Lack of Accountability
“Unsafe care is one of the prices we pay for not having
an organized system of care with clear lines of accountability.”
1 Virtually all experts now agree that total reorganization
and reform are urgently needed to fix what is now a disjointed,
inefficient and unsafe system of healthcare delivery.
Accountability For Patient Protection, Safety And Oversight
Most Americans today believe that federal or state health regulations
exist which assure patient safety. The public generally assumes
that licensing and accreditation confer a “Good Housekeeping
Seal of Approval” on its healthcare practitioners and institutions.
2 Moreover, most of us have been brought up to implicitly
trust that our doctors will always do the right thing in the right
way at the right time.
Unfortunately, nothing could be further from the truth!
State licensing and accreditation processes have focused very limited
attention on patient safety, and even their minimal efforts have
confronted strong resistance from healthcare providers and organizations.
if a hospital or other healthcare institution is accredited by the
Joint Commission on Accreditation of Healthcare Organizations (JCAHO),
it will be deemed to have satisfied most state quality and federal
safety standards so that no further governmental inspection or monitoring
The JCAHO is a private organization which was founded and currently
operated by physicians and hospitals executives, the very profession
and industry it ostensibly oversees. Historically, this type of
self regulation in business has been an unmitigated disaster.
As a Washington Post article put it, “Enron and its successor
scandals have shown that one should be skeptical of highly qualified
professionals—in those cases, accountants—who promise
to regulate themselves. This skepticism should now be applied to
Numerous experts believe that JCAHO accreditation fails to do an
adequate job in protecting the public and providing necessary oversight.
4 Even JCAHO acknowledges, “Physicians do not associate
accreditation with quality and patient safety.” 5
Many now agree 6 with Public Citizen, a health research
group and consumer advocate, when it argues that:
[b]ecause of problems in the process by which it conducts surveys
and sanctions hospitals, and structural problems inherent in the
fact that the organization is composed of members of the industry
it is supposed to regulate, the JCAHO does not do an adequate
job in protecting the public and providing necessary oversight.
It is time to remove the deemed status of JCAHO accreditation
and return the task of hospital inspections to an independent
governmental body answerable to the public. 7
Accountability For Performance Standards And Quality Measurement
American physicians have never been held accountable for their safety
performance or for the quality of their work. As one patient safety
expert stated, “[t]here remains within health care a persistent
refusal to confront
providers' responsibility for severe quality problems. There is
a silence of deed--failing to take corrective actions-and of word--failing
to discuss openly the true consequences of that inertia. These silences
distort public policy, delay change, and, by leading (albeit inadvertently)
to thousands of patient deaths, undermine the moral foundations
of medical professionalism.” 8
It is time to establish and thereafter enforce objective quality
measurement, safety standards and performance guidelines. Healthcare
institutions also should be held accountable to performance standards
regarding continuous improvement in safety and quality.
Dr. Lucian Leape, one of our nations leading patient safety professionals,
describes the current state of the American healthcare system: “There
is no accountability. A fundamental principle has to be the development
and then the enforcement of procedures and standards. We can’t
make real progress without them. When a doctor doesn’t follow
them, something has to happen. Today, nothing does, and you have
a vicious cycle in which people have no real incentive to follow
the rules because they know there are no consequences if they don’t.”
Accountability For Harmful Medical Error
Currently, our healthcare providers are simply not held accountable
for preventable medical errors that result in death or serious injury.
(see, Lack of Disclosure).
Although a number of states currently mandate external reporting
of serious adverse events—usually to the state health department—in
most cases the information collected is intended to be protected
by law from potential claimants. Virtually all state programs fail
to provide public access to the information and most require subpoena
or court order for release of information.
In 1999, the Institute of Medicine (IOM) broke the public silence
about medical errors in its landmark report, To Err is Human:
Building a Safer Health System . It called for a nationwide
mandatory reporting system for serious preventable adverse events
based on the public’s right to know about and be protected
from hazards, and from the basic principle of fairness. 10
The IOM’s recommendations regarding mandatory reporting “are
designed to generate standardized information that can be used to
understand and track known hazards and to take preventive action.
11 As the report states: “The public has the right
to expect health care organizations to respond to evidence of safety
hazards by taking whatever steps are necessary to make it difficult
or impossible for a similar event to occur in the future. The public
also has a right to be informed about unsafe conditions.”
In addition, the mandatory reporting was intended to provide an
avenue for harmed patients to gain access to information regarding
the circumstances surrounding an injury and use it to seek justice
for the negligent or reckless care. The IOM intended meaningful
public access to information about serious harms. 13
The report states that “requests by providers for confidentiality
and protection from liability seem inappropriate in this context.”
It has now been close to five years since the IOM published its
landmark report, and our nation has still failed to follow its recommendations.
“The IOM's focus on 'system' improvement ignores the repeated
refusal by physicians and hospital leaders to adopt systems.”
Therefore, we are left with a healthcare industry that is unorganized,
decentralized and fragmented. Its ability to protect the public
from medical errors and poor quality healthcare is uncoordinated
and ineffective. Moreover, consumers still have not been properly
educated about the type of medical errors that may occur in our
healthcare system, their potential severity or rate of recurrence.
“There is endemic secrecy, deference to authority, defensiveness,
and protectionism. Despite much rhetoric about the primacy of patients'
interests, it seems that when it matters most, those interests are
too often subordinated to the needs and interests of health care
organizations and professionals.” 16
There is not another business in America that would be allowed
to operate in such an unsafe, irresponsible and unaccountable manner!
Return to Top
Last update on: 10/3/06