A Report on the Medical Care Availability and Reduction of Error Act

Health Policy Newsletter

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Volume 15 Number 4 December, 2002 Article 2

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A Report on the Medical Care

Availability and Reduction of Error Act

Stanton N. Smullens, MD*

* Jefferson Health System

Jefferson University, Jefferson Health System and the Office of Health Policy and Clinical

Outcomes, 1015 Walnut Street, Suite 115, Philadelphia, PA 19107.

Suggested Citation:

Smullens SN. A report on the Medical Care Availability and Reduction of Error Act. Health Policy

Newsletter 2002; 15(4): Article 2. Retrieved [date] from http://jdc.jefferson.edu/hpn/vol15/iss4/2.

Stanton N. Smullens: A Report on the Medical Care Availability and Reduction of Error Act

Health Policy Newsletter Vol. 15, No. 4 (December 2002), Article 2

A Report on the Medical Care Availability and

Reduction of Error Act

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On May 20, 2002, Governor Mark Schweiker signed Act 13, the MCARE Law (Medical

Care Availability and Reduction of Error Act). This was a significant moment in

Pennsylvania history since attempts at medical liability reform have essentially failed

over the past twenty-five years. The Act has three significant portions, the first of

which addresses liability reform. The second portion deals with liability insurance

reform, including the CAT Fund (Medical Professional Liability Catastrophic Loss

Fund). Chapter 3 of the Act addresses the complicated issue of patient safety.

The Act was the result of intense negotiations between the Pennsylvania Medical

Society, the Hospital Alliance of Pennsylvania, the Pennsylvania Trial Lawyer’s

Association, the insurance industry and, of course, the Legislature. The fact that any

law was actually signed is a credit to the medical and hospital communities who

finally realized that talking about liability issues was not enough, but that active

participation in the political process was necessary. What galvanized action and what

was at stake, and remains at stake, is the availability of quality care for patients in

Pennsylvania. It was this issue that finally prompted the passage of this historic Act.

Like all compromises, none of the groups at the table walked away fully satisfied that

they had achieved all of their aims. Indeed further legislation was signed into law as

Act 57 on June 19, 2002. On October 11, 2002, a bill to stop venue “shopping” also

was signed. These new laws improved some of the medical liability issues not

addressed in Act 13.

The major provisions of Chapter 3 establish a Patient Safety Trust Fund, which

initially is set at five million dollars for the 2002-03 budget year. It also creates a

Patient Safety Authority. Currently Chapter 51 of the state’s licensure regulations

(adopted June 1998) requires mandatory reporting of serious events to the

Department of Health. When Act 13 is fully operational, it will supercede Chapter 51,

and there will be mandatory reporting of serious events to the Patient Safety

Authority as well as to the Department of Health. Infrastructure failures (power

outages, strikes, etc.) will continue to be reported to the Department of Health. Of

great significance is that for the first time it will be mandatory to report incidents

(“near misses”) to the Patient Safety Authority. It requires medical facilities to

develop and implement a Patient Safety Plan, designate a Patient Safety Officer, and

establish a Patient Safety Committee.

Chapter 3 further requires health care workers to report serious events to their

Patient Safety Committee and provides “whistle blower” protection against retaliation

to those reporting. Of importance is that the information is protected in both the

Patient Safety Committee and the Patient Safety Authority by strong confidentiality

provisions. Reports may also be sent anonymously to the Patient Safety Authority if

there is a concern that the medical facilities’ Patient Safety Committee is not

responding appropriately. Failure by a health care worker to report a serious event

must be referred to the appropriate professional licensing board. The Act also

requires mandatory written disclosure of serious events to the patient.

Stanton N. Smullens: A Report on the Medical Care Availability and Reduction of Error Act

Health Policy Newsletter Vol. 15, No. 4 (December 2002), Article 2

The eleven members of the Patient Safety Authority are regulated by the Act – the

House selects two, and the Senate selects two. The six appointed by the Governor

consist of a physician, a nurse, a pharmacist, a health care worker employed by a

hospital, and two residents of the State, only one of whom is a health care worker.

The chairman of the Authority is the Physician General of the State – Robert S.

uscalus, D.O. The responsibilities of the Patient Safety Authority are very clearly

delineated in the Act. They are to manage the Patient Safety Trust fund, contract

with an appropriate entity to collect and analyze data regarding reports of serious

events and incidents, issue recommendations on how to reduce serious events and

incidents, receive and investigate anonymous reports, and report annually to the

General Assembly. It is very clear that the organization wants to be a learning

organization and plans to work to develop the trust of the medical facilities of the

state that report to it. These medical facilities include acute care hospitals, birthing

centers and surgery centers.

The Patient Safety portion of Act 13 presents a unique opportunity for the medical

facilities in the state to learn from their serious events and incidents. It has the

potential to carry out the mandate of the Institute of Medicine’s Report of November

1999, To Err is Human, and to learn from serious events and incidents that

compromise safe patient care. At the same time, there is great concern expressed by

the health care community about sharing this critical data in a state and a city known

for its unfriendly medical liability climate. This is understandable, but it is the law of

the state, and if handled well, can be a positive undertaking for health care in our

Commonwealth.

About the Author

Stanton N. Smullens, MD, is Chief Medical Officer of the Jefferson Health System and

a Member of the Patient Safety Authority. Please address questions and comments

to stanto[email protected]