Hospitals save lives. The men and women who work in them make a positive difference for countless individuals who have been stricken with poor health.
But when hospitals make mistakes, they can kill. And the public has a right to know shortly after a serious mistake has occurred, not six months later.
Under the state’s “adverse events” reporting law, serious mistakes that maim or kill a patient must be reported to the Connecticut Department of Health. However, there are problems with the state’s law and lawmakers need to correct them.
Attorney General Richard Blumenthal is correct to call for sweeping changes to the state’s “adverse events” reporting law for hospitals. Blumenthal, citing a recent Hartford Courant report that found thousands of serious hospital errors go unreported, not investigated, and not disclosed to the public, is calling for a complete overhaul of the state’s “adverse events” reporting law with Connecticut Center for Patient Safety Executive Director Jean Rexford.
Blumenthal said, “This law is a deadly and disgraceful failure, shielding hospitals and medical professionals from scrutiny and accountability and leaving patients in the dark. Medical mistakes causing death and serious illness usually go unreported, undisclosed and uninvestigated, undermining patient protection. A law intended to expose and address medical incompetence instead abets cover-up and concealment. Gaping loopholes keeping most hospital medical errors secret — including more than 50 that resulted in death — are unconscionable and unacceptable.”
In addition, current federal and state laws do not permit for public disclosure of serious mistakes until their investigations are complete, delaying disclosure for months.
The “adverse events” reporting law should require immediate notification to government officials, and upon confirmation that a serious mistake occurred, it should be posted on the state’s Web site as soon as possible.
The public has a right to know that a serious problem exists or existed at a hospital where they may seek emergency care or treatment.
Take the case of Saint Francis Hospital and Medical Center. On May 18, a cardiac bypass pump had a catastrophic failure during a patient’s surgery, ultimately causing the patient’s death.
Although Saint Francis voluntarily suspended its operation of elective cardiac surgeries in July for a brief time, the public was not made aware of the circumstances that prompted the hospital’s move for nearly three months when, in August, some additional details were disclosed by the Centers for Medicare and Medicaid Services in a two-page letter sent to Christopher Dadlez, president and chief executive office of Saint Francis.
On Nov. 12, about six months after the bypass pump failed, the full details about the incident were finally disclosed when the state Department of Public Health placed Saint Francis Hospital on a one-year probation and posted a consent order detailing the hospital’s errors on its Web site.
Changing state law to require prompt and full disclosures of hospital medical errors will most likely result in a higher standard of care for patients.
While lawmakers consider improving the reporting requirements of hospital medical errors, it is important that they also look at the financial factors that may contribute to deadly hospital mistakes.
More than half of the state’s 30 acute care hospitals lost money last year and nearly a third are experiencing financial distress, according to an annual report by the state Office of Health Care Access.
Improving the quality of health care requires multiple solutions.
