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8/17/2000

Senate Gets Double Dose of Patient Safety

Cheryl A. Thompson

Two bills introduced last Thursday by members of the Senate Health, Education, Labor and Pensions Committee pit Republicans against Democrats in a contest that may determine which political party can say it cares more about patient safety.

In bringing forth their respective bills, Sens. James M. Jeffords (R-Vt.) and Edward M. Kennedy (D-Mass.) referred to the findings of the Institute of Medicine (IOM) report entitled "To Error Is Human," issued in late 1999. The senators likewise emphasized that flaws in the health care system, not misdeeds by health care workers, cause most medical errors. 

Both bills call for founding the Center for Quality Improvement and Patient Safety, an entity originally proposed in February by a task force assigned by President Clinton to recommend actions the government should take to decrease the number of medical errors. 

Among the task force's recommendations were the creation of the center in the Agency for Healthcare Research and Quality and a requirement for nationwide mandatory reporting of adverse events that result in death or serious harm. Neither Senate bill calls for a mandatory reporting system. 

Major Features of Patient Safety Bills Introduced in U.S. Senate on June 15 

The Patient Safety and Errors Reduction Act (S. 2738) 

The Voluntary Error Reduction and Improvement in Patient Safety Act (S. 2743) 

Sponsoring senator 

James M. Jeffords (R-Vt.) 

Edward M. Kennedy (D-Mass.) 

Cosponsors 

Bill Frist (R-Tenn.) and Michael B. Enzi (R-Wyo.) 

Christopher J. Dodd (D-Conn.) and Patty Murray (D-Wash.) 

Overview 

Amends the Public Health Service Act to reduce medical mistakes and medication-related errors 

Amends the Public Health Service Act to develop an infrastructure for creating a national voluntary reporting system to continually reduce medical errors and improve patient safety 

Sets up Center for Quality Improvement and Patient Safety in the Agency for Healthcare Research and Quality (AHRQ) 

Yes 

Yes 

Provides a "framework of support" for medical-error reduction efforts under way in public and private sectors 

Yes 

Does not specify 

Establishes National Patient Safety Surveillance System in AHRQ for voluntary reporting of adverse events and "close calls" and monitoring of specific types of adverse events 

No 

Yes 

Protects the confidentiality of information voluntarily submitted to quality improvement and medical error reporting systems 

Yes 

Yes, for information submitted to systems administered by AHRQ 

Protects health care workers against workplace retaliation for submitting reports to AHRQ programs 

Does not specify 

Yes 

Maintains patients’ and their lawyers’ access to the entire medical record 

Yes 

Does not specify 

Requires the Secretary of the Department of Health and Human Services to take steps to ensure the implementation of safety-promoting evidence-based practices at programs under the Secretary’s authority 

No 

Yes 

Requires the Director of the Office of Personnel Management to incorporate safety-promoting evidence-based practices as purchasing standards for the Federal Employees Health Benefits Program 

No 

Yes 

Funding for AHRQ 

More than the $20 million originally recommended by President Clinton, but the exact amount is not specifieda 

$50 million for fiscal year (FY) 2001, with gradual increases to $200 million for FY 2005, to fund error-related research and the reporting systems 

Supporting groups 

United States Pharmacopeia, American Hospital Association, American Health Quality Association (members are peer-review organizations), American College of Physicians/American Society of Internal Medicine, American Psychological Association, and Institute for Safe Medication Practices 

American Health Quality Association; Massachusetts Hospital Association; and Federation of Behavioral, Psychological and Cognitive Sciences (some members are human factors researchers) 

a According to a press release issued by Sen. Enzi's office, S. 2738 authorizes $50 million for fiscal year 2001 for setting up the Center for Quality Improvement and Patient Safety. Source: Congressional Record for June 15, 2000 

Both bills have been referred to the Senate Health, Education, Labor and Pensions Committee for further discussion. 

Last Wednesday, the House passed the appropriations bill for funding AHRQ in fiscal year 2001. AHRQ requested $250 million, but the House countered with $224 million. AHRQ says the Senate will consider its appropriations bill, which reportedly includes $270 million for the agency, sometime this week.