Less Harm, Fewer Lawsuits

Once Seen as Risky, One Group of Doctors Changes Its Ways | WSJ | 5.21.05

Anesthesiologists Now Offer Model of How to Improve Safety, Lower Premiums Surgeons Are Following Suit

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.

Over the past two decades, anesthesiologists have advocated the use of devices that alert doctors to potentially fatal problems in the operating room. They have helped develop computerized mannequins that simulate real-life surgical crises. And they have pressed for procedures that protect unconscious patients from potential carbon-monoxide poisoning.

All this has helped save lives. Over the past two decades, patient deaths due to anesthesia have declined to one death per 200,000 to 300,000 cases from one for every 5,000 cases, according to studies compiled by the Institute of Medicine, an arm of the National Academies, a leading scientific advisory body.

Malpractice payments involving the nation’s 30,000 anesthesiologists are down, too, and anesthesiologists typically pay some of the smallest malpractice premiums around. That’s a huge change from when they were considered among the riskiest doctors to insure. Nationwide, the average annual premium for anesthesiologists is less than $21,000, according to a survey by the American Society of Anesthesiologists. An obstetrician might pay 10 times that amount, Medical Liability Monitor, an industry newsletter, reports.…

A 1999 report by the Institute of Medicine noted that “few professional societies or groups have demonstrated a visible commitment to reducing errors in health care and improving patient safety.” It identified one exception: anesthesiologists.

“If there were any specialty where you said, ‘Show me who has done anything right,’ I would point to the anesthesiologists,” says Neil Kochenour, medical director at the University of Utah Hospitals and Clinics. “They have really made some inroads and some impact.”

Medical errors are a leading cause of death in the U.S., killing between 44,000 and 98,000 Americans each year, according to various studies.…

In part by analyzing claims, the anesthesiologists were able to document the extent to which patients were dying because of a simple mistake: Anesthesiologists were inserting the patient’s breathing tube down the wrong pipe. Rather than putting it down the trachea, which leads to the lungs, they were accidentally inserting it down the esophagus, which leads to the stomach. The problem was, there was no way to determine quickly whether the tube was in the right pipe. Patients often simply turned blue or their blood turned dark. By then, it was usually too late to save them.…

Failing to adhere to ASA recommendations can expose hospitals to malpractice liability. By 1990, says Dr. Pierce, almost all American hospitals had pulse oximeters and capnographs.…

Other specialties have noticed how the anesthesiologists have fared. Dr. Griffen of the College of Surgeons says that more surgeons have begun to see a connection between improving patient safety and lowering malpractice premiums. The college’s closed-claims study so far involves about 350 cases, and the group hopes it will grow to 500 this year.…

With what the ASA has accomplished it is hard to make any arguments about premium reduction without similar purposeful quality awareness and interventions. Kudos ASA.