Medical errors

By SHARON SALYER

Herald Writer

The diagnosis is still out for a new state law intended to hold hospitals publicly accountable for their mistakes.

Since June, the public has had access to inspection, patient complaint and medical error reports. Records acquired last week by The Herald show, for example, that since August, hospitals statewide have conducted surgery on the wrong body part or person 11 times, including once at Everett’s hospital.

But the reports don’t tell citizens much more.

About two-thirds of the state’s hospitals haven’t even turned in reports on errors or other incidents that could cause patients harm, the documents don’t describe the nature of the incidents, and the way the information is collected could lead to confusion, health experts say.

"One of the dilemmas is we know we don’t have full reporting from hospitals," Byron Plan, who oversees the state Health Department’s health care survey, said of the number of reports filed by the state’s 94 hospitals.

"We would expect more," he said, adding that hospitals will be reminded about the requirements during annual inspections by the agency.

The move for hospitals to report such problems, and for the reports to be publicly disclosed, are part of a national trend for increased accountability. Legislation requiring more public disclosure of problems in Washington hospitals took four years to be approved.

Last year, the Institute of Medicine said medical errors caused 44,000 to 98,000 deaths a year, more than the number resulting from auto accidents, cancer or AIDS, and far more than the numbers killed or injured in plane crashes each year.

Collecting such information in Washington is a challenge.

Hospitals are only required to report the date when errors or other incidents that could cause patients harm occurred. With no legal requirements to publicly disclose more facts about what happened, hospitals are on the honor system when discussing what went wrong, if they agree to talk at all.

Two-thirds of the state’s hospitals, including Stevens Hospital in Edmonds and Cascade Valley in Arlington, did not file any of these reports since the requirement went into effect last year, according to the state Health Department.

It’s hard to admit mistakes, even with the relative anonymity of the reporting forms, health officials say. This is compounded by a legal environment in which patients readily file lawsuits when medical mistakes occur.

"Do you run to your boss when you make a mistake?" asked Gary Bennett, director of facilities and services licensing for the state Health Department. "Being open is not most people’s first instinct."

Medical staff fear they will be "victimized by disclosing that one instance out of 1,000 that didn’t go perfectly," said Ray Crerand, chief executive of Everett’s hospital.

Although the broad category of operating on the wrong patient or body part brings to mind the 1995 case of the Florida patient whose surgeon amputated the wrong foot, the incidents as described by hospital officials appear to be much more benign:

At Providence Everett Medical Center, more surgical exploration was conducted than required for a young patient’s appendectomy. No harm was done from the surgery.

At Seattle’s Virginia Mason Medical Center, a surgeon reportedly was an inch away from the optimal site for the incision; at the University of Washington Medical Center, kidney stones were supposed to be removed from both kidneys and instead were only removed from one.

Bellevue’s Overlake Hospital Medical Center was the only hospital in the state to report two cases of procedures on the wrong patient or body part, Health Department records show. Hospital officials refused to discuss details other than to say that the patients reportedly were not harmed by the mistakes.

Another problem with the system is the broadness of the reporting categories.

Simply reporting an event without knowing details of the case could lead the public to misinterpret what happened, hospital officials note.

For example, a March report of an unanticipated death of a patient at Valley General Hospital in Monroe occurred after a patient developed an embolism or blockage to a blood vessel – what hospital officials characterize as a rare complication from a routine hospitalization.

The UW medical center’s reported problem of not completing the kidney stone removal procedure was reported in the category of "surgery performed on the wrong patient or body part."

"I’m not sure which is better, the shorthand (of the report’s categories) or no reporting," said Dr. Eric Larson, medical director of the UW’s medical center. "It’s one of the shortcomings of the system that you report it this way because it’s the only category.

"We reported it in the spirit of ‘Let’s learn as a group from this near-miss,’ even though there was no damage or injury."

Reports to the state Health Department are just part of a hospital’s response to medical errors and problems. Confidential internal investigations and reviews of these cases by fellow hospital employees also take place.

State Rep. Jeanne Edwards, D-Bothell, who worked as an administrator at the Everett hospital for 13 years, said the closed-door, internal investigations are taken seriously.

"They’re dealt with and dealt with very strongly," she said of the problems identified in these investigations.

At least the new reports are a good start, said the Health Department’s Bennett.

Even though the state now requires only bare-bones information about critical problems, "I view this as an important first step in an overall strategy," Bennett added, "that not just Washington, but the whole country is going to have to employ when looking at medical errors."

And accountability is important, said Crerand, the Everett hospital administrator.

"Disclosure and admitting your errors is part of being a good community steward," he said. "I think it’s crucial we have an oversight mechanism."

You can call Herald Writer Sharon Salyer at 425-339-3486or send e-mail t

salyer@heraldnet.com.

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