Hospitals' mistakes are going unreported

Despite laws in Pa. and N.J. aimed at reducing errors, compliance is spotty, experts say.

"It requires that something trigger the system," he said, such as a patient complaint.

Plaintiff lawyers said there were many cases to examine because of a large loophole in reporting requirements.

Hospitals don't report serious events if patients have been warned of the possibility of them in consent forms, said Clifford Rieders, a trial lawyer and member of the Patient Safety Authority's board.

He said he thought one reason many hospitals don't want to report serious events is that the law also requires that patients be informed in writing within a week of such problems. So, if a hospital doesn't report a problem, it doesn't have to send the patient that letter.

Rieders says the agency has allowed hospitals to determine for themselves what constitutes a serious event and the agency has failed to come up with a solid definition in six years.

Fixing this "is not a priority," he added.

Others on the authority's 10-member board said the agency was working on more concrete definitions.

"We are trying to come up with a tighter interpretation," said Ana Pujols-McKee, chair of the authority's board and chief medical officer at Presbyterian Medical Center in Philadelphia.

McKee said the disparity in reporting just became apparent after three full years of results.

In 2007, the authority said hospitals and other health facilities reported 7,277 serious events and 204,706 near misses. Hospitals accounted for 99 percent of the reports.

While it's important to study each of those reports, it is at least as crucial to identify hospitals that are not participating at all, said Conway, of the health-care improvement institute.

"We cannot improve care unless we understand the problems," Conway said. "There can't be safety without transparency."