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Columbia, ranked last for hospital patient safety during the period studied. Compared to the worst state (N.J.), the best state (Minn.) had an overall almost 30-percent lower relative risk of developing one or more of the 13 patient safety incidents in its hospitals. However, performance variation between best and worst state was even more significant with individual patient safety incidents. For example, patients had an almost 92-percent lower relative risk of developing post-operative physiologic and metabolic derangements (post-operative delirium) in the top state compared to the bottom state. When compared to the Second Annual Patient Safety in American Hospitals study, the rates of six key quality improvement focus areas remained unimproved in 2004. Focus areas include metabolic derangements, post-operative respiratory failure, decubitus ulcer, post-operative pulmonary embolus or deep vein thrombosis, and hospital-acquired infections. These six areas continued to worsen on average by almost 12 percent or more over three years (2002 through 2004). The patient safety incidents with the highest incidence rates continued to be failure to rescue, decubitus ulcer, and post-operative sepsis. Failure to rescue improved 13 percent during the study period, while postoperative sepsis worsened by almost 25 percent. In July, 2006 the IOM issued another report on errors in healthcare. This report, Preventing Medication Errors, focused specifically on the high rates of medication errors. Most Americans have taken medication at one time or another. It's estimated that in any given week four out of every five U.S. adults will use prescription medicines, over-the-counter drugs, or dietary supplements, and nearly one-third of adults will take five or more different medications (IOM, 2006). Some of the harm done by medications can be anticipated, as they are the potential side effects that may be caused by the medications. The potential benefit of using the medication is determined by the patient and prescriber to be worth the risk of the side effects which may be possible with the use of a particular medication. However, some adverse drug events (ADEs) occur as injuries that happened because of an error in prescribing, dispensing or administering a medication. Such errors can be prevented. Some of the harm done by medications can be anticipated, as they are the potential side effects that may be caused by the medications. The potential benefit of using the medication is determined by the patient and prescriber to be worth the risk of the side effects which may be possible with the use of a particular medication. However, some adverse drug events (ADEs) occur as injuries that happened because of an error in prescribing, dispensing or administering a medication. Such errors can be prevented. In 2008 the actor Dennis Quaid and his wife became celebrity spokespersons regarding medication errors after their twin infants, in November, 2007, were given 1,000 times the dosage of heparin than was ordered-twice! In that situation, according to their 60 Minutes interview (March 16, 2008), the error occurred because a pharmacy technician stored the higher heparin doses in the wrong place and a nurse who administered the drug to the babies failed to verify the amount. Additionally, the Quaids then also sued Baxter Healthcare Corp., accusing the company of negligence in packaging different doses of Heparin in similar vials with blue backgrounds. The findings of the IOM study are that medication errors are quite common - and that they are very costly to the population. At least 1.5 million preventable ADEs occur in the U. S. each year. The true number may be much higher. A hospitalized patient in the US can expect to be subjected to more than one medication error per day! In the state of Florida, medical errors have improved, as per the above Third Annual Patient Safety in American Hospitals Study. Florida was among the16 states that performed statistically significantly better than expected. Florida health officials have been collecting data on medical mistakes from hospitals and walk-in surgery centers since 2001. The reports do not include hospital names; they identify aggregate data only. Despite the improvement noted above, data collected by Florida officials indicate that more than 1,000 patients died in Florida hospitals from adverse events between January 2001 and June 2004. Additionally, nearly 400 patients have needed surgery to remove a sponge or other object left inside them in a prior operation (Gaul, Washington Post, 2005). Defining Medical Errors The National Patient Safety Foundation (NPSF), in 2003, defined patient safety and healthcare error (NPSF, 2005): Patient safety is the prevention of healthcare errors, and the elimination or mitigation of patient injury caused by healthcare errors. A healthcare error is an unintended healthcare outcome caused by a defect in the delivery of care to a patient. Healthcare errors may be errors of commission (doing the wrong thing), omission (not doing the right thing), or execution (doing the right thing incorrectly). Errors may be made by any member of the healthcare team in any healthcare setting. There is no universal definition of medical errors. The many healthcare organizations that are currently focused on healthcare errors do not all define medical errors in the same way. Sometimes medical errors are called something other than an "error". Other terms or words used to identify a medical error include (Kirker, 2003): Adverse event, adverse outcome; Medical mishap, unintended consequences; Unplanned clinical occurrence; unexpected occurrence; untoward incident; Therapeutic misadventure; bad call; Peri-therapeutic accident; Sentinel event; Iatrogenic complication; iatrogenic injury; Hospital acquired complication. Patient Safety Organizations The Patient Safety and Quality Improvement Act of 2005 (Patient Safety Act) authorized the creation of Patient Safety Organizations (PSOs) to improve the quality and safety of U.S. health care delivery. The Patient Safety Act encourages clinicians and health care organizations to voluntarily report and share quality and patient safety information without fear of legal discovery. Despite the many terms used to describe medical errors, patient safety is the focus of multiple patient safety organizations. Their task is to collect data, assess it for trends, and make recommendations to hospitals and others about ways to prevent future mistakes. The US Department of Health and Human Services collates the data and is charged with disseminating best practices. Some patient safety organizations are: This article is presented for educational purposes only and should not be taken as a substitute for legal advice, which should be obtained from personal legal counsel. Nevertheless, the FMA hopes that the information provided here and in its other publications continues to assist physicians in answering many of their most common legal questions allowing them to treat patients, instead of addressing legal concerns. Last Update: September 2007 ETHICS OF CAPITATION In recent years, the American Medical Association (AMA) and Florida Medical Association (FMA) House of Delegates have wrestled with the issue of whether capitation and other programs designed to minimize the quantity, if not quality, of health care are ethical. More importantly, however, both organizations also have addressed the issue of whether physicians who participate in such plans are acting ethically. Critics of physician capitation argue that any system which encourages a physician to withhold care must be unethical. For various reasons, however, both the AMA and FMA have not found such plans, and those who contract with them, to be unethical per se. Two key factors have contributed to the decision not to condemn such plans and these providers. The first is the purely legal risk of an antitrust violation. Were organized medicine to make an official pronouncement finding those who participated in capitation plans to be acting unethically, such plans may have reason to allege that