1. Shalo, Sybil


Will financial disincentives reduce the rate of adverse events?


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An amputation of the wrong limb, a clamp left in a patient's body after surgery, an infant abducted from its crib-clinicians widely agree that these events, which the National Quality Forum (NQF) has referred as "never events," should never happen in a health care facility. (See


Still, they happen. Consequently, in 2008 the Centers for Medicare and Medicaid Services will begin withholding reimbursement for costs related to hospital-acquired infections and plans to expand this practice to other adverse events (those included on the NQF's 2002 list of 27, known as the "Never 27"), essentially providing a financial incentive for clinicians not to make major mistakes.


Taking that concept a step further, the California legislature as of July 1 was scheduled to require hospitals to report adverse events to the state department of health services and to give the department the authority to fine hospitals-not exceeding $50,000 per violation-and make the information public. The California law includes one additional adverse event: "an adverse event or series of adverse events that cause the death or serious disability of a patient, personnel, or visitor."


These state and federal efforts, according to their supporters, are intended to reduce the alarming number of medical errors by mandating timely reporting and threatening providers' bottom lines. Although a few states have recently enacted reporting laws, the Minnesota Department of Health (MDH) has been tracking statewide reports of such events for the past four years and is considered one of the leaders in the field. Diane Rydrych, assistant director of the MDH's Division of Health Policy, has seen an upward trend in the number of reported events since the division's first report but says that it's hard to tell whether that's because of an increase in events or of more widespread reporting. While she understands the rationale behind fining clinicians, she believes that the only way to decrease the number of adverse events is for health care workers to feel safe reporting them when they happen-a feeling that such laws might not foster.


"We've heard stories in which a surgeon is about to operate on the wrong side and a tech in the OR is afraid to speak up," Rydrych says. "What's necessary is a change of culture, and that can take a very long time."

Figure. At a news co... - Click to enlarge in new windowFigure. At a news conference in Raleigh, North Carolina, on April 3, 2003, Alice Lloyd opposes two legislative bills capping some damages in medical malpractice cases. Lloyd's legs, left arm, and most of her right hand had to be amputated as a result of preventable medical errors, she said, according to the Associated Press.

Jim Conway, senior vice president at the Boston-based Institute for Healthcare Improvement, agrees, but sees two sides. "A fine trivializes the situation," he says. "It goes into the same bucket as firing the staff, writing a couple of new policies, and hoping it doesn't happen again." On the other hand, he says, it could work if it results in an increase in the reporting of errors. "It depends on whether you work in an organization in which 'never events' are associated with bad people or one in which it's understood that the vast majority of such events are caused by bad systems."


Sybil Shalo



Major depression in parents and grandparents raises the risk of respiratory illness in children, according to a study in the May issue of Archives of Pediatric and Adolescent Medicine. The 20-year follow-up study including 161 children and their parents and grandparents shows that the risk of respiratory illness in children whose parents have major depression is more than three times higher than in those whose parents don't have major depression. The risk was even higher in children whose parents and grandparents had major depression. Prenatal smoking or a history of respiratory disease in parents does not explain the link, and parental depression does not influence the odds of other physical illnesses. If larger studies confirm these results, treatment of parents' major depression may become a strategy for preventing children's respiratory illness, the authors write.


Office of Public Affairs. Centers for Medicare and Medicaid Services. Eliminating serious, preventable, and costly medical errors-never events. [Press release]. 2006 May 18.