News in brief - Aug. 18, 2003

AMA, CMA weigh in on staff governance - Pa. Medical Society calls for end to lawsuit abuse - Commission proposes rule to protect medical staff self-governance - Illinois bill takes doctors out of executions - Universal protocol could prevent wrong surgeries - AHA gives recognition for creating culture of patient safety

AMA, CMA weigh in on staff governance

The American Medical Association and the California Medical Assn. are siding with the medical staff at Community Memorial Hospital in Ventura, Calif., in a dispute over medical staff self-governance. The medical associations filed a joint friend-of-the-court brief in a case filed in Superior Court in Ventura.

The medical staff is suing the hospital administration, claiming it violated self-governance by unilaterally amending medical staff bylaws, refusing to recognize elected medical staff officers, interfering with quality assurance functions, and other grievances. Hospital administrators dispute the claims and say that the medical staff is a department within the hospital and that it doesn't have standing to sue.

In the friend-of-the-court brief, the CMA and AMA argue that state and federal legal precedents establish and reinforce a medical staff's position as a separate legal entity, and that status allows the medical staff to best ensure high-quality care.

Pa. Medical Society calls for end to lawsuit abuse

Medical malpractice insurance underwriters in Pennsylvania lost $18 million last year, with most losses due to claims payments and legal costs, according to a study by the Pennsylvania Dept. of Insurance. The state's insurers have lost money four years in a row, and Pennsylvania is one of 19 states the AMA has declared to be in the midst of a medical liability insurance crisis.

State doctors are required to have $1 million in liability insurance.

"The only way to bring liability insurance costs down and to ensure continued access to care for patients is to end lawsuit abuse," said Pennsylvania Medical Society President Edward H. Dench, Jr., MD, who has called for a cap on noneconomic damage awards.

In 2002, insurers spent $136.9 million on legal costs, according to the analysis. "The current system is too expensive, especially considering that seven out of 10 malpractice claims are dropped, dismissed, withdrawn or found in favor of the defendant," Dr. Dench said. "Yet these meritless cases cost money to defend."

Commission proposes rule to protect medical staff self-governance

The Joint Commission on Accreditation of Healthcare Organizations has proposed a new rule that would prohibit hospitals or medical staffs from using language allowing unilateral amendment of medical staff bylaws.

Current standards bar unilateral amendment of bylaws, but the new standard would provide for citation of noncompliance if either medical staff or governing body bylaws permit such changes.

"This proposed performance element is extremely valuable to self-governance of the medical staff," said Greg Abrams, California Medical Assn. legal counsel. "If adopted, it would stop hospital administrations from legitimizing their medical staff bylaw violations by claiming they can just amend them anytime they feel like it."

If approved, the new standard will be published in next year's Comprehensive Accreditation Manual for Hospitals.

Illinois bill takes doctors out of executions

The Illinois State Medical Society finally won its fight against physician involvement in executions when Gov. Rod Blagojevich in July signed into law a bill prohibiting such involvement.

The law, which received unanimous support in both houses of the Illinois General Assembly, mandates that the "Dept. of Corrections shall not request, require or allow a health care practitioner licensed in Illinois, including but not limited to physicians and nurses, regardless of employment, to participate in an execution."

The law covers both direct physician involvement, such as administering a lethal injection, and indirect involvement, such as pronouncing a prisoner dead. Illinois now is aligned with AMA policy, which opposes all physician involvement in executions.

The law removes part of a 1987 law that shielded physicians from being sanctioned for execution participation. Now the Dept. of Corrections must reveal the names of physicians participating in executions to the Dept. of Professional Regulations, which will provide those names to the appropriate disciplinary boards.

Universal protocol could prevent wrong surgeries

A set of guidelines has been approved for preventing wrong-site, wrong-procedure and wrong-person surgery, and all accredited surgery organizations will have to comply with the regulations beginning July 1, 2004.

The Board of Commissioners of the Joint Commission on Accreditation of Healthcare Organizations approved the "Universal Protocol" in July, and the guidelines will apply to all operative and invasive procedures. The rules requirements include verifying the process before operating, marking the site, taking a "time out" before starting the procedure and adapting the requirements to nonoperating-room settings, including bedside procedures.

Although organizations acknowledge that operations on the wrong person or the wrong site should never happen, the commission has said it receives five to eight new reports of wrong-site surgery each month. The protocol is the product of a national summit on wrong-site surgery that took place last spring between the Joint Commission, the AMA, the American Hospital Assn., the American College of Physicians, the American College of Surgeons, the American Dental Assn. and the American Academy of Orthopaedic Surgeons.

AHA gives recognition for creating culture of patient safety

The Abington Memorial Hospital in Abington, Pa., was awarded the American Hospital Assn.'s American Hospital Quest for Quality Award in recognition of its creation of a patient-safety culture with a blame-free environment in which medical error reporting is encouraged.

Abington Memorial also was recognized for adopting a systems-based approach to patient safety, using computerized physician order entry and Web-based patient monitoring, and focusing on evidence-based medicine.

Others recognized for fostering a patient-safety culture were the Madison-based University of Wisconsin Hospital and Clinics, the Beaumont Hospitals in Royal Oak, Mich., and the Olympic Medical Center in Port Angeles, Wash.