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February 7, 2019

4 doctors self-reported their mistakes. No patients were harmed—but the doctors are facing subpoenas anyway.

Daily Briefing

    At least four ED doctors at Rhode Island Hospital are facing allegations of medical misconduct from the state's Department of Health (DOH) after they self-reported mistakes, including "wrong-side" X-rays, that didn't result in patient harm.

    The move has alarmed experts, who say officials are inappropriately targeting individual doctors rather than trying to resolve systemic problems, Arthur Allen reports for Politico.

    Why ED doctors are facing subpoenas

    Rhode Island Hospital since June 2018 has been under a consent decree with the state after four mistakes involving radiological procedures. The decree requires the hospital to report all near-misses or other patient safety risks to the state's DOH, Allen reports.

    Doctors at the hospital have been complying with the decree, reporting errors that did not harm patients but that they believed revealed potential safety risks. As a result of these self-reported incidents, at least four ED doctors have been subpoenaed by the state's DOH.

    The doctors who received subpoenas declined to speak with Politico, Allen writes. However, a colleague of the doctors said one of the subpoenas cited "incompetent, negligible, or willful misconduct in the practice of medicine," including "rendering of medically unnecessary services" that "fail to conform with standards." The subpoena also said Rhode Island's DOH would be ordering a hearing on the doctor's activities "forthwith."

    The self-reported errors in these cases involved X-rays and other scans the doctors incorrectly ordered via the hospital's EHR. In three of the cases, doctors ordered scans on the wrong side of a patient's bodies, and in one case, a doctor ordered a scan on the wrong patient.

    Joseph Wendelken, a spokesperson for Rhode Island's DOH, would not specifically comment on the subpoenas, but said the investigations are required by law, Allen writes. "For health care facilities to ensure patient safety, they must be able to accurately identify patients at all times," Wendelken he said, adding, "We consider wrong site procedures and identification errors to be 'never events,' meaning they should never occur."

    Experts, doctors say subpoenas could harm efforts to improve EHR safety

    Many doctors and experts have raised concerns about these subpoenas, arguing that Rhode Island's DOH is punishing providers when it instead should be looking at how it can help providers make EHRs more user-friendly and safe.

    According to Allen, EHR experts say errors when ordering X-rays and scans "are common because EHR screens are complex, and it's easy to click on the wrong icon or patient name."

    Gita Pensa, an ED physician and a professor of medicine at Brown University, said punishing providers for reporting these mistakes sends the wrong message. Pensa in a tweet wrote, "Physicians have been willingly self-reporting near misses or errors, often but not always related to EHR entry, to the DOH. And instead of working with those docs to target pain points, the DOH has begun individually targeting these MDs with threats of fines."

    Jason Adelman, chief patient safety officer at New York-Presbyterian Hospital, said, "Anyone punishing individual providers for these events is punishing the wrong thing. These are system issues, not the provider being reckless. The focus should be on things like EHR usability and safety."

    David Levesque, a spokesperson for Rhode Island Hospital, said the subpoenas have not harmed the hospital's efforts to report medical errors and improve care. He said DOH's actions have "done nothing to impact our transparency," which "remains a point of pride and is unwavering" (Allen, Politico, 1/30).

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