Clinton orders hospitals to reduce medical errors

President calls on states to adopt mandatory reporting within 3 years


WASHINGTON -- President Clinton ordered yesterday that all hospitals in the United States take steps to reduce medical errors that kill tens of thousands of people each year. The president said he supports mandatory reporting of all such errors.

Clinton called for a nationwide system of reporting medical errors, somewhat like the system used by airlines to report aviation safety hazards.

Rather than imposing a federal requirement now, he is pressuring the states to adopt reporting requirements within three years.

"We know that if we do the right things, we can dramatically reduce the time when the wrong drug is dispensed, a blood transfusion is mismatched or a surgery goes awry," Clinton said.

"I'm not here to find fault; I'm here to find answers."

The American Medical Association and American Hospital Association have vehemently opposed mandatory reporting of errors, saying it could expose doctors and hospitals to more lawsuits.

If doctors and hospital employees fear being sued, the groups said, they will be reluctant to discuss the lessons that could be learned from their mistakes.

Clinton's advisers had suggested moving with caution, but Clinton endorsed virtually all the recommendations made three months ago by the National Academy of Sciences in a report on medical errors.

He endorsed the academy's goal of reducing medical mistakes by 50 percent over five years.

He also asked Congress for $20 million to create a Center for Quality Improvement and Patient Safety as part of the Department of Health and Human Services' Agency for Health Care Research and Quality.

"When it comes to reporting, we want the federal government to lead by example," Clinton said.

Responses from Maryland hospital officials yesterday were subdued. No one questioned the need for reporting and investigating errors, but without seeing the proposal, administrators were only cautiously supportive. Lacking certain protections, they said, federal requirements could inhibit reporting processes that are already in place.

"I would be concerned if the president's proposal does not mention the concomitant need for tort reform to protect those who do the investigating and those being investigated," said Dr. William Thomas, senior vice president of medical affairs for MedStar Health, a Columbia-based nonprofit that comprises seven hospitals in Maryland and the District of Columbia.

"Our feeling is we're pretty early in the discussion, but it's hard not to support something that's clearly needed and may have been neglected on a national level," said David G. Rorison, senior vice president for clinical effectiveness for the University of Maryland Medical Center.

"We have our own ways of looking at quality patient care, but to the extent that there's broader participation, that would be valuable."

Some of the president's recommendations require congressional approval, but he has ample authority under existing laws to require other steps.

For example, the federal government is developing a regulation that would require more than 6,000 hospitals participating in Medicare to have programs to reduce medical errors.

Under the regulation, to be published this year, hospitals would, in most cases, have to establish automated systems for ordering prescription drugs so that they could avoid the mistakes caused by a doctor's bad handwriting or by confusion over telephone orders.

Hospitals must meet federal standards as a condition of getting Medicare money, which accounts for about 40 percent of the average hospital's revenue. Using that lever, the federal government sets detailed standards covering every aspect of hospital activity, from sanitation to fire safety to infection control.

Clinton's proposals, or something similar, seem likely to become reality because the issue has great appeal to consumers, and this is an election year; because the government already has the power to do much of what Clinton wants; because Congress is eager to take action; and because lawmakers have a convenient vehicle, the "patient's bill of rights" pending before a conference committee of House and Senate negotiators.

The president asked the Food and Drug Administration to develop new standards to prevent errors caused by drug names that sound alike and packages that look alike.

In addition, new labeling standards will require drugmakers to highlight dangerous drug interactions and common dosage errors. "No more handwritten prescriptions that no one can read," Clinton said.

The FDA is developing a system to allow doctors, nurses and pharmacists to report medication errors online.

All 500 military hospitals and clinics and more than 3,000 blood banks will have to report serious errors under the president's plan.

The element of the president's plan most likely to cause friction is his support for mandatory reporting to the states of medical errors that cause serious injury or death.

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