    [Public Papers of the Presidents of the United States: WILLIAM J. CLINTON (1999, Book II)]
    [December 7, 1999]
    [Pages 2216-2219]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks on Improving Health Care Quality and Ensuring Patient Safety and
    an Exchange With Reporters
    December 7, 1999

        The President. Good morning, everyone. I'd like to thank Secretary
    Herman, Janice Lachance, and the other representatives of the Federal Government
    who are here. I'd like to thank the leaders representing consumers,
    health care providers, business, labor, and quality experts who are
    here. This is a very impressive group of Americans who have come
    together to discuss the question of reducing medical errors.
        Last week the Institute of Medicine released a disturbing report
    about patient safety and medical errors in our Nation's health care
    system. According to the study, as many as 98,000 Americans lose their
    lives each year as a result of preventable medical errors. Up to 7,000
    die because of errors in prescribing medicine. And the cost of all these
    errors add as much as $29 billion to our medical bills.
        But this is about far more than dollars or statistics. It's about
    the toll that such errors take on people's lives and on their faith in
    our health care system. We just had a terrific meeting this morning to
    talk about what we can do to save lives, to prevent errors, to promote
    patient safety. We have the finest health care system in the world, the
    best professionals to deliver that care. But too many families have been
    the victims of medical errors that are avoidable, mistakes that are
    preventable, tragedies, therefore, that are unacceptable.
        Everyone here agrees that our health care system does wonders but
    first must do no harm. Now let me be clear about one thing: Ensuring
    patient safety is not about fixing blame; it's about fixing problems in
    an increasingly complex system, about creating a culture of safety and
    an environment where medical errors are not tolerated. In short, it's
    about working together to zero in on patient safety and zero out
    preventable errors. This morning's meeting builds

    [[Page 2217]]

    on our administration's longstanding record to improve health care
    quality.
        Almost 3 years ago, I established the Commission on Consumer
    Protection and Quality Care, chaired by Secretary Shalala and Secretary Herman. That
    Commission produced a landmark report and led to my own executive action
    to provide patient protections to one out of every three Americans
    enrolled in Federal health care plans. It also set the stage for the
    Congress to pass a strong, enforceable Patients' Bill of Rights.
        But the Commission has made clear that the challenge goes beyond
    patient protections for all Americans in all plans. We must also improve
    the quality of care. That's why I created an interagency task force to
    coordinate administration efforts in this area; why I asked the Vice
    President to launch the quality forum--and
    I thank Dr. Ken Kizer for being here
    today--a private advisory panel to develop uniform quality standards so
    that health plans compete on quality and not just cost, and consumers
    and businesses have better tools to judge what plans are best for them.
        In a few moments, I'll announce new steps our administration is
    taking to promote quality and to reduce medical errors. But first, I
    want to turn it over to one of our partners in that effort. If there is
    one thing we have learned, it's that effectively managing the
    prescribing and dispensing of drugs is one of the best ways we can
    improve quality and hold down cost. The president of the American
    Hospital Association, Dick Davidson, is
    here this morning to announce a major new medical safety campaign
    they're launching with the Institution for Safe Medication Practices.
    It's truly a prescription for better health for all Americans. So I'd
    like to ask Dick to tell you about it.

    [At this point, American Hospital Association President Richard J.
    Davidson made brief remarks.]

        The President. Thank you very much, Dick.
        I also want to just take a moment out here to thank Dr. Bill
    Richardson of the Kellogg Foundation for
    the Institute of Medicine report, and all those others who worked with
    him on it. It was a terrific document.
        Now, let's talk about what we can do at the Federal level. First,
    I'm signing an executive memorandum this morning directing our health
    care quality task force to analyze the Institute of Medicine study and
    to report back to me, through the Vice President, within 60 days about the ways we can implement their
    recommendations.
        I'm also calling on the task force to evaluate the extent to which
    medical errors are caused by misuse of medications and medical devices
    and to develop additional strategies to reduce these errors.
        Second, I want the Federal Government to lead by example. So I'm
    instructing the Government agencies that administer health plans for 85
    million Americans to take an inventory of the good ideas out there now
    to reduce medical errors. They should apply those techniques to the
    health programs they administer and do so in a way that protects patient
    privacy.
        As a first step, I'm announcing today that each of the more than 300
    private health plans participating in the Federal Employee Health
    Benefits Program now will be required to institute quality improvement
    and patient safety initiatives. And I want to thank Janice
    Lachance, the head of our Office of
    Personnel Management, who had responsibility for figuring out how we
    were going to do this in record time. [Laughter]
        Third, ongoing research to enhance patient safety, to reduce patient
    errors, is absolutely critical. So we're increasing our investment in
    this area. Yesterday I signed legislation reauthorizing the Agency for
    Health Care Quality and Research in providing $25 million for research
    to improve health care quality and prevent medical errors. Through the
    work of the agency, we're also engaging our partners at the State level.
        In March we'll convene the first national conference with State
    health officials to promote best practices in preventing medical errors.
    And I want to thank Dr. John Eisenberg for
    his leadership of that agency.
        Finally, I'm directing my budget and health care teams to develop
    quality and patient safety initiatives for next year's budget so that we
    can ensure we're doing all we can to combat this problem. I want next
    year's budget to provide the largest investment to eliminate medical
    errors, improve quality, and enhance patient safety we've ever offered.
        The Institute of Medicine's report makes clear that a systematic
    approach to reducing medical errors gives us the best chance of success.
    Years ago, we took that approach in aviation, and

    [[Page 2218]]

    we've dramatically reduced errors and saved lives. By working together,
    we can achieve the same goals in the health care industry. The American
    people deserve this, and we intend to provide it.
        I am committed to working with all these people in partnership to do
    our part to save lives in needless medical errors, to make the best
    health care system in the world even better in the new century.
        Thank you very much.
        Q. Mr. President, many Americans, I would venture to say, were
    shocked, probably, to hear about this report, to learn that tens of
    thousands of people die each year, and tens of thousands more are
    injured because of medical errors. Does it call into question whether or
    not we have the best health care system in the world?
        The President. No, I don't think it does. I think what it calls into
    question is whether we've done everything we can to invest the kind of
    money in avoiding errors that other big complex systems have.
        I mentioned aviation, but I might also point out workplace safety.
    We have a representative from General Motors here who talked about how dramatically they have reduced
    injury in the workplace. Or if I could use an analogy that I think is,
    in some ways, even more appropriate, in the 1980's, when the American
    manufacturing sector was under withering competition from overseas and
    burdened by our big debt and high interest rates, they underwent the
    most disciplined imaginable review of every single process in every
    complex manufacturing operation to go to a zero-error rate.
        If you look at the medical profession, if you look at the way
    hospitals work, if you think--Dick said tens of millions of people--I'm
    sure there are hundreds of millions of hospital visits every year--just
    to take hospitals. There are many people who are older who are taking
    multiple medications, who go to multiple doctors, so that what happens
    is, you've got a very complex set of processes that, as we have gotten
    to live longer, have become more complex and even more interactions. And
    what we need to do is to take--step back and take a critical look at
    each and every step along the way.
        There have been big changes in the roles that various people in the
    health care system play. Have they all been properly trained to play
    that role? Do they all check with each other? Are there the right kind
    of teams in place in every health care setting that work for safety?
    These are the kinds of questions that we have invested more money and
    time and research in, in the workplace and when we fly on airplanes,
    than we have in the health care arena. And we just have to do that now.
        The good news about this is, this is something we can do something
    about. But if you ask me, does it mean we don't have the best health
    care system in the world, I would say, no, it doesn't mean that. Keep in
    mind, the life expectancy now is, what, over 76 years; anybody who lives
    to be 65 in America has a life expectancy in excess of 82 years. And
    when we finish the mapping of the human genome, I think sometime early
    in the next century, we'll look at babies being born that have a life
    expectancy of nearly 100 years.
        So I think that this is just a problem that--I applaud the lack of
    defensiveness that all the players in the health care system have
    displayed here. I applaud the report. And we know what the dimensions of
    this problem are, and now we've got the people in place with the
    determination to solve it. And I think that we ought to look at this as
    a very positive event in the progress of American health care.

    Elian Gonzalez

        Q. Mr. President--[inaudible]--to President Castro's threats of
    retaliation against the U.S. unless that Cuban boy is returned?
        The President. I will do a press conference tomorrow, and I'll
    answer all those other questions. I'm looking forward to it.

    Health Care Quality

        Q. Speaking of lack of defensiveness, should the White House have
    spotted this problem of medical errors sooner and taken action sooner?
    And also, isn't this a problem, now, for hospitals and other medical
    providers, because if they take action to remedy past mistakes, they
    admit past mistakes, and couldn't they be open to lawsuits?
        The President. Well, first of all, I think there has been a lot of
    work on this over the last 3 years. But I don't think there's any
    question that the Institute of Medicine report, with its actual
    calculation of the numbers of lives lost, has focused everybody's
    attention more on this, including me. And I think the only productive
    thing to do is to look forward now.

    [[Page 2219]]

        Secondly, when this report came out, I learned that 22 States--if
    you look at what the report recommends, it recommends mandatory
    reporting of serious mistakes and errors, and 22 States have that in
    place and presumably don't have any more significant lawsuit or medical
    malpractice problems than the rest of the country as a whole.
        And regardless--you know, once you know about a problem, you're
    under a moral obligation to deal with it. So you can't--whatever the
    consequences are, we have to go forward.
        Finally, I do not believe that the kind of systematic improvement in
    safety training and processes, hospital after hospital after hospital,
    clinic after clinic after clinic, and in outpatient settings, will
    increase liability. No one can begrudge the improvement of processes.
    That still won't establish or fail to establish liability in a
    particular case. So I don't see that as a problem.
        But whatever the problems are, they're not nearly as important as
    saving thousands and thousands of lives that obviously are there to be
    saved now. And that's what all these people behind us are saying. And I
    think they reflect the overwhelming views of doctors, hospitals, nurses,
    and everybody else in the health care system.
        So this is a good day for America, not only because of this report
    but because of the response to this report.
        Thank you very much, and I'll see you tomorrow.

    Note: The President spoke at 11:45 a.m. in the Rose Garden at the White
    House. In his remarks, he referred to Dr. Kenneth W. Kizer, M.D.,
    president and chief executive officer, National Quality Forum; W.K.
    Kellogg Foundation president and chief executive officer William
    Richardson, chair, Institute of Medicine Committee on Quality of Health
    Care in America; and Bruce E. Bradley, director of managed care plans,
    General Motors. The transcript released by the Office of the Press
    Secretary also included the remarks of Mr. Davidson.