Law allows confidential reports on medical errors

Gov. Donald L. Carcieri has signed legislation allowing so-called “patient safety organizations” (PSOs) in Rhode Island. Such entities allow health care providers to confidentially report medical errors, near misses and other safety concerns and get expert advice on how to avoid future occurrences.
Connecticut, whose legislation was a model for Rhode Island, already has PSOs for hospitals, nursing homes and ambulatory surgical centers.
The idea is that while providers must be held responsible for any harm they do to patients, to actually improve, they need to be able to speak candidly about their mistakes. And the more that is known, in the big picture, about safety issues, the better they can be addressed.
A federal law, the Patient Safety and Quality Improvement Act of 2005, provided for regional PSOs to be created across the country: confidential, voluntary, liability-free reporting systems certified by the government but run independently.
In February, bills were introduced on behalf of Dr. David R. Gifford, the state health director, to create a Rhode Island PSO that would serve the purposes envisioned by the federal law, but would be more closely tied to the R.I. Department of Health.
The PSO would have been chosen through the state contracting process and could have been given authority to investigate incidents on the state’s behalf. The PSO wouldn’t replace the state’s existing reporting system for adverse incidents and errors and it wouldn’t have directly forwarded reports it got from providers. But if it learned of an event that the law requires to be reported, it would have required the provider to report it.
All hospitals, nursing homes, ambulatory surgery centers, physician operatories and other licensed health facilities would have reported their data to the PSO, and the PSO would have kept a patient safety database – with identifiable information removed – and analyzed the data to find the root causes of errors, help providers improve, and guide public policy.
The Hospital Association of Rhode Island and the Rhode Island Medical Society both said they supported the basic idea, just not quite as Gifford had proposed it.
For the doctors, the biggest worry was that information reported to the PSO could be used against them in a malpractice lawsuit or other proceedings. That’s not supposed to happen with a PSO, and while the bill said the PSO’s “recommendations and investigative work product” could not be used in any way prohibited by the federal law, including use by regulatory and administrative bodies in disciplinary or civil proceedings, the language wasn’t quite strong enough for the Medical Society.
The language as finally approved by the House and Senate is much stronger, deeming all “patient safety work” involving the PSO to be “privileged” and not subject to federal, state, or local civil, criminal or administrative subpoenas, not subject to discovery, not subject to disclosure under the Freedom of Information Act or the state public records law, and not admissible as evidence in court or disciplinary proceedings.
Just as big was the change made at the hospitals’ urging. All those plans to have the state pick the PSO and work closely with it were ultimately dropped, and the legislation, as passed, gives the state a limited role: It can certify an entity as a PSO if it is deemed to have qualified staff and a mission to improve patient safety, is not a component of a health insurer, and has a mission that does not create a conflict of interest with the providers it works with.
In addition, Gifford is to also establish a “quality of care advisory committee” to advise the department on PSO-related issues, with 14 members representing hospitals, long-term care providers, ambulatory surgical centers and the community at large.
As originally planned, funding for the PSO will come through a patient-safety surcharge shared by hospitals, nursing homes and health insurers, not to exceed $600,000 per year.
While initially, the Rhode Island Quality Institute expressed an interest in serving as the state PSO, President and CEO Laura Adams said recently that it’s “entirely up in the air” who would be best-suited to serve that role – though she reiterated her support for the concept.
And Edward J. Quinlan, president of the Hospital Association, said the group is doing its own research to determine what type of PSO might work best for Rhode Island, and whether it makes sense, for example, to share one with hospitals in other states. &#8226