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| Improve patient safety – an issue of vital concern to North Carolina families |
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Increasing the safety of patients will require innovative efforts by health care providers, vigorous oversight by regulatory agencies and active participation by ordinary citizens. The legislature also has a critical role to play: first, in identifying the dimensions of the problem and, second, in ensuring that state regulatory agencies have the tools and structure to perform their job.
1. There is a well-documented epidemic of preventable medical errors in the American health care system. The Harvard Medical Practice Study, first published in 1991, studied adverse events at New York hospitals and concluded that more than 80,000 patients die in American hospitals due to preventable mistakes each year. The celebrated study of the Institute of Medicine, To Err is Human (1999), validated those findings by conducting an extensive study of adverse incidents in Utah, Colorado, and New York and finding that from 44,000 to 98,000, people die each year from medical errors in hospitals in the US. Using the lower estimate, medical error is the 8th largest cause of death in the country – causing more deaths than motor vehicle accidents, breast cancer, and AIDS. These statistics, which measure preventable deaths in hospitals, understate the extent of the patient safety problem. The data do not include the much greater number of patients who are maimed and disabled (but not killed) by medical mistakes. Nor do they include deaths caused by malpractice in the outpatient setting.
2. North Carolina newspapers have recently documented several cases in which doctors engaged in repeated preventable errors, and the Medical Board failed to take timely and appropriate action to protect patients. Those stories include an alcoholic doctor in Wilmington who performed scores of improper gastric bypass operations; a neurosurgeon blind in one eye and color blind in the other who continued to be permitted to practice after numerous botched operations; and doctors in Duplin County who continued to practice after multiple felony drug convictions, and committed multiple acts of malpractice, resulting in serious injuries and at least one fatality.
3. The legislature should take steps to increase the effectiveness of the North Carolina Medical Board. In presentations to this committee, the Medical Board asked for authority to raise annual assessments of licensed physicians so that Board will have more resources to fulfill its mission. We support increased funding for the Board, so long as other important issues are addressed. First, physicians should be required to inform the board of every malpractice payment, all out-of-state discipline taken against the physician, and any criminal convictions. Furthermore, the Board must be given the authority and mandate to impose fines when a physician or insurer fails to comply with statutory reporting requirements.
4. The North Carolina Medical Board provides too little information to the public about physicians, depriving patients of vital facts they need to make an informed decision in selecting a doctor. Other state medical boards, including Virginia’s, publish on the board’s website comprehensive information about each licensed physician’s criminal conduct, revocation of hospital privileges, malpractice payments, and out-of-state disciplinary actions. North Carolina should join the growing list of states that provide basic information about doctors to consumers.
5. The North Carolina Medical Board does not meet national standards for independence. The purpose of the Medical Board is to protect the public. The purpose of the North Carolina Medical Society—the doctors’ political arm -- is to protect the interests of physicians. By statute, every physician member of the Medical Board is chosen by the North Carolina Medical Society, and those physicians hold a permanent majority of board seats. Model legislation of the Federation of State Medical Boards (FSMB) provides that the physician members of a medical board be appointed by the Governor, that any individual, organization or group may suggest members, and that all medical societies and associations are requested to recommend two or more appointees for each available physician Board seat. Inconsistent with that standard, N.C.G.S. §90-3 provides that the North Carolina Medical Society nominates all the physician members of the North Carolina Medical Board. The FSMB publishes a compendium of data about state medical boards. That document shows that there are 70 state medical boards – several states have separate boards for osteopathic medicine. Of those 70 boards, only eight permit a single association or society to nominate the physician members. According to Public Citizen, the national consumer organization, “independence from state medical societies” is a critical factor in the effectiveness of state medical boards.
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