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Canadian doctors' leaders take charge of project to reduce medical error
POLICY AND PEOPLE
Canadian doctors’ leaders take charge of project to reduce medical error he Royal College of Physicians and Surgeons of Canada will spearhead a 1-year exercise to create a national patient-safety strategy to alleviate concerns about medical error. 35 professional, hospital, physician, government, and licensing bodies met at the Royal College’s annual conference on Sept 22 and agreed to establish a steering committee to hammer out the details of a national strategy over the next 6 months. Participants argued that a national safety strategy, complete with some form of oversight body, are necessary to restore Canadian faith in the efficacy of the health-care system. Among the issues to be tackled are whether or not regulatory changes are needed to obligate physicians to make full and open disclosure to patients, as well as report all incidents of medical error. Although participants at a special plenary session on patient s a f e t y at the conference on “Achieving Quality Health Care
T
through Education, Professional Development and Research” indicated that Canada lags well behind international counterparts such as the UK and Australia in addressing the problem of medical error. College president Bernard Langer said in an interview that he hopes the gap can be closed quickly once the regulatory and reporting issues are resolved. But Langer added that it is far too early to estimate how costly such an initiative might ultimately prove, although he is hopeful that federal and provincial governments will open their coffers once it becomes apparent that spiralling health-care costs can be constrained by reducing medical error. The funding “would depend on the scope of the project that’s presented”, said Langer. “But it’s such an important issue and it could have such a substantial impact on health care, and the quality of health care, that I think to do it right, there may be quite large amounts of money
involved. We’re talking millions of dollars. I just don’t know how many millions.” Delegates heard that Australia needed US$50 million over 5 years to launch its patient-safety strategy, which included measures to establish national registration of physicians, national audit arrangements, national incident monitoring, and mandatory collection of morbidity and mortality data. Physicians were also told that the medical community must abandon its “culture of blame” and focus on improving health care rather than assigning blame in cases of medical mishap. Taking that first step will require significant modifications in physician attitudes, argued adjunct professor of health policy Lucian Leape at Harvard School of Public Health (Boston, MA, USA). Physicians must realise that “safety is more important than my own ego and my own power”. Wayne Kondro
French court compensates disabled child
News in brief
F
Pill drug firms face trial Manufacturers of third generation oral contraceptives, Schering, Organon and Wyeth, will face a multi million pound compensation claim, said lawyers representing 123 UK women on Oct 1. “We are confident that all the evidence is now in place to establish that the risks associated with third-generation oral contraceptive pills are greater than those of their predecessor pills and that the manufacturers should have carried out research into this and taken steps to protect the public”, said the lawyers. The trial will take place in a London high court in January, 2002.
rench medical organisations and disabled persons’ organisations warn that the rights of handicapped people could be affected after a court of appeal in Bordeaux ruled that a 10-year-old girl with mental and physical disabilities should receive compensation because her mother was not informed during her pregnancy that the child might be disabled and did not get the opportunity to consider an abortion. The court heard that the parents were not informed by the doctor of the fetus’s possible health complications and the physician did not give parents the choice of an abortion. The judge awarded the family compensation of US$85 000 and housing rent payments for life. This trial follows the verdict of a similar French case in November, 2000. In the Perruche case France’s supreme court ruled that parents of a severely physically and mentally handicapped child, Nicolas Perruche, should be compensated because their child’s disabilities had not been discovered during the mother’s pregnancy. In this case the boy’s parents argued that doctors had failed to diagnose a rubella infection during
THE LANCET • Vol 358 • October 6, 2001
the pregnancy, which was likely to cause disabilities to the unborn child. The parents argued that had they known about the infection they would have had an abortion. Three similar cases have been tried in French courts and all were rejected because the courts found no evidence of medical error. The French bioethics committee, the French Medical Association, and the French general practitioners association fear that these judgements will promote a negative view of handicapped people. Such decisions may suggest that “handicapped persons are better off not born”, they have argued. Disabled people’s groups agree with this view and consider that the general population will show less respect to disabled persons if the courts are perceived to oppose “the universal right of any person to live in dignity and respect”. The French social minister Elisabeth Guigou will launch a debate to solve the ethical questions raised by these cases with a view to publish guidelines for doctors and patients.
WHO consults on drug list WHO has published a revised consultation document as part of the process to improve how drugs are selected for its essential drugs list. The list serves as a model for national essential drug lists. However the process by which drugs are selected has been criticised and WHO asked member states to comment on its ideas to improve the process earlier this year. The latest document has been revised according to those comments and is available for further discussion until Oct 15.
Denis Durand de Bousingen
1167
For personal use. Only reproduce with permission from The Lancet Publishing Group.
Canadian doctors’ leaders take charge of project to reduce medical error he Royal College of Physicians and Surgeons of Canada will spearhead a 1-year exercise to create a national patient-safety strategy to alleviate concerns about medical error. 35 professional, hospital, physician, government, and licensing bodies met at the Royal College’s annual conference on Sept 22 and agreed to establish a steering committee to hammer out the details of a national strategy over the next 6 months. Participants argued that a national safety strategy, complete with some form of oversight body, are necessary to restore Canadian faith in the efficacy of the health-care system. Among the issues to be tackled are whether or not regulatory changes are needed to obligate physicians to make full and open disclosure to patients, as well as report all incidents of medical error. Although participants at a special plenary session on patient s a f e t y at the conference on “Achieving Quality Health Care
T
through Education, Professional Development and Research” indicated that Canada lags well behind international counterparts such as the UK and Australia in addressing the problem of medical error. College president Bernard Langer said in an interview that he hopes the gap can be closed quickly once the regulatory and reporting issues are resolved. But Langer added that it is far too early to estimate how costly such an initiative might ultimately prove, although he is hopeful that federal and provincial governments will open their coffers once it becomes apparent that spiralling health-care costs can be constrained by reducing medical error. The funding “would depend on the scope of the project that’s presented”, said Langer. “But it’s such an important issue and it could have such a substantial impact on health care, and the quality of health care, that I think to do it right, there may be quite large amounts of money
involved. We’re talking millions of dollars. I just don’t know how many millions.” Delegates heard that Australia needed US$50 million over 5 years to launch its patient-safety strategy, which included measures to establish national registration of physicians, national audit arrangements, national incident monitoring, and mandatory collection of morbidity and mortality data. Physicians were also told that the medical community must abandon its “culture of blame” and focus on improving health care rather than assigning blame in cases of medical mishap. Taking that first step will require significant modifications in physician attitudes, argued adjunct professor of health policy Lucian Leape at Harvard School of Public Health (Boston, MA, USA). Physicians must realise that “safety is more important than my own ego and my own power”. Wayne Kondro
French court compensates disabled child
News in brief
F
Pill drug firms face trial Manufacturers of third generation oral contraceptives, Schering, Organon and Wyeth, will face a multi million pound compensation claim, said lawyers representing 123 UK women on Oct 1. “We are confident that all the evidence is now in place to establish that the risks associated with third-generation oral contraceptive pills are greater than those of their predecessor pills and that the manufacturers should have carried out research into this and taken steps to protect the public”, said the lawyers. The trial will take place in a London high court in January, 2002.
rench medical organisations and disabled persons’ organisations warn that the rights of handicapped people could be affected after a court of appeal in Bordeaux ruled that a 10-year-old girl with mental and physical disabilities should receive compensation because her mother was not informed during her pregnancy that the child might be disabled and did not get the opportunity to consider an abortion. The court heard that the parents were not informed by the doctor of the fetus’s possible health complications and the physician did not give parents the choice of an abortion. The judge awarded the family compensation of US$85 000 and housing rent payments for life. This trial follows the verdict of a similar French case in November, 2000. In the Perruche case France’s supreme court ruled that parents of a severely physically and mentally handicapped child, Nicolas Perruche, should be compensated because their child’s disabilities had not been discovered during the mother’s pregnancy. In this case the boy’s parents argued that doctors had failed to diagnose a rubella infection during
THE LANCET • Vol 358 • October 6, 2001
the pregnancy, which was likely to cause disabilities to the unborn child. The parents argued that had they known about the infection they would have had an abortion. Three similar cases have been tried in French courts and all were rejected because the courts found no evidence of medical error. The French bioethics committee, the French Medical Association, and the French general practitioners association fear that these judgements will promote a negative view of handicapped people. Such decisions may suggest that “handicapped persons are better off not born”, they have argued. Disabled people’s groups agree with this view and consider that the general population will show less respect to disabled persons if the courts are perceived to oppose “the universal right of any person to live in dignity and respect”. The French social minister Elisabeth Guigou will launch a debate to solve the ethical questions raised by these cases with a view to publish guidelines for doctors and patients.
WHO consults on drug list WHO has published a revised consultation document as part of the process to improve how drugs are selected for its essential drugs list. The list serves as a model for national essential drug lists. However the process by which drugs are selected has been criticised and WHO asked member states to comment on its ideas to improve the process earlier this year. The latest document has been revised according to those comments and is available for further discussion until Oct 15.
Denis Durand de Bousingen
1167
For personal use. Only reproduce with permission from The Lancet Publishing Group.