Public Health Analysis
Public Health Analysis
Public Health Analysis
Overview of the Health Problem
Every year, more than 100,000 lives are lost as a result of various medical errors conducted by medical professionals and practitioners in various licensed health facilities in California. This is according to the 1999 study conducted by the Institute of Medicine. In the year 2009, 1,500 errors were reported by medical providers where 1,015 of the cases concerned serious bedsores on patients. Out of 1,500 case of adverse events reported to the state that year, 30 of them resulted into death of patients and serious disability on patients. 12 of the cases reported were linked to suicides and suicide attempts by the patients in various health care facilities. According to California Watch, six of the patient died as a result of serious burns or electric shock while in health care facilities. More surprising is that thirty of the cases were as a result of sexual assault on patients by medical care staffs (Jewett, 2010).
This is just an example from one year; many more such cases are reported every year in the Department of Public Health. However, the department of Public Health continues to fine hospitals for not reporting incidents of adverse events but no lasting solution to this problem have been sought. According to earlier reports by California Watch (before July 2010), "the department had fined medical facilities more than $1 million for failing to report or delaying reports of more than 260 errors" (Jewett, 2010).
Acquired adverse events in medical facilities have continued to receive a huge public outcry as many people continue to suffer in the hands of medical professionals and practitioners in medical facilities. The question here is why should innocent members of the public continue to suffer in the hands of those who are entrusted to provide medical care to them'. The proposed bill by Mike Feuer on new policies and practices concerning adverse medical events is seen as an opportunity to bring amendments in the medical field in order to bring to an end the problems arising from the question posed above.
According to Institute of Medicine, patients seeking medical treatment are entitled to quality, timely, safe and appropriate medical care. Health care facilities licensed by the government through the Department of Public Health and health care providers are very important resources in the society as they perform life-saving procedures. They ensure the health of the members of the public as well as their welfare. However, in spite of their good intention to ensure presence of a health society, adverse events do occur in the health facilities where patients are harmed with many cases of deaths and disabilities reported from patients as a result of adverse events.
The Institute of Medicine among other medical researchers have come into a consensus that adverse events in our health facilities is a serious problem and something need to be done before the situation gets out of control. These researchers are of the opinion that one way to reduce occurrence of adverse events in our health facilities is to conduct ongoing health care providers' education as well as establishing safety plans and procedures (Jewett, 2010).
Lack of quick intervention or not intervention to problems of adverse events, from a personal perspective, would result to more and more cases of adverse events on patients where many people are likely to lose their lives or be rendered mentally and/or physically disabled. The dire consequences of these events are likely to be felt at a national level were the economically productive people and the potentially productive people (the young generation) will be unable to serve the nation and hence reducing the productivity of the nation.
Overview of the Bill and Stakeholders
On February 25, 2009, an assembly Member by the name Feuer introduced a public health bill titled Hospital Acquired Conditions' which was basically concerned with adverse medical events. The existing laws by the time of introduction of this bill established various programs for promotion of health and prevention of disease which included licensing and regulation of health facilities that are under the administration of State Department of Public Health. According to the existing laws, health facilities were to report to the State Department of Public Health all patients' adverse events within 5 days (AB 542, 2009).
The bill was seeking to expand the specified adverse events that required reporting to include, surgical-site infections, catheter-associated urinary tract infection, and manifestation of poor glycemic control (AB 542, 2009). The bill was also seeking a requirement that all surgical clinics to comply with reporting requirements for adverse events just like other health facilities. The State Department of Public Health was therefore required to collect and investigate adverse information and events respectively.
According to Feuer, medical director and the director of specified facilities would make reports on adverse events to the medical governing body on annual basis, and would be required to make contracts between health care service plan and health care providers that would stipulate that there would be consistency in non-billing for and non-payment of confirmed adverse events (Bill Analysis: AB 542, 2009).
AB 542 public health bill on adverse events on patients acquired from health facilities provided that the State Public Health Officer would establish a quality improvement and reporting office within the department of public health run by the state. Quality Improvement and Reporting Office would be responsible for providing leadership in minimizing adverse events in health facilities, improving patients' safety and ensuring patients' quality of care. All health facilities and clinics would perform root cause analysis of any adverse event reported in their facilities and make a report to the Quality Improvement and Reporting Office as well as to the patient as recommended.
For the purpose of developing recommendations for non-billing and non-payment practices and policies for substantiated adverse events, the Secretary of California Health and Human Services would set up a Health Care Quality Improvement Committee. According to the proposed bill, the committee would be required to report its initial recommendations to the California Health and Human Services Secretary before September, 2010 (AB 542, 2009). All health care service providers would be prohibited by the bill to bill for services related to confirmed adverse events on patients.
As per the existing laws, the Managed Risk Medical Insurance Board administers a Medi-Cal Program where qualified low-income children are provided with health services. Similarly, the State Department of Health Care Services also runs a Medi-Cal Program under which health care services are provided to qualified low-income individuals (AB 542, 2009). The proposed bill would require that a contract be made between health care services provider and the Healthy Families Program, insurer(s), health care service plan and the Medi-Cal Program. The contract would stipulate that the parties in the contract would be consistent with non-billing and non-payment policies for substantiated adverse events. To facilitate this, the bill would seek to change the current definition of existing crimes and then impose a state-mandated local program.
Finally on the provisions of the bill, according to the California Constitution, the state is supposed to reimburse a specified amount of money to local agencies and school districts as mandated by the state. There are established provisions for making such reimbursement under statutory provisions. The proposed bill would provide that no reimbursement will be required by this act for a particular reason.
The stakeholders affected by the proposed bill include, all health care service facilities, the government through various departments of health, insurance companies, and the public in general. Health care service facilities include medical hospitals and surgical clinics both public and private. These health care facilities will be affected by the proposed bill because they will have to adjust their policies concerning billing for patients as a result of adverse events. In most cases, when adverse events are reported on patients from any of the health care facilities, they require the affected patient(s) to meet all the costs associated with treatment from such events. On passing of the proposed bill, all the health facilities will be required to get into agreements through signing of contracts with health service plan providers that will provide that they will be consistent with the billing and payment policies to be provided concerning substantiated adverse events.
In the United States, the government through the states is responsible for providing and controlling health care related services. Therefore, the government through the State Department of Public Health, State Department of Health Care Services and the office of California Secretary of Health and Human Services is a big stakeholder affected by the proposed bill. These offices are mandated to oversee provision of health care services to the citizens of California on behalf of the federal government.
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