes little sense.

What is agreed is that we need better and more complete data.

The practice of not reporting adverse events has been excused by many because it is caused by physicians’ fears of having their reputations damaged and suffering economic damages. But any public disclosure will risk reputation damage, regardless of legal ramifications, and the brunt of economic awards is almost always borne by an insurance company.

The occurrence of unintentional preventable harm also occurs outside health-care settings. Take for example an accident involving a pedestrian. If the driver leaves the scene, he cannot excuse his actions by saying that he was worried about his reputation and economic damages.

This is why it is so important to report harm to the patient and patient’s family. It is the ethical thing to do. And not doing so can create a culture of “Defend and Deny” which can lead to a degradation of quality in the entire institution.

It is hard to hold staff accountable when they know where the skeletons are buried. Some health-care facilities are adopting a policy of full disclosure, apology and rapid compensation, and are obtaining lower legal costs and higher patient satisfaction. This philosophy was pioneered Dr. Steve Kraman at the Lexington Veterans Administration Hospital.

Do not look for oversight agencies to save the day and improve quality. In Kentucky, there is a law (KRS 216B.185) which prevents the health department from performing routine accreditation surveys in the vast majority of hospitals if the facility has had an accreditation visit by a Centers for Medicare & Medicaid Services-approved organization. The largest one, The Joint Commission, was actually forged out of the health-care industry and for many advocates, it is an example of self-policing.

There are at least three such organizations and they compete for business. Usually competition is good. But which organization performs the accreditation survey is not selected by consumers, the state or CMS. It is selected by the hospitals. I bet that, like a college student’s selection of which professor to take to obtain credits for a difficult course, facilities do not select the most rigorous accreditor.

To make matters worse, CMS evaluates the effectiveness of the surveys performed by accrediting organizations and has found disparity rates of approximately 40 percent. In other words, on follow-up surveys by CMS, at least one significant patient safety problem was found. It’s hard to believe that this rate of accuracy fulfills the intent of Kentucky’s law which uses these surveys “as evidence that a hospital demonstrates compliance with all licensure requirements.”

Certainly, we can do better than this.

All preventable deaths should be counted and quality information needs to be readily available to the consumer.

There is room for improvement in patient safety in every facility, even in higher-functioning ones. As stated by Jim Conway, past senior vice president of Institute for Healthcare Improvement, “In the gap between excellence and perfection, there is suffering, harm, tragedy and death.”

Kevin Kavanagh of Somerset is a retired physician and board chairman of Health Watch USA.