Catch us live on BlogTalkRadio every



Tuesday & Thursday at 6pm P.S.T.




Saturday, February 12, 2011

INTERNATIONAL NEWS: Hospitals won't admit mistakes

OFF THE WIRE
Montreal : http://www.montrealgazette.com/health/Hospitals+admit+mistakes/4262765/story.html
Hospitals won't admit mistakes
Law requiring disclosure of medical errors has no teeth, victims say, and so many statistics remain hidden from the public
By CHARLIE FIDELMAN, The Gazette
Isabel Perreault was 28 and in perfect health when she showed up at Sacre Coeur Hospital in 1998 with a broken leg after a motorcycle accident. Within 14 hours, she was dead -her respiratory system had shut down.
Looking for answers, Perreault's mother appealed to the hospital's director of professional services and the director-general, but the cause of death remained shrouded in secrecy, guarded by patient confidentiality.
It took a coroner's report -delivered eight months after she died -for the family to learn what killed her. Several doctors had given Perreault drugs for her pain, resulting in a lethal combination.
Rather than sue the hospital, Perreault's family joined other victims of medical error to lobby for government changes.
The Perreault incident became a turning point in provincial health policy, prompting Quebec, in 2002, to adopt legislation on patient safety -Bill 113. The province became the first in Canada to legally require hospitals to identify, track and make public their medical errors, incidents and near misses.
But nearly a decade later, victims, their families and critics say they are no further ahead.
Despite the legislation, the province's hospitals and the bodies that govern them continue to function like a secret society, one that polices itself, said Quebec malpractice lawyer Jean-Pierre Menard, whose Montreal office handles medical error cases exclusively.
Hospitals have implemented risk management teams and they're keeping inhouse records -but the results are rarely made public.
In fact, it's not clear how Quebec enforces Bill 113. No fines are levied if a hospital fails to promptly record an incident in its registry -or fails to record it at all, a Health Department official told The Gazette.
In November 2010, The Gazette, unable to find a record of medical errors online or obtain such records from Montreal hospitals, filed an access-to-information request with the McGill University Health Centre's Royal Victoria Hospital and with the Montreal Jewish General Hospital. One request was denied and is under appeal. The other remains unanswered.
Hospital infection rates are another example of hard-to-get information in Quebec. While the Quebec Health Department does provide infection rates, it is often about eight months after the fact, and can often be incomprehensible to members of the general public. Some hospitals, for example, provide infection rates as a calculation per 10,000 patients per day.
"For the non-specialist, it means nothing," said Jacques Besson, head of the Association for Victims of Nosocomial Infections (infections contracted during a hospital stay), which has long lobbied for statistics in real time.
"We pay for the health system -we have a right to know what's going on," Besson said.
By comparison, Ontario has hospital statistics about errors and infections for its 200 facilities on one central website  www.health.gov.on.ca/patient_safety/public/ps_pub.html
covering the top eight kinds of adverse events, including infection rates. Outbreaks are reported in real time.
In July, Ontario's website added a surgical safety checklist compliance rating for each hospital, because consistent use of the checklist has been shown to reduce death associated with surgical care.
The tracking of adverse events with a public website "is the most ambitious project in Canada," said Dr. Michael Baker, head of patient safety for the Ontario Ministry of Health and professor of medicine at the University of Toronto.
The issue is transparency, and it encourages improvement where needed, Baker said. "There's a political move in Ontario to broaden the quality of safety measurements that are made public."
Quebec's Health Department, in addition to making no error data available to the public, also refuses to release or make public upon request hospitals' annual death rate. The reasoning behind this is that such data could compromise patient confidentiality, said Nathalie Levesque, a spokesperson for Quebec Health Minister Yves Bolduc.
There is no law in Quebec requiring that hospital deaths be made public.
"This is unacceptable. There's no reason why the public cannot have this information," Menard said, especially since Quebec law obliges hospitals to track medical errors, including infections, drug dosage mistakes and surgical accidents.
Incidentally, Quebec is the only province that did not participate in the Canadian Institute for Health Information's Hospital Standardized Mortality Ratio, calculated over five years and considered an important measure of patient safety and quality of care, which allows hospitals to assess their mortality rates, identify areas for improvement, and track their progress over time.
Quebec has promised to harmonize its record-keeping methods with the rest of the country in time for the next mortality assessment, but has opted out of another CIHI program -a pilot project for a national system for medical error reporting.
Meanwhile, the legislation that Perreault's mother and patient advocates fought so hard for -Bill 113 -continues to function haphazardly.
Quebec law requires hospitals to be transparent by reporting to patients and relatives "any incident or accident as soon as possible after becoming aware of it." But some families still rely on coroners' reports to understand the circumstances of a loved one's death in a hospital.
There are specific circumstances that legally oblige hospitals to give medical records to a third party -that is, for insurance purposes and to determine whether there has been medical negligence.
In reality, it's often a huge fight for families. Many are forced to hire lawyers because hospitals routinely refuse to release health records to next-of-kin and legal heirs.
Also, the law does not apply to dozens of "boutique" surgery clinics, or private medical centres exploding on the Quebec scene.
Ten years ago, the Institute of Medicine in the United States found that as many as 98,000 people die needlessly each year because of preventable medical harm. Also using data from 10 years ago, a landmark Canadian study led by Toronto University health researcher Ross Baker found that 24,000 Canadians die each year from medical errors.
But perhaps among the most glaring gap is that nine years after adopting Bill 113, the Health Department itself has yet to set up its registry of medical errors. It's been delayed by technical difficulties, Bolduc said.
Critics say that the registry suffers from poor compliance. As many as 57 per cent of Quebec's hospitals have failed to provide medical error data to their regional boards -an issue that's stalling the provincial registry, Menard said.

cfidelman@montrealgazette.com

Access to information is governed by Quebec's Act Respecting Access to Documents Held by Public Bodies and the Protection of Personal Information.
As the title of the law suggests, you're making a request for documents. Be as specific as possible about what you're seeking. Even if you don't know the name of the document or who wrote it, try to at least specify the time period, the exact nature of the information you want and what department or service it concerns.
You must make the request in writing, with your name, contact information and the day's date.
Send the request to the person in charge of access to information, who will confirm receipt of the request. The delay for the public body to respond is 20 days -if it cannot do so within that delay, it can have an additional 10 days after giving notice to the applicant.
There is no fee for filing an access request. There is also no charge for looking at the documents. The body will charge for photocopies.
If your request is refused, you can file an appeal with the Commission d'acces a l'information du Quebec within 30 days of the decision. To contact the Commission d'acces a l'information,
http://www.cai.gouv.qc.ca/  or 1-888-528-7741.

Linda Gyulai
Today's poll question
In 2002, Quebec adopted legislation requiring hospitals to identify, track and make public their medical errors. However, while hospitals are keeping in-house records, they rarely make them public. Should hospitals have to make such data public?

Vote online at
montrealgazette.com/secretsociety
Next chapter in this series
Tomorrow: Meetings of the City of Montreal executive committee, which runs the municipal apparatus, continue to take place behind closed doors. And since Mayor Gerald Tremblay's arrival in office, every resolution passes unanimously, according to the minutes that are released.
By Linda Gyulai