The risk physicians face for reporting patient harm: 7 insights

When physicians speak up about patient care issues to combat preventable errors, harm and death, they often report these problems while risking repercussions from the health systems that employ them, according to a post by the Texas Medical Association.

The Texas Medical Association explored several instances of physicians reporting patient care issues, including Lakeway, Texas-based neurologist Robert Van Boven, MD, who frequently speaks out against the lack of transparency from hospitals on potentially deadly errors.

Here are seven insights.

1. Medical errors stem in part from patient safety culture issues at teaching hospitals, where numerous errors may remain unreported. For example, in a recent analysis, STAT looked at federal inspection data and found a significantly large gap in training quality at U.S. teaching hospitals, based on how frequently CMS cited the hospitals for deficiencies. Collectively, STAT found more than 5,500 safety violations took place at teaching hospitals from 2014-17.

2. "In the places where young doctors-in-training practice, what they learn can affect how the person will practice for decades to come," Rosemary Gibson, a patient safety advocate and the author of Wall of Silence, which explores the untold story of medical mistakes, told STAT. "They're developing habits … and it's essential for trainees to learn in clinical settings where patient safety is baked into the system."

3. In Dr. Van Boven's case, reporting medical errors has led to protracted legal battles with Lakeway Regional Medical Center going back to 2012, when the neurologist said he began internally reporting numerous alleged issues with patient care involving "death, harm or significant risk thereof," according to one of his court filings cited by the Texas Medical Association.

4. Dr. Van Boven said he turned to regulatory agencies after he did not see progress with the internal reports. Every one of the six reports Dr. Van Boven made to the Texas Department of State Health Services between 2015 and 2016 resulted in investigations that found one or more violations, according to letters Dr. Van Boven received from DSHS. In 2015, CMS issued a "statement of deficiencies" for Lakeway Regional, which required the hospital to outline its plans to correct those deficiencies.

5. However, Dr. Van Boven filed suit against the hospital in 2015, claiming he faced retaliation from the hospital. He alleged the hospital retaliated against him by engaging in bad-faith reporting to the Texas Medical Board in 2014, which led to a board complaint over a file of 15 cases that he said Lakeway misrepresented as a peer-review file.

6. Dr. Van Boven shared several other complaints with the hospital, including a 2016 email from an attorney representing Lakeway, between Dr. Van Boven's settlements with the hospital, that appeared to suggest Dr. Van Boven would have to "identify and withdraw any complaints he has" with regulatory agencies, and "agree to cease and desist from making further such reports" to reach the settlement. However, Dr. Van Boven said he denied the request for silence. Litigation between Dr. Van Boven and the hospital continues. An attorney for Lakeway Regional declined comment to the Texas Medical Association. 

7. To address this issue of reporting patient harm, Dr. Van Boven suggests a multi-faceted approach, including improved legal safeguards for reporting complaints about patient care. "The culture of silence — a lack of transparency and disclosures in hospitals, borne of fear and reprisals, exerts a chilling effect on learning from and correcting deadly errors," Dr. Van Boven said.

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