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Health Matrix: Journal of Law-Medicine




Although the goal of patient safety is a laudable one, it is questionable whether state and national policy can be made on so vague a concept as "medical error." There is neither an accurate baseline nor reliable current data that could be used to validate the effectiveness of reporting systems as tools for improving patient safety. This Article examines the difficulty in estimating the incidence of medical error, including the lack of uniform standards of measurement and the legal and cultural disincentives to accurate reporting of error. Part I provides a brief background of the IOM report and addresses the reliability of error statistics derived from clinical studies, including those relied on by the IOM. Clinical empirical data are pertinent to the legal discussion of medical error because they provide a baseline from which to measure a reduction in error and because the IOM used these figures in support of its proposal for comprehensive medical error reporting laws as part of the cure for an ailing health system. Part II examines the inherent problems with using current reporting systems to identify and to measure any reduction in the rate of medical error. Most systems are not effective in capturing medical errors because they lack standardized definitions of reportable events. In particular, there is a patchwork of legislation at the state level that substantially limits the usefulness of the data collected. Efforts to obtain reliable information on medical error have also been hindered by the problem of underreporting, primarily due to fear of malpractice litigation and employer retaliation. Part III explores a framework for state and federal legislation to improve reporting systems and to enhance the ability to gather useful and valid information on medical errors. Part IV presents a brief conclusion.

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Case Western Reserve University School of Law

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