One specialty group of medical providers has largely shielded itself from the rising cost of medical-malpractice insurance. Over the past two decades, anesthesiologists have advocated the use of devices that alert doctors to potentially fatal problems in the operating room. Their innovative practices have resulted in lower fatalities and low malpractice premiums.
Innovation
Twenty years ago anesthesiologists took a road less traveled in the medical profession and they have been reaping the rewards ever since by paying less for malpractice insurance than many doctors in other specialties. In 1984 they formed the Anesthesia Patient Safety Foundation and, rather than choosing to advocate and lobby for laws that would protect them against lawsuits by patients and their families, anesthesiologists focused on improving patient safety. Functioning under the theory "less harm to patients means fewer lawsuits", anesthesiologists developed computerized mannequins that simulate real-life surgical crisis, advocated the use of devices that alert doctors to potentially fatal problems in the operating room, and have pressed for procedures that protect unconscious patients from potential carbon-monoxide poisoning.
Since the creation of the Anesthesia Patient Safety Foundation in 1984, patient deaths due to anesthesia related problems have declined to one death per 200,000 to 300,000 cases from one for every 5,000 cases, according to studies compiled by the Institute of Medicine, an arm of the National Academies and a leading scientific advisory body. Malpractice payments involving the nation's 30,000 anesthesiologists are down too, and they pay some of the smallest malpractice premiums around. Obstetricians pay approximately 10 times the amount of an anesthesiologist, according to Medical Liability Monitor, an industry newsletter. Once considered the riskiest doctors to insure, anesthesiologists now have an average annual premium of less than $21,000, according to an American Society of Anesthesiologists survey. Premiums range from as little as $4,300 a year to as high as $56,000 for those who have been sued before or who perform higher-risk procedures.
A variety of studies report medical errors as the leading cause of death in the U.S., killing between 44,000 and 98,000 Americans each year, however a 1999 report by the Institute of Medicine when noting that "few professional societies or groups have demonstrated a visible commitment to reducing errors in health care and improving patient safety" listed anesthesiologists as the lone exception.
In the 1990's, the Patient Safety Foundation funded research into the problem of body temperature falling when room-temperature intravenous fluids are infused into the blood. The results of those studies have been to implement greater care in keeping patients warm during surgery, often with specially heated blankets or blood and fluid warmers.
Many anesthesiologists also support legislative moves to rein in malpractice suits, but overall, they have put more emphasis on improving safety.
Impact
The high tech mannequins have helped anesthesiologists to practice responses to allergic reactions and other life-threatening situations. The creation of a database with information collected from insurers on closed malpractice claims has resulted in an overall picture of how anesthesia accidents tend to occur. In many instances, patients were dying simply because anesthesiologists were inserting the patient's breathing tube down the esophagus rather than down the trachea. The research resulted in two innovations that have all but eliminated death and injury from intubation errors - the pulse oximetry to measure oxygen levels in the blood through a clip on the patient's finger and capnography to measure carbon dioxide in expelled breath.
Since 1986, the Foundation has been very instrumental in urging anesthesiologists to make use of pulse oximetry as part of the ASA's basic standards for anesthesia care. They later added recommendations for the use of capnography. Anesthesiologists have also become much better at preventing patient exposure to carbon monoxide, an unintended by-product of the process of cleansing a patient's exhaled breath of carbon dioxide before the air is recycled back to the patient's lungs.
According to Public Citizen, a consumer-advocacy group in Washington, D.C., anesthesiologists accounted for 3.8% of all malpractice suits between 1985 and 2001, a 4.1% drop from 1972. According to the American Society of Anesthesiologists, the median payment in a malpractice suit against an anesthesiologist has dropped 46% from $332,280 in 1970 to 179,010 in 1990. Malpractice insurance rates for anesthesiologists have dropped too, decreasing by 37% over the past 20 years.
Inspiration
The mission of the Anesthesia Patient Safety Foundation is to ensure that no patient shall be harmed by anesthesia.
"If there were any specialty where you said, 'Show me who has done anything right,' I would point to the anesthesiologist," said Neil Kochenour, medical director at the University of Utah Hospitals and Clinics. "They have really made some inroads and some impact."
The World Inquiry editorial team edited this profile from the original submission of the interviewer or other source. The views expressed do not necessarily represent Case Western Reserve University, the Weatherhead School of Management or the Center for Business as an Agent of World Benefit. More >>
