We are playing devil’s advocate here in lieu of our last post. We posted to cause some discussion. Please enjoy.
In medical circles, preventable errors sometimes occur. These errors range from minor mistakes like leaving a patient lying in one position for too long; to more serious ones like performing a surgery on the wrong part of the body. The outcomes of such errors can range from patient discomfort to debilitating injury or even death.
In a bid to reduce medical errors (especially the ones which cause severe injuries or death), both federal and state agencies impose a number of penalties on hospitals. Medicare, for instance, does not pay for treatments linked to medical errors. Almost all states impose fines on hospitals which don’t report the incidences of severe medical errors.
The state of California is especially severe in its penalties. First of all, hospitals face penalties of up to $125,000 per incident of medical error. Secondly, the state has a mechanism for shaming errant hospitals. It does this by publishing the names of hospitals, as well as details of medical errors in publicly accessible news outlets, blogs and social media.
Compared to other states, California’s penalties seem rather draconian. This is because the penalties can be imposed irrespective of whether or not the incident was voluntarily reported. However, the real sticking point is about the effectiveness of such measures. In other words, are the severe penalties imposed on hospitals leading to an overall reduction in the rate or severity of preventable medical errors?
According to an analysis of California state data carried out by the San Diego Union-Tribune, the answer is no. The state’s severe penalties haven’t contributed towards any noticeable reduction in the incidences of preventable medical errors. At least there isn’t any significant reduction when a comparison is made with states whose penalties aren’t as severe.
Since 2007, California has fined hospitals a total of $17 million for preventable medical errors. The state has also publicly shamed a total of 192 hospitals for a range of errors such as leaving surgical sponges inside patients, performing surgeries on wrong parts of the body and giving patients fatal doses of medication.
These punishments haven’t led to overall reduction in the frequency of such errors. For instance, the incidences of foreign bodies left inside patients bodies is currently higher than its pre-2007 levels. In fact, as of March 2016, the combined number of all medical errors was higher than the numbers in 2006 – before the state introduced its penalties and shaming program.
Basically, nine years of severe financial penalties and public shaming have done nothing to reduce the incidences of medical errors. In fact, imposing the punishments on specific hospitals hasn’t led to a remarkable drop in the medical errors within those hospitals.
There have been cases of some hospitals being penalized on numerous occasions. The most poignant example is the UC San Francisco Medical center which has been fined 9 times. Another example is the Southwest Healthcare System which has two hospitals in Murrieta and Widlomar which have been penalized a total of 13 times. In each of these cases, the fines have ranged from $75,000 to $125,000.
If the penalties were effective, they would have led to reductions in medical errors – if not generally, then at least in specific hospitals which have been penalized. However, if a hospital can be fined 9 or 13 times over a nine-year period, then it is obvious that any systemic changes which the fines are intended to bring actually isn’t happening.
Most medical experts think that the severe penalties could actually be discouraging hospitals from reporting incidences of medical errors. After all, if even voluntarily reporting the incidences still leads penalties, then what motivation do hospitals have to actually report them?
Basically, the penalties could be creating an atmosphere which makes it less likely for medical staff to voluntarily report incidences of medical errors. And yet, in order to reduce the errors, it is essential to create a culture in which medical personnel can easily come forth and report them.
The evidence that California’s hospitals could be underreporting incidences of medical errors is found in the state’s statistics. For instance, in the 2015 fiscal year, the state reported a total of 1,283 deaths from medical errors. Some experts find this extremely low, when compared to the numbers from national studies.
Their argument goes as follows. According to data from national studies, between 200,000 and 400,000 people die annually as a result of medical errors. Given that the state of California has almost 10% of the nation’s population, it wouldn’t be a stretch to expect it to contain 10% of the fatalities. This means that the total number of medical error fatalities should be between 20,000 and 40,000 annually. This basically means that the 1,283 reported is an extremely small fraction of the actual numbers.
There are those who argue that the steep financial penalties could be depriving hospitals of the resources they could have used to improve their operations. Instead of fining a hospital $100,000, it would be more effective to tell the hospitals to use the money to make improvements which are directly related to the medical error. Otherwise, the fines will only benefit the health departments to which they are paid.
Using financial penalties in an attempt to reduce medical errors actually trivializes the problem. The simple fact is that minimizing medical errors is quite complex. This is because the possible root causes of the errors can be varied. Even for a specific category of errors (e.g. performing wrongful surgical procedures) the actual causes can vary from one hospital to work. As such, using a one-size-fits-approach is unlikely to be effective.
After all, there are specific types of medical errors which have reduced over time – even without the use of extreme penalties. For instance, the incidences of blood infections arising from catheters dropped by 50% between 2008 and 2014, according to the CDC. These blood infections used to arise from a common error – leaving central line catheters (which are used to deliver medicines) – for too long. A concerted effort of education and training – without any extreme penalties – is what brought about the reduction in the error.
The bottom line is that medical errors can be reduced without resorting to draconian penalties. This is not to suggest that hospitals should never be sanctioned over actions which endanger patient safety. The point is that the sanctions shouldn’t discourage hospitals from reporting incidences, or deprive them of the very resources they need to reduce such incidences. Otherwise, medical errors penalties of the kind found in California could actually be exacerbating – rather than minimizing – the problem of medical errors.