Wednesday, February 29, 2012

The quest for medical error transparency suffers setbacks

Two recent articles in American Medical News highlight the difficulties in moving toward a blameless culture in medicine.

First we have the results of an Agency for Healthcare Research and Quality survey of 600,000 staff from over 1100 hospitals. Half of them “believe their mistakes are held against them, and 54% said that when an adverse event is reported, ‘it feels like the person is being written up, not the problem.’" And two-thirds are concerned that records of errors are maintained in their personnel files. Despite lip service by medical thought leaders, the reported responses have not changed since the last AHRQ survey in 2007.

Much more alarming is the second piece, which involves a family secretly recording a conversation with the chief medical officer [CMO] of an Ohio hospital.

Two days after knee surgery, a man died of cardiac arrest apparently secondary to an overlooked high serum potassium level. Before he died, the patient’s children met with the CMO, who had not personally been caring for the patient. Unaware that the conversation was being recorded, the CMO “made sympathetic and apologetic comments and admitted fault on the part of the hospital for Smith's condition, according to court records.”

The Ohio appellate court ruled that the secret recording was admissible and not protected by peer review privilege, as had been argued by the CMO’s lawyers. They had claimed that the CMO had learned of the error via the peer review process. Ohio law states that as long as one party consents, conversations can be recorded.

Thus we are left with pie-in-the-sky appeals for greater transparency and candor regarding medical errors [the so-called “Just Culture”] vs. a litigious society with stealth technical capabilites and a workplace atmosphere of fear and distrust.

Somehow I do not foresee a major change in the way doctors and hospital staffs approach this issue.


Anonymous said...

If the hospital was wrong and admitted fault and/or wrong doing why is this case even being appealed thus opening the door for peer review and its protection. I do not know what the case status is but wonder if there is more to the story.I am sure this case will be watched by many.Keep us updated

Skeptical Scalpel said...

Good questions. I will try to follow up on it but as you know, these things may drag on for years.

Anonymous said...

I just checked, this case is a year or so old. It appears the hospital claimed peer review protection and the appeal court disagreed on the elements submitted to justify the protected status. There is more to the story including issues with the lab. Very interesting read.I am sure the hospital wasn't expecting that. I doubt if this case will be made public but who knows.

Skeptical Scalpel said...

Thanks for the update. Could you give me the link to the story?

Anonymous said...

There are numerous stories on the net, the above is the actual transcript from the appeals decision.

Skeptical Scalpel said...

Thanks for the link. It is very interesting reading. The CMO erred by telling the family what the root cause analysis found. Once he told them, the information was no longer privileged. It is unclear whether it ever was privileged at all.

Here's an interesting quote from the ruling, "The peer-review privilege is not a generalized cloak of secrecy over the entire peer-review process."

Anonymous said...

Nursing still believes that the way to reduce accidents is naming, blaming an shaming.

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