Patient safety at the fore as experts discuss the state of health care BY JOHN GOLDEN jgolden@westfairinc.com
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lizabeth Frost, an anesthesiologist and professor of anesthesiology at Mount Sinai Hospital’s Icahn Medical Center, startled some in the audience for the recent Powerful Women in Science, Research and Medicine panel in New Rochelle with her frank observation on safety standards in hospital operating rooms. “The operating room is actually labeled as The Black Hole,” she said. It contains an array of poorly labeled drugs that lack bar coding and can too easily be wrongly given to surgical patients. And in 17 states in the U.S., the health care professional administering anesthesia to a patient need not be a physician, she said. Increasingly certified nurse registered anesthetists perform that role in the OR. “There is one error per patient per hospital day in the U.S. today,” Frost added. “We need more oversight, no question,” she said. “I would be terrified to go into an operating room.” Balancing patient safety with efficient care that makes use of new drug therapies and medical techniques and discoveries such as pharmacogenomics was a common theme among panelists in a wide-ranging lunch-hour discus-
sion presented by Westfair Communications, parent company of the Business Journal, and the College of New Rochelle. The panel was moderated by Maureen Killackey, director of clinical cancer services at NewYorkPresbyterian/Lawrence Hospital in Bronxville and professor at Columbia University Medical Center, and Elizabeth Bracken-Thompson, partner at the Thompson & Bender public relations and advertising agency in Briarcliff Manor. “Health care is actually a very dangerous profession,” said Sharon C. Kiely, senior vice president for medical affairs and chief medical officer at Stamford Hospital. “Is this system the safest it can possibly be and when will be the day that we will all be partners in that goal?” Veterinarian Ellen M. Levee, senior director of veterinary services and vivarium operations at Regeneron Pharmaceuticals Inc., suggested some false perceptions among the public must be overcome. “I can tell you what bugs me is when you tell somebody you work for a biopharmaceutical company and they say, ‘Oh, you’re the bad guys,” she said. “Biopharmaceuticals use science and technology to get medicines to patients more quickly.” Levee noted the high costs to develop and market drugs for companies like Regeneron. Yet every reputable drug company has pro-
grams for patients who can’t afford the cost of those drugs on the market. “I think we need to see more of that throughout the health care system,” she said. “Even those promising drugs have to be carefully vetted before they can go on to the mass population,” Levee said. She cited the example of Regeneron’s first developed drug therapy, which targeted amyotrophic lateral sclerosis, the progressive neurodegenerative disease. Regeneron’s drug cured ALS in laboratory mice and rats, but was shown in clinical trials to be ineffective for humans. “We have to balance safety with efficiency,” Killackey said. She agreed that the approval process for new drugs at the U.S. Food and Drug Administration can be too slow. “But there is a way to do things systematically and carefully,” she said. For new and more effective drug therapies, said Jane Brody, personal health columnist at The New York Times, “There’s a lot of resistance within the (medical) profession that needs to be changed as well.” Brody said the practice of medicine “has not improved and I think we need to have more vigilant patients” who ask questions about their care. Kiely said obtaining informed consent from patients cannot be condensed to a 30-second talk. Her system at Stamford
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Hospital allows a careful review by patients and their families. In many hospitals, “It’s usually relegated to a very short conversation and a quick signature,” she said. Kiely drew laughs from the audience with this advice for patients when consulting with an examining physician: “If they won’t let you go for a second opinion, run to the second opinion.” Kiely said while the health care environment can do harm to patients, health care professionals are its “second victims. In my view, the system let them down. To improve the system and reduce errors, “You have to have a speak-up culture,” she said. “Because culture trumps strategy every single day.” With unbridled malpractice litigation, “It’s really an almost impossible environment,” Kiely said. “It really doesn’t allow people to take risks.” Brody seemed to delight many in the audience when she declared, “An annual exam is unnecessary.” Frost agreed, saying that medical exams are only needed when one sees a change in one’s health. “Common sense,” she said. “A lot of it is common sense.” “I think it’s reasonable to have an exam every once in a while, but we do overdo medicines,” Kiely said.