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    Tuesday, June 21, 2005

    Anesthesiology malpractice

    Today in the Wall Street Journal there is an article about anesthesiologists and the headway in malpractice insurance they have achieved due to an increased focus on safety.

    The WSJ reports that
    Anesthesiologists pay less for malpractice insurance today, in constant dollars, than they did 20 years ago. That's mainly because some anesthesiologists chose a path many doctors in other specialties did not. Rather than pushing for laws that would protect them against patient lawsuits, these anesthesiologists focused on improving patient safety. Their theory: Less harm to patients would mean fewer lawsuits.

    ...In 1982, the ABC news program "20/20" aired a piece on anesthesia-related deaths. "It was a devastating indictment of anesthesia," recalls Ellison C. Pierce Jr., a retired professor of anesthesiology at Harvard Medical School who is considered by many to be the father of the modern anesthesia-safety movement.

    ...Dr. Pierce at the time was president of the American Society of Anesthesiologists. In 1985, that group provided $100,000 to launch the Anesthesia Patient Safety Foundation. The new foundation was unusual in medicine: a stand-alone organization solely devoted to patient safety. Working closely with the larger ASA, from which it still receives about $400,000 a year, the foundation galvanized safety research and improvement.

    ...One advance was the development of high-tech mannequins that allow anesthesiologists to practice responses to allergic reactions and other life-threatening situations. Anesthesiologists say the mannequins have also allowed them to become more proficient at performing an emergency procedure akin to a tracheotomy that involves slitting open a clogged airway -- something a doctor can't practice on live patients.

    The innovations of anesthesiologists continue today.

    ...Anesthesiologists are now focused on alarm bells. Modern anesthesia machines come equipped with audible alarms that sound when certain thresholds, such as oxygen levels, are crossed. But the alarms irritate many surgeons, so some anesthesiologists have turned them off. The foundation has documented 26 alarm-related malpractice claims between 1970 and 2002, or a little more than one a year. Of those, more than 20 resulted in either death or brain damage.

    The foundation is pushing to adopt a formal standard that prohibits anesthesiologists from disabling the alarms. "I would not fly on an airplane if the pilot announced all the alarms were being turned off," says Robert K. Stoelting, the foundation's current president. "Our patients deserve the same safety net."
    The total article is a great read and an indictment of the current trend in tort reform. John Stossel, author of Gimme a Break and a strong libertarian, argues that there is far too much tort in this country. Malpractice insurance is often used as an example.

    But this article shows that doing a job well is more effective that tort in reducing rates.

    Also, I have a suggestion for the alarm bell thing. Instead of turning off the alarms, or making some needless rule on keeping the alarms on, just configure the monitor with earplugs. I've seen the monitors, and it wouldn't be hard to put an earplug in one ear, maybe wireless maybe not, so the anesthesiologist can hear the alarm without breaking the concentration of the surgeons.

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