California public health officials are scrutinizing hospitals that claim to be error-free, questioning whether nearly 90 facilities have gone more than three years without any significant mistakes in care.
Eighty-seven hospitals — more than 20% of the 418 hospitals covered under a law that took effect in 2007 — have made no reports of medical errors, according to the California Department of Public Health.
The high percentage has raised concerns that errors have gone unreported. Some patient advocates say it is an indication that hospitals are unwilling to police themselves. State officials have given hospitals until Tuesday to verify their records as error-free or to report errors, as required by law.
Jamie Court, president of the Santa Monica-based advocacy group Consumer Watchdog, called it "almost inconceivable" that so many hospitals were error-free for the last three years.
"This is a see-no-evil, hear-no-evil problem. If you're not looking, you're not going to find any," Court said. "But if you are looking, you're more than likely to find some, regardless of the size of the hospital."
State law outlines 28 medical errors that hospitals must report to the state because they place patients at risk of death or serious injury. After investigating, the state can issue fines of $50,000 for the first incident, $75,000 for the second and $100,000 for the third or subsequent error at the same hospital. The state must be notified of such errors within five days of the incident, with fines of up to $100 a day for delays.
The state has substantiated reports of 1,100 medical errors since the law took effect in 2007. During that period, the state has fined 112 hospitals for medical errors, and 39 of those have appealed.
State Sen. Elaine Alquist (D- Santa Clara), who wrote the medical error law, said she was concerned that errors are going unreported.
"What are the chances that nearly a quarter of California's hospitals didn't have a single medication, surgical or safety error since the reporting requirement became law?" Alquist asked.
Among the hospitals with no reported errors are about a dozen state facilities, accounting for more than 1,055 beds, including the massive Atascadero and Patton state hospitals.
Two dozen of the hospitals are in the Los Angeles area, each with fewer than 200 beds. Some of the largest and best-known include Community Hospital of Long Beach, Temple Community Hospital in Los Angeles, Resnick Neuropsychiatric Hospital at UCLA in Westwood and Shriners Hospitals for Children Los Angeles.
Resnick hospital officials said it was not surprising that psychiatric facilities would have few errors, because they do not handle the high-risk surgical cases seen at acute-care hospitals. There were 19 psychiatric hospitals on the list of those not reporting errors.
Karen White, Temple Community's risk manager, said the 150-bed hospital and other small facilities on the list also handle fewer high-risk patients because they do not have emergency rooms or obstetrics departments.
White said she was pleased that Temple Community had no reportable medical errors.
"Hopefully there will be more and more people on the list every year," she said.
In some cases, however, hospitals may have been listed incorrectly. Debby Rogers, vice president of quality and emergency services at the California Hospital Assn., said her office contacted all of the hospitals on the list, and officials at some said they had reported medical errors. She would not identify those hospitals.
Although state law defines preventable medical errors, Rogers said many hospital officials are unclear about which incidents should be reported.
For instance, hospitals are required to report when an object is left in a patient after surgery. But if the surgeon discovers the object before he or she finishes sewing up the patient and removes it, Rogers said, should that incident be reported to the state? Hospitals should err on the side of caution and report anything that might be an adverse event, a state spokesman said.
"There's confusion. I don't know that I would say there's underreporting or overreporting . Probably there's a little bit of both," Rogers said.
So far, 66 hospitals have been fined for failing to report errors, including at least one on the no-errors list: the San Diego Hospice and the Institute for Palliative Medicine. The state-licensed hospital was fined $12,700 in May 2008 for failing to report a medication error the year before, according to state records.
Melissa DelaCalzada, spokeswoman for the hospital, said it did not initially consider the incident a medical error and disputed the state's findings. The facility later paid the fine and submitted a plan of correction to the state.
California Hospital Assn. officials said they are working with the state Department of Public Health to clarify how it defines reportable errors in its regulations.
The department is hiring a University of California faculty expert in public data reporting to review medical error data and gauge potential underreporting, said spokesman Ralph Montano. The post will be funded out of $250,000 in fines collected from hospitals last fiscal year, money earmarked for patient safety, Montano said.
Anthony Wright, executive director of Sacramento-based Health Access, said he hopes the list of error-free hospitals can be verified and one day used to prevent the state-defined medical errors, also called "never events."
"If there are hospitals that are getting zero errors, which is the goal, we should find out what they're doing right so we can replicate it," Wright said.
"But we should also tease out the difference between people who are having the systems in place to prevent 'never events' from happening and those that are just not reporting."