Representatives from all quarters of the health-care debate came together in the White House Rose Garden Tuesday to get behind a pretty simple premise: Health-care workers shouldn't make the kind of mistakes that cost the lives of as many as 98,000 patients a year.
Flanked by representatives of the health-care industry, business, labor and government, President Clinton signed an executive memorandum directing his health-care quality task force to analyze last week's Institute of Medicine study that quantified the deaths attributable to medical errors, many of them as a result of wrong prescription-drug doses.
The independent study estimated that medical mistakes kill between 44,000 and 98,000 Americans each year. About 7,000 deaths were attributed to errors in prescribing or dispensing drugs. The IOM found flaws in the way hospitals, clinics and pharmacies operate. "Once you know about a problem, you're under a moral obligation to deal with it," Clinton said when asked whether admitting mistakes might expose health-care professionals to increased lawsuits. "Whatever the consequences are, we have to go forward."
Clinton did more than use the presidential bully pulpit to get medical plans and hospitals on the right track. Each one of the more than 300 private health plans that insure federal workers will now be required to institute quality-improvement and patient-safety measures, the president said.
Clinton also said he plans to make sure there's enough money in his 2001 budget -- scheduled to be released early next year -- to "provide the largest investment to eliminate medical errors, improve quality and enhance patient safety we've ever offered."
About 85 million people -- one in three Americans -- get their health care paid for all or in part by the federal government. This gives the federal government significant leverage over these private health companies. And if such practices are put in place for federally covered workers and their families, others covered under such plans are likely to benefit as well.
Like the managed-care industry, which Tuesday said it supports Clinton in this effort, the head of the largest hospital organization also said his group is on board. "We can and we must do better," American Hospital Association president Richard J. Davidson said at the White House. In a letter to its 5,000 members, the AHA said, "We have to create an environment in which we can learn from failure -- a safe, non-punitive environment that supports candid discussion of errors, their causes and ways to prevent them,"
Clinton's effort got a boost from the nation's largest private-sector health-care purchaser, General Motors. "The IOM study suggests that of the 1.25 million people GM covers, on average more than one life is lost each day due to preventable medical error," said Jim Cubbin, executive director of GM Health Care Initiatives. "That is unacceptable." GM's purchasing clout, like that of the federal government, could lead to substantial changes in the health-care system. For example, GM will require the hospitals that serve its employees to use the Computer Physicians Order Entry system. The system, said Cubbin, has been shown to reduce serious prescribing errors by more than 50 percent. Yet fewer than 1 percent of hospitals use it.
At the other end of Pennsylvania Avenue, Sen. Ted Kennedy, D-Mass., announced he will introduce the Error Reduction and Improvement of Patient Safety Act. His legislation would make sure the IOM's recommendations are carried out. He would create a new Center for Patient Safety, which would require hospitals and nursing homes to adopt concrete measures to reduce medical errors as a condition of participating in Medicare and Medicaid. And he would require health organizations to report to their states any medical errors that result in serious injury or death. About one-third of states currently have such requirements. Kennedy said he was "amazed and enormously distressed" over the IOM report and predicted a "strong bipartisan bill" next year.