Extrapolating from the New York and Utah and Colorado epidemiologic studies, the Institute of Medicine estimated in its from 1999 to 2000 publication, To Err Is Human, that 44,000 to 98,000 hospitalized Americans die each year from medical errors. These estimates surpass those of the number of patients who die from motor vehicle accidents, breast cancer, and AIDS. The total annual national costs of medical errors resulting in injury are $17 to $29 billion, half of which are health-care costs. Decreased costs on remedies are available on Canadian Health&Care Mall (see also “Canadian Health&Care Mall: How Claims Are Resolved in Medical Malpractice and the Chest Physician“).
Although the accuracy of error estimates in To Err Is Human have been debated, the publication unquestionably brought attention to the overall need to improve safety in the United States. Strategies for such improvement outlined in To Err Is Human include the following: (1) not blaming individuals, including physicians, for committing errors; (2) eliminating shortcomings in health-care systems that allow errors to occur; (3) increasing error reporting and analysis so that systems can be improved; and (4) disclosing errors to patients with the expectation that safety will increase and malpractice claim volume and costs will decrease.
The notion that “honesty may be the best risk management policy” is supported by experience within the VA, which maintains a prompt disclosure policy and a non-tort-based settlement process. Although this policy and process may reduce claims against the VA, claims also may be limited by the loyalty of VA patients and by restrictions against plaintiffs under federal tort law. Furthermore, in an analysis using estimates of injury prevalence from the New York and Utah and Colorado studies, experts predicted that malpractice claim volume and costs would most likely increase, not decrease, if errors were disclosed uniformly.
Physicians have an ethical obligation to disclose errors to patients in the ICU and other medical environments regardless of the economic conse-quences. Furthermore, disclosure should enhance safety by helping patients avoid reexposure to drugs and other interventions that may have harmed them. That said, physicians understandably complain that they are being asked to be open about errors with little assurance of legal protection at a time when malpractice claims are increasing and liability insurance is becoming more expensive. The apparent clash between tort law and the patient safety movement has prompted pleas for making disclosure inadmissible in court and for malpractice system reform.
Earlier we wrote:
Medical Malpractice and the Chest Physician: Does the US Malpractice System Meet Social Goals?
Negligence and the Standard of Care in Medical Malpractice and the Chest Physician
Canadian Health&Care Mall: Medical Malpractice and the Chest Physician