Admitting mistakes: Iowa doesn’t require reports of medical errors

Andrew Leffler went to the University of Iowa Hospitals and Clinics in Iowa City in 2002 for broken leg and says an epidural that leaked into his spinal column and damaged his nerves left him with a permanent disability.

“I went there with a broken leg and came out of there paralyzed from the waist down,” said Leffler, 54, of Keokuk.

His experience is one example of the claims of medical errors - some minor, some catastrophic - that happen in hospitals in Iowa and across the nation. Twenty-six states require hospitals to report their medical mistakes to the state.

Iowa does not.

Public reporting of medical errors, including so-called “never events” like surgery on the wrong body part or discharge of infants to the wrong parents, reduces errors and helps patients shop for the safest hospitals, openness advocates said.

But opponents of mandatory reporting say Iowa hospitals already voluntarily report their medical outcomes.

“Government regulation does not create that kind of buy-in or progress,” said Scott McIntyre, spokesman for the Iowa Hospital Association. “It can stifle innovation as providers focus on meeting the mandate and little more.”

The association favors providing information to the Iowa Healthcare Collaborative, which posts online dozens of PDFs with medical outcomes of various procedures done at Iowa hospitals. The charts don't include raw numbers and aren't searchable by hospital.

“It's not enough,” said Dean Lerner, former director of the Iowa Department of Inspections and Appeals. “States that have (mandatory) public reporting have seen bigger changes, bigger improvements.”

Reporting in Minnesota

Minnesota, which has required reporting of medical errors since 2003, saw a 3.5 percent drop in adverse events between 2009 and 2010.

Falls causing serious injury in hospitals dropped by 20 percent that year and, for the first time since 2003, the state had no deaths from falls, said Diane Rydrych, assistant director of the division of health policy with the Minnesota Department of Health.

Minnesota hospitals were worried malpractice lawsuits would spike with mandatory reporting of 28 adverse outcomes, said Lawrence Massa, president of the Minnesota Hospital Association.

That hasn't happened.

“If something terrible happens in a hospital, it's generally going to result in a lawsuit whether the adverse reporting system is in place or not,” Massa said.

Minnesota hospitals have embraced safety campaigns, such as the Safe Count Call to Action, which pushes hospital employees to verify all implements are removed from patients after medical procedures, Massa said.

“We believe very strongly what gets measured, gets improved,” he said.

It hasn't been all victories for Minnesota hospitals. They reported 48 wrong patient/wrong site procedures in 2010, up from 44 the previous year.

Patients want reporting

Patients put high value on hospitals owning up to mistakes.

“It's O.K. if you screw up. Just acknowledge it and go on,” Leffler said.

Leffler sued the university in 2004 and settled with the state five years later for $850,000. He got $485,000 after legal bills.

Leffler walks now with crutches and can't do many of the things he loves, like carpentry and tinkering with the Harley-Davidson he may never ride again.

UI Hospitals spokesman Tom Moore said the hospital can't discuss terms of legal settlements such as Leffler's.

AARP Iowa reported last fall that 75 percent of older Iowans who are likely voters think hospitals should be required to publicly report the number of serious, preventable errors.

“We as consumers pay for hospital services in many different ways and we have a right to know if they are doing well or poorly and if they are safe,” said Kathy Day, a registered nurse and patient advocate from Maine.

Day, whose father died two years ago of a hospital-acquired staph infection, is pushing her Legislature for public reporting of incidents when patients contract the bacterial infection in the hospital as a way to prevent the ailment.

Hospitals track errors

Most hospitals track their medical errors and try to learn from them.

The UI Hospitals and Clinics has used a computer program called the Patient Safety Net since 2007 to track medical errors and safety problems in the 729-bed facility.

Each report gets a “harm score” that ranges from A. “Unsafe conditions” to I. “Death.” A team of hospital leaders analyzes the most serious reports to figure out how to fix the system to avoid future problems.

“Our whole goal is to prevent these things from happening,” said Dr. Richard LeBlond, UI Hospitals' chief quality officer.

Employees have filed about 50,000 reports to the Patient Safety Net since May 2007, LeBlond said. Only a small share are serious medical errors, he said, but the UI has refused to provide The Gazette any information about the reports - even summaries of the most serious cases - saying it would discourage employees from filing future reports.

The UI's safety program costs about $500,000 a year for salaries and membership to the University HealthSystem Consortium, which runs the PSN, LeBlond said.

Dr. Mark Valliere, chief medical officer for Mercy Medical Center in Cedar Rapids, doesn't think mandatory reporting of errors is a full-proof way to eliminate them.

“In past days, anytime an error occurred, it was somebody's fault,” Valliere said. “Now we're looking more at what the system can do.” For example, Mercy purchased a pharmaceutical robot in 2009 that limits human error in dispensing prescription drugs.

Study finds more errors

Adding to the discussion about public reporting of medical errors is a new study showing the number of mistakes may be much higher than previously thought.

The study in the April issue of the journal Health Affairs found that one-third of nearly 800 patients treated in three metro U.S. hospitals in 2004 experienced an adverse event. The Office of the Inspector General found similar numbers in a sampling of Medicare patients treated in 2008.

The U.S. Department of Health and Human Services announced earlier this month plans to spend up to $1 billion to reduce preventable hospital injuries by 30 percent and cut preventable admissions by 20 percent.

Reaching those targets would save the U.S. health care system an estimated $35 billion over three years.

The federal government is also responding to pleas for openness by releasing new data on medical errors.

The U.S. Centers for Medicare & Medicaid Services released data earlier this month showing Iowa hospitals reported 225 incidents of Hospital-Acquired Conditions, which are eight types of medical errors including falls, pressure ulcers and foreign objects retained after surgery. These numbers are for Medicare patients discharged between Oct. 1, 2008, and June 30, 2010.