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Doctors push for more patient safety program funding

A state hiring freeze leaves a Massachusetts care assessment program out in the cold.

By Andis Robeznieks, amednews staff. Sept. 8, 2003.

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When the former editor of the New England Journal of Medicine speaks, people listen.

So when Arnold S. Relman, MD, resigned from his state medical board's patient care assessment committee to protest staff shortages and a work backlog he felt put patients at risk, it garnered a lot of attention. It also spotlighted an innovative patient-safety program and reminded observers that even the most celebrated programs do not always run smoothly.

"We decided to speak out and make waves," said Dr. Relman, who was joined by Mary Anna Sullivan, MD, who also resigned her posts as committee chair and member of the Massachusetts Board of Registration in Medicine. "We've made some people at the board angry with us."

A prominent supporter of the program is Lucian L. Leape, MD, adjunct professor of health policy and management, Harvard School of Public Health, Boston.

"They met with hospital leaders and followed through with them to make sure changes were made after bad things happened," Dr. Leape said. "The objective is not to 'catch people' -- doctors or hospitals -- but to get them to investigate problems and do something about them. ... I know of no state program that is as aggressive with hospitals regarding correcting systems failures."

Created by the Massachusetts Medical Malpractice Reform Act of 1986, the patient care assessment program's purpose is to investigate adverse events at health care institutions in confidential proceedings that are protected from subpoena and discovery. It reviews between 450 and 500 reports annually, evaluates the institutions' investigation of the events, and plans for corrective action.

"It holds the medical staff's feet to the fire," Dr. Relman said.

Drs. Relman and Sullivan resigned to protest a backlog of some 400 unread reports, which Dr. Relman blamed on a staff shortage. Gov. Mitt Romney instituted a statewide hiring freeze to help manage a budget shortfall, but Dr. Relman insisted there should be money available for PCA hires, because physician licensing fees were recently increased from $250 every two years to $400 in an effort to give the board more resources.

"Nothing got done, and the reports are piling up," he said. "Hospitals don't think we are interested and probably are not reporting as much."

Originally, there was a staffing equivalent of 3.5 nurses to prepare reports for the committee; now it is 1.5. In an effort to reduce the backlog while complying with the state's hiring freeze, work has been outsourced. Both Drs. Relman and Leape said that isn't a solution.

"This is an unsatisfactory option because it misses the point of the review process," said Dr. Leape. "In the past, before support was reduced, hospital reports were reviewed by a panel of senior, well-respected physicians on the board who had been doing it for some years and understood the process, commanded the respect of the hospitals and made it a constructive learning experience."

Yes, more staff is needed

Although he wasn't pleased with Dr. Relman's criticism, the chair of the Board of Registration in Medicine, Martin Crane, MD, was diplomatic.

"His prestige and commitment to this field is without equal, but some of his criticisms may have been unfair and may have been done to make a point about staffing," said the South Weymouth-based obstetrician and gynecologist. "I think Dr. Relman is correct in saying that we do need more staff and funding for this program, but it's not entirely proper to say this would acutely endanger patient care."

Dr. Crane said PCA will be getting more funds, but a decision was made to beef up the board's licensing and enforcement divisions first.

"Sometimes good things come out of difficult situations," he said. "We are aware of the problems, but it's only going to make us better. We're making changes, now give us a chance."

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