POTENTIAL - ACT 13, the final signed version of HB1802, contains provisions intended to improve patient safety within the confines of treatment at a medical facility. They were added as a conciliatory offering to consumer groups and those legislators concerned with patient safety. In this regard Act 13 creates a political body known as the Patient Safety Authority, under the control of a board of directors made up of 11 appointed members.
Contractors will be hired to collect, analyze, and evaluate data regarding medical incidents and serious events which have occurred at medical facilities, which did or had the potential to cause patient injury or death. These entities are required to make recommended changes in health care practice and procedures to the Board for the purpose of reducing such events and incidents. They are also required to advise reporting medical facilities of immediate changes that can be instituted to reduce serious events and incidents.
The Patient Safety Authority will, in, turn receive and evaluate recommendations from contractors and report those recommendations to the Department of Health. After consultation and approval by the DOH, the Patient Safety Authority will issue recommendations to medical facilities on changes to reduce the number and severity of serious medical events and incidents.
Each medical facility is required to establish a patient safety committee to develop and implement a patient safety plan for reporting serious events and incidents.
Medical facilities are required to provide patients affected by a serious event with written notification of such an event. However, such notification shall not constitute an acknowledgement or admission of liability.
The Department of State Medical Licensing Boards shall have access to reported information for the purpose of licensure or disciplinary action against a health care worker.
That's it in a nutshell. There is potential here. The bright spot in my opinion is the requirement for medical facilities to notify patients and their families of serious medical incidents and events. This is contrary to past practice at most medical facilities. The problem with this provision and other Act 13 patient safety measures is that they do not require enforcement. The Patient Safety Board is to be made up primarily of doctors and other health care workers most of who will be appointed by the governor, and therein lies the problem.
WIDENING THE ROAD TO A WASHED OUT BRIDGE - Let's begin with the last item cited above, namely giving the DOS licensing boards access to Patient Safety data for the purpose of licensure and/or disciplinary action. The State Medical Boards can simply chose to ignore such information. There is no requirement for those Boards to take action. At least in regard to the Current State Boards of Medicine and Osteopathic Medicine, giving them additional authority to take licensure action against a doctor is akin to widening the road to a washed out bridge. Unless the Patient Safety information suggests there were also violations of federal, state, or local laws or regulations, Board of Medicine mandates, licensing violations, educational inadequacies, and the like, no action will be taken. If such violations are discovered, however, malpractice and danger to patient safety may be cited as a matter of convenience in any disciplinary action taken against a doctor. It is very simply defined as selective enforcement and the medical boards of the Ridge / Schweiker administrations have utilized it extensively.
A similar problem faces other Patient Safety provisions. The Governor will appoint 7 of 11 members of the Patient Safety Board. Members of his political party will appoint two more members. The top two Department of Health positions were appointed by Governor Ridge. Political operatives of the Governor are established within the Departments of State and Health and thereby establish policy within each of those departments. So while there may be some improvement in patient safety as a result of Act 13, significant results depend on the willingness of the Governor's appointees to enforce them.
PREDICTION - If the party in power retains control of the Governors office, any improvement in patient safety will come in spite of the Administration's unwillingness to take licensure/disciplinary action against doctors on primary charges related to public safety. There may be some improvement in procedures and some lower echelon health care workers may be disciplined, but doctors will be protected as usual. While the Patient Safety benefits of Act 13 may be limited, the costs will not. Medical facilities will be assessed for the costs of the Patient Safety Board and the contractors they employ. Medical facilities will also bear the costs of in-house patient safety committees. As medical facilities depend on fees for income, ultimately these costs will be passed on to your employer and/or you in the form of higher insurance rates.
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