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As medical errors kill more people, peer review should become more transparent

The latest study of inpatient deaths caused by medical errors — this one by Johns Hopkins researchers — reveals the astonishing fact that in the 17 years since the groundbreaking To Err Is Human report made headlines, estimates of avoidable deaths in hospitals have not decreased, but rather have increased. Medical errors now account for more deaths in the U.S. than any other cause, except for heart disease and cancer, the Hopkins study finds.

The landmark To Err is Human study, published in 1999 by the Institutes of Medicine, estimated annual error-related hospital deaths at 98,000. The study published this month and spearheaded by Dr. Martin Makary, professor of surgery at Johns Hopkins University School of Medicine, pegged error-caused inpatient deaths at 251,000 per year. A Journal of Patient Safety study published in 2015 estimated errors in patient care harm some 440,000 patients each year.

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It is time to implement more aggressive measures to combat this epidemic of medical errors, even a measure that undoubtedly would not sit well with doctors, hospitals and, most certainly, their liability insurance carriers. But it is a measure that the health care industry should embrace if its No. 1 priority truly is patient safety. What is this measure? Doing away with keeping secret from the public the findings of hospital peer review committees.

Convened when a suspected error has led to serious injury or death of a patient, these committees include the doctor who was attending to the patient, others with first-hand knowledge of events and senior hospital staff. They meet behind closed doors to review and discuss what happened, who is to blame and, we hope, how future mistakes might be prevented. Information from these peer review sessions, often called "morbidity and mortality" conferences, is protected from disclosure by law in all 50 states and the District of Columbia. The stated rationale behind these medical peer review privilege statutes is "to provide a safe forum in which medical professionals can review the quality of care and work to reduce medical errors," according to the Journal of Legal Medicine. From my perspective as an advocate for patients' rights for over 30 years, I would argue that the unstated rationale is to sweep errors under the rug, or at least avoid aiding patients and their families in their quest to be compensated for the harm they suffered.

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Keeping a lid on peer review findings is an obstacle to reducing errors. As the study authors observed, "Currently, deaths caused by errors are unmeasured and discussions about prevention occur in limited and confidential forums, such as a hospital's internal root cause analysis committee or a department's morbidity and mortality conference. These forums review only a fraction of detected adverse events and the lessons [learned] are not disseminated beyond the institution or department."

The information that could be shared with health care consumers and doctors to prevent similar mistakes would be priceless. Disclosing all facts and findings surrounding adverse events in hospitals holds major public benefits:

•Information gleaned by one hospital's doctors about mistakes and how they might have been prevented could easily be shared with thousands of doctors who might one day use that knowledge to prevent a similar mistake.

•The more knowledge health care consumers have about how medical errors happen, the more proactive and helpful they can be in their own care. Patient involvement has been shown to help health care staff make fewer errors. The U.S. Agency for Healthcare Research and Quality agrees, advising consumers, "The best way to help prevent medical errors is to be an active member of your health care team."

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The loss of a quarter of a million Americans each year from medical mistakes is proof that the current system of secret peer review is not working as devised and, in fact, is causing patients, their families and the public great harm. It's time to end it.

Howard A. Janet, founder and managing partner of the Baltimore law firm of Janet, Jenner & Suggs, LLC, is the author of "Navigating a Medical Malpractice Lawsuit: What You Need to Know," co-author of "Patients' Rights and Doctors' Wrongs — Secrets to a Safer Pregnancy and Childbirth," and lead author of "Representing Plaintiffs in Medical Malpractice Cases." His email is haj@myadvocates.com.

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