Patient safety legislation -- an urgent call to action

A message to all physicians from AMA President Donald J. Palmisano, MD.

By Donald J. Palmisano, MDis a general and vascular surgeon in private practice in New Orleans. He was AMA president during 2003-04. Posted May 17, 2004.

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Almost a year ago, on June 18, I said in my inaugural address: "Do your homework. Have courage. And don't give up." Now my journey as AMA president nears its end. Although this will be my last column, it certainly won't be the last time I call upon the Federation of Medicine to act on behalf of our patients and our profession.

The AMA's No. 1 legislative priority is to bring common sense to the medical liability system. We continue to be relentless in that pursuit. A critical corollary is to bring forth a system that will enhance patient safety. We now have the opportunity to improve the prospect for the greater safety for our patients through legislation that is under discussion in Congress.

On March 12 last year, the U.S. House of Representatives passed -- by more than 400 votes -- HR 663, the "Patient Safety and Quality Improvement Act."

This legislation would create a confidential, voluntary reporting system that physicians and other health care professionals could use to report information on errors to groups known as patient safety organizations. The PSO would collect and analyze unique patient safety data, provide feedback on patient safety improvement strategies and disseminate the lessons learned to all in medicine.

The Senate companion bill, S 720, unanimously passed the Senate Health, Education, Labor and Pensions Committee in July 2003. It's a bipartisan bill, with support from both the Senate Majority Leader Bill Frist, MD (R, Tenn.) and bill co-sponsor, Sen. John Breaux (D, La.). Yet when the Senate leadership tried to bring up the bill under a unanimous consent request last month, Minority Whip Sen. Harry Reid (D, Nev.) objected because his Democratic colleagues wanted more time to study the bill.

We are hard pressed to understand why the Senate is having such a difficult time passing legislation to improve patient care.

The House passed a bill in March 2003. The Senate HELP Committee unanimously reported S 720 out of committee nearly 10 months ago.

The bill is the equivalent of the Aviation Safety Reporting System applied to medicine: voluntary, confidential reporting of errors and near misses, with review by experts and feedback given to those concerned about how to fix the system and prevent future problems. And the information remains confidential, just as in the Aviation Safety Reporting System. Yet passage of this patient safety legislation would not diminish the right of any patient to file litigation.

In its 1999 report on medical errors, "To Err is Human: Building a Safer HealthSystem," the Institute of Medicine found that "[errors] almost always result from poorly defined systems -- not from careless providers." In order to stop errors, we need to prevent them through improved systems of safety -- just as the nuclear and aviation industries do. This means that we need to know more about how errors occur -- or almost occur -- within a given system. We need to do our homework -- and get to evidence-based solutions.

The fear of lawsuits deters health care professionals from reporting when errors happen, which hinders efforts to determine how to prevent recurrences. We need to put into place a reporting system that physicians and other health care professionals can use to report errors without fear their reporting will trigger lawsuits.

Transforming a system of shame and blame into a culture of safety akin to that in the aviation industry has been the goal of the National Patient Safety Foundation, which the AMA helped found in 1996. The NPSF is an independent, nonprofit, multidisciplinary organization that is working to move us away from a focus on individual errors and punishment, and move us toward a focus on safety systems. In such a system, nonpunitive, voluntary reporting of problems would be the norm.

Studies have shown that system change -- as opposed to lawsuits -- can be very effective in reducing errors. A study from the Agency for Healthcare Research and Quality, a branch of the U.S. Dept. of Health and Human Services, reports that errors involving anesthesia have been reduced to 5.4 per million, from up to 50 per million, simply by using standardized guidelines and protocols, and by standardizing equipment.

In short, there are measurably better ways than litigation to improve patient safety. And none of these measures compromise patient access to medical care.

The proposed legislation stuck in Congress offers a uniform, federal approach to improving patient safety. Let us hope that this bill is not being held hostage because of election-year politics. Improving patient safety is not a partisan issue. The patients of America will not be served if patient safety legislation falls victim to another Senate filibuster. Safety experts, including the Joint Commission on Accreditation of Healthcare Organizations and the NPSF, are in favor of this legislation.

Medicine must raise its voice to let Congress know that it fully supports this bill -- the Patient Safety and Quality Improvement Act (S 720) -- and make sure that it passes in this Congress. Call your senators through the AMA Grassroots Hotline: 800-833-6354. Or e-mail them through the AMA's Grassroots Action Center capwiz.com/ama/home/. Tell them that they need to pass this bill now.

We're so close to the finish line on this bill -- contact your senators to help push it through now. Tell them that passing this bill will create a victory for all parties and all patients in America.

Surely the plaintiff attorneys who file suits against doctors, claiming they are working for patient safety, should embrace this bill and urge its passage. I look forward to receiving copies of their letters to senators in support of this safety legislation.

In closing, let me say thank you to all of you who have read or heard my words, who have taken action on behalf of medicine's issues, and who continue to make American medicine the very best in the world. It's been an honor to serve you. Goodbye and God bless America, our great land of liberty!

Donald J. Palmisano, MD is a general and vascular surgeon in private practice in New Orleans. He was AMA president during 2003-04.

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