Malpractice liability plays only a limited and inconsistent role in doing what it should: giving doctors an incentive to practice safely.
Medical mistakes are dangerous, costly, and often hidden until it's too late. Patients do their best not to think about them, because of their need to trust in their doctors. Who wants to study a surgeon's error rates right before going under the knife? For their part, doctors don't like to admit they erred, especially when they might get sued. But a culture that avoids confronting mistakes will only perpetuate them.
Medical leaders and patient groups have made some progress reducing one type of error: infections contracted in hospitals. Organizations like the Institute for Healthcare Improvement and medical schools like Johns Hopkins University have engaged and educated doctors and nurses about preventing these infections. Consumers Union and other patient groups have won enactment of legislation in 30 states to require hospitals to report how often their patients contract a preventable infection. Congress has provided funds for additional infection reporting in the Affordable Care Act (ACA). As a result of all of this effort, infection rates are declining. The Centers for Disease Control and Prevention has found declines of as much as 58 percent for various hospital infections over the last several years.
However, there remain a vast number of safety problems in desperate need of improvement. Thirteen years ago, the Institute of Medicine estimated that between 44,000 and 98,000 hospital patients die each year from preventable medical errors. That's roughly the same level of deaths revealed in a recent study by the Inspector General at the Department of Health and Human Services, which pegs the number of Medicare patient deaths from preventable errors at 79,000 each year. In addition to the senseless tragedy of unnecessary death, such errors cost Medicare nearly $2 billion annually, in part because many non-lethally injured patients require additional care to fix the mistakes.
From any point of view, the response to these errors has been wholly inadequate. On the one hand, the research clearly shows that too little is done to identify and prevent them. On the other hand, doctors often provide excessive care to shield themselves in case of a malpractice lawsuit. Although estimates of the cost of this defensive medicine vary considerably due to differences in research methodologies, the potential savings is at least in the tens of billions of dollars.
By ensuring that the effort to reduce medical errors is a fully open and productive enterprise, we can greatly improve patient care and decrease health care costs. To achieve this critical transparency, policy makers and medical professionals should draw from the successful process that hospitals forged in fighting against infections:
- Develop error prevention techniques for medical professionals through hands-on research;
- Set standards for identifying and collecting data on all types of medical errors through regulations; and
- Apply pressure to prevent errors through legal reforms.
The president and Congress should set a national goal to cut medical errors in half by the end of the next presidential term in the following ways:
Develop prevention techniques. One of the early successes in the fight to reduce infection rates came from the Michigan Health & Hospital Association Keystone Center. With the support of federal and state agencies and insurance plans, Michigan hospitals worked with the Johns Hopkins University medical school to develop a simple but effective checklist to prevent infections from central-line catheterization, a process that involves inserting a tube in a patient's vein. This checklist reduced those infections by two-thirds in Michigan hospitals. Today, according to Consumers Union research, 166 hospitals throughout the nation have completely eliminated this type of infection.