Patient safety: Separating misinformation from truth

AMA Leader Commentary. By Donald J. Palmisano, MD, Dec. 15, 2003.

AMA LEADER COMMENTARY

A few words about current events in medical practice

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A message to all physicians from AMA President Donald J. Palmisano, MD.

The poet Emily Dickinson wrote that "Truth is such a rare thing, that it is delightful to tell it." When it comes to the issue of patient safety, in this age of unfettered litigation, it is also necessary and important to tell the truth -- because so often it is obscured by myth, misrepresentation and misinformation -- and because lives are at stake.

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Topic: Liability crisis

One myth put forth by trial lawyers is that their pursuit of medical liability lawsuits isn't a safari for cold, hard cash but is meant to reduce physician errors. They argue that litigation must be used as a big stick to keep the world safer.

To justify their tactics, they cite a report from the Institute of Medicine that included flawed, outside data blaming medical errors for 44,000 to 98,000 deaths per year.

The AMA long has been a champion for patient safety, and we believe that even one preventable error that harms a patient is one too many.

But we take issue with the estimates contained in the IOM report -- and how these estimates have been misinterpreted and misrepresented.

So do other prominent independent researchers, who also have disputed these estimates.

For example, critics have noted that the estimates were extrapolated from data collected years ago from just a few hospitals. Others have pointed out flaws in the methodology.

It's worth noting that the IOM does make one fact clear -- medical errors aren't about "bad doctors," despite our opponents' claims.

Errors can involve nurses, pharmacists, health technicians, aides -- in short, anyone who is working in the complex system of health care delivery. This word -- " system" -- is key to understanding how medical errors happen and how we can prevent them.

According to that same IOM report, "errors almost always result from poorly defined systems -- not from careless providers."

To stop errors, we need to prevent them through improved systems of safety, just as is done in the nuclear and aviation industries.

The AMA believes we have to move away from a culture of shame and blame and towards a culture of prevention and safety.

That's why we helped launch the National Patient Safety Foundation in 1996 and why we continue to support its work with funding, not just rhetoric -- $6.5 million and counting.

We continue to challenge the Assn. of Trial Lawyers of America to match our donations to the National Patient Safety Foundation. To date, they haven't offered one thin dime. Is this a hint that the trial lawyers are more interested in suing physicians than in saving patients?

And they are loath to change a system of jackpot justice -- one that has no restrictions, no sanctions and no shame in filing frivolous lawsuit after frivolous lawsuit. This is even as they lecture us about ethics, and even as they pocket a third or half of the award given a plaintiff in liability cases. (And even as some pay for expenses out of the client's remaining share).

What we need now is some peer review and accountability for attorneys who apparently see little difference between filing baseless lawsuits and buying lottery tickets at a liquor store. Their reasoning is that an insurer or a jury may give lots of money -- even though there is no negligence -- simply because the client has a less-than-desired outcome from medical care.

One can hear the roars of indignation if a surgeon told a trial attorney with a ruptured spleen that if he died there would be no charge, but if he lived, the surgeon would take one-third of the lawyer's future lifetime earnings for saving his life. Of course, doctors would never do that -- it would be unethical.

The fear of being sued obviously discourages health care professionals from reporting problems when they happen. It hampers efforts to determine what went wrong and how to prevent it.

To truly protect patients, the AMA supports the Patient Safety and Quality Improvement Act or HR 663 -- legislation recently passed by the House of Representatives -- that would help create a voluntary, confidential error reporting system that allows review by experts, who report back to those involved on how to fix the system. The fix is then shared with all.

That is how the aviation safety reporting system works. Similar legislation, S 720, has been approved by the Senate Health, Education, Labor and Pensions Committee -- unanimously. In both chambers, the AMA has been immersed in bipartisan negotiations.

If enacted, this legislation could help us transform the existing culture of blame into a culture of safety.

These battles won't be easy. The trial bar is a formidable, well-financed foe. But physicians can win this battle, provided we stand together and speak with one voice. Or if you prefer, a chorus of voices -- but the message must be the same. For proof, look at Proposition 12 in Texas, where voters approved a constitutional amendment to allow caps on noneconomic damages in medical liability cases. The Texas doctors showed that success follows when everyone works together.

You can help. Pick up the phone and call 800-AMA-3211 to join the AMA if you haven't already. Then call 800-833-6354. This toll-free hotline will connect you to your federal representatives. Encourage them to support medical liability reform.

Already the AMA has enlisted more than 50,000 patient activists, who have generated 150,000 contacts with key senators. Help us get even more patients involved. The AMA Web site has details on the Patients' Action Network (www.patientsactionnetwork.com)and the Physician Action kit (www.ama-assn.org/ama/pub/category/10155.html). And check out Medical Liability Reform Now in the members-only section (www.ama-assn.org/ama1/x-ama/upload/mm/-1/mlr3rdnowpdf.pdf). It shatters the myths and misinformation spread by the opponents of commonsense reforms.

It's up to us to fight for medical liability reform and patient safety legislation. Because if we don't do it, who will?

Dr. Palmisano, a general and vascular surgeon in private practice in New Orleans, as well as an attorney, was president of the AMA during 2003-04.