Accountability: Patient Safety and Policy Reform

Accountability: Patient Safety and Policy Reform

Accountability: Patient Safety and Policy Reform

Accountability: Patient Safety and Policy Reform

Synopsis

According to a recent Institute of Medicine report, as many as 98,000 Americans die each year as a result of medical error -- a figure higher than deaths from automobile accidents, breast cancer, or AIDS. That astounding number of fatalities does not include the number of those serious mistakes that are grievous and damaging but not fatal. Who can forget the tragic case of 17-year-old Jésica Santillán, who died after receiving a heart-lung transplant with an incompatible blood type? What can be done about this? What should be done? How can patients and their families regain a sense of trust in the hospitals and clinicians that care for them? Where do we even begin the discussion?

Accountability brings the issue to the table in response to the demand for patient safety and increased accountability regarding medical errors. In an interdisciplinary approach, Virginia Sharpe draws together the insights of patients and families who have suffered harm, institutional leaders galvanized to reform by tragic events in their own hospitals, philosophers, historians, and legal theorists. Many errors can be traced to flaws in complex systems of health care delivery, not flaws in individual performance. How then should we structure responsibility for medical mistakes so that justice for the injured can be achieved alongside the collection of information that can improve systems and prevent future error? Bringing together authoritative voices of family members, health care providers, and scholars -- from such disciplines as medical history, economics, health policy, law, philosophy, and theology -- this book examines how conventional structures of accountability in law and medical structure (structures paradoxically at odds with justice and safety) should be replaced by more ethically informed federal, state, and institutional policies. Accountability calls for public policy that creates not only systems capable of openness concerning safety and error -- but policy that also delivers just compensation and honest and humane treatment to those patients and families who have suffered from harmful medical error.

Excerpt

The Institute of Medicine (IOM) report To Err Is Human presented the most comprehensive set of public policy recommendations on medical error and patient safety ever to have been proposed in the United States. Prompted by three large insurance industry-sponsored studies on the frequency and severity of preventable adverse events, as well as by a host of media reports on harmful medical errors, the report offered an array of proposals to address at the policy level what is being identified as a new “vital statistic”: that as many as 98,000 Americans die each year as a result of medical errors—a figure higher than deaths due to motor vehicle accidents, breast cancer, or AIDS. And this figure does not include those medical harms that are serious but nonfatal.

The IOM recommendations resulted in a surge of media attention to the issue of medical error and in swift bipartisan action by President Clinton and the 106th and then the 107th Congress. Shortly after the report was issued in 2000, President Clinton lent his full support to efforts aimed at reducing medical error by 50 percent over five years. In Congress, the report prompted hearings and the introduction of a host of bills including the SAFE (Stop All Frequent Errors) Act of 2000 (S. 2378), the Medication Errors Reduction Act of 2001 (S. 824 and H.R. 3292), and recently the Patient Safety and Quality Improvement Act of 2002 (S. 2590) and the Patient Safety Improvement Act of 2002 (H.R. 4889). Although none of these bills has made it into law, each represents ongoing debate about the recommendations in the IOM report. Because the IOM recommendations have been either a catalyst or a touchstone for all subsequent patient safety reform proposals—whether by regulation or by institutions hoping to escape regulatory mandates—I introduce this volume with a brief description of the IOM reports point of departure, the problem it seeks to address, and the solutions it identifies. From there, this chapter maps out the . . .

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