Another perspective on tort reform: when there are no more torts, it won't matter how many personal injury lawyers there are. Voluntary efforts won't work By Michael L. Millenson USA Today August 5, 2004 http://www.usatoday.com/usatonline/20040805/6427034s.htm The usually quarrelsome U.S. Senate recently approved medical-error legislation by a unanimous voice vote -- reason enough for citizen suspicion. When no special interest wants to fight something, it's usually the public interest that's losing out. Although groups representing doctors and hospitals praised the bill's prescription of a confidential, voluntary reporting system as good medicine, the reality resembles a placebo more than a truly potent cure. Instead of taking a significant step forward, Congress sidestepped the chance to support health professionals who have spent years trying to get colleagues to provide safer care. Congress correctly agreed with the Institute of Medicine (IOM) diagnosis that we need a system fix rather than finger-pointing at individuals. Unfortunately, Congress also ignored the scientific literature on systemic behavior change. Tipping points don't come about from tiptoeing timidly. While voluntarism is valuable, it has been five years since a landmark IOM report made patient safety a public scandal. During that time, doctors and hospitals have not voluntarily organized to stop the preventable deaths and injuries of hundreds of thousands of patients with anything close to the energy used to battle malpractice awards worth hundreds of thousands of dollars. Doctors and hospital managers are not venal and uncaring. In fact, many care so much that they find it too painful to face up to the commonplace nature of errors. As a result, doctors routinely protest that the patient-safety issue is overblown. I've seen it firsthand hundreds of times. If you really believe in systemic change, you have to be willing to shock a lethargic system into abandoning the status quo. The way to do that is with the mandatory reporting of serious errors. In Minnesota, for example, progressive hospitals supported the mandatory reporting and analysis of 27 serious events, along with appropriate confidentiality and legal ''safe harbor'' provisions. Moreover, errors are tabulated and made public each year. Across the U.S., a few courageous hospitals even involve patient representatives in error-prevention panels. No member of Congress would think of making airline-crash prevention voluntary. Protecting the sick and the vulnerable among us is surely at least as important. Michael L. Millenson is author of "Demanding Medical Excellence: Doctors and Accountability in the Information Age."