Standards require hospitals to report errors to patients

Hospitals will lose accreditation if they don't tell patients when they are victims of medical errors, say new standards by the Joint Commission on Accreditation of Healthcare Organizations.

By Damon Adams, amednews staff. July 23, 2001.

The Veterans Affairs Medical Center in Lexington, Ky., doesn't try to cover up when a patient is given the wrong medication or a doctor errs during surgery.

The center freely admits the mistakes, then advises patients to get an attorney and helps them fill in claim forms.

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"We take full responsibility and we apologize and we tell them that they are due compensation," said Chief of Staff Steve Kraman, MD, whose hospital has been disclosing errors to patients voluntarily since 1987. "We don't hide anything."

Hospitals across the country now must embrace a disclosure practice similar to one used at the Lexington VA.

Under new standards effective July 1, hospitals are required to tell patients when they are harmed by medical errors. The new standards for hospitals were introduced by the Joint Commission on Accreditation of Healthcare Organizations, which accredits about 5,000 hospitals.

The standards call for hospitals to launch efforts to prevent errors and to create discussion between hospital leadership and the rest of the hospital staff. Open talks about patient safety should encourage reporting of errors and involve staff in designing systems to prevent errors, Joint Commission officials said. If a hospital makes a medical mistake but fails to notify the patient, the hospital faces losing its accreditation.

A job for physicians

And Joint Commission leaders want doctors to be the ones to do the notifying. "I really expect the responsible physicians to be out on the lines talking to the patients, not somebody from administration," said Dennis O'Leary, MD, commission president.

That's in line with the AMA's opinion that physicians are ethically bound to inform patients of mistakes. Concerns about liability from disclosure should not impact the doctor's honesty with the patient, the AMA said.

"The AMA believes it is a physician's ethical responsibility to be candid and truthful with a patient at all times," said AMA Board Trustee Donald J. Palmisano, MD. "This is important to the integrity of the patient-physician relationship."

But patient advocates and others say errors are often kept secret for fear of lawsuits.

"These incidents are not even being reported internally. These people are frightened," Dr. O'Leary said.

He said the Joint Commission's revised standards encourage internal reporting of medical errors so hospitals can analyze and redesign their systems to prevent mistakes. The new rules are among efforts within the medical community to cut errors in response to a 1999 Institute of Medicine report that said medical errors kill up to 98,000 hospital patients each year.

"Patient safety needs to be job one for hospitals across the country, and that's what our standards are seeking to do," he said.

The Joint Commission's surveyors will check for compliance with the new standards during regular hospital inspections. They will meet with doctors, nurses and patients to try to determine if hospitals accurately report errors to the accrediting agency. Dr. O'Leary said the standards are not intended to place blame but to improve patient safety.

"If you fire every caregiver who made a mistake or an error, pretty soon you won't have anybody left," he said.

Some hospitals say they have initiated safety programs in recent months. Some have formed committees to examine mistakes, while others have increased training. Hospitals also are turning to technology, having doctors use handheld computers to order prescriptions.

The American Hospital Assn. supports the Joint Commission's new standards and telling patients when an error occurs. "It's very reflective of what we have been urging our members to do the last two years," said Don Nielsen, MD, AHA senior vice president for quality leadership. "This will provide a much more open environment for discussion and learning of medical errors."

Dr. Nielsen and Dr. Kraman say patients are less likely to sue if they are told about a medical mistake.

And honesty has been the best policy for the VA center in Lexington, Dr. Kraman pointed out.

The center started disclosing errors to patients after it lost two lawsuits that cost more than $1.5 million. Now it makes about 14 settlements with patients annually, at an average of $15,000 each, Dr. Kraman said.

"We just decided we weren't going to fight these things," he said. "If we confirm that we [made an error], we'll negotiate with them until they are satisfied that they are being treated fairly."

When her father died in 1997 from medication errors at the Lexington center, Sandy Reynolds initially sought revenge. That changed after hospital workers came to her and admitted what happened.

"When they came into my home and said, 'We are so sorry, we should have caught this,' everybody was truly sorry. What was I going to fight?" said Reynolds, a shop owner in Salyersville, Ky. "An apology, that's what everybody wants."

ADDITIONAL INFORMATION:

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Revisions to Joint Commission Standards in Support of Patient Safety and Medical/Health Care Error Reduction (http://www.jcaho.org/standard/fr_ptsafety.html)