Medical Malpractice: The Role of Patient Safety Initiatives

Publication Date: July 2006

Publisher: Library of Congress. Congressional Research Service


Research Area: Health; Law and ethics



Medical malpractice and malpractice insurance continue to be issues of great concern to physicians, consumers, legislators, and others. Most of the discussion about rising malpractice insurance premiums has centered on limiting the damage awards in malpractice suits, though some attention also has been given to insurance reforms. A third, related area that has received less consideration in malpractice discussions is patient safety. Patient safety refers to the panoply of rules, practices, and systems related to the prevention of medical injury. Intrinsic to patient safety efforts are strategies to prevent medical errors.

While patient safety and medical errors have generated a great deal of discussion in legislatures in the past several years, such discussion typically has taken place separately from the debates concerning malpractice. For example, S. 544, the Patient Safety and Quality Improvement Act of 2005, encouraged the voluntary reporting and analysis of medical error data. S. 544 became P.L. 109-41 on July 29, 2005. However, medical liability issues are addressed in other legislation -- specifically, H.R. 5/S. 354, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2005, S. 22, the Medical Care Access Protection Act of 2006, and S. 23, the Healthy Mothers and Healthy Babies Access to Care Act.

The separation of patient safety concerns from medical malpractice issues has not always been the case. Several states have passed legislation that included provisions that addressed both malpractice and patient safety issues. Research studies have explored the links between the two issues, and a few bills introduced during the 109th Congress, such as S. 1337 and S. 1784, address those links. Therefore, it is appropriate and timely to reconsider these issues collectively, and revisit the role patient safety initiatives could play in the prevention of both medical errors and medical malpractice.

Strategies to enhance patient safety differ according to the specific provider type targeted. For instance, physician education includes providing clinical guidelines about appropriate treatments for specific medical conditions, while hospital education involves performance feedback from an external organization. At the same time, general approaches may apply to both physicians and hospitals. For example, medical error reporting is a key component for patient safety enhancement, regardless of the provider focus.

The impact of patient safety initiatives on the quality of care provided continues to be an open question. Individual initiatives have resulted in promising outcomes, but the overall impact of these efforts has been mixed. To some degree, this is the case because implementation has not been as pervasive as initial intentions suggested, and also because not enough research has been done to identify, enumerate, and assess patient safety efforts.

This report will be updated periodically.