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New York accused of going easy on malpracticing doctors
Study: EDs generate more improper dosing errors, fewer interceptions
Many hospitals fall behind disclosure expectations

Patient Safety Monitor Alert, March 18, 2003

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NEW YORK ACCUSED OF GOING EASY ON MALPRACTICING DOCTORS

The state of New York isn't hard enough on "repeat-offender" doctors, a new study charges.

"New York's Dangerous—and Undisciplined—Doctors," which analyzed data from the National Practitioner Data Bank, shows that the state failed to discipline most of its physicians who made three or more medical malpractice payments during the past 12 years, according to a press release. Between 1990 and 2002, only 10 percent of those doctors had their license suspended or revoked or lost other clinical privileges. The state Board of Professional Medical Conduct did not punish any of the others, according to the report, which was published by Public Citizen—a consumer advocacy group based in Washington, DC.

Seven percent of the doctors in New York are responsible for more than two-thirds of malpractice payouts in the state since 1990, said Frank Clemente, director of Public Citizen, in a press release.

The release called on doctors to focus on patient safety rather than the "non-existent 'liability crisis.' " The Medical Society of the State of New York told the Associated Press that high malpractice premiums have forced some doctors out of the state. However, Public Citizen's found that premiums for doctors in New York did not rise much between 1992 (when they were approximately $821 million) and 2001 (when they were $873 million.)

STUDY: EDs GENERATE MORE IMPROPER DOSING ERRORS, FEWER INTERCEPTIONS

Which medication errors occur most frequently in an emergency department (ED)? Physicians failing to communicate the correct medication for a patient, patients receiving the wrong dose of a medication, or not receiving a medication at all, according to a new report from the United States Pharmacopeia (USP). The organization analyzed medication error reports submitted to its national databases since 1998 to determine recommendations for preventing the most common medication errors in the ED.

Improper dosing was the most common error reported in that department, while errors of omission happened most frequently in the rest of the hospital. More than three quarters of the errors reported in the ED occurred during prescribing or administering. In addition, USP found that staff managed to intercept only 23 percent of errors in the ED. In other areas of the hospital, 39 percent were intercepted. USP attributes the lower percentage to the interruptions, fast pace, and pressure of working in the department.

To prevent these errors, USP recommends health care facilities take measures such as purchasing premixed intravenous solutions and unit dose medications, as well as minimizing verbal orders for medications.

Go to www.usp.org and click on "USP Identifies Leading Medication Errors in Hospital Emergency Departments" under the "headlines" section to learn more.

MANY HOSPITALS FALL BEHIND DISCLOSURE EXPECTATIONS

Worried that your hospital doesn't do its part when it comes to disclosure? You're in good company. Though most hospitals disclose harm to patients "some of the time," only one-third have board-approved disclosure policies in place, a national survey of risk managers in early 2002 has found, according to an article published in the journal, Health Affairs, earlier this month.

More than half of the respondents said they would always disclose serious injuries or death. However, respondents were more likely to disclose nonpreventable harms than preventable ones when they were presented with actual clinical scenarios, according to an abstract of the article.

The Joint Commission on Accreditation of Healthcare Organization's patient safety standards, which took effect in July 2001, require hospitals to disclose all unanticipated outcomes to patients.

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