Iowa should catch up with other states’ rules

By Dean Lerner

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Kudos to Gazette reporter Erin Jordan for informing readers about hospital “never events” (April 29), commonly defined as medical errors that should never occur because they are preventable and threaten the health of patients.

Such “never events” include injuries or death associated with the use of contaminated drugs, medication errors, the unintended retention of a foreign object in a patient, and surgery on the wrong body part or the wrong patient. Jordan exposed sobering facts about the disturbing frequency with which these events occur, noting their devastating human and fiscal impact.

Iowa, unlike the majority of states, regrettably does not require our individual hospitals to report these errors for publication.

The Department of Inspections and Appeals (DIA) is responsible for licensing Iowa's 126 hospitals and promulgating rules promoting patient safety. During my tenure as its director, we tried to pass rules requiring hospitals to report all “never events” for unfettered access by the public. Our proposal included the information utilized by the majority of states from the National Quality Forum, the 28 defined “never events,” so that Iowans would benefit from access to accepted, standardized information.

Before proposing these rules, the DIA completed a thorough due diligence evaluation of their expected impact. The National Academy for State Health Policy provided evidence on the positive impact the DIA's requirements would foster. A University of Iowa Department of Health Management and Policy report, “Public Reporting of Adverse Events in Iowa,” concluded that reductions in adverse events have been linked to statewide data collection and public reporting systems.

The report cited Minnesota as a primary example. Our proposal mirrored Minnesota's.

Under Iowa law, an entity called the Hospital Licensing Board (HLB) is required to approve or disapprove the DIA's proposed rules to promote safe treatment of patients in Iowa's hospitals. Its membership is unduly weighted in favor of hospital administrators and ownership interests. Unfortunately, the HLB members refused to even bring the DIA's “never event” rules to a vote.

The stilted composition of the HLB has long thwarted meaningful hospital reforms. The DIA has repeatedly, but unsuccessfully, proposed legislation to eliminate the HLB because of the Iowa Hospital Association's (IHA) undue influence (some members sat on both boards), hospital conflicts of interest, and bias.

There is no evidence that Gov. Terry Branstad's administration is seeking the elimination of the HLB or continuing the effort to have Iowa join other states requiring hospital error reporting. This lack of action is not surprising, given the powerful special interest lobby of the IHA, which makes hundreds of thousands of dollars of campaign contributions.

A review of Minnesota's hospital-specific information is available at www.health.state.mn.us/patientsafety/ae/index.html. Contrast that system with the volunteered alternative information offered and supported by the IHA from their aligned Iowa Healthcare Collaborative (IHC) at www.ihconline.org/aspx/publicreporting/iowa

report.aspx.

The UI report noted that the IHA-supported IHC voluntary reporting efforts “do not readily correspond” with those pursued in states that support adverse-event reporting systems.

Recent federal health care law developments further support the proposition that sunshine through mandated public information is a powerful antiseptic. The Centers for Medicare and Medicaid Services (CMS) this month proposed rules that will enable consumers to select higher-quality, lower-cost hospitals and other health care providers by making very specific data/reports available to the public.

Shame on the hospital-based power broker special interests and their co-opted elected officials who insist on blocking public access to information, choosing instead to complicate the issue, promote an unsatisfactory alternative, and do their best to convince us that the “never event” public reporting issue is too difficult to understand. It's not. Iowans deserve the benefits from adopting the best practices of other states and recent health law reforms.

Dean Lerner served as deputy director of the Iowa Department of Inspections and Appeals from 2002 to 2007 and as DIA director from 2007 until January, when Gov. Branstad replaced him. Comments: deanalerner@gmail.com