NC Health Care Recommendations: Patient Safety, Quality and Accountability

On April 11, 2006, the North Carolina House Select Committee on Health Care released recommendations for the 2006 legislative short session. Many of them will be controversial, and taken together they have the potential to significantly change the way that North Carolinians access health care and insurance (and how much we pay). Some of these topics are pretty technical, but no less important for their difficulty. I'm hoping that these posts will begin a conversation on the best course for North Carolina's efforts at healthcare reform.

I'll publish the recommendations of the six subcommittees in six posts, along with some of the background information from each report. The subcommittees are:

1. Enhanced Accountability

The Subcommittee recommends that House Select Committee on Health Care approve and include in its report to the 2006 General Assembly the draft legislation entitled An Act to Strengthen the Authority of the North Carolina Medical Board to Discipline Physicians and Certain Others Authorized to Practice Medicine in order to Improve Patient Safety, as Recommended by the House Select Committee on Health Care.

The thrust of this recommendation is to increase the accountability of doctors, hospitals, and other health care workers by amending North Carolina General Statutes § 90-14. The amendments would:

  • expand the punishments that can be handed out by the Medical Board—in addition the ability to "deny, annul, suspend, or revoke a license," the Board would now be able to mete out conditional probation, place limitations on doctors and hospitals, publicly reprimand them, and require additional training;
  • add to the long list of errors and omissions that can trigger these penalties a failure to maintain practicing credentials in the two years prior to a an application for an initial license;
  • add a "three strikes" rule for doctors impaired by drugs, alcohol, or mental health;
  • provide immunity from civil lawsuit for persons, businesses, and organizations who provide an expert medical opinion to the board in the matter of a physician who is being disciplined (these folks already have immunity for reporting and investigating violations);
  • require that when the licensee requests a hearing, they will be heard before at least three Board members (right now the minimum number of Board members is one);
  • add some teeth—when a licensee fails to report certain problems it will be fined between $500 and $1,000 per violation; if any licensee fails to respond to a Board request for additional information, it will be fined between $500 and $1,000;
  • finally, broaden reporting requirements to include not only doctors, but physician assistants and nurse practitioners.

If I can be a little snarky for just a second: I don't see why all of this is necessary. I mean, the problems of errors and accountability in health care are really just fabricated by money-grubbing trial lawyers, right?

2. Infection Control & Epidemiology

The Subcommittee recommends that House Select Committee on Health Care approve and include in its report to the 2006 General Assembly the draft legislation entitled An Act to Appropriate Funds for the Statewide Program on Infection Control and Epidemiology.

Three things I did not know before reading this report: (i) you have a one in twenty chance during a hospital stay of getting a hospital-acquired infection; (ii) the cost of these infections is 90,000 lives and $6.5 million annually; and (iii) to fight the problem, North Carolina has SPICE—the Statewide Program for Infection Control and Epidemiology.

Right now, SPICE gets $163,000 a year to conduct education at state hospitals and other care facilities, provide consulting services to hospitals, and teach a class at UNC's med school on infection prevention. Says SPICE: "Think of what we could do with $663,000!" Here's why the subcommittee recommends that they get the money: hospitals are implementing infection control protocols recommended by the Institute for Healthcare Improvement and need help. The funding would let SPICE more regularly visit individual hospitals and conduct inspections and training. SPICE would also use the funding to draft and propagate its own protocols. A study suggests that beefing up our infection control program could reduce the number of hospital-acquired infections by 7% to 48%.

3. Continuation of the Subcommittee

The Subcommittee recommends that it continue its work after the adjournment sine die of the 2006 Session of the General Assembly.

The subcommittee didn't have a chance to finish; can it have an extension?