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Writing the following year for “AHRQ: Morbidity and Mortality Rounds on the Web,” Paul Barach noted that Amendment 7 had eliminated confidentiality provisions recommended by the near-miss reporting program and allowed full access to all patient records, including all meetings, morbidity and mortality conferences, root cause analyses, and any other professional exchanges of information related to a patient’s injury or death. Brach noted that risk management professionals said that Amendment 7 had done immense harm to quality assurance and peer-review protections developed over the previous twenty years and caused an immediate decline in the reporting of adverse events throughout the state. Amendment 8 also had an unintended chilling effect on the reporting of near misses and adverse events (Barach, 2005).
The two amendments to the state constitution did indeed introduce a great deal of confusion and uncertainty into the Florida medical errors situation and they exacerbated an already recognized issue with under-reporting of adverse events. Approximately three dozen court cases were filed in the four years following the passage of Amendment 7, with lower-court decisions ruling both for and against the release of information. Two cases eventually found their way to the Florida Supreme Court, which rendered its decision in favor of Amendment 7 in both cases in early 2008 (Florida Senate, 2008; Rosenfeld, 2008).
The Florida Patient Safety Corporation operated until May 2009, when its enabling statute was repealed at the corporation’s request. Since 2004 the FPSC had followed its legislative mandate to establish itself as a working entity. It had acquired preliminary certification as a PSO from the AHRQ and gotten the Near Miss Reporting System (NMRS) up and running. However, part of its establishing legislation required it to obtain grants and other private funding in order to fully support itself. It was never able to do so; and, in fact, the FPSC believed that some funding should always come from the state as a show of support for its mission.
State funding for the FPSC ended after the 2007–2008 fiscal year and the first casualty was the NMRS. Although senate committee recommendations had been to continue the corporation and extend the exceptions allowing confidentiality of reports, it was unclear how the latter would fit with the Florida Supreme Court decisions regarding Amendment 7. On January 29, 2009, the FPSC “Board of Directors voted to seek repeal of the statutes establishing the corporation and this was accomplished in May 2009 (Florida House, 2009; Florida Legislature, 2006; Florida Senate, 2007, 2008, 2009; Florida Statutes, 2009).
Reports in the Florida media in 2011 suggested the system remained in a state of paralysis, in part due to conflicts, or perceived conflicts, between state and federal laws and in part because the apparent refusal of some hospitals to make available reports of adverse events; however, the situation is extremely complex and the issues and laws vary depending on who is requesting what information and for what reasons. The Florida General Counsel’s Office, on July 1, 2008, provided notice to risk managers throughout the state that information reported to the AHCA under state law was exempt from the mandates of Amendment 7; for PSOs, such as the Patient Safety Organization of Florida, Inc., formed in 2009, federal law supersedes state law in providing confidentiality for records (CBS, 2011; Florida General Counsel, 2008; PSOFlorida, 2009; Rosenfeld, 2008). What information is currently publicly available (January 2014) adds little new to this situation. Healthcare workers would be well advised to keep abreast of the news, as it may apply to them, and to be knowledgeable of their facility’s policies and procedures concerning medical errors prevention and reporting.
In 2008 the Florida Patient Safety Corporation officially endorsed a private program called “SorryWorks!” as an effective method for addressing medical errors. The goal of the program, which is still in operation, is to establish a process that involves an initial disclosure, close contact with the patient and family, and a resolution that includes open communication. The main points are to disclose and compensate quickly when an error has occurred, vigorously defend medically appropriate care, and learn from mistakes (PSQH, 2008). According to the Sorry Works! website, Florida is one of 36 states with an “apology law” on the books, but these vary widely from state to state. For more information visit: www.sorryworks.net (SorryWorks!, 2014).
Florida Reporting Requirements
Florida requires that all licensed healthcare facilities establish an internal risk management program that includes:
· The investigation and analysis of the frequency and causes of general categories and specific types of adverse incidents to patients
· The development of appropriate measures to minimize the risk of adverse incidents to patients
· The analysis of patient grievances that relate to patient care and the quality of medical services
· A system for informing a patient or an individual identified pursuant to state law that the patient was the subject of an adverse incident
· The development and implementation of an incident reporting system. . . [that requires all agents and employees to report]. . . adverse incidents to the risk manager. . . within 3 business days after their occurrence (Florida Statutes, 2014)
Details of these sections contain requirements for licensing and training; any specific limitations, definitions of reportable events; and the encouragement of innovative solutions to the problem of medical errors. Additional sections of state law stipulate facility reporting requirements, and requirements that the Agency for Health Care Administration (AHCA) post summary reports a minimum of quarterly on its website. Facility reports are of two types: (1) Code 15 reports, which cover occurrences of eight of the most serious types of adverse events and must be reported to the AHCA within 15 days of occurrence; and (2) annual summary reports of all incidents (Florida Statutes, 2014).
In addition, a separate section of state law requires the AHCA to collect data on hospital-acquired infections (Florida Legislature, 2010). While Florida was the first state to publish a hospital-specific report on hospital-acquired infections in 2005, a March 2010 review of state-by-state activities from the Committee to Reduce Infection Deaths (RID) notes that the Florida reports are disappointing due to weaknesses in data collection, detail, and methodology (RID, 2011).
In 2011 the Florida Department of Health announced it had received funding from the American Recovery and Reinvestment Act (ARRA) for a Healthcare-Associated Infection Prevention Program intended to help both monitor and prevent HAIs. While current information (2014) on the program’s status is not available on the department’s website, detailed information on Florida’s various programs is available from the CDC (CDC, 2013).