Organized Medicine Has Opposed Key Institute of Medicine (IOM) Recommendations on Patient Safety
Statement By Arthur A. Levin, MPH
January 9, 2003
I had the privilege of serving as a member of the Institute of Medicine’s Committee on Quality of Health Care in America that issued two major reports. The first report, "To Err is Human," was released in November 1999, over three years ago. It documented the staggering epidemic of medical errors occurring in our health care system.
The Committee’s second report, "Crossing the Quality Chasm," was published in February 2001 and described what a quality 21st century U.S. health care system should look like. The Chasm report suggested there are six "aims" which a quality health care system must embody: it should be safe, effective, patient-centered, timely, efficient and equitable.
We are here today because, instead of confronting the medical error epidemic and vigorously pursuing the recommendations of the Institute of Medicine and others to improve patient safety, organized medicine is investing its resources and not inconsiderable political power in a firestorm of activity that includes proposed state and federal "tort reform" legislation and front page and prime time stories describing how a so-called "crisis" in medical malpractice insurance premiums is what is hurting patients. Nothing could be further from the truth. It is the epidemic of medical errors that is hurting patients.
The AMA’s depiction of the "crisis" – one focused on malpractice insurance premiums – conveniently serves to distract everyone from the reality that it is organized medicine that continues to vigorously oppose, both at the federal and state level, a series of recommendations aimed at reducing the number of medical errors that emerged from the IOM work. Such obstruction of efforts to make real progress in "curing" the medical errors epidemic focuses on several key recommendations of the IOM Committee.
The executive summary of the IOM medical errors report, after enumerating the substantial dimensions and costs, both in human and resource terms, of the medical error epidemic, went on to say:
"Yet silence surrounds this issue [of medical errors.] For the most part consumers believe they are protected. Media coverage has been limited to reporting of anecdotal cases. Licensure and accreditation confer, in the eyes of the public, a "Good Housekeeping Seal of Approval." Yet licensing and accreditation processes have focused only limited attention on the issue, and even these minimal efforts have confronted some resistance from health care organizations and providers
The report goes on to say:
"The goal of this report is to break this cycle of inaction. The status quo is not acceptable and cannot be tolerated any longer…. it is simply not acceptable for patients to be harmed by the same health care system that is supposed to offer healing and comfort."
Strong words that made me proud of being part of the Institute of Medicine effort. Perhaps this is a good time to repeat those words written 1999: "the status quo is not acceptable and cannot be tolerated any longer." But by diverting public attention away from the real problem, organized medicine is in fact perpetuating the status quo. Worse, by working to obstruct implementation of a number of the major recommendations critical to improving patient safety, organized medicine is saying "it is" acceptable for patients to continue to suffer preventable harm.
Here are some of the IOM recommendations that organized medicine resists – while it is busy trying to reduce physician practice overhead by denying compensation to those harmed by negligence:
(1) The IOM recommended that there be a nationwide mandatory reporting system of serious errors – those that result in death or serious harm – for hospitals, other institutional providers and ambulatory care systems. And that some of the data collected should be made publically available.
The IOM argued that such a system ensures a response to reports of serious harm, holds organizations and providers accountable for maintaining safety, responds to the public’s right to know, and provide incentives to health care organizations to implement safety systems that reduce the likelihood of such events occurring. Simply put, without mandatory reporting and public disclosure nothing will ever change – at least not significantly.
This recommendation drew immediate fire from the AMA. Then AMA President Nancy Dickey wasted no time in calling out the troops to make sure that this recommendation would go nowhere – and it has not. But without such a system there is no accountability – and no incentive to improve patient safety.
Another recommendation was that health professional licensing bodies should do two important things:
(1) implement periodic re-examinations and re-licensing of doctors, nurses, and other key providers, based on both competence and knowledge of safety practices.
In other words, the IOM recognized the failure of a system of health professional licensure in perpetuity. Its time for a overhaul of an approach to professional licensure that may have been up to the task the last century, but certainly fails to protect the public now. According to the IOM, the rapid pace of change in health care, based on the constant development of new technologies and information make periodic assessment of both physician skills and knowledge essential for patient safety.
(2) Work with certifying and credentialing organizations to develop more effective methods to identify unsafe providers and take action.
As the IOM noted, under present systems the time between the discovery of a problem with an unsafe provider, an investigation and subsequent action or sanction can be years. That’s to long for the public to continue to be placed in jeopardy from an unsafe provider.
Organized medicine works overtime to insert more and more due process into the discipline process – and that only lengthens the process. Hospitals, facing the prospect of lengthy litigation, proceed gingerly when considering taking away a physician’s privileges. Managed care plans have been found to include heavily sanctioned doctors – in some cases after their licenses have been suspended – in their panels of doctors. In short, no one is really minding the store and putting patient safety.
The Institute of Medicine challenged the U.S. healthcare system to reduce medical errors by fifty percent by the year 2005. It appears that doctors and other providers will fall far short of that goal. Because of organized medicine’s resistance to nationwide mandatory reporting of errors resulting in serious harm, we do not even have a way of knowing whether things are getting better or getting worse. The failure to meet the IOM’s challenge means that tens of thousands of patients will suffer death or serious harm – outcomes that could well have been prevented – for many more years to come.