The New York Times

Wednesday, December 8, 1999

Moving Fast on Patient Safety

The Institute of Medicine reported last week that between about 50,000 and 100,000 patients die in hospitals each year because of medical mistakes. President Clinton responded yesterday by embracing the report and ordering his administration to take immediate action. For Washington, that is a remarkably rapid turnabout.

The institute estimated that perhaps 3 percent of hospital patients suffered injuries from treatment. About half are preventable. The problem, the report said, is not individual carelessness as much as faulty systems that fail to catch mistakes -- such as administering the wrong dose of drugs -- before they injure patients.

Mr. Clinton instructed a task force to report within 60 days on steps to improve patient safety. He directed federal agencies to come up with remedies in time for his next budget address. By presidential order, he instructed the agency that oversees health plans for federal employees to require that those plans develop systems for cutting down errors. It is expected that improvements in plans that cover nine million federal employees and their families will spread to other patients.

The institute report itself contains useful suggestions. It calls for a federal center for patient safety to distribute information about preventing errors, as well as mandatory reporting of serious injuries and voluntary confidential reporting of less serious errors. Confidentiality, it argued, is needed to discourage doctors from hiding mistakes to save themselves professional or financial ruin.

Meanwhile, Senator Edward Kennedy of Massachusetts announced that he would introduce a bill that would put the institute's proposals into effect and require hospitals to adopt error-preventing systems or else risk losing Medicare and Medicaid patients.

That would cover most hospitals in the country.

The institute's frightening statistics were known to health experts long before last week. Yet no one has figured out how to get hospitals and physicians to do better. Employers say they cannot make intelligent choices among health plans because data on the quality of these plans are unreliable. The health plans say they cannot undertake the huge cost of producing reliable data because employers do not act on them.

Even adopting the institute's recommendations in full will not completely solve this chicken-and-egg problem. But the proposals should produce better information and at the same time protect patients.