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.