Support Safer Care Margaret E. O'Kane
The Baltimore Sun, July 12, 2003 Republicans, backed by the American Medical Association, are lobbying for malpractice
reform that caps payouts to patients for pain and suffering.
The medical establishment and the General Accounting Office, the investigative
arm of Congress, say that fear of excessive payouts in malpractice cases is driving
health care costs up through higher insurance premiums for doctors and unnecessary
tests ordered by anxious physicians.
But Democrats and patient advocates oppose any reform that limits liability verdicts
to, say, $250,000 per incidence, arguing that this is nowhere near enough to compensate
patients for damages due to bodily harm caused by medical error.
The House of Representatives recently attacked a different part of the health
care elephant, passing legislation in April that would create a voluntary national
patient safety database for the reporting of medical errors. It would analyze
submitted data and offer recommendations for future prevention. Doctors who participate
would be held harmless.
Is nobody able to connect the dots here?
Malpractice doesn't happen in a vacuum. Most lawsuits are the direct result of
medical errors. While some control of payouts may be highly desirable, malpractice
caps do not address the problem of medical errors and the resultant harm to patients.
And, as the Institute of Medicine has made plain, most medical errors are not
caused by bad doctors but by inadequate safeguards or antiquated systems. They
include the continued use of paper medical records and prescriptions instead of
computerized systems that help manage patient care, or which provide alerts to
guard against inappropriate dosing or harmful interactions.
So patient safety and medical malpractice are already inextricably linked. What
if they were linked in a legislative solution as well? Here's how it would work:
Doctors who participate in the voluntary national reporting initiative and who
adopt systems that are known to support safer care would be given a "safe harbor"
from runaway malpractice verdicts. Patients who use those doctors could feel secure
that their caregivers are less likely to make errors and physicians would see
the benefits of malpractice relief.
But free choice is retained. Physicians who prefer not to report or use systems
that promote safe practice can do so, but they may pay the price in higher malpractice
judgments and loss of clientele.
No doctor wants to be the cause of an error or the target of a lawsuit. But most
physician practices or hospital-based providers cannot afford the investment in
systems that support better care (for example, computerized prescription ordering),
especially when they receive no financial incentives from malpractice insurers,
consumers or payers for doing so.
But linking voluntary patient safety initiatives with protection from excessive
malpractice judgments could provide the incentive doctors need to start investing
in such systems. If malpractice insurers got on board by offering discounted premiums
to physicians that made themselves accountable through the system, those savings
could be put back into upgraded systems that help reduce errors.
In fact, there are several models for this kind of incentive operating around
the country. One is in Colorado, where a physician-owned malpractice firm called
COPIC provides liability insurance for the majority of licensed physicians. COPIC-insured
physicians know they are expected to notify COPIC of any incidents that might
result in a claim against them.
"We require our physicians to call in incidents," says COPIC's CEO, Dr. Jerome
Buckley. "Anything that smells, feels, tastes like a problem or potential problem
must be called in. Our physicians will never be penalized for calling in an incident.
But they will definitely be penalized if they don't. If a claim is filed and we
haven't heard about it from the doctor, he or she will get called before the underwriting
committee."
COPIC also conducts an audit of physicians focused on the use of systems and
processes that reduce error.
Any national effort to accomplish malpractice reform will only be successful
to the extent that it attacks the cause of the lawsuits: medical errors. Legislation
that links voluntary accountability for quality and patient safety with financial
incentives will protect both patients and physicians.
Margaret E. O'Kane is president of the National Committee for Quality Assurance. | 
