Patient Safety
N.S. government posts medical errors on website
August 20, 2014
HALIFAX – The Nova Scotia government has followed through on a promise, posting its medical mistakes registry on the health department website, CBC News has reported. According to the government website, making the information public “raises the level of accountability – and demonstrates a commitment to transparency and openness. The goal is to share lessons learned and prevent the event from happening again.”
For the first six months of 2014, 27 serious adverse events were reported. Twenty-one of those incidents resulted in “adverse health effects leading to death or serious disability” while a patient was being cared for at a facility in Nova Scotia, including three incidents where a patient died or was injured after a fall while being cared for by a district health authority or the IWK.
Other mistakes include five patient suicides or attempted suicides, three serious diagnostic errors and six cases of severe bedsores.
“But there’s not necessarily causation between one and the other,” said chair of the Nova Scotia quality and patient safety advisory committee, Catharine Gaulton (pictured). She said the information instead aims to “trigger a review to see whether there is in fact an opportunity for improvement.” Details of the incidents were withheld for patient safety.
Mistake victims: Sharon Fisher was the victim of a diagnostic mistake in 2013. Her breast was removed after a lab error mixed up her biopsy results with another patient with cancer.
“Oh no, you never get used to it,” she says. “I still haven’t looked in a mirror and I won’t.” Her case prompted the province to create the new policy on reporting serious adverse events.
Before this year, the nine health authorities across the province had their own methods of dealing with mistakes that led to serious disability or death. The new policy now dictates incidents from all authorities be reported to the Department of Health and Wellness within 12 hours.
Tanya Barnett has long been pushing for a documented approach to medical mistakes and will be taking a close look at what is released. Barnett lost her 17-year-old daughter Jessica after test results were read in error by specialists. That led to a faulty diagnosis.
“The trend may be that one particular physician is not doing a very good job,” she says. “They need to know that, to take matters into their own hands to fix that.”
Barnett posted a YouTube video that chronicled her daughter’s misdiagnosis at the IWK Health Centre. It has been viewed 37,000 times.
Too few mistakes? Personal injury lawyer Ray Wagner says 27 seems like a low number of incidents for the first six months of 2014, but thinks it will empower patients.
“It enables patients to be able to look at the data and say ‘I’m going in to this particular location for this particular procedure. There have been some problems with, for instance, post-operative care, maybe there’s been a higher infection rate. I’m going to be more vigilant, I’m going to ask more questions,’” he says.