JCAHO: Liability crisis is a barrier to patient safety

Declaring that the medical liability crisis is a barrier to improving medical safety and quality, the Joint Commission on Accreditation of Healthcare Organizations has issued a "road map" for reform that includes strategies to prevent medical injury, promote open communication and create a "patient-centered" injury compensation system.

JCAHO President Dennis O'Leary, MD, presented those three broad strategies and 19 specific recommendations at a Feb. 10 press conference. The recommendations included encouraging adherence to clinical guidelines, encouraging nonpunitive error reporting, prohibiting settlement gag clauses, and advocating for court-appointed, independent expert witnesses.

Dr. O'Leary was joined at the press conference by Susan Sheridan, the co-founder of Consumers Advancing Patient Safety, who praised the boldness of JCAHO proposals.

Sheridan said that she was shocked at the lack of ethics among expert medical witnesses, and she called on medical associations to take action against their members who give "junk testimony."

These thoughts were echoed by Randall R. Bovbjerg, an attorney with the Urban Institute's Health Policy Center, who said it was not enough "to pound on bad experts," but good experts have to be encouraged to come forward.

AMA Immediate Past President Donald J. Palmisano, MD, agreed that measures are needed to ensure honest testimony by expert witnesses.

"We have to make sure that witnesses who give testimony tell the truth and, if they don't tell the truth, that they be held accountable by state boards of medical examiners," Dr. Palmisano said in an interview.

JCAHO's proposals are contained in a white paper acknowledging that caps on noneconomic damages have been effective in managing increases in liability insurance premiums, but it also states that capping damages "does not address all of the factors that lead to litigation on the front end."

At the press conference, Dr. O'Leary noted that caps are a positive step, but they "don't actively serve" patient safety improvement.

Dr. Palmisano said the AMA agrees that "caps are not the final answer" to the medical liability crisis, but they are an effective emergency measure that can help stabilize the nation's sick health care system.

"We applaud [JCAHO's] efforts to solve the broken liability system," Dr. Palmisano said. "The bottom line is ensuring access to care in times of critical need."