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Friday, June 29, 2001
Copyright © Las Vegas Review-Journal

New rules to reveal doctors' mistakes

Standards to keep errors from being 'buried'

New safety standards taking effect Sunday will for the first time require hospitals to tell patients when a doctor made a mistake while caring for them.

Patients who suffer because of botched surgeries, misdiagnosis, wrong medications and other mistakes must be notified immediately under the new regulations issued by the Joint Commission on Accreditation of Healthcare Organizations.

The nonprofit commission -- which monitors nearly 5,000 hospitals across the country, including 14 in Las Vegas -- developed the standards in response to the Institute of Medicine's estimate that medical errors kill between 44,000 and 98,000 hospital patients each year.

"Clearly, more needs to be done to protect patients," accreditation commission President Dr. Dennis O'Leary said. "Most of these errors are buried inside organizations. They are not reported to us, and they are not even reported internally."

Hospitals now are not required to report medical mistakes, although some volunteer the information to affected patients or for research purposes to the accreditation commission, said Janet McIntyre, commission spokeswoman. The commission accredits nearly 90 percent of hospitals across the country, including federal and public facilities.

The new regulations affect all hospital medical staff but don't specify which staff members will be charged with telling patients about treatment mistakes. Individual hospitals will develop their own policies to implement the standards.

University Medical Center officials said doctors in charge of the patient will be the designated messenger if medical errors occur.

"The effort now is to create a blame-free environment to welcome input and correct anything that needs to be fixed," said the medical center's chief administrative officer, Jackie Taylor. "Previously, there's been a hesitancy for people to admit medical errors because of retribution."

Valley Hospital Medical Center emergency room physician Flip Homansky said he is in favor of the regulations but added that a formal policy has yet to be developed at the hospital. He also said medical errors that result in patient harm often are not discussed but should be.

"Only good will ultimately come from this," he said. "Errors are usually not intentional, and we can learn from mistakes. If there's a problem with medication because two meds sound too much alike or because the handwriting for the prescription isn't good, we can learn from that."

Homansky doesn't expect doctors to embrace the new regulations immediately because admitting medical errors is professionally humiliating and can open the door for lawsuits.

The new standard, however, is designed not to penalize doctors but to encourage open dialogue about medical mistakes among doctors, patients and administrators. Thus, any information regarding medical errors will not be available to the general public, O'Leary said. The goal, instead, is to track errors and put systems in place to ensure they don't recur.

Combating medical mistakes can be as simple as requiring surgeons literally to write on which limb needs to be removed, said O'Leary, who said he frequently handles cases of wrong-site surgery in which a healthy leg or kidney is removed instead of a diseased one. He said if physicians try to hide the mistakes and open discussion is discouraged, the errors will continue.

Las Vegan Ellie Halverson said the new regulations probably wouldn't have saved her from debilitating medical mistakes she suffered, but she would have appreciated the honesty from local physicians.

Halverson now must carry oxygen and use a scooter to get around after area physicians failed to diagnose and appropriately treat a bacterial infection she suffered two years ago.

"The bacteria went into my feet and ate some of my bones," Halverson said. "Just three years ago, I danced at my wedding, and now I can't walk without oxygen."

It's cases such as Halverson's that the accreditation commission hopes the new standards will prevent. Had the new regulations been in place at the time, doctors would have had to discuss the misdiagnosis with Halverson and set up criteria to keep a similar situation from happening again.

The accreditation commission is charged with making sure hospitals are in compliance through vigorous on-site surveys and interviews with hundreds of medical professionals, staff members and patients at each hospital. The commission performs random unannounced surveys as well as scheduled surveys once every three years.

"We talk to at least 100 people during these surveys," O'Leary said. "If you're programming 100 people to tell a lie, well, it's actually easier to comply with the standards than to do that."

After the new regulations go into effect Sunday, any hospital found in violation will have three months to comply with them. If the hospital is still in violation after three months, the facility gets one more chance before its accreditation is yanked.

The three-month window applies only to situations that are not immediately life-threatening. Problems such as malfunctioning equipment or inadequate infection-control policies could require immediate attention.