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U.S. Department of Health and Human Services | ||||
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| REMARKS BY: | TOMMY G. THOMPSON, SECRETARY OF HEALTH AND HUMAN SERVICES |
| PLACE: | Before the House Ways and Means Subcommittee on Health, Washington, D.C. |
| DATE: | September 10, 2002 |
Good morning, Madame Chairwoman and members of the Subcommittee. It's always good to see you, Madame Chairwoman, and to thank you for your ongoing commitment to quality health care for all Americans. I'm proud to be your partner in that effort.
I am honored to appear before this important Subcommittee today to discuss ways the federal government can help reduce medical errors and improve the safety of the health care services Americans receive.
I first testified before Congress about this issue early in my tenure as Secretary of Health and Human Services. Reducing medical errors - and doing so dramatically - is a priority for this Administration.
In the last few years the Department of Health and Human Services has developed a coordinated set of initiatives to identify and reduce threats to patient safety and improve the quality of patient care. Yet while these initiatives are important, they are only a beginning.
As we all know, the Institute of Medicine=s landmark 1999 report, To Err is Human, alerted the nation to the patient safety challenge in ways that prior studies had not. The IOM estimated that up to 98,000 Americans die each year as a result of medical errors, making such errors the 8th leading cause of death in the United States.
More people die from medical errors than from automobile accidents … breast cancer … or AIDS. And while there has been subsequent debate about the actual number of deaths, the precise number is less significant than the indisputable fact that the rate of medical errors is unacceptably high.
So, for the sake of public health, much more can and must be done to eliminate the barriers that discourage health care providers from participating, voluntarily and enthusiastically, in local and regional patient safety and quality improvement efforts.
Yet the main barrier is that professionals fear that if they report some event or some condition that is less than perfect the report will be used to generate litigation, not redress or correct the problem.
The savings generated by national malpractice litigation reform would help provide a prescription drug benefit for seniors and help the uninsured obtain insurance. We in the Bush Administration are doing all we can to take those steps, and we won't stop until the job is done.
One of the steps we must take is addressed in your legislation, Madame Chairwoman. Without question, health care providers need assurances that if they report errors, the information will be used constructively, not as evidence in a trial. The President made this point explicit in his speech in my great home state at the Medical College of Wisconsin, when he said, and I quote, "We actually have a system that penalizes doctors for trying to prevent errors and avoid complications in patient care" because when they discuss information about patient care they put themselves, or others, at risk of a lawsuit.
I am pleased to say that the legislation this Committee is considering - legislation that you have authored, Madame Chairwoman, for which I thank you very deeply - represents an essential change in direction, taking us away from the "blame game" after there has been an injury and setting us on the more productive path of improving the system and preventing adverse events from occurring in the first place.
It will do so by encouraging a culture of learning and constant quality improvement in our health care system. Of course, the vast majority of doctors, nurses, and other health care professionals are dedicated, conscientious people who work long hours under very difficult circumstances.
And, in fact, health professionals are not opposed to quality improvement. Just the opposite - they embrace it. But as they have told all of us, it must be real and meaningful quality improvement, done in a supportive and cooperative way. The legislation before this Committee meets these important principles.
Madame Chairwoman, your legislation provides the types of protections that the President believes are essential to foster the development and institutionalization of quality improvement efforts in our health care system. I commend you and your colleagues for your leadership in developing, and, we hope, enacting this important legislation.
The proposal assures doctors and other health professionals that if they report information to expert Patient Safety Organizations, the information will be used for patient quality improvement efforts and will be kept confidential. This will encourage them to report, and will greatly increase the amount of data available for analysis by experts.
Because they will receive information from more than one hospital and about more than one doctor, they will be able to detect patterns of good and bad practices that might not otherwise be noticeable on a single provider basis. They will be able to provide recommendations to local providers about system changes that the providers would not have been able to develop on their own. These new Patient Safety Organizations will promote collaboration and cooperation among providers on a regional basis. They will be proactive.
The legislation recognizes that new ways of addressing quality are needed. It focuses on system improvement, not attacks on providers. It will make it easier to bring information about how the system works, rather than one provider, one doctor or even one hospital. And it will be able to gather information from a broad range of providers and see how the system works.
Let me share with you how detection of medical errors and sharing of information can bring significant change when errors become much too extensive. Anesthesiologists have dramatically reduced the patient death rate from anesthesia administered during surgery, from two deaths per 10,000 anesthetics in the mid-1980s to about one death for every 200,000 - 300,000 anesthetics administered today.
How did they do it? First, they acknowledged that a problem existed and then shared the information that changed the way anesthesiology was practiced. They standardized anesthesia machines to ensure consistency in the delivery of drugs … and also addressed issues of fatigue and sleep deprivation, changes in training, and competing institutional priorities.
Anesthesiologists have shown us what can be done. It's a combination of technology, work processes, human factors, institutional culture, and the working environment.
The bill is forward looking and proactive. The Patient Safety Organizations will be able to examine processes and look at outcomes at various institutions, and make suggestions for improvements.
And the measure recognizes the value of local and private quality efforts. Doctors and hospitals will be able to work together with local Patient Safety Organizations to identify problems and experiment with different ways of improving care.
Madame Chairwoman, your bill also complements existing HHS patient safety activities and, in turn, they will help to guide our ongoing technical assistance to private sector initiatives and the patient safety organizations.
Included in these efforts are our Patient Safety Task Force, which brings together the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, and the Food and Drug Administration, along with our lead research agency on patient safety, the Agency for Healthcare Research and Quality.
One of our initiatives, which has been undertaken by the FDA, includes our partnering with the private sector to develop technologies, such as bar coding medications, that will produce electronic prescription programs that can be introduced widely and help diminish the number of medication errors.
Bar coding is so simple. Grocery stores use it all the time. We are funding research to apply bar coding technology to the way patient information is stored and reviewed and the way medications are dispensed. This would save money and, much more importantly, save lives.
In total, the FDA is receiving $5 million in new funding for patient safety, bringing its total funding for this issue to $22 million. The new funds will allow the agency to improve its ability to assess and follow-up on reports of adverse events that occur after the use of FDA-regulated products.
An important goal of the Task Force is to simplify the reporting of patient safety data to HHS agencies. The current system is unnecessarily burdensome. The same adverse event often needs to be reported in different ways on separate forms to different HHS components and those who report the data never learn whether it was useful.
The Patient Safety Task Force will replace this cumbersome system, providing a streamlined system that uses new technologies to help collect and analyze incoming data.
Our funding requests also reflect our commitment. Included in AHRQ=s FY 2003 budget submission is a request for $2 million to launch a Patient Safety Improvement Corps, experts who will work with State health departments and health care institutions to expand State and local capacity to use existing knowledge to identify and eliminate threats to patient safety.
So, Madame Chairwoman, I look forward to working with you on this legislation because it is not some matter of arcane public policy or some set of rules only an actuary could love. It's about saving lives, nothing more, nothing less. And that's worthy of our time, our energy and our commitment.
I would be happy to answer any questions Members of the Subcommittee might have. Thank you very much.