A followup to my critique of Public Citizen's complaint about Oregon's Medical Malpractice reform. I said that the world outside the National Practitioner Data Bank is much larger than the world inside it. For a vivid illustration of how much bigger it is, see this post from Adrianna McIntyre at Incidental Economist. Around 3%-4% of hospitalizations result in injuries due to medical care, and 1% result in injuries due to substandard care. Of the Injuries due to substandard care only 2% result in medical malpractice claims.
Reversing that, for every medical malpractice prompted by an injury caused by substandard care during a hospitalization, there are 50 injuries caused by substandard care that didn't prompt a claim plus another 100 - 150 injuries caused by standard care.
Public Citizen worries about the information lost by decreasing the number of claims entering the little green slice that represents the medical malpractice system. In a world where that reporting could be maintained cost-free, sure we'd be better off with it. But is maintaining current reporting so important that it's worth discouraging reforms that would increase reporting and scrutiny of the vast world now outside the medical malpractice system?
posed by Nick Budnick in comments on Oregon's new medical mediation law helps bad doctors, national group says
The story is about how Public Citizen is critical of a Disclose and Compensate tort reform program Oregon enacted earlier this year. The question asked how to weigh the potential loss of reporting of some incidents to the National Practitioner Data Bank(NPDB) state medical board as a result of them being settled through mediation. [alas, I misunderstood the question!] My response:
Public access to the
NPDB
doesn't include names of physicians. Access to that information is generally restricted to hospitals and credentialing
organizations. Given that, I wouldn't call those reports "public
information." Weighing their value
requires knowing how those reports get used in real life, and I don't know that
(maybe a future story?)
But I'll speculate
that how those reports get used is on second hand decisions: Should we renew so and so's credentials? Should we revoke them? Should we hire or grant privileges? Except for the case where a
facility is reviewing an incident which happened on their premises (and in that
case they shouldn't need an NPDB report to tell them what happened) none of those decisions can influence the
process that lead to error, assuming there was one. They are go / no-go decisions about a
specific person and they only effect errors to the extent those individuals are
personally responsible for them.
There are really bad doctors and
having a process that can get rid of them is a good thing. But most doctors aren't really bad and most
adverse events aren't attributable to a single individual. Keying off Merwin's comment below most
doctors are neither superheroes nor super villains, they're regular people
typically working in complicated, interdependent systems. A malpractice monitoring system that only
catches super villains isn't that helpful.
Consider some
statistics. Over the last 10 years there
were on average 14,787 medical malpractice payments reported to the NPDB each
year. For the sake of argument let's
suppose each and every one of those involved a death. Well, the IOM
estimates there are 44,000 preventable deaths caused by medical errors each
year, just in hospitals. So even using
charitable assumptions there are two preventable deaths outside the NPDB system
for every one that makes it in. And when
you use less favorable assumptions- fewer than a third of NPBD med
mal payments involve a fatality and estimates of preventable deaths due to
error go much higher-
it's clear that the world outside the NPBD system is a lot bigger and no less consequential than
the world inside it.
Oregon's reform is
an acknowledgment of that reality, and intended to encourage institutions to
dig deeper into adverse events to better understand why they happened and
prevent their recurrence. It's meant to
impact the broad middle ground where most practice is, not the narrow
extreme. And where a provider is at the
extreme you have to consider the chance they wouldn't resolve in mediation and
they'd get reported to the NPDB anyway.
Opinions will vary,
but to me the NPDB issue looks like a small cost for a potentially large gain
in patient safety. I'm surprised and disappointed Public Citizen objects to that.
