[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.