Posted on Mon, Jan 31, 2011
Public health officials in California are looking into hospitals claiming to be free from any medical errors. Almost 90 facilities have had no significant mistakes in dispensing medical care over the past three years.
The Department of Health in California stated that 87 of 418 hospitals covered by the law, which became effective in 2007 have not made any reports detailing medical errors. With these hospitals comprising above 20% of the covered facilities, the possibility of unreported errors has been greatly considered. Several patient advocates consider this as indicating the opposition of hospitals towards self-policing. Hospitals were given a deadline by state officials to validate their error-free status or to report their errors, as required by law.
Jamie Court, the president of Consumer Watchdog, an advocacy group based in Santa Monica, considers having many error-free hospitals in three years to be “almost inconceivable.” He added that where one prefers not to look, no errors will be found; while where one chooses to look, some errors will likely be found, regardless of the bed capacity of the hospital.
The state law identifies 28 medical errors, which must be reported by hospitals to the state. These errors put patients at risk, whether it's serious injury or death. Post-investigation, fines range from $50,000, $75,000, or $100,000 for first, second, or third/subsequent incidence of errors in same hospitals. Fines up to $100 per day are imposed on delays of error notification beyond the prescribed five days within the incidence.
Since 2007 when the law on medical error became effective, 1,100 medically related errors had been reported to California government, during which it fined 112 hospitals due to medical errors, with 39 appealing.
State Senator Elaine Alquist, a Democrat from Santa Clara, the law author, expressed concern on unreported errors and questioned the probability of almost a quarter of California hospitals without errors on medication, surgery, or safety since 2007.
The hospitals without reported errors include around twelve state facilities with a total of at least 1,055 beds. Two dozen are in Los Angeles, each with less than 200 beds.
The absence of errors could have been due to the absence of surgical cases as in the case of psychiatric hospitals like the Resnick Neuropsychiatric Hospital, or the absence of obstetrics departments or emergency rooms in small facilities like the 150-bed Temple Community Hospital.
There have also been cases of incorrectly listed hospitals. The California Hospital Association’s vice president for quality and emergency services, Debby Rogers, revealed that her office communicated with all the facilities included in the list. Officials of several hospitals claimed that they have indeed reported medical errors. Rogers, however, decided not to name those hospitals.
The state law defines the preventable medical errors. However, a lot of hospital officials admit being vague on which kind of errors should be reported. Given the confusion, underreporting, over reporting, or both could occur.
To-date, the state has imposed fines on 66 hospitals for their failure to report errors. State records show that in May 2008, the San Diego Hospice and the Institute for Palliative Medicine, included in the error-free list, had been fined $12,700 for its failure to report an error in medication in 2007.
The hospital’s spokeswoman said that the incidence was not initially considered as a medically related error and the facility questioned the state’s findings. It eventually paid the fine then submitted to the state their plan of correction.
Officials of the California Hospital Association now work with California’s Public Health Department, clarifying law’s regulations and the definitions of reportable errors.
The Department has hired a faculty from the University of California with expertise in reporting public data to eventually scrutinize data on medical error and assess possible underreporting. Fines amounting to $250,000 worth taken the previous fiscal year from erring hospitals will fund the post, as the fines are money meant for patient safety.
Anthony Wright, the executive director of Health Access, based in Sacramento, stated his hopes that the list of hospitals with no errors will be verified and someday may be used to avoid the medical errors, called “never events,” as defined by the state. He added that hospitals getting zero errors should be studied in order to replicate their best practices. Wright further emphasized the need to differentiate people who institute systems to prevent the occurrence of “never events” and those who simply do not report the errors.